Mental Health Problems of Prison and Jail Inmates, DOJ BJS, 2006
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U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics Special Report September 2006, NCJ 213600 Mental Health Problems of Prison and Jail Inmates Doris J. James and Lauren E. Glaze BJS Statisticians At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 705,600 inmates in State prisons, 70,200 in Federal prisons, and 479,900 in local jails. These estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates. The findings in this report were based on data from personal interviews with State and Federal prisoners in 2004 and local jail inmates in 2002. Highlights High prevalence of mental health problems among prison and jail inmates Selected characteristics Criminal record Current or past violent offense 3 or more prior incarcerations Substance dependence or abuse Drug use in month before arrest Family background Homelessness in year before arrest Past physical or sexual abuse Parents abused alcohol or drugs Charged with violating facility rules* Physical or verbal assault Injured in a fight since admission Percent of inmates in — State prison Local jail With With mental mental problem Without problem Without 61% 25 74% 63% 56% 19 56% 49% 44% 26 76% 62% 36% 20 53% 42% 13% 27 39 58% 24 20% 6% 10 25 43% 14 10% 17% 24 37 19% 8 9% 9% 8 19 9% 2 3% Mental health problems were defined by two measures: a recent history or symptoms of a mental health problem. They must have occurred in the 12 months prior to the interview. A recent history of mental health problems included a clinical diagnosis or treatment by a mental health professional. Symptoms of a mental disorder were based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). • Nearly a quarter of both State prisoners and jail inmates who had a mental health problem, compared to a fifth of those without, had served 3 or more prior incarcerations. • State prisoners who had a mental health problem were twice as likely as those without to have been homeless in the year before their arrest (13% compared to 6%). Percent of inmates in — State Federal Local prison prison jail 56% 45% 64% 24 14 21 49 40 60 • Female inmates had higher rates of mental health problems than male inmates (State prisons: 73% of females and 55% of males; local jails: 75% of females and 63% of males). • Jail inmates who had a mental health problem (24%) were three times as likely as jail inmates without (8%) to report being physically or sexually abused in the past. More than two-fifths of State prisoners (43%) and more than half of jail inmates (54%) reported symptoms that met the criteria for mania. About 23% of State prisoners and 30% of jail inmates reported symptoms of major depression. An estimated 15% of State prisoners and 24% of jail inmates reported symptoms that met the criteria for a psychotic disorder. • About 74% of State prisoners and 76% of local jail inmates who had a mental health problem met criteria for substance dependence or abuse. • Over 1 in 3 State prisoners and 1 in 6 jail inmates who had a mental health problem had received treatment since admission. • Nearly 63% of State prisoners who had a mental health problem had used drugs in the month before their arrest, compared to 49% of those without a mental health problem. • State prisoners who had a mental health problem were twice as likely as State prisoners without to have been injured in a fight since admission (20% compared to 10%). Mental health problem Any mental problem Recent history Symptoms *Includes items not shown. A quarter of State prisoners had a history of mental health problems Among all inmates, State prisoners were most likely to report a recent history of a mental health problem (table 1). About 24% of State prisoners had a recent history of a mental health problem, followed by 21% of jail inmates, and 14% of Federal prisoners. A recent history of mental health problems was measured by several questions in the BJS’ inmate surveys. Offenders were asked about whether in the past 12 months they had been told by a mental health professional that they had a mental disorder or because of a mental health problem had stayed overnight in a hospital, used prescribed medication, or received professional mental health therapy. These items were classified as indicating a recent history of a mental health problem. State prisoners (18%), Federal prisoners (10%), and jail inmates (14%) most commonly reported that they had used prescribed medication for a mental problem in the year before arrest or since admission. They were least likely to report an overnight stay in a hospital for a mental health problem. Approximately, 5% of inmates in State prisons, 2% in Federal prisons, and 5% in local jails reported an overnight stay in a hospital for a mental health problem. Prevalence of symptoms of mental disorders among prison and jail inmates The Survey of Inmates in State and Federal Correctional Facilities, 2004, and the Survey of Inmates in Local Jails, 2002, included a modified structured clinical interview for the DSM-IV. The surveys collected information on experiences of inmates in the past 12 months that would indicate symptoms of major depression, mania, or psychotic disorders. The surveys did not assess the severity or duration of the symptoms, and no exclusions were made for symptoms due to medical illness, bereavement, or substance use. Inmates in mental hospitals or otherwise physically or mentally unable to complete the surveys were excluded from the sample. Symptoms in past 12 months or since admission Major depressive or mania symptoms Persistent sad, numb or empty mood Loss of interest or pleasure in activities Increased or decreased appetite Insomnia or hypersomnia Psychomotor agitation or retardation Feelings of worthlessness or excessive guilt Diminished ability to concentrate or think Ever attempted suicide Persistent anger or irritability Increased/decreased interest in sexual activities Thoughts of revenge Psychotic disorder symptoms Delusions Hallucinations 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. Major depression or mania symptoms covered a range of feelings and behaviors, such as persistent sadness, loss of interest in activities, insomnia or hypersomnia, psychomotor agitation, and persistent anger or irritability. Insomnia or hypersomnia and persistent anger were the most frequently reported major depression or mania episodes with nearly half of jail inmates (49%) reporting these symptoms. Attempted suicide was the least reported symptom by State State prison Percent of inmates in — Federal Local prison jail 32.9% 35.4 32.4 39.8 39.6 35.0 28.4 13.0 37.8 34.4 28.4 23.7% 30.8 25.1 32.8 31.4 25.3 21.3 6.0 30.5 29.0 21.3 39.6% 36.4 42.8 49.2 46.2 43.0 34.1 12.9 49.4 29.5 34.1 11.8% 7.9 7.8% 4.8 17.5% 13.7 Note: Data are based on inmate self-report in the Survey of Inmates in State and Federal Correctional Facilities, 2004, and the Survey of Inmates in Local Jails, 2002. See References for sources on measuring symptoms of mental disorders based on a modified Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). 