The study was headed by Dr. Henry Steadman, Ph.D and Dr. Steven Samuels, Ph.D of Policy Research Associates Inc. and Dr. Fred C. Osher, M.D. of the Council of State Governments Justice Center.
Five jails participated in the two-phase, data-collection study. Phase one ran from May 2002 through January 2003. Phase two ran from November 2005 through June 2006. Nine interviewers were trained to conduct the clinical research interviews for phase one and sixteen were trained for phase two. Intensive training, numerous practice interviews and graded evaluations ensured a high rate of aptitude reliability among interviewers. Many of the interviewers from phase one also participated in phase two.
Four jails participated in each phase. Phase one included Montgomery County Jail and Prince George County Jail in Maryland and Albany County Jail and Rensselaer County Jail in New York. Phase two included the same jails with the exception of the Albany jail which was replaced by New York’s Montgomery County Jail.
Screening for mental illness began with a Brief Jail Mental Health Screen (BJMHS) upon admission. During phase one data was collected from 11,438 male and female prisoners. Phase two included 10,562 prisoners.
Prisoners exhibiting symptoms of mental disorders during the BJHMS were then administered “a semi-structured clinical interview designed to assess the presence of selected DSM-IV axis I diagnoses (18).” (SCID) DSM-IV is the Diagnostic Statistical Manual - IV Edition used by clinicians to identify behavioral disorders.
Interviewers screened participants for evidence of bipolar disorder I, II, various schizophrenic disorders, delusional and psychotic disorders. SCID interviews were conducted within 72 hours of admission into the jails. Signed consent forms were obtained from each of the participants. Overall refusal rate for both phases was 31 percent. The refusal rates were higher for women than men.
Percentages for admission of male prisoners with serious mental illness ranged from 12.8 to 20.8 percent in phase one and from 7.7 to 16.3 percent in phase two. Percentages for women ranged from 28.3 to 47.7 percent in phase one and 20.7 to 32.1 percent in phase two. Pooled data from both phases showed an average of 14.5 percent for men and 31 percent for women.
Generalizing the data, researchers concluded that “When these estimates are applied to the 13 million annual jail ad-missions in 2007…there were about two million (2,161,705) annual bookings of persons with serious mental illnesses into jails.” Researchers noted that the prevalence rate for females is double that of men. This is troubling “given the rising number and proportion of female inmates in U.S. jails.”
The study attributes the high rate of serious mental illness among prisoners to a “limited access to community behavioral health services.” This data is valuable for planning purposes and shows that jail administrators should anticipate that almost 15 percent of male admissions and 31 percent of female admissions will include some form of serious mental illness.
Several very debilitating axis I disorders such as anxiety disorder, which are also prevalent among prisoners, were not included in the study. Results call for “a clearer explication of the contributing factors and discussion of appropriate responses” not currently being met by our country’s criminal justice system.
The study, considered the most reliable research in the last 20 years, advocates the need to “address the tremendous cost of incarceration” and “alternatives to incarceration where appropriate.” It points out that incarceration only further deteriorates the condition of mentally ill prisoners. The problem only gets worse if those afflicted are sent to prison. [See PLN October 2008; pages 10 [ 40]. Source: Prevalence of Serious Mental Illness among Jail Inmates.
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