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, ethinicity, 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.