Caring for Those Who are Neglected and Forgotten: Psychiatry in Prison Environments

In comparison to the general population, prisoners all over the world have an increased risk of suffering from mental disorders and a high risk of poor health outcome and premature death after release. Prison suicide is the most common preventable cause of death in prison and a major issue for mental health professional working with detainees. Based on the results of international suicide research, there is a consensus that the suicide rates in penal institutions are several times higher than that of the general population. What factors and circumstances are causing the gap between suicide risk of detainees and resident population is yet not understood, suggesting that variations in prison suicide rates reflect differences in criminal justice systems including, possibly, the provision of psychiatric care in prison. Aiming at prevention of prison suicide few prison specific screening instruments have been developed, which are in some places part of the admission routine. Although suicide rates in prison are high, suicide in prison is rare in comparison to self-harming behavior and suicidal ideation, which are quite common. Some cases of self-harming behavior are connected to true suicidal ideation, but it has to be mentioned that there are cases in which self-harm is carried out with untold and/or unwanted motives. Although malingering and exaggeration are considered typical problems of psychiatric work in prison, according to current research only 10–25% of male prisoners show malingering. Because most psychiatric disorders are diagnosed clinically, they may be even more prone to being feigned than somatic disorders. In this context, mental healthcare providers in prison should offer teaching opportunities and psychiatric departments of prison hospitals may function as a place for advanced training. Prison populations all over the world predominately consist of younger males, female prisoners and elderly prisoners are a minority. Understanding of specific burden of age and gender for incarceration is needed to improve mental health care for female and elderly detainees.

This Research Topic is aiming to promote an intense and sound discussion about standards for psychiatric care in prison with the aim to improve diagnostic procedures, therapeutic approach and transfer management after release. By its nature prisons are secluded places which do not serve research requirements. This makes it more difficult to initiate a scientifically discussion about treatment standards and possible state-of-the-art procedures. To come closer to knowing what clinically works in that field, it is of great importance to gather information about clinical experience in different forensic environments. We therefore welcome all different types of papers including systematic reviews, meta-analysis and original research using observational or interventional design, case-reports and theoretical reflections. Although welcomed articles are broad in scope a substantial connection to clinical work in prison mental health care is expected.