Primary Psychoses Among Sentenced Prisoners in Finland

BACKGROUND: Recent studies suggest an increased prevalence of primary psychotic disorders among sentenced prisoners in Finland. Exploring the extent and correlates of lifetime primary psychoses through high-quality data is crucial for early identification and effective interventions within correctional settings. AIMS: To establish the current lifetime prevalence and comorbidities of primary psychotic disorders among sentenced prisoners in Finland and to explore associations between these and sex, solitary confinement, forensic mental health examination, index offence and total days imprisoned. METHODS: Data were derived from a subsample (n = 295) of the Health and Wellbeing of Prisoners 2023 (Wattu IV) study (n = 529). Assessments included Structured Clinical Interview for the US Diagnostic and Statistical Manual for Mental Disorders (DSM-IV; SCID I and II). Details of offending to date and imprisonment history from official records and self-reported solitary confinement were included in the database. Logistic regression analysis was used to examine associations between lifetime primary psychotic disorders and variables significantly related in binary analyses. RESULTS: Twenty-four (8%) participants had a lifetime primary psychotic disorder, according to SCID-based data. A further 100 (34%) had a lifetime substance-induced psychotic disorder. The odds of primary psychotic disorder were over five times (OR 5.22) higher among women than men. For more detailed analyses, prisoners with a drug-related psychosis could not be separated from prisoners without psychosis. The odds of disciplinary solitary confinement were over three times (OR 3.36) higher among those with lifetime primary psychosis than among all other sentenced prisoners and over four and a half times (OR 4.61) higher among those requesting it. Neither index offence nor total lifetime days imprisoned had any relationship with primary psychosis. CONCLUSIONS: This study updates the understanding of lifetime primary psychotic disorders and their correlates in Finnish prisons, descriptively suggesting a likely rise in their prevalence from 6% in 2017 to 8% in 2023, a 33% increase. The finding that twice as many female as male prisoners have primary psychosis aligns with previous research. The higher use of solitary confinement among sentenced prisoners with lifetime primary psychosis than among other sentenced prisoners, including those with substance-related psychosis, is new and troubling. As only one third of these prisoners with primary psychosis had had a court-ordered forensic mental health examination to determine the need for psychiatric treatment and, specifically, compulsory treatment instead of a prison sentence, our findings suggest an urgent case for re-examining pathways into healthcare for prisoners both during pretrial detention and after sentencing.