Maden, Anthony; (1993) Psychiatric disorder in women serving a prison sentence. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Women commit less crime than men and this has contributed to a tendency to regard female prisoners as psychiatrically abnormal. This idea has helped to shape penal policy but the empirical evidence is inconclusive. A review of studies of psychiatric disorder in prisoners shows that no survey in this country has applied the same methods to comparable groups of women and men. The thesis describes a case-note and interview study of a representative, cross- sectional sample comprising 25% of all women serving a prison sentence in England and Wales. A five percent sample of the male sentenced prison population was used for comparison purposes. Diagnoses were assigned on clinical grounds and an assessment was made of the treatment needs of all "cases". The prevalence of psychosis, around two percent, was similar in the two groups but women had higher rates of mental handicap (6 v. 2.3%), personality disorder (18 v 10%), neurosis (18 v 10%) and substance abuse (26 v 12%). Within each diagnostic group, female and male prisoners share many clinical and criminological characteristics. The higher prevalence rates can be explained in part by the low rate of "normal" offending in women, which means that a greater proportion of female offenders are likely to be psychiatrically "abnormal", even when the absolute number of mentally disordered male offenders is far higher. Neurotic disorders are more common in women and have no straightforward relationship to offending. The implications of the findings for psychiatric services are discussed. Women with psychosis or other severe disorders share many of the characteristics that make mentally disordered male prisoners difficult to place, including chronicity, limited compliance and recidivism. Psychiatric surveillance of female prisoners is more efficient but there is considerable variation in standards between institutions. Women will make greater demands for treatment within prison, mainly because of neurotic symptoms and substance abuse. There is a need to increase the availability of counselling and contact with drug treatment agencies. Women's prisons lack a therapeutic community of the Grendon type, which may be of benefit to a substantial minority of inmates.

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