Objectives: To describe the prevalence of psychiatric morbidity and the treatment needs of new committals to Irish prisons.

Methods: A population survey of 615 prisoners representing 7.9% of male committals to Irish prisons in the year of survey, 313 remands (9.6% of total remand committals) and 302 sentenced committals (6.4% of total sentenced committals). The main outcome measures were ICD-10 diagnoses of mental disorder based on interviews using SADS-L and prison medical records.

Results: Current prevalence rates of any psychotic illness were 3.8% (remand) and 0.3% (sentenced), six month prevalence rate 5.1% (remand) and 2.6% (sentenced) and lifetime rate 9.3% (remand) and 6.6% (sentenced). Schizophrenia and drug/organic psychoses were the most common psychoses. Major depressive disorder had a current prevalence of 4.5% (remand) and 4.6% (sentenced), a six month prevalence of 4.8% (remand) and 6.0% (sentenced), and a lifetime prevalence of 8.6% (remand) and 15.9% (sentenced). Sixty-point-six per cent of the sample had a current substance misuse problem.

Conclusions: There is significant psychiatric morbidity in committal prisoners.

Legislation governing committal practice has been a cause of controversy worldwide. A review of the relevant literature highlights the ongoing debate between those advocating broadly based ‘need for treatment’ criteria as a basis for committal (‘Parens Patriae’), and those who advocate more narrowly defined criteria requiring evidence of ‘dangerousness’ to validate committal. Current committal law in Ireland follows the ‘Parens Patriae’ tradition. However the recently published Green Paper on Mental Health points out that the current law is not compatible with international obligations, making reform inevitable. The Green Paper suggests various alterations in relation to committal criteria and procedures, with the retention of both ‘need for treatment’ as well as ‘dangerousness’ as valid committal criteria. These changes appear to be compatible with the ‘Stone criteria’ adopted as a model committal law by the American Psychiatric Association.