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The re-building of Holloway prison in the 1970s was based on the assumption that women in prison have high rates of psychiatric disorder. Criticism of Holloway was often directed at the unwarranted medicalization of women's criminality and contemporary evidence provided only limited support for the notion that women in prison had higher levels of psychiatric disorder than men. Interpretation of research findings was difficult because none of the studies applied the same methods to comparable groups of women and men in prison. This paper describes a case-note and interview study of a representative, cross-sectional sample comprising 25 per cent of all women serving a prison sentence in England and Wales. A 5 per cent sample of the male sentenced prison population was used for comparison purposes. An assessment was made of the treatment needs, if any, of all women given a diagnosis.The prevalence of psychosis was approximately 2 per cent in both groups. Women had a higher prevalence of mental handicapjlearning difficulties (6 per cent compared to 2 per cent in men), personality disorder (18 per cent v 10 per cent), neurotic disorders (18 per cent v 10 per cent), and substance abuse (26 per cent v 12 per cent). Despite higher percentage rates for some disorders, women are outnumbered by men in all diagnostic categories.Female and male prisoners with psychosis share many characteristics that make alternative placements difficult, including chronicity, non-compliance with treatment, and recidivism. As the number of women requiring transfer to hospital is small, they could be accommodated by the health service without any significant increase in bed numbers but most had a history of rejection by local psychiatric facilities, suggesting that they would require a specialized service.Whilst in custody, women make greater demands on prison health services, mainly because of higher rales of personality disorder, substance abuse, and neurosis. The Criminal Justice Act 1991 may help some of these women by providing a greater range of non-custodial services but there is also a need to increase the availability of treatment services for some groups of prisoners, particularly those with drug or personality problems. |
