Objective: This study estimated current prevalence rates of serious mental illness among adult male and female inmates in five jails during two time periods (four jails in each period). Methods: During two data collection phases (2002–2003 and 2005–2006), recently admitted inmates at two jails in Maryland and three jails in New York were selected to receive the Structured Clinical Interview for DSM-IV (SCID). Selection was based on systematic sampling of data from a brief screen for symptoms of mental illness that was used at admission for all inmates. The SCID was administered to a total of 822 inmates—358 during phase I and 464 during phase II. To determine the current (past-month) prevalence of serious mental illness (defined as major depressive disorder; depressive disorder not otherwise specified; bipolar disorder I, II, and not otherwise specified; schizophrenia spectrum disorder; schizoaffective disorder; schizophreniform disorder; brief psychotic disorder; delusional disorder; and psychotic disorder not otherwise specified), interview data were weighted against strata constructed from the screening samples for male and female inmates by jail and study phase. Results: Across jails and study phases the rate of current serious mental illness for male inmates was 14.5% (asymmetric 95% confidence interval [CI]=11.0%–18.9%) and for female inmates it was 31.0% (asymmetric CI=21.7%–42.1%). Conclusions: The estimates in this study have profound implications in terms of resource allocation for treatment in jails and in community-based settings for individuals with mental illness who are involved in the justice system. Psychiatric Services 60:761–765, 2009)

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Prevalence of Serious Mental Illness Among Jail Inmates

Mental health: A report of the surgeon general

A convenience sample of 100 female jail inmates was interviewed by two female clinical psychologists using measures of trauma exposure, psychopathology, sexual risk behavior, parenting skills, and perceived needs for service. Participants had high rates of lifetime trauma exposure (98%), current mental disorders (36%), and drug/alcohol problems (74%).More than half of the women showed deficits in parenting skills. Participants described their primary problems as being in the areas of substance abuse and family issues, and they endorsed a variety of potential services they would like to be able to access. Unless trauma and victimization experiences, mental health needs, and functional difficulties are taken into account in program development, incarcerated women are unlikely to benefit optimally from in-house and postrelease programs.

Trauma Exposure, Mental Health Functioning, and Program Needs of Women in Jail

Two federal reports dating from 1999 and 2006 are by far the most widely cited sources for the prevalence of mental illness among persons in U.S. jails and prisons. To provide a broader picture of the issue, the author undertook a systematic review of 28 articles published between 1989 and 2013. Not only did the review confirm the high prevalence of mental illnesses among prisoners, it identified a litany of health problems associated with the incarceration of persons with mental illness and profound difficulties in finding housing and employment after release.

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Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review

The Sequential Intercept Model provides a conceptual framework for communities to use when considering the interface between the criminal justice and mental health systems as they address concerns about criminalization of people with mental illness. The model envisions a series of points of interception at which an intervention can be made to prevent individuals from entering or penetrating deeper into the criminal justice system. Ideally, most people will be intercepted at early points, with decreasing numbers at each subsequent point. The interception points are law enforcement and emergency services; initial detention and initial hearings; jail, courts, forensic evaluations, and forensic commitments; reentry from jails, state prisons, and forensic hospitalization; and community corrections and community support. The model provides an organizing tool for a discussion of diversion and linkage alternatives and for systematically addressing criminalization. Using the model, a community can develop targeted strategies that evolve over time to increase diversion of people with mental illness from the criminal justice system and to link them with community treatment.

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Use of the Sequential Intercept Model as an approach to decriminalization of people with serious mental illness.

Almost all jail inmates with mental illness will leave correctional settings and return to the community Inadequate transition planning puts jail inmates who entered the jail in a state of crisis back on the streets in the middle of the same crisis The outcomes of inadequate transition planning include the compromise of public safety, an increased incidence of psychiatric symptoms, hospitalization, relapse to substance abuse, suicide, homelessness, and rearrest Although there are no outcomes studies to guide evidence-based transition-planning practices, there is enough guidance from the multisite studies of the organization of jail mental health programs to create a best practice model This article presents one such model

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A Best Practice Approach to Community Reentry From Jails for Inmates With Co-Occurring Disorders: The Apic Model

This article describes a lawsuit that created a right to discharge planning for people with psychiatric disabilities leaving New York City jails. The article, written by one of the attorneys representing the plaintiff class, describes Brad H. v. City of New York, uses affidavits and records gathered during the litigation to highlight essential components of mental health discharge planning in jails and prisons, and argues that a so-called transinstitutionalization of the rights of incarcerated people with psychiatric disabilities through litigation may be one strategy for reducing criminalization of mental illness.

Transinstitutionalization in the Courts: Brad H. v. City of New York, andthe Fight for Discharge Planning for People With Psychiatric Disabilities Leaving Rikers Island

Heather Barr

Papers

A Best Practice Approach to Community Reentry From Jails for Inmates With Co-Occurring Disorders: The Apic Model

Transinstitutionalization in the Courts: Brad H. v. City of New York, andthe Fight for Discharge Planning for People With Psychiatric Disabilities Leaving Rikers Island