[NYAPRS Enews] MHW: High Prevalence of Psych Disability in US Jails; Particularly High For Women

[Matt Canuteson]

SMI Prevalence In Jails Particularly High For Women

Medical Health Weekly June 8th 2009

 

The prevalence estimates for serious mental illness (SMI) among men and
women in jails are about three to six times higher than those in the
general population, indicating that as many as 2 million bookings of
people with SMI may occur each year, according to a new study published
in the June issue of Psychiatric Services. (For a copy of the report,
visit www.csg.org)

 

The study, "Prevalence of Serious Mental Illness Among Jail Inmates,"
also found that females had about double the rate of SMI compared with
their male counterparts. The data from the study are the most reliable
information on the rate of SMI in the jail system in 20 years, according
to a team of researchers from the Council of State Governments Justice
Center.

 

Researchers estimated the current prevalence rates of SMI among male and
female inmates at two jails in Maryland and three jails in New York
during 2002-2003 and 2005- 2006. They administered the Structured
Clinical Interview for DSM-IV (SCID) to a total of 822 inmates.

 

The study found that 14.5 percent of males and 31 percent of females -
or 16.9 percent of all inmates interviewed - met SMI criteria.
Researchers note that the percentage of women with SMI is particularly
troubling, given the overall growth in the female inmate population and
the lack of research on the reasons for the overrepresentation.

 

The report notes that if the findings were applied to the 13 million
jail admissions reported nationally in 2007, this would suggest that
more than 2 million bookings of people with SMI may occur annually.

 

The addition of post-traumatic stress disorder (PTSD) to the analysis
increased the prevalence estimate of SMI to 17.1 percent for men. For
women, the addition of PTSD as an SMI raised the prevalence rate from 31
percent to 34.3 percent. Researchers said that one possible explanation
for the high estimates overall is limited access to community behavioral
health services.

 

"The study confirms what the field has known about the
overrepresentation of persons with mental illness in the criminal
justice system," Fred C. Osher, M.D., director of health systems and
service policy at the Council of State Governments, told MHW. "The 14
percent rate [for men] is very high but it was a stunning prevalence
figure for women at 31 percent."

 

Researchers can only speculate about the gender differentiation, he
noted. While the study does not explain the causes of this disparity,
possible causes may include childhood experiences and higher rates of
trauma exposure for women, researchers said.

 

Osher pointed to a 2007 study of Connecticut inmates appearing in the
Journal of the American Academy of Psychiatry and the Law by Robert L.
Trestman, M.D., director of the Center for Correctional Mental Health
Services Research, and colleagues. They evaluated inmates who were not
identified at intake as having a mental illness and found that over
two-thirds met criteria for a lifetime psychiatric disorder, including
anxiety disorders and antisocial personality disorder.

 

The methods used in the current study, noted researchers, were not
consistent with other efforts to establish the prevalence of mental
illnesses in jails. The findings are often, and mistakenly, cited as
evidence of an escalating problem, they noted. "When different
definitions of mental illness are used or different methodologies of
assessing mental illness are employed, it is not valid to compare
results or infer trends," said Osher. "Previous studies defined 'mental
health problems' as having a symptom of mental illness and therefore
high prevalence estimates were cited."

 

Osher added, "Therefore it would not be legitimate to conclude that high
rates of 'mental health problems' are evidence of an escalating
problem." Osher noted that the methodology used in the most recent study
"represents the "best science in assessing inmates with serious mental
illness in more than 20 years."

 

Researchers pointed to several limitations in the study. Because no
measure of functional impairment was used, it is unclear whether these
individuals met federal and state definitions of serious or severe
mental illness. Additionally, the definition of SMI did not include some
Axis I disorders that can be very severe, such as anxiety disorder. Some
Axis II disorders, such as borderline personality disorder, can also be
severe, and none were included, noted researchers.

Field Innovations

The study noted that in line with the recommendations of the Criminal
Justice/Mental Health Consensus Project report and the President's New
Freedom Commission on Mental Health, many communities have instituted
mechanisms to divert individuals with SMI from the front door of the
jail to community-based services, or have established linkages to
services through transition planning.

 

There are a number of innovations in the field to help divert
individuals with mental illness from going to jail, said Osher. He cited
the Memphis, Tenn. CIT (Crisis Intervention Team) program that teaches
police officers and communications operators, who are often the first
point of contact for those with mental illness, how to deal with persons
in crisis, how to recognize different types of mental illness, and how
to get the person the most appropriate services. Osher also cited
specialized courts, such as mental health courts, which help to link
former inmates into the community as a condition of their release. "The
terms of participation of a defendant will likely require adherence to a
treatment plan that is developed after engagement in the court program,"
he said. Other innovative programs include Specialized Law- Enforcement
Responses, Specialized Probation Caseloads, and post booking diversion
programs.

 

"We must improve policies and [foster the collaboration] of mental
health and criminal justice systems if we are going to make it work,"
Osher said. "We need to do a good job of assessing for mental illness at
the time of intake," he added.

 

Oftentimes people with mental health issues do not have access to
services in the community, he said. They may not even be aware of their
need for mental health services until they are first arrested, Osher
added. "This becomes a public health opportunity," he said.

 

Important Federal Program

Osher also talked about the importance of the Mentally Ill Offender
Treatment and Crime Reduction Act (MIOTCRA), which helps states and
counties design and implement collaborative efforts between criminal
justice and mental health systems. The legislation was reauthorized last
year and has been funded by Congress over the last four years at
increasing levels, said Osher.

 

Laurel Stine, director of federal relations at the Judge David L.
Bazelon Center, said that the Center is calling for full funding of
MIOTCRA. "While this report should raise alarm among members, it is
critical to note that we have proven solutions ready for
implementation," she said. Stine added, "These programs divert people
with serious mental illnesses from jail and prison or help them re-enter
society after they have served a sentence by providing evidence- based
services for their mental health care."

 

The report was initially released at a congressional briefing by the
Council of State Governments Justice Center and was co-sponsored by the
Bazelon Center. 

 

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