Psychiatric morbidity in older prisoners: unrecognized and undertreated

Background: The aging population in prison is growing rapidly in the United Kingdom. This trend is also found in other countries worldwide. As this population increases prison authorities will need to adjust the custody process to accommodate increasing mental and physical frailty. Methods: This study examined the prevalence of psychiatric disorders and physical disorders, including dementia, in prisoners aged 50 years and over from four prisons in and around Staffordshire to see whether detection and treatment rates have improved over the past decade during which there has been a dramatic increase in the number of older prisoners. Subjects were assessed using the Geriatric Mental State Examination, the Mini-Mental State Examination and Short Form 12 and their prison records. Results: Sixty prisoners (50%) had a diagnosable mental disorder, with depression being most common, and 15 (12%) prisoners had signs of cognitive impairment. Only 18% of those with a psychiatric diagnosis were prescribed medication from the appropriate class. Physical problems were also common in this population with an average self-report of 2.26 problems per prisoner. Conclusions: Mental disorders in older prisoners are common, but despite recent training initiatives they often go undetected and untreated. Prisoners themselves accurately self-report mental disorder, but the best way of detecting dementia in the prison population remains unclear. The psychological and physical health of this prison population was poorer than that of their community-based peers.