To the Editor: We read with great interest the article by Jacques Baillargeon, Ph.D., et al. (1), published in the January 2009 issue of the Journal. Dr. Baillargeon et al. showed that persons with major psychiatric disorders have a substantially higher risk for multiple incarcerations compared with those without psychiatric disorders. This is a novel finding that emphasizes the need for alternatives to incarceration in the case of mentally ill offenders.

To confirm the increased risk of repeat incarceration among individuals with psychiatric illness, we examined 21,857 pre-trial forensic psychiatric reports made in the Netherlands between 2000 and 2006. According to Dutch law, defendants who are suspected of committing a crime while possibly suffering from a mental disorder must undergo a pre-trial psychiatric evaluation. We examined the number of individuals who were reported for different crimes, and multiple pre-trial reports for different crimes were filed for 2,089 individuals (10.8% [Table 1]). Consistent with the results reported by Dr. Baillargeon et al., we found that persons who had multiple pre-trial reports for different crimes were more likely to suffer from a psychiatric disorder, particularly a psychotic disorder but not an affective disorder. More than one-half of the offenders who had multiple psychiatric reports were not receiving treatment from mental health services. We wholeheartedly agree with Dr. Baillargeon et al. that programs promoting continuity of care are warranted for inmates who suffer from psychiatric disorders.

1.Baillargeon J, Binswanger IA, Penn PV, Williams BA, Murray OJ: Psychiatric disorders and repeat incarcerations: the revolving prison door. Am J Psychiatry 2009; 166:103–109

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