Mentally Ill Prison Population
When a severely mentally ill person becomes homeless, there is a very high likelihood that person will subsequently be arrested at least once. According to a 1985 study of over 200 homeless people in Los Angeles, 76 percent of those who had previously been in a psychiatric hospital had also been arrested (Gelberg, Linn, & Leake, 1988).
Typically, the severely mentally ill who are homeless are repeatedly arrested. According to another study, of those severely mentally ill people jailed in the Los Angeles County jail, 74 percent had additional, previous arrests (Lamb & Lamb, 1990). Even among those severely mentally ill who are not homeless, 40 percent become involved in the criminal justice system at some point in their lives (NAMI, 1993).
Traditionally, mentally ill inmates have not received treatment. That is beginning to change, though slowly. As awareness grows of the seriousness of the problem, programs are being developed to aid mentally ill people who are arrested, so that they receive proper treatment. One such program is “jail diversion,” which prevents jailing the suspect. Instead, he or she is taken directly to a mental health facility for evaluation or is ordered to receive treatment instead of jail time. If a mentally ill person is jailed or imprisoned, the facility may not have any mental health providers on staff or available. However, some jails and prisons employ psychiatrists, psychologists, social workers, and/or mental health counselors to provide mental health care for inmates.
The relatively new Mental Health Court Program was developed to accommodate the growing number of arrested, mentally ill individuals. Approximately 150 of these courts now exist and they employ specialists in criminal justice and mental health. These specialists work together to provide case management, voluntary outpatient or inpatient care, and prevention of future arrests (Office of Justice Programs: Bureau of Justice Assistance, n.d.).
According to the Diagnostic and Statistical Manual of Mental Disorders:
A mental disorder is a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.(American Psychiatric Association, 2000, p. xxxi)
In any given year, approximately 25 percent of all adults in the United States qualify for a diagnosis of a mental disorder (Kessler, Chiu, Demler, & Walters, 2005). That rate rises to 46 percent over a lifetime (Kessler, Berglund, Demler, Jin, & Walters, 2005).
The most common mental disorders include mood disorders, especially major depressive disorder, commonly referred to as depression. Other common mental disorders are anxiety disorders, such as generalized anxiety disorder and panic disorder. Some of the more severe, chronic mental disorders include schizophrenia, severe forms of bipolar disorder, schizoaffective disorder, and other psychotic disorders.
Dual diagnosis is the co-occurrence of a substance use disorder and mental disorder. In other words, those with a dual diagnosis have abused or become dependent on alcohol, illicit drugs, or prescription drugs and also have a mental illness.
The Epidemiologic Catchment Area (ECA) was one of the first studies of dual diagnosis. Its findings have been replicated many times over the years (Regier et. al, 1990). The National Comorbidity Survey (NCS) is a more recent study of the prevalence of dual diagnosis and its findings indicated much higher prevalence rates (Kessler et. al, 1990). According to the ECA, approximately 60 percent of those with mental illness also abuse substances. That rate rose to 79 percent in the NCS study