Knocking on prison's door: a 10-fold rise in the number of psychotic prisoners in Finland during the years 2005-2016.
BACKGROUND
As in many European countries, Finnish psychiatric services experienced a rapid process of deinstitutionalization in the 1990s. In recent decades, the decrease in numbers of psychiatric hospital beds has in several countries been found to be linked with increasing criminality among severely mentally ill individuals. It has been concluded that deinstitutionalization could be the main reason for this development.


AIM
To investigate whether the prevalence of severely mentally ill persons to prison is a growing trend also in Finland.


METHODS
We searched for the annual data in electronic case files of all prisoners about the ICD-10 diagnostic group of the most severe psychotic disorders. We also searched for the comorbid substance use disorders. Psychotic disorders due to substance abuse only were excluded from this study.


RESULTS
During the years 2005-2016, a rapid 10-fold increase in psychotic disorders has occurred in Finnish prisons. In 2016, 185 prisoners (5.9% of all Finnish prisoners) were diagnosed as having a psychotic disorder that was not induced by substance abuse. The causes of this dramatic change are unclear. Comorbid substance abuse disorders were detected in only 39.5% of these prisoners and therefore substance abuse can only partly explain the increasing criminality of the severely mentally ill persons. 80.5% of psychotic disorders were diagnosed in Psychiatric Hospital for prisoners and 19.5% in prison policlinic services.


CONCLUSION
Trans-institutionalization has become a serious challenge for the Finnish criminal justice and mental health systems. Further studies are needed to detect the causes of this change. More specialized services for severely mentally ill persons are needed both in the community psychiatry and also inside the prison services.
['Jüriloo|Alo|A|', 'Pesonen|Lauri|L|', 'Lauerma|Hannu|H|']
D000328:Adult D003688:Deinstitutionalization D005260:Female D005387:Finland D006778:Hospitals, Psychiatric D006801:Humans D008297:Male D028642:Mentally Ill Persons D008875:Middle Aged D015995:Prevalence D011329:Prisoners D011330:Prisons D011618:Psychotic Disorders D019966:Substance-Related Disorders D055815:Young Adult
prisoners deinstitutionalization trans-institutionalization Penrose’s law psychosis