Linda A. Teplin

The prevalence of severe mental disorder among male urban jail detainees: Comparison with the epidemiologic catchment area program

This paper presents the prevalence rates of schizophrenia and major affective disorders by age and race among a random sample of male jail detainees. Subjects were administered the National Institute of Mental Health Diagnostic Interview Schedule (NIMH-DIS). The jail prevalence rates were then compared with general population data from the five-city Epidemiologic Catchment Area program using difference of proportion tests and loglinear analysis. After controlling for demographic differences between the jail and five-city samples, the jail prevalence rates were still two to three times higher than those in the general population. These findings suggest several public policy modifications concerning the psychiatric management of our burgeoning jail population.

Co-occurring disorders among mentally ill jail detainees: Implications for public policy.

Studies have demonstrated that police often arrest the mentally ill when treatment alternatives would be preferable but are unavailable. Thus, jails may contain disproportionate numbers of severely mentally ill persons who have co-occurring disorders. Data on the co-occurrence of severe mental disorder, substance abuse, and antisocial personality disorders were gathered from 728 randomly selected male urban jail detainees. Using difference of proportions tests and loglinear analysis, the authors demonstrated that most subjects with a severe mental disorder (schizophrenia or a major affective disorder) also meet criteria for a substance abuse or antisocial personality disorder. These findings suggest several changes in public policy regarding health care delivery in correctional settings and for the general population.

Psychiatric and substance abuse disorders among male urban jail detainees.

This paper presents prevalence rates by race/ethnicity and age for nine psychiatric and substance use disorders found in a random sample of 728 male jail detainees. Two thirds of the sample detainees had had a disorder other than antisocial personality during their lifetimes; half of these had had an episode within 2 weeks of the interview. More than 30% currently had either a severe mental disorder or a substance use disorder. Detainees with severe mental disorders or substance use disorders were most often in jail because they had committed nonviolent crimes. Policy implications of the results are discussed.

HIV and AIDS Risk Behaviors in Juvenile Detainees: Implications for Public Health Policy

HIV and AIDS are increasingly diseases of minorities and the disadvantaged.1,2 These same groups are disproportinately involved in the justice system.3 Detained youths may be at particular risk. Sexually transmitted diseases, related to HIV and AIDS,4-6 are prevalent among detained youths. Moreover, although HIV seropositivity is infrequent among detained youths,4 studies of adult detainees suggest that detained youths are at great risk for developing HIV as they age.