2 Mental Health Problems of Prison and Jail Inmates prisoners (13%), Federal prisoners (6%) and local jail inmates (13%). A psychotic disorder was indicated by any signs of delusions or hallucinations during the 12-month period. Delusions were characterized by the offenders’ belief that other people were controlling their brain or thoughts, could read their mind, or were spying on them. Hallucinations included reports of seeing things others said they did not see or hearing voices others did not hear. Approximately, 24% of jail inmates, 15% of State prisoners, and 10% of Federal prisoners reported at least one symptom of psychotic disorder (table 1). Number of positive responses Major depressive disorder symptoms 0 1-2 3-4 5 or more Mania disorder symptoms 0 1 2 3 4 Psychotic disorder symptoms 0 1 2 Percent of inmates in — State Federal Local prison prison jail 29.5% 26.1 20.5 23.9 38.8% 27.9 17.1 16.2 22.8% 23.8 23.0 30.4 27.3% 21.5 20.5 17.7 13.1 35.6% 23.3 17.7 14.0 9.4 22.5% 17.0 20.1 22.0 18.4 84.6% 11.1 4.2 89.8% 7.8 2.4 76.0% 16.8 7.2 Symptoms of mental disorder highest among jail inmates Jail inmates had the highest rate of symptoms of a mental health disorder (60%), followed by State (49%), and Federal prisoners (40%). Symptoms of a mental health disorder were measured by a series of questions adopted from a structured clinical interview for diagnosing mental disorders based on the DSM-IV (see box on page 2 and References for sources on DSM-IV measures). The questions addressed behaviors or symptoms related to major depression, mania, or psychotic disorders that occurred in the 12 months before the interview. To meet the criteria for major depression, inmates had to report a depressed mood and decreased interest or pleasure in activities, along with 3 additional symptoms of depression. In order to meet the criteria for mania, inmates had to report 3 symptoms during the 12-month period. For a psychotic disorder, 1 symptom of delusions or hallucinations met the criteria. The high rate of symptoms of mental health disorder among jail inmates may reflect the role of local jails in the criminal justice system. Jails are locally operated correctional facilities that receive offenders after an arrest and hold them for a short period of time, pending arraignment, trial, conviction, or sentencing. Among other functions, local jails hold mentally ill persons pending their movement to appropriate mental health facilities. While jails hold inmates sentenced to short terms (usually less than 1 year), State and Federal prisons hold offenders who typically are convicted and sentenced to serve more than 1 year. In general, because of the longer period of incarceration, prisons provide a greater opportunity for inmates to receive a clinical mental health assessment, diagnosis, and treatment by a mental health professional.1 1Persons who have been judged by a court to be mentally incompetent to stand trial or not guilty by reason of insanity are not held in these correctional facilities and are not covered by this report. Table 1. Recent history and symptoms of mental health problems among prison and jail inmates Mental health problem Any mental health problem Recent history of mental health problema Told had disorder by mental health professional Had overnight hospital stay Used prescribed medications Had professional mental health therapy Symptoms of mental health disordersb Major depressive disorder Mania disorder Psychotic disorder Percent of inmates in — State Federal Local prison prison jail 56.2% 44.8% 64.2% 24.3% 13.8% 20.6% 9.4 5.4 10.9 5.4 2.1 4.9 18.0 10.3 14.4 15.1 8.3 10.3 49.2% 39.8% 60.5% 23.5 16.0 29.7 43.2 35.1 54.5 15.4 10.2 23.9 Note: Includes inmates who reported an impairment due to a mental problem. Data are based on the Survey of Inmates in State and Federal Correctional Facilities, 2004, and the Survey of Inmates in Local Jails, 2002. See Methodology for details on survey sample. See References for sources on measuring symptoms of mental disorder based on a Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). aIn year before arrest or since admission. b In the 12 months prior to the interview. Table 2. Prevalence of mental health problems among prison and jail inmates State prison inmates Mental health problem Number Percent Any mental health problem* 705,600 56.2% History and symptoms 219,700 17.5 History only 85,400 6.8 Symptoms only 396,700 31.6 No mental health problem 549,900 43.8% Federal prison inmates Number Percent 70,200 44.8% 13,900 8.9 7,500 4.8 48,100 30.7 86,500 55.2% Local jail inmates Number Percent 479,900 64.2% 127,800 17.1 26,200 3.5 322,900 43.2 267,600 35.8% Note: Number of inmates was estimated based on the June 30, 2005 custody population in State prisons (1,255,514), Federal prisons (156,643, excluding 19,311 inmates held in private facilities), and local jails (747,529). *Details do not add to totals due to rounding. Includes State prisoners, Federal prisoners, and local jail inmates who reported an impairment due to a mental problem. High proportion of inmates had symptoms of a mental health disorder without a history Around 4 in 10 local jail inmates and 3 in 10 State and Federal prisoners were found to have symptoms of a mental disorder without a recent history (table 2). A smaller proportion of inmates had both a recent history and symptoms of mental disorder: 17% in State prisons, 9% in Federal prisons, and 17% in local jails. An estimated 7% of State prisoners, 5% of Federal prisoners, and 3% of local jail inmates were found to have a recent history of a mental health problem and no symptoms. About 1 in 10 persons age 18 or older in the U.S. general population met DSM-IV criteria for symptoms of a mental health disorder • An estimated 11% of the U.S. population age 18 or older met criteria for mental health disorders, based on data in the National Epidemiologic Survey on Alcohol and Related Conditions, 2001-2002 (NESARC). Percent of U.S. population age 18 or older with symptoms of a mental disorder Total Male Female Any symptom 10.6% 8.7% 12.4% Major depressiona 7.9 5.5 10.1 a Mania disorder 1.8 1.6 2.0 Psychotic disorderb 3.1 3.2 3.1 • Similar to the prison and jail inmate populations, females in the general population had higher rates of mental disorders than males (12% compared to 9%). Note: See Methodology for sources on mental health disorders in the general population. aIn the last 12 months, not excluding symptoms due to bereavement, substance use, or a medical condition. b Based on life-time occurrence. Source: National Institute on Alcohol Abuse and Alcoholism, NESARC, 2001-2002. Mental Health