The aim of this survey was to determine the prevalence of current and lifetime mental disorder and deliberate self-harm among male prisoners in Greece. The subjects were 80 randomly selected remanded and sentenced prisoners in a Greek prison. They were assessed for mental disorder including suicidality and substance misuse using the Mini International Neuropsychiatric Interview (MINI). We also collected information regarding contact with psychiatric services, previous deliberate self-harm as well as physical health and conducted a brief assessment of their intellectual functioning.
Mental disorder was diagnosed in 63 (78.7%) prisoners. The main diagnoses were: anxiety disorder, 30 (37.5%); major depression, 22 (27.5%); antisocial personality disorder, 30 (37.5%); alcohol dependence, 21 (26.3%) and opiate dependence 22 (27.5%) and schizophrenic or bipolar disorder 9 (11.2%). Deliberate self-harm prior to and during imprisonment was reported by 15% and 2.5% of prisoners, respectively, and 12 prisoners (15%) had IQ below 75.
This survey identified a significant level of need for specialist mental health services in prison. Further studies are required to assess the specific needs of those patients who are too unwell to remain in prison, the need for specific treatments for substance misuse and improved assessment/treatment of common psychiatric disorders.
Despite the difficulties in epidemiological research of mental disorder in prison populations (Teplin, 1990), a number of studies in western countries (e.g. Fazel & Danesh, 2002) have demonstrated a high prevalence of serious mental disorder in prisoners. A significant proportion of prisoners have a degree of intellectual disability (Coid, 1984) with some studies identifying a considerable number of prisoners with a mean full-scale intelligence quotient (IQ) of 67 (Brooke et al., 1996, Coid, 1988 and Gunn et al., 1991). Over the last decades, the prison population has been steadily rising resulting in a growing number of mentally disordered prisoners (Chelala, 1999 and Fryers et al., 1998).
Compared to the general population, prisoners are more likely to have more frequent suicide attempts. In North American prisoners, the leading cause of death has been found to be suicide (Burch & Erickson, 1979). There is also evidence that deliberate self-harm is a common behaviour in prisoners (Leibling, 1992) and that a considerable proportion of those who commit suicide in prison have a history of psychiatric inpatient care prior to imprisonment (Dooley, 1990). Studies in the United States of America (Bland, Newman, Dyck, & Orn, 1990), United Kingdom (Leibling & Kraup, 1993) and elsewhere have identified a number of vulnerability factors that lead to increased risk for deliberate self-harm. Those include being male, young, absence of supportive relationships outside the prison (Beigel and Russell, 1972 and Hankoff, 1980) and a history of alcohol/drug misuse or dependence (Bland et al., 1990).
In Greece, similarly with other European countries, the prison population is increasing and comprises of a high proportion of immigrants. Immigrants comprise 10% of the population in Greece but 45.7% of the prison inmates in Greece are immigrants (Ministry of Justice, 2000). Suicide is a relatively uncommon event in the general population in Greece (Lonnquist, 2000). The reported rate is 3 suicides/100,000/year, which is the lowest in comparison with other European countries, for example 9.4/100,000/year in the UK (WHO, 2000). There is no recent research on the prevalence of mental disorder and deliberate self-harm in Greek prisoners.
Prison surveys can be a useful guide to service demand and unmet needs. This paper presents the findings of a prison survey that examines the lifetime and current prevalence of psychiatric disorder, previous contact with psychiatric services and the prevalence of deliberate self-harm in a male prison population in Greece. Details regarding assessment of drug and alcohol misuse will only be discussed briefly as they have been reported in detail elsewhere (Fotiadou et al., 2004).
