International perspectives and practice differences

Across the developed world, services for those with mental disorder in prison have been established but are seldom equivalent to those found in the community. Prisoners are largely the socio-economically deprived with high rates of mental disorder. They have often been victimized. Prisons are our new asylums. In the United States three times as many mentally ill people are in prison than in psychiatric hospital. It is essential that whatever our geographical location, we learn from other jurisdictions and other systems. Rates of imprisonment, organization of psychiatric services, and location of treatment of mentally disordered offenders all vary; and it is easy to fall into the trap of assuming that the system with which you are familiar is the right one. There are major differences across the world in terms of rates of imprisonment, place of treatment of acutely ill prisoners, and the structure of our mental health services in prisons. Those requiring hospital care should be transferred out of prison for this. Independence of health services from correctional services would promote the development of the former. One challenging issue for correctional psychiatry in some jurisdictions is capital punishment and psychiatrists ethically should have no role in executions and be aware of the ethical stance of the World Psychiatric Association. This chapter examines correctional psychiatry in an international context and explores similarities and differences in our practices, and the cultural, political, and economic background to these.