Improving mental state in early imprisonment

Background: Pre-trial prisoners have high rates of mental disorder, but to date, little is known about mental state change or stability among them.

Aim: The aim of this study was to describe mental state change over the first 4 weeks of imprisonment.

Methods: Two hundred and fifty-seven new pre-trial male prisoners consented to participate in a prospective interview study. Recruited men tended to be younger than non-recruited men, but otherwise similar. Mental state was assessed 1 and 4 weeks after reception, using the Comprehensive Psychopathological Rating Scale and two self-rating instruments [the 90-item symptom checklist (SCL-90); the Beck Depression Inventory].

Results: After 4 weeks, 170 of the men were still in prison. In their demographics, previous offending, imprisonment, mental health histories or mental health ratings at initial interview, they did not differ from the 87 who were bailed, transferred, sentenced or had their case discontinued. The most sensitive of the rating schedules - the SCL-90 - identified only one new case among the 170 men, but the more illness-specific ratings suggested up to a 10% emergence of new cases by then. By contrast, while two-thirds of the men remained cases according to the SCL-90, about half of the men who had initial interview illness ratings were no longer 'cases'.

Discussion and implications for practice: Measured in terms of 'caseness', distress is likely to be apparent on reception into prison and relatively resistant to change compared with symptoms of mental disorder per se. One-off screening at reception could be misleading. A limitation of our study is that we could measure mental state only twice. A third measure would have clarified whether, in such circumstances, the trend towards improvement is sustained, but brevity of residence in any one prison at this stage tends to preclude this.