Problems of Prison and Jail Inmates 3 Table 3. Prison and jail inmates who had a mental health problem, by selected characteristics Characteristic All inmates Gender Male Female Race Whitea Blacka Hispanic Othera,b Age 24 or younger 25-34 35-44 45-54 55 or older Percent of inmates in — Federal Local State prison jail prison 56.2% 44.8% 64.2% 55.0% 73.1 43.6% 61.2 62.8% 75.4 62.2% 54.7 46.3 61.9 49.6% 45.9 36.8 50.3 71.2% 63.4 50.7 69.5 62.6% 57.9 55.9 51.3 39.6 57.8% 48.2 40.1 41.6 36.1 70.3% 64.8 62.0 52.5 52.4 a Excludes persons of Hispanic origin. Includes American Indians, Alaska Natives, Asians, Native Hawaiians, other Pacific Islanders, and inmates who specified more than one race. b Mental health problems more common among female, white, and young inmates Female inmates had much higher rates of mental health problems than male inmates. An estimated 73% of females in State prisons, compared to 55% of male inmates, had a mental health problem (table 3). In Federal prisons, the rate was 61% of females compared to 44% of males; and in local jails, 75% of females compared to 63% of male inmates. The same percentage of females in State prisons or local jails (23%) said that in the past 12 months they had been diagnosed with a mental disorder by a mental health professional. This was almost three times the rate of male inmates (around 8%) who had been told they had a mental health problem. Percent of inmates in — State prison Local jail Mental problem* Male Female Male Female Recent history 22% 48% 18% 40% Diagnosed 8 23 9 23 Overnight stay 5 9 4 9 Medication 16 39 12 30 Therapy 14 32 9 23 Symptoms 48% 62% 59% 70% *See table 1 for detailed description of categories. Table 4. Homelessness, employment before arrest, and family background of prison and jail inmates, by mental health status Characteristic Homelessness in past year Employed in month before arresta Ever physically or sexually abused before admission Physically abused Sexually abused While growing up — Ever received public assistanceb Ever lived in foster home, agency or institution Lived most of the time with — Both parents One parent Someone else Parents or guardians ever abused — Alcohol Drugs Both alcohol and drugs Neither Family member ever incarcerated — Mother Father Brother Sister Child Spouse Percent of inmates in — State prison Federal prison Local jail With With With mental mental mental problem Without problem Without problem Without 13.2% 6.3% 6.6% 2.6% 17.2% 8.8% 70.1% 75.6% 67.7% 76.2% 68.7% 75.9% 27.0% 22.4 12.5 10.5% 8.3 3.8 17.0% 13.7 7.3 6.4% 5.4 1.7 24.2% 20.4 10.2 7.6% 5.7 3.2 42.5% 30.6% 33.3% 24.9% 42.6% 30.3% 9.5 9.8 6.3 47.7% 40.8 10.2 25.1 16.9 1.9 6.2 74.9 41.3% 4.0 13.4 29.4 5.1 2.3 0.9 45.4% 39.8 13.5 33.3 21.7 2.2 9.4 66.7 44.6% 5.0 15.3 29.4 5.5 3.4 2.6 50.5% 38.8 10.3 20.0 15.4 1.4 3.2 80.0 38.9% 3.2 9.9 27.0 4.2 2.8 1.8 18.5 41.9% 43.8 11.6 39.3 23.6 3.1 12.7 60.7 51.7% 7.2 20.1 35.5 7.0 2.7 1.7 14.5 40.5% 45.4 12.0 37.3 23.2 2.7 11.5 62.7 52.1% 9.4 22.1 34.8 11.3 4.0 2.4 6.0 49.1% 40.4 9.4 18.7 14.1 1.1 3.4 81.3 36.2% 3.4 12.6 25.8 5.1 2.6 0.9 a The b reference period for jail inmates was in the month before admission. Public assistance includes public housing, AFDC, food stamps, Medicaid, WIC, and other welfare programs. The prevalence of mental health problems varied by racial or ethnic group. Among State prisoners, 62% of white inmates, compared to 55% of blacks and 46% of Hispanics, were found to have a mental health problem. Among jail inmates, whites (71%) were also more likely than blacks (63%) or Hispanics (51%) to have a mental health problem. The rate of mental health problems also varied by the age of inmates. Inmates age 24 or younger had the highest rate of mental health problems and those age 55 or older had the lowest rate. Among State prisoners, an estimated 63% of those age 24 or younger had a mental health problem, compared to 40% of those age 55 or older. An estimated 70% of local jail inmates age 24 or younger had a mental health problem, compared to 52% of those age 55 or older. 4 Mental Health Problems of Prison and Jail Inmates Homelessness, foster care more common among inmates who had mental health problems State prisoners (13%) and local jail inmates (17%) who had a mental health problem were twice as likely as inmates without a mental health problem (6% in State prisons; 9% in local jails) to have been homeless in the year before their incarceration (table 4). About 18% of State prisoners who had a mental health problem, compared to 9% of State prisoners who did not have a mental problem, said that they had lived in a foster home, agency, or institution while growing up. Among jail inmates, about 14% of those who had a mental health problem had lived in a foster home, agency, or institution while growing up, compared to 6% of jail inmates who did not have a mental health problem. Low rates of employment, high rates of illegal income among inmates who had mental problems An estimated 70% of State prisoners who had a mental health problem, compared to 76% of those without, said they were employed in the month before their arrest. Among Federal prisoners, 68% of those who had a mental health problem were employed, compared to 76% of those who did not have a mental problem. Among jail inmates, 69% of those who had a mental health problem reported that they were employed, while 76% of those without were employed in the month before their arrest. Of State prisoners who had a mental health problem, 65% had received income from wages or salary in the month before their arrest. This percentage was larger for inmates without a mental health problem (71%). Over a quarter (28%) of State prisoners who had a mental health problem reported income from illegal sources, compared to around a fifth (21%) of State prisoners without a mental problem. Sources of incomea Wages, salary Welfare Assistance from family or friends Illegal income Compensation paymentsb Percent of State prison inmates With mental problem Without 65% 71% 6 4 14 28 9 8 21 6 a Includes personal income in month before arrest, except for compensation which was in the month before admission. b Includes Supplemental Security Income (SSI) payments and pension. Table 5. Substance dependence or abuse among prison and jail inmates, by mental health status Substance dependence or abuse Any alcohol or drugs Dependence Abuse only Alcohol Dependence Abuse only Drugs Dependence Abuse only No dependence or abuse State prison With mental problem Without 74.1% 55.6% 53.9 34.5 20.2 21.1 50.8% 36.0% 30.4 17.9 20.4 18.0 61.9% 42.6% 43.8 26.1 18.0 16.5 25.9% 44.4% Note: Substance dependence or abuse was based on criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). For details, see Substance Dependence, Abuse and Treatment of Jail Inmates, 2002, <http://www.ojp.usdoj.gov/bjs/ abstract/sdatji02.htm>. Past physical or sexual abuse more prevalent among