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The articles we select for Evidence-Based Mental Health must pass two stages: first they must pass our basic validity criteria and then the editors assess each article for clinical relevance. A number of articles meet the inclusion criteria but are not abstracted due to lack of space. We will highlight the most interesting of these here and list the rest.
“A gigantic asylum is a gigantic evil, and figuratively speaking a manufactory of chronic insanity.” An observation by John Arlidge on the large psychiatric hospitals being built in Victorian England but the sentiment could be equally applied to the overcrowded prisons of the 21st century. Approximately 25% of sentenced men in prison in the UK, and over 40% of sentenced women, have been estimated, using clinical criteria, to require psychiatric treatment or further assessment. The closure of inpatient beds, failure of community services and in the US mandatory sentencing for drug offences have all been implicated in the transformation of prisons to the new asylums. It is also an international issue (see HeadtoHead (http://blogs.bmj.com/ebmh-talk): Welcome to the Asylum! http://blogs.bmj.com/ebmh-talk/2009/04/30/welcome-to-the-asylum). Research on prison mental health struggles to get into the pre-eminent journals—try browsing Medline—but these three papers have managed to spark some editorial interest. For those who still need telling that diversion schemes are a good thing, this cohort study from Texas (Am J Psychiatry 2009;166:103–9), where they have over 100 “correctional facilities”, finds that inmates with schizophrenia, bipolar disorder and major depression had as much as a threefold increase in risk of at least four incarcerations over the 6 year study period. We all know that suicide happens commonly in prison, with rates in the UK at least five times that of the general population. Paradoxically, this review of risk factors (J Clin Psychiatry 2008;69:1721–31) finds …
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