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BACKGROUND: African-Caribbean men are over-represented in psychiatric and forensic services and in the prison population. A failure of community services to engage mentally ill African-Caribbean men and their presentation through the criminal justice system culminates in a repeated pattern of forensic service and criminal justice system contact. METHOD: We carried out a cross-sectional survey during a one-year period of a sample of potentially mentally ill men remanded to HMP Brixton in south London. Men were interviewed to establish their place of birth, first language, socio-demographic profile, ethnicity, psychiatric diagnosis, levels of alcohol and substance misuse, criminality, violence involved in their index offence, past psychiatric and forensic contacts and outcome of court appearance. RESULTS: Two hundred and seventy-seven men were interviewed. In comparison with White men, African-Caribbean men were more often diagnosed as having schizophrenia and were more often sent to hospital under a mental health act order. African-Caribbean men were remanded in custody despite more stable housing conditions and more favourable indices of lifetime criminality, substance misuse and violence. CONCLUSIONS: Community services, including diversion schemes, should be especially sensitive to African-Caribbean men with schizophrenia who 'fall out of care', who are not diverted back into care and are therefore unnecessarily remanded.

Original publication




Journal article


Br J Psychiatry

Publication Date





337 - 344


Adult, Africa, Age Distribution, Crime, Cross-Sectional Studies, England, Forensic Medicine, Humans, Male, Mental Disorders, Middle Aged, Prisoners, Prospective Studies, Referral and Consultation, Social Control, Formal, West Indies