Why some court-ordered psychiatric patients remain in prison in Europe

According to the World Health Organization, approximately one-third of people in European prisons live with a serious mental illness, including schizophrenia, bipolar disorder, and major depressive disorder. Although not all require hospitalisation, a significant subset consists of individuals whom courts have explicitly designated as needing psychiatric or forensic-psychiatric care. In principle, these individuals should be diverted from prison to secure hospital facilities equipped to deliver specialised treatment. In practice, however, chronic shortages of appropriate hospital placements mean that many remain in prison for extended periods—sometimes for months or indefinitely—despite formal orders requiring their transfer. This persistent gap between legal mandate and operational capacity raises profound concerns for human rights and public safety.

Data from the Council of Europe’s SPACE reports show that information on this population is incomplete, inconsistent, and difficult to compare across jurisdictions. European states use differing definitions of “forensic psychiatry,” operate varying institutional models, and maintain separate data systems across justice and health sectors. Consequently, the true scale of the problem remains unknown, although evidence from individual national studies suggests that the number of affected individuals is substantial and increasing.

Four main factors underpin Europe’s limited understanding of how many mentally ill offenders remain unlawfully in prison despite treatment orders:

1. Inconsistent Definitions
   Countries classify forensic psychiatric care differently, making reliable cross-national comparison extremely difficult.
2. Fragmented Reporting Systems
   Justice and health agencies often use incompatible databases, and few countries integrate information across sectors, leading to incomplete or contradictory records.
3. Chronic Shortages of Secure Hospital Capacity
   Decades of bed reductions—driven by deinstitutionalisation, fiscal austerity, and shifting policy priorities—have significantly diminished the availability of secure psychiatric treatment.
4. Political Sensitivity and Institutional Reluctance
   Governments may be hesitant to draw attention to shortcomings affecting offenders with mental illness, fearing accusations of leniency or public criticism of systemic neglect.

The interplay of these factors has created a Europe-wide landscape in which systemic failure is widespread yet poorly documented.

Europe’s total prison population is approximately 1.02 million. Even conservative estimates—suggesting that between 0.1% and 0.5% of incarcerated individuals are subject to unimplemented court orders for psychiatric hospitalisation—imply that between 1,000 and 5,000 people may be confined in prisons when they should legally and clinically be receiving treatment in secure hospitals. Verified national figures already account for nearly 1,000 such cases (including in Belgium, the Netherlands, and Sweden), indicating that the continent-wide total is almost certainly far higher.

A particularly important and under-explored dimension of this issue concerns the role of probation services. Across Europe, probation agencies frequently serve as intermediaries between courts, health services, and correctional systems. Their involvement in assessment, supervision, and diversion processes means they may be uniquely positioned to identify gaps and advocate for appropriate placements for mentally ill offenders. However, the extent of probation’s involvement varies significantly across jurisdictions, and there is a pressing need to better understand both current practices and potential opportunities for system improvement.

If you work in, or manage, a probation service anywhere in Europe and can provide insight into the situation faced by individuals with mental illness who remain in prison despite being designated for hospital treatment, your input would be extremely valuable.

Please contact:
Charlie Brooker
Royal Holloway, University of London
Charlie.brooker@rhul.ac.uk

Text written by Charlie Brooker