Fred C. Osher

Prevalence of Serious Mental Illness Among Jail Inmates

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.

Alcohol use and abuse in schizophrenia. A prospective community study

The authors examined patterns of alcohol use among 115 DSM-III schizophrenics discharged from the state hospital and participating in an urban aftercare program. According to ratings by mobile outreach clinicians, 45% of the patients used alcohol, and 22% were clearly abusing alcohol. Alcohol use was associated with younger age, male sex, street drug use, medication noncompliance, lack of psychosocial supports, increased symptomatology, chronic medical problems, and a higher rate of rehospitalization. Even minimal drinking, not considered alcohol abuse by clinicians, predicted rehospitalization during 1-year prospective follow-up.

Reliability and validity of the SF-12 health survey among people with severe mental illness.

Objective.The objective of this work was to assess the reliability and validity of the Medical Outcomes Study Short-Form 12-Item Health Survey (SF-12) in a large sample of people with severe mental illness (SMI). Methods.We examined the internal factor structure of the SF-12, compared component scores for this sample with normative levels, examined test-retest reliability, and examined convergent and divergent validity by comparing SF-12 scores to other indexes of physical and mental health. Results.The SF-12 distinguished this sample of people with SMI from the general population, was stable over a 1-week interval, consisted of 2 fairly distinct factors, and was related to physical and mental health indexes in expected ways. Conclusions.The SF-12 appears to be a psychometrically sound instrument for measuring health-related quality of life for people with SMI.

Recent Victimization in Women and Men With Severe Mental Illness: Prevalence and Correlates

The problem of violence against individuals with severe mental illness (SMI) has received relatively little notice, despite several studies suggesting an exceptionally high prevalence of victimization in this population. This paper describes the results of an investigation of the prevalence and correlates of past year physical and sexual assault among a large sample of women and men with SMI drawn from inpatient and outpatient settings across 4 states. Results confirmed preliminary findings of a high prevalence of victimization in this population (with sexual abuse more prevalent for women and physical abuse more prevalent for men), and indicated the existence of a range of correlates of recent victimization, including demographic factors and living circumstances, history of childhood abuse, and psychiatric illness severity and substance abuse. The research and clinical implications of these findings are discussed.

The Social–Environmental Context of Violent Behavior in Persons Treated for Severe Mental Illness

OBJECTIVES This study examined the prevalence and correlates of violent behavior by individuals with severe mental illness. METHODS Participants (N = 802) were adults with psychotic or major mood disorders receiving inpatient or outpatient services in public mental health systems in 4 states. RESULTS The 1-year prevalence of serious assaultive behavior was 13%. Three variables-past violent victimization, violence in the surrounding environment, and substance abuse-showed a cumulative association with risk of violent behavior. CONCLUSIONS Violence among individuals with severe mental illness is related to multiple variables with compounded effects over the life span. Interventions to reduce the risk of violence need to be targeted to specific subgroups with different clusters of problems related to violent behavior.

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

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.

Race and ethnicity, mental health services and cultural competence in the criminal justice system: are we ready to change?

By the end of 2003, 3.2% of the U.S. adult population or 6.9 million adults were incarcerated, on probation or on parole. While non-whites constitute approximately 25% of the general U.S. population, they represent the majority of the prison (62%) and jail population (57%), a 33% increase since 1980. Approximately 15% of this prison and jail population has active symptoms of serious mental illness with two-thirds likely to have a co-occurring substance use disorder diagnosis. Meanwhile, the lack of adequate mental health and substance abuse treatment within all levels of the criminal justice system continues to exist. This is further exaggerated by the dearth of evidence showing appropriate cultural awareness and competence in delivery of these much needed services to a majority non-white population. This article will review the existing racial disparities present in the criminal justice system, the lack of appropriate psychiatric services, and the effect of cultural dissonance in service provision when services do exist. Policy implications and recommendations are included in the conclusion with a call for action to all agencies directly and indirectly affected by this multifaceted problem.

Response to “Consultation to residential psychosocial rehabilitation agencies”

The article by Dr. Kupers is a welcome addition to the l i terature on an often overlooked and undervalued component of any comprehensive service system for adults with serious mental il lnesses--residential programming. One need not stretch far for hypotheses which link the increasing number of homeless persons with mental illnesses on our streets, in our jails and prisons, and within our shelters, to failures of our systems of care to provide adequate residential support. Dr. Kupers has appropriately identified the staff of these residential facilities as linchpins to successful integration of formerly institutionalized consumers within our community settings. The training of providers and provision of clinical support to these residential programs must be carefully examined to assure effective use of the scarce mental heal th resources that exist. Dr. Kupers accurately describes the underpaid and under t ra ined status of most residential workers. He also conveys his respect for their role and the working conditions to which they are exposed. It is my experience that the mental heal th community often err in devaluing the expertise and opinions of residential staff (analogous to mistakes made with family members) and in turn diminish the capacity of the system