Data Confirm MH Crisis Growing in U.S. Prisons

Data showing the prevalence of mental illness among inmates continue to indicate a crisis that is being inadequately addressed. More than half of prison and jail inmates were found to have a mental health problem, according to a report released by the U.S. Department of Justice's Bureau of Justice Statistics in September. About a third of state prisoners (34 percent) with a mental health problem received treatment during incarceration, while only 17 percent of jail inmates did.

Jail inmates reported the highest rate of mental health problems (60 percent), followed by state (49 percent) and federal prisoners (40 percent).

Symptoms were measured using a series of questions adapted from a structured clinical interview for diagnosing mental disorders based on DSM-IV. Mental health problems were identified by the presence of symptoms generally associated with major depression, mania, and psychotic disorders in the year prior to the interview.

The surveys did not assess the severity or duration of symptoms, and no exclusions were made for symptoms due to medical illness, bereavement, or substance use.

Inmates who were unable to complete the surveys due to physical or mental impairment were excluded. For this study, the report noted, “estimates of DSM-IV symptoms of mental disorder provide a baseline indication of mental health problems among inmates rather than a clinical diagnosis of mental illness.”

The data are based on findings from the department's Survey of Inmates in State and Federal Correctional Facilities, 2004, and the Survey of Inmates in Local Jails, 2002. Approximately 14,500 state prisoners, 3,700 federal prisoners, and 7,000 jail inmates completed face-to-face interviews for the surveys.

To be categorized as having a mental health problem characterized by the researchers as symptomatic of major depression, inmates had to report experiencing depressed mood and decreasing interest or pleasure in activities, along with three additional depression symptoms.

To be categorized as having mania, inmates had to report three symptoms of mania during the preceding year, and to be categorized as having a psychotic disorder, inmates had to experience delusions or hallucinations during the previous year.

Inmates also answered questions about drug use, past psychiatric treatment, and history of physical or sexual abuse.

According to the findings, about 74 percent of state prisoners and 76 percent of jail inmates having symptoms characteristic of a mental disorder also met criteria for substance dependence or abuse.

Moreover, prison inmates who had a mental health problem were incarcerated for an average of five months longer than were prisoners without such a problem.

For inmates who received some type of psychiatric treatment during incarceration, prescription medication was the most common. For instance, about 27 percent of state prison inmates, 19 percent of federal prison inmates, and 15 percent of jail inmates reported taking a psychotropic medication while confined.

Inmates found to have a psychiatric problem were also more often charged with breaking facility rules. An estimated 24 percent of state prisoners with a mental health problem, compared with 14 percent without, had been charged with a physical or verbal assault on correctional staff or another inmate.

The numbers encapsulated in the report clearly demonstrate that increasingly, people with mental illness are being criminalized, Henry Weinstein, M.D., chair of APA's Committee on Jails and Prisons, told Psychiatric News. “It is the committee's mission to reverse this trend.”

Weinstein pointed out that incarcerating people with mental illness is also quite costly to society, since people with mental illness often serve longer sentences than those without such illnesses.

He emphasized as well that inmates have a “constitutional right” to psychiatric care, noting that the quality of mental health services provided to them differs dramatically from facility to facility.

Others expressed concern that the methodology used in the surveys does not yield accurate numbers of people with mental illness in the nation's jails and prisons.

Since the survey excluded inmates who refused or were unable to complete the survey, relied on inmates' self-reporting of symptoms, and did not include information about symptom severity or duration, the findings probably don't apply to prisoners with severe and persistent mental illness, according to Mary Zdanowicz, J.D., executive director of the Treatment Advocacy Center, a national nonprofit organization based in Arlington, Va., whose mission is to eliminate barriers to treatment of severe mental illness.

“These data aren't going to address the issues facing people with severe mental illness” in jails and prisons, she told Psychiatric News. Referring to some of the questions asked of inmates, she said,“ The survey reports on inmates who are sad, feel guilty, angry, irritable, et cetera. Frankly, I worry more about the inmates who didn't report these feelings.”

After acknowledging that “this report may not contain completely accurate numbers” of people with severe mental illness in prisons and jails, Tom Hamilton, the National Alliance on Mental Illness (NAMI) liaison to APA's Committee on Jails and Prisons and a past president of NAMI-Texas, said the report highlights that there are too many people with mental illness who are behind bars.

“The sooner we begin to understand the cost of incarcerating the mentally ill,” Hamilton noted, “the sooner we can improve access to mental health treatment in the community. This is where they should be treated in the first place.”

Hamilton, who owns an investment company in Texas, also thought it was noteworthy that only a third of state prisoners in the report had received psychiatric treatment in prison.

“If I run a business, and I have a 33 percent failure rate in the product I'm turning out, I wouldn't be in business for very long. This finding may indicate that we're not doing a very good job at treating people in the community,” he said.

The report “Mental Health Problems of Prisons and Jail Inmates” is posted at<www.ojp.usdoj.gov/bjs/abstract/mhppji.htm>.▪