Severe Mental Disorders Highly Prevalent in Jails, Prisons



BOSTON – U.S. correctional institutions are estimated to be housing 1 million men and women with serious mental illnesses such as schizophrenia or a major affective disorder, investigators reported at the annual meeting of the American Academy of Psychiatry and the Law.

The estimated prevalence of serious mental disorders among U.S. inmates ranges from 7% to 16%. Men with mental illness are four times more likely to be incarcerated than the general population, and women with mental illness have an eightfold higher risk, reported Georgia Stathopoulou, Ph.D., and her colleagues from Massachusetts General Hospital and Harvard Medical School, both in Boston.

"The prevalence of serious mental health issues is higher among incarcerated individuals than in the general population, and is associated with specific sociodemographic characteristics like male gender, younger age, and non-white race. Severe psychopathology is also associated with higher recidivism and more serious criminal offenses," wrote Dr. Stathopoulou and colleagues Dr. Fabian Saleh and Kristen Czarnecki in a poster presentation.

The investigators reviewed the medical literature and U.S. Department of Justice statistics to get a handle on the size of the problem.

They found that about 804,000 people with severe mental disorders are jailed annually, and that 72% of both men and women with serious mental illness who are in jail had a co-occurring substance use disorder.

The high rates of substance use and abuse is one of the primary factors contributing to the high incarceration rate of the mentally ill, they said. Other factors, they said, are:

"The prevalence of serious mental health issues is higher among incarcerated individuals than in the general population."

• Insufficient community resources.

• A national drug policy that emphasizes interdiction over treatment.

• Delays in release from prisons and jails to the community.

• Insufficient inmate access to evidence-based mental health therapies.

• Insufficient planning for reentry of mental health inmates into the community.

Jail inmates with mental health disorders are twice as likely as inmates without mental illness to have been homeless in the year before their arrest (13% vs. 6%), 3 times more likely to report a history of sexual or physical abuse (24% vs. 8%), and twice as likely to have lived in a foster home or institution when they were growing up, the authors found.

Specific criminal actions associated with mental disorder diagnoses include higher rates of assault among inmates with bipolar disorder, and higher assault, homicide, and drug possession rates among those with schizophrenia or nonschizophrenic psychosis.

High Recidivism Rates

The investigators cited a retrospective study of more than 79,000 Texas inmates, which found that inmates with bipolar disorder were more than 3 times more likely than inmates without psychiatric disorders to be incarcerated 4 or more times during a 6-year period (Am. J. Psychiatry 2009;166:103-9).

Inmates with major depressive disorder, schizophrenia, and nonschizophrenic psychotic disorders also were significantly more likely to be imprisoned repeatedly, compared with the general prison population.

In all, 89% of the state public and private adult correctional facilities provide some type of mental health services to inmates. Of this group, 51% provide around-the-clock services, 71% offer therapy or counseling from trained mental health professional, and 73% dispense psychotropic drugs.

"We need new treatments, and these treatments have to be evidence based. These treatments have to address both public safety and the clinical needs of inmates," Dr. Stathopoulou said in an interview.

The authors did not disclose a funding source for the study. Dr. Stathopoulou reported that she had no relevant conflicts of interest.

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