inmates who had mental health problems State prisoners who had a mental health problem (27%) were over two times more likely than those without (10%) to report being physically or sexually abused in the past. Jail inmates who had a mental health problem were three times more likely than jail inmates without to have been physically or sexually abused in the past (24% compared to 8%). Family members of inmates with mental problems had high rates of substance use and incarceration Inmates who had a mental health problem were more likely than inmates without to have family members who abused drugs or alcohol or both. Among State prisoners, 39% of those High rates of both mental health problems and substance dependence or abuse among State prison and local jail inmates • An estimated 42% of inmates in State prisons and 49% in local jails were found to have both a mental health problem and substance dependence or abuse. • Slightly less than a quarter (24%) of State prisoners and a fifth (19%) of local jail inmates met the criteria for substance dependence or abuse only. Percent of inmates in — Federal prison Local jail With With mental mental problem Without problem Without 63.6% 49.5% 76.4% 53.2% 45.1 27.3 56.3 25.4 18.5 22.2 20.1 27.8 43.7% 30.3% 53.4% 34.6% 25.1 12.7 29.0 11.8 18.6 17.7 24.4 22.8 53.2% 39.2% 63.3% 36.0% 37.1 22.0 46.0 17.6 16.1 17.2 17.3 18.4 36.4% 50.5% 23.6% 46.8% Mental health problems and Percent of inmates in — substance depenState Federal Local dence or abuse prison prison jail Both 41.7% 28.5% 48.7% Dependence or abuse only 24.4 27.3 18.9 Mental problems only 14.5 16.3 15.0 None 19.5 27.8 17.3 who had a mental health problem reported that a parent or guardian had abused alcohol, drugs, or both while they were growing up. In comparison, 25% of State prisoners without a mental problem reported parental abuse of alcohol, drugs, or both. A third (33%) of Federal prisoners who had a mental health problem, compared to a fifth (20%) of those without, reported that a parent or guardian had abused alcohol, drugs, or both while they were growing up. An estimated 37% of jail inmates who had a mental health problem said a parent had abused alcohol, drugs, or both while they were growing up. This was almost twice the rate for jail inmates without a mental health problem (19%). The majority of prison and jail inmates who had a mental health problem (52%) reported that they had a family member who had been incarcerated in the past. Among those without a mental health problem, about 41% of State inmates and 36% of jails inmates reported that a family member had served time. Over a third of both State prisoners and local jail inmates who had a mental health problem (35%) had a brother who had served time in prison or jail. The rate for inmates without a mental health problem was 29% in State prisons and 26% in local jails. Mental Health Problems of Prison and Jail Inmates 5 Inmates who had mental health problems had high rates of substance dependence or abuse Among inmates who had a mental health problem, local jail inmates had the highest rate of dependence or abuse of alcohol or drugs (76%), followed by State prisoners (74%), and Federal prisoners (64%) (table 5). Substance dependence or abuse was measured as defined in the DSM-IV.2 Among inmates without a mental health problem, 56% in State prisons, 49% in Federal prisons, and 53% in local jails were dependent on or abused alcohol or drugs. 2For a detailed description of the DSM-IV measures, see Substance Dependence, Abuse and Treatment of Jail inmates, 2002, <http:// www.ojp.usdoj.gov/bjs/abstract/sdatji02.htm.> By specific type of substance, inmates who had a mental health problem had higher rates of dependence or abuse of drugs than alcohol. Among State prisoners who had a mental problem, 62% were dependent on or abused drugs and 51% alcohol. An estimated 63% of local jail inmates who had a mental problem were dependent on or abused drugs, while about 53% were dependent on or abused alcohol. When dependence was estimated separately from abuse only, local jail inmates who had a mental health problem had the highest rate of drug dependence (46%). They were two and a half times more likely to be dependent on drugs than jail inmates without a mental problem (18%). Table 6. Substance use among prison inmates and convicted jail inmates, by mental health status Type of substance Alcohol or drugs Regular usea In month before offense At time of offense Drugs Regular usea In month before offense At time of offense Alcohol Regular usea In month before offense At time of offense Binge drinkingb Percent of inmates in — State prison Federal prison Local jail With With With mental mental mental Without problem Without problem Without problem 87.1% 80.3 53.2 77.2% 70.4 42.5 82.3% 75.8 41.1 75.4% 68.1 30.6 89.9% 81.6 53.8 78.7% 69.6 42.8 75.5% 62.8 37.5 61.2% 49.1 25.8 71.0% 57.1 31.1 59.2% 45.2 23.0 78.1% 62.1 34.0 57.5% 41.7 19.8 67.9% 61.7 34.0 43.5 58.3% 52.5 27.5 29.5 66.0% 59.5 21.7 37.8 58.2% 53.6 15.1 25.7 72.6% 80.7 35.0 48.2 61.8% 74.1 30.4 29.9 aRegular alcohol use is defined as daily or almost daily or more than once a week for more than a month. Regular drug use is defined as once a week or more for at least one month. drinking is defined as having consumed a fifth of liquor in a single day, or the equivalent of 20 drinks, 3 bottles of wine, or 3 six-packs of beer. bBinge Table 7. Drug use in the month before the offense among convicted prison and jail inmates, by mental health status State prison With Types of drug used mental in month before offense problem Without Any drug 62.8% 49.1% Marijuana or hashish 45.7% 33.3% Cocaine or crack 24.4 17.9 Heroin/opiates 8.9 7.2 Depressantsa 7.3 3.0 Methamphetamines 12.6 8.8 Other stimulantsb 5.8 2.8 c Hallucinogens 8.0 3.4 Percent of inmates in — Federal prison Local jail With With mental mental problem Without problem Without 57.1% 45.2% 62.1% 41.7% 41.2% 32.0% 43.4% 27.1% 21.1 15.5 24.2 14.7 7.2 4.7 9.6 4.6 6.7 2.7 8.5 2.0 10.9 9.6 11.7 6.2 4.5 2.5 5.2 2.4 9.3 3.0 7.5 2.9 a Include b Include c barbiturates, tranquilizers, and quaaludes. amphetamines. Include LSD, PCP, and ecstasy. 6 Mental Health Problems of Prison and Jail Inmates A larger percentage of State prisoners who had a mental health problem than those without were found to be dependent on drugs (44% compared to 26%). Among Federal prisoners, 37% who had a mental health problem were found to be dependent on drugs, compared to 22% of those without. State prisoners (30%) and local jail inmates (29%) who had a mental health problem had about the same rate of alcohol dependence. A quarter of Federal prisoners (25%) who had a mental problem were dependent on alcohol. Over a third of inmates who had mental health problems had used drugs at the time of the offense Over a third (37%) of State prisoners who had a mental health problem said they had used drugs at the time of the offense, compared to over a quarter (26%) of State prisoners without a mental problem (table 6). Also, over a third (34%) of local jail inmates who had a mental health problem said they had used drugs at the time of the offense, compared to a fifth (20%) of jail inmates who did not have a mental problem. Marijuana or hashish was the most common drug inmates said they had used in the month before the offense (table 7). Among inmates who had a mental health problem, more than twofifths of those in State prisons (46%), Federal prisons (41%), or local jails (43%) reported they had used marijuana or hashish in the month before the offense. Almost a quarter of inmates in State prisons or local jails who had a mental health problem (24%) reported they had used cocaine or crack in the month before the offense. A smaller percentage of inmates who had a mental health problem had used methamphetamines in the month before the offense — 13% of State prisoners, 11% of Federal prisoners, and 12% of jail inmates. Binge drinking prevalent among inmates who had mental problems Inmates who had a mental health problem were more likely than inmates without a mental problem to report a binge drinking experience. Among State prisoners who had a mental health problem, 43% said they had participated in binge drinking in the past, compared to 29% of State prisoners without mental problems. Similarly, jail inmates who had mental problems (48%) had a much higher rate of binge drinking than jail inmates without mental problems (30%). Inmates who had a mental problem were more likely than inmates without to have been using alcohol at the time of the offense (State prisoners, 34% compared to 27%; Federal prisoners, 22% compared to 15%; and jail inmates, 35% compared to 30%.) Violent offenses common among State prisoners who had a mental health problem Among State prisoners who had a mental health problem, nearly half (49%) had a violent offense as their most serious offense, followed by property (20%) and drug offenses (19%) (table 8). Among all types of offenses, robbery was the most common offense (14%), followed by drug trafficking (13%) and homicide (12%). An estimated 46% of State prisoners without a mental health problem were held for a violent offense, including 13% for homicide and 11% for robbery. Table 8. Most serious offense among prison and jail inmates, by mental health status Most serious offense Total Violent offenses Homicide Sexual assault* Robbery Assault Property offenses Burglary Larceny/theft Fraud Drug offenses Possession Trafficking Public-order offenses Weapons DWI/DUI State prison With mental problem Without 100% 100% 49.0% 46.5% 11.6 12.9 11.0 10.4 13.6 11.3 10.5 9.7 19.6% 17.7% 8.6 7.7 4.2 3.5 3.0 2.7 19.3% 23.8% 5.7 6.3 12.9 17.0 11.9% 11.9% 2.6 2.4 2.2 3.2 Percent of inmates in — Federal prison Local jail With With mental mental problem Without problem Without 100% 100% 100% 100% 16.0% 13.2% 26.5% 23.7% 2.5 2.3 2.6 2.5 1.1 0.7 3.4 3.6 9.6 7.6 5.7 5.1 2.0 1.9 12.5 10.5 7.2% 6.1% 26.9% 19.7% 0.7 0.3 7.9 4.2 0.5 0.4 7.7 5.6 4.9 4.5 5.3 4.2 51.3% 58.3% 23.4% 27.0% 2.0 3.8 10.1 12.3 47.7 52.6 11.6 12.9 22.3% 19.0% 22.6% 29.3% 14.0 8.5 2.3 1.4 0.2 0.2 5.5 8.1 Note: Summary categories include offenses not shown. *Includes rape and other sexual assault. Table 9. Use of weapon, by mental health status of convicted violent State prison and local jail inmates Use of weapons Any weapon Firearm Knife or sharp object Other weapons* No weapon Number of violent inmates Percent of inmates in — State prison Local jail With With mental mental problem Without problem Without 37.2% 36.9% 20.6% 21.2% 24.4 27.5 12.3 13.1 10.2 7.4 6.1 5.1 3.7 2.7 2.8 4.0 62.8% 63.1% 79.4% 78.8% 328,670 242,524 60,787 34,305 Note: Details do not add to total because inmates may have used more than one weapon. *Other weapons include blunt objects, stun guns, toy guns, or other specified weapons. About 24% of State prisoners without a mental problem were held for drug offenses, particularly drug trafficking (17%). Almost an equal percentage of jail inmates who had a mental health problem were held for violent (26%) and property (27%) offenses. About 12% were held for aggravated assault. Jail inmates who had a mental health problem were two times more likely than jail inmates without a mental problem to be held for burglary (8% compared to 4%). Use of a weapon did not vary by mental health status Convicted violent offenders who had a mental health problem were as likely as those without to have used a weapon during the offense (table 9). An estimated 37% of both State prisoners who had a mental problem and those without said they had used a weapon during the offense. By specific type of weapon, among convicted violent offenders in State prisons who had a mental health problem, slightly less than a quarter (24%) had used a firearm, while a tenth (10%) had used a knife or sharp object. Violent criminal record more prevalent among inmates who had a mental health problem State prisoners who had a mental health problem (61%) were more likely than State prisoners without (56%) to have a current or past violent offense. Percent of State prison inmates with violent criminal record With mental problem Without 61% 56% Violent criminal record Any violent offense Current violent offense, no prior 13 Violent recidivist 47 Note: Details may not add to total due to rounding. 17 39 Among repeat offenders, an estimated 47% of State prisoners who had a mental health problem were violent recidivists, compared to 39% of State prisoners without a mental problem (table 10). Mental Health Problems of Prison and Jail Inmates 7 Nearly a third (32%) of local jail inmates who had a mental health problem were repeat violent offenders, while about a quarter (22%) of jail inmates without a mental problem were violent recidivists. A larger proportion of inmates who had a mental health problem had served more prior sentences than inmates without a mental problem (table 11). An estimated 47% of State prisoners who had a mental health problem, compared to 39% of those without, had served 3 or more prior sentences to probation or incarceration. Among jail inmates, 42% of those with a mental health problem had served served 3 or more prior sentences to probation or incarceration, compared to 33% of jail inmates without a mental problem. State prisoners who had mental health problems had longer sentences than prisoners without Overall, State prisoners who had a mental health problem reported a mean maximum sentence that was 5 months longer than State prisoners without a mental problem (146 months compared to 141 months) (table 12). Among jail inmates, the mean sentence for those who had a mental problem was 5 months shorter than that for jail inmates without a mental problem (40 months compared to 45 months). By most serious offense, excluding offenders sentenced to life or death, both violent State prisoners who had a mental health problem and those without had about the same mean sentence length. Violent State prisoners who had a mental health problem were sentenced to serve a mean maximum sentence length of 212 months and those without, 211 months. Among prisoners sentenced to life or death, there was little variation in sentence length by mental health status (not shown in table). About 8% of State prisoners who had a mental health problem and 9% of those without were sentenced to life or death. Among Federal prisoners, 3% of both those who had a mental health problem and those without were sentenced to life or death. Table 10. Criminal record of prison and jail inmates, by mental health status State prison Criminal record No prior sentence Current violent offense Current drug offense Current other offense Violent recidivist Current and prior violent Current violent only Prior violent only Nonviolent recidivist Prior drugs only Other prior offenses With mental problem 20.5% 13.4 3.1 4.1 47.4% 17.2 17.7 12.5 32.0% 3.0 29.0 Without 27.0% 16.9 5.1 5.0 39.2% 13.4 15.3 10.4 33.8% 4.0 29.8 Percent of inmates in — Federal prison Local jail With With mental mental problem Without problem Without 32.2% 36.9% 34.9% 43.3% 5.1 4.9 12.1 13.8 15.2 21.6 8.8 12.6 11.9 10.4 14.0 16.8 27.5% 23.8% 31.9% 22.4% 7.4 4.4 9.9 6.8 4.9 4.4 11.4 6.9 15.3 15.0 10.5 8.7 40.3% 39.2% 33.2% 34.3% 7.1 9.5 3.0 3.4 33.2 29.8 30.2 30.9 Note: Excludes inmates for whom offense and prior probation or incarceration sentences were unknown. Table 11. Number of prior probation or incarceration sentences among prison and jail inmates, by mental health status Percent of inmates in — Federal prison Local jail With With mental mental Without problem Without problem Without 28.5% 34.1% 38.3% 24.5% 30.6% 16.1 14.9 16.5 16.8 18.9 16.8 15.6 14.9 16.7 17.2 24.0 21.3 20.1 22.8 20.3 10.6 10.0 7.1 12.4 8.6 4.0 4.0 3.1 6.7 4.4 State prison Number of prior sentences 0 1 2 3-5 6-10 11 or more With mental problem 22.1% 15.3 15.5 26.3 13.9 6.9 Note: Excludes inmates for whom prior probation or incarceration sentences were unknown. Table 12. Mean maximum sentence length and mean total time expected to serve, by mental health status and offense Most serious offense State prison inmates All offensesc Violent Property Drug Public-order Federal prison inmates All offensesc Violent Property Drug Public-order Local jail inmates All offensesc Violent Property Drug Public-order a Mean maximum sentence lengtha With mental problem Without Mean total time expected to serve until releaseb With mental problem Without 146 mos 212 103 84 81 141 mos 211 96 94 66 93 mos 139 60 48 51 89 mos 138 58 50 40 128 mos 174 70 131 102 135 mos 202 53 139 100 99 mos 119 63 103 87 106 mos 131 58 112 83 40 mos 67 41 40 16 45 mos 73 36 59 16 14 mos 18 16 18 7 18 mos 31 14 25 8 Based on the total maximum sentence for all consecutive sentences. Excludes inmates for whom offense was unknown. b Based on time served when interviewed and time to be served until the expected date of release. Excludes inmates for whom admission date or expected release date were unknown. c Includes other offenses not shown. 8 Mental Health Problems of Prison and Jail Inmates State prisoners who had a mental health problem expected to serve 4 months longer than those without Overall, the mean time State prisoners who had a mental health problem expected to serve was 4 months longer than State prisoners without a mental problem (93 months compared to 89 months). Among convicted jail inmates who expected to serve their time in a local jail, there was little variation by mental health status in the Table 13. Mean time expected to be served by convicted local jail inmates sentenced to jail Mean time expected to be served Less than 3 months 3 to 6 months 7 to 12 months 13 to 24 months 25 to 36 months 37 to 60 months More than 5 years Number of inmates amount of time expected to be served. About 55% of those who had a mental problem, and 54% of those without, expected to serve 6 months or less (table 13). A third of State prisoners who had mental health problems had received treatment since admission State prisoners who had a mental health problem (34%) had the highest rate of mental health treatment since admission, followed by Federal prisoners (24%) and local jail inmates (17%) (table 14). All Federal prisons and most State prisons and jail jurisdictions, as a matter of policy, provide mental health services to inmates, including screening inmates at intake for mental health problems, providing therapy or counseling by trained mental health professionals, and distributing psychotropic medication.3 Percent of convicted local jail inmates With mental problem Without 27.4% 26.8% 27.9 27.3 24.0 22.4 9.7 8.7 3.7 3.4 3.2 5.0 4.0 6.4 115,290 72,356 3 See Mental Health Treatment in State Prisons, 2000, <http://www.ojp.usdoj.gov/bjs/abstract/ mhtsp00.htm> and Census of Jails, 1999, <http:/ /www.ojp.usdoj.gov/bjs/abstract/cj99.htm>. Note: Excludes inmates for whom admission date or expected release date were unknown. Table 14. Mental health treatment received by inmates who had a mental health problem Type of mental health treatment Ever received mental health treatment Had overnight hospital stay Used prescribed medications Had professional mental health therapy Received treatment during year before arrest Had overnight hospital stay Used prescribed medications On prescribed medication at time of arrest Had professional mental health therapy Received treatment after admission Had overnight hospital stay Used prescribed medications Had professional mental health therapy Percent of inmates who had a mental problem in — State prison Federal prison Local jails 49.3% 35.3% 42.7% 20.0 9.5 18.0 39.5 28.0 32.7 35.4 25.6 31.1 22.3% 14.9% 22.6% 5.8 3.2 6.6 15.8 10.1 16.9 11.3 7.3 12.3 11.5 8.0 12.3 33.8% 24.0% 17.5% 5.4 2.7 2.2 26.8 19.5 14.8 22.6 15.1 7.3 Note: Excludes other mental health treatment. Table 15. Mental health treatment received by all State prison inmates, 2004 and 1997 Percent of State prison inmates Type of mental health treatment Ever any mental health treatment Had overnight hospital stay Used prescribed medications Had professional mental health therapy Had other mental health treatment Received treatment after admission Had overnight hospital stay Used prescribed medications Had professional mental health therapy Had other mental health treatment Number of inmates 2004 31.2% 12.2 23.9 21.6 3.6 19.3% 3.1 15.1 12.7 1.9 1,226,171 1997 28.3% 10.7 18.9 21.8 3.3 17.4% 3.8 12.3 12.3 1.9 1,059,607 More than a fifth of inmates (22%) in State prison who had a mental health problem had received mental health treatment during the year before their arrest, including 16% who had used prescribed medications, 11% who had professional therapy, and 6% who had stayed overnight in a hospital because of a mental or emotional problem. Among jail inmates who had a mental health problem, an estimated 23% had received treatment during the year before their arrest: 17% had used medication, 12% had received professional therapy, and 7% had stayed overnight in a hospital because of a mental or emotional problem. Taking a prescribed medication for a mental health problem was the most common type of treatment inmates who had a mental health problem had received since admission to prison or jail. About 27% of State prisoners, 19% of Federal prisoners, and 15% of jail inmates who had a mental problem had used prescribed medication for a mental problem since admission. An overnight stay in a hospital was the least likely method of treatment inmates had received since admission. Among inmates who had a mental problem, about 5% of those in State prisons, 3% in Federal prisons, and 2% in local jails had stayed overnight in a hospital for a mental problem. Use of medication for a mental health problem by State prisoners rose between 1997 and 2004 The proportion of State prisoners who had used prescribed medication for a mental health problem since admission to prison rose to 15% in 2004, up from 12% in 1997 (table 15). There was little change in the percentage of inmates who reported an overnight stay in a hospital since admission (around 3%), or in the percentage who had received professional mental health therapy (around 12%). State prisoners who said they had ever used prescribed medication for a mental or emotional problem in the past rose to 24% in 2004, up from 19% in 1997. Overall, 31% of State prisoners said they had ever received mental health treatment in the past, up from 28% in 1997. Mental Health Problems of Prison and Jail Inmates 9 Among jail inmates, in 2002 around 30% said they had received treatment for a mental health problem in the past, up from 25% in 1996. The proportion who had received treatment since admission (11%) was unchanged. Mental health treatment Ever any treatment Overnight stay Medication Therapy Other treatment Since admission Overnight stay Medication Therapy Other treatment Percent of jail inmates 2002 1996 30% 25% 12 10 22 17 22 18 3 3 11% 11% 1 1 9 9 5 4 1 -- --Less than 0.5%. Rule violations and injuries from a fight more common among inmates who had a mental health problem Prison or jail inmates who had a mental health problem were more likely than those without to have been charged with breaking facility rules since admission (table 16). Among State prisoners, 58% of those who had a mental health problem, compared to 43% of those without, had been charged with rule violations. An estimated 24% of State prisoners who had a mental health problem, compared to 14% of those without, had been charged with a physical or verbal assault on correctional staff or another inmate. Among Federal prisoners who had a mental health problem, 15% had been charged with a physical or verbal assault on correctional staff or another inmate compared to 7% of those without a mental problem. Jail inmates who had a mental health problem were twice as likely as those without to have been charged with Three-quarters of female inmates in State prisons who had a mental health problem met criteria for substance dependence or abuse Female State prisoners who had a mental health problem were more likely than those without to — • meet criteria for substance dependence or abuse (74% compared to 54%), • have a current or past violent offense (40% compared to 32%), • have used cocaine or crack in the month before arrest (34% compared to 24%), • have been homeless in the year before arrest (17% compared to 9%). They were also more likely to report — • 3 or more prior sentences to probation or incarceration (36% compared to 29%), • past physical or sexual abuse (68% compared to 44%), • parental abuse of alcohol or drugs (47% compared to 29%), • a physical or verbal assault charge since admission (17% compared to 6%). Characteristics of females in State prison, by mental health status Selected characteristics Criminal record Current or past violent offense 3 or more prior probations or incarcerations Substance dependence or abuse Alcohol Drugs Drug use in month before arrest* Cocaine or crack Methamphetamines Family background Homeless in year before arrest Past physical or sexual abuse Parent abused alcohol or drugs Charged with violating facility rules* Physical or verbal assault Injured in a fight since admission Percent of female inmates With mental problem Without 40.4% 35.9 74.5% 41.7 65.5 63.7% 33.9 17.1 32.2% 28.7 53.6% 25.8 45.6 49.5% 24.2 16.3 16.6% 68.4 46.9 50.4% 16.9 10.3% 9.5% 44.0 29.1 30.6% 5.7 3.8% *Includes items not shown. facility rule violations (19% compared to 9%). Inmates in local jails who had a mental health problem were also four times as likely as those without to have been charged with a physical or verbal assault on correctional staff or another inmate (8% compared to 2%). A larger percentage of inmates who had a mental health problem had been injured in a fight since admission than those without a mental problem (State prisoners, 20% compared to 10%; Federal prisoners, 11% compared to 6%; jail inmates, 9% compared to 3%). Table 16. Disciplinary problems among prison and jail inmates since admission, by mental health status Type of disciplinary problem since admission Charged with rule violations* Assault Physical assault Verbal assault Injured in a fight State prison With mental problem Without 57.7% 43.2% 24.1 13.8 17.6 10.4 15.2 6.7 20.4% 10.1% Percent of inmates in — Federal prison With mental problem Without 40.0% 27.7% 15.4 6.9 11.0 5.4 7.9 2.4 11.4% 5.8% Local jail With mental problem Without 19.0% 9.1% 8.2 2.4 4.7 1.6 5.2 0.9 9.3% 2.9% * Includes violations not shown (for example: possession of a weapon, stolen property or contraband, drug law violations, work slowdowns, food strikes, setting fires or rioting, being out of place, disobeying orders, abusive language, horseplay, or failing to follow sanitary regulations). 10 Mental Health Problems of Prison and Jail Inmates Methodology The findings in this report are based on data in the Survey of Inmates in State and Federal Correctional Facilities, 2004, and the Survey of Inmates in Local Jails, 2002. Conducted every 5 to 6 years since 1972, the BJS’ inmate surveys are the only national source of detailed information on criminal offenders, particularly special populations such as drug and alcohol users and offenders who have mental health problems. The survey design included a stratified two-stage sample where facilities were selected in the first stage and inmates to be interviewed in the second stage. In the second sampling stage, interviewers from the Census Bureau visited each selected facility and systematically selected a sample of inmates. Computer-assisted personal interviewing (CAPI) was used to conduct the interviews. Survey of Inmates in State and Federal Correctional Facilities, 2004 The State prison sample was selected from a universe of 1,585 facilities. A total of 287 State prisons participated in the survey; 2 refused, 11 were closed or had no inmates to survey, and 1 was erroneously included in the universe. A total of 14,499 inmates in the State facilities were interviewed; 1,653 inmates refused to participate, resulting in a second-stage nonresponse rate of 10.2%. The Federal prison sample was selected from 148 Federal prisons and satellite facilities. Thirty-nine of the 40 prisons selected participated in the survey. After the initial sample of inmates was drawn, a secondary sam- ple of 1 in 3 drug offenders was selected. A total of 3,686 inmates in Federal facilities were interviewed and 567 refused to participate, resulting in a second-stage nonresponse rate of 13.3%. Survey of Inmates in Local Jails, 2002 The local jail sample was selected from a universe of 3,365. Overall, 465 jails were selected, and interviews were held in 417 jails; 39 jails refused or were excluded for administrative reasons; and 9 were closed or had no inmates. A total of 6,982 inmates were interviewed; 768 inmates refused to participate, resulting in a secondstage nonresponse rate of 9.9%. Accuracy of survey estimates The accuracy of the survey estimates depends on sampling and measurement errors. Sampling errors occur by chance because a sample of inmates rather than all inmates were interviewed. Measurement error can be attributed to many sources, such as nonresponse, recall difficulties, differences in the interpretation of questions among inmates, and processing errors. The sampling error, as measured by an estimated standard error, varies by the size of the estimate and the size of the base population. These standard errors may be used to construct confidence intervals around percentages. For example, the 95% confidence interval around the percentage of jail inmates in 2002 who had a mental health problem is approximately 64.2% plus or minus 1.96 times .83% (or 62.6% to 65.8%). Standard error tables for data in this report are provided in References American Psychological Association, Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), 1994. Michael B. First, Robert, L. Spitzer, Miriam Gibbon, and Janet B.W. Williams, User’s Guide for the Structured Clinical Interview for DSM-IV Axis I Disorders, American Psychiatric Publishing, Inc. Arlington, Va., March 2002. the Appendix which is available in the electronic version of the report at <http://www.ojp.usdoj.gov/bjs/abstract/ mhppji.htm>. A detailed description of the methodology for the State and Federal Prison survey, including standard error tables and links to other reports or findings, is available on the BJS Website <http:// www.ojp.usdoj.gov/bjs/abstract/ sicf04.htm>. A detailed description of the methodology for the Survey of Inmates in Local Jails is available at <http://webapp.icpsr.umich.edu/ cocoon/NACJD-STUDY/04359.xml>. Measures of mental health problems in the general population Caution should be used when making comparisons between prison and jail inmates and the general population based on the a 12-month DSM-IV structured interview. There are significant variations in the questionnaire design and data analysis. For example, questions on the severity or duration of symptoms and questions about whether symptoms are due to breavement, substance use, or a medical condition may vary from survey to survey. For details on the methodology used in the National Epidemiologic Survey on Alcohol and Related Conditions, sponsored by the National Institute on Alcohol Abuse and Alcoholism, see the Data Reference Manual, <http:// niaa.census.gov/>. For additional information on the prevalence of mental disorders in the general population, see the National Survey on Drug Use and Health, sponsored by the Substance Abuse and Mental Health Services Administration, <http:// www.oas.samhsa.gpv/nsduh.htm>. Also, see the National Comorbidity Survey Replication Study, sponsored primarily by the National Institute of Mental Health, <http:// www.nimh.nih.gov/healthinformation/ ncs-r.cfm>. U.S. Department of Health and Human Services, National Epidemiologic Survey on Alcohol and Related Conditions, 2002, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland. U.S. Department of Health and Human Services, National Survey on Drug Use and Health, 2002, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Rockville, Maryland. Mental Health Problems of Prison and Jail Inmates 11 *NCJ~213600* U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics PRESORTED STANDARD POSTAGE & FEES PAID DOJ/BJS Permit No. G-91 Washington, DC 20531 Official Business Penalty for Private Use $300 The Bureau of Justice Statistics is the statistical agency of the U.S. Department of Justice. Jeffrey L. Sedgwick is director. Doris J. James and Lauren E. Glaze wrote this report, under the supervision of Allen J. Beck. Laura M. Maruschak, Todd D. Minton, and Tracy L. Snell verified the report. Rebecca L. Medway provided programming assistance. Tina Dorsey edited the report and Jayne Robinson prepared it for final printing, under the supervision of Marianne Zawitz. Tracy L. Snell, under the supervision of Allen J. Beck, was project manager for the Survey of Inmates in State and Federal Correctional Facilities. For the State and Federal prisoners survey, at the U.S. Census Bureau Steven M. Bittner, Colette Heiston, and Kenneth Mayo carried out questionnaire design, data collection and processing, under the supervision of Marilyn M. Monahan, Demographic Surveys Division. Renee Arion programmed the questionnaire and Dave Keating programmed the listing instrument, under the supervision of Rob Wallace, Technologies Management Office. Programming assistance in the Demographic Surveys Division was provided by Chris Alaura, Mildred Ballenger, Bach-Loan Nguyen, and Scott Raudabaugh, under the supervision of David Watt. This report in portable document format and in ASCII and its related statistical data and tables— including appendix tables— are available at the BJS World Wide Web Internet site: <http://www.ojp.usdoj.gov/bjs/mhppji.htm> 12 Mental Health Problems of Prison and Jail Inmates Dave Hornick and Danielle N. Castelo, Demographic Surveys Methods Division, under the supervision of Thomas F. Moore, designed the sample and weighting specifications. Sydnee ChattinReynolds and Luis Padilla, Field Division, under the supervision of Richard Ning, coordinated the field operations. The affiliations for the Census Bureau date to the time of the survey. Contributors to the Survey of Inmates in Local Jails are listed in Profile of Jail Inmates, 2002, at <http://www.ojp. usdoj.gov/bjs/abstract/pji02.htm>. September 2006, NCJ 213600 Office of Justice Programs Partnerships for Safer Communities http://www.ojp.usdoj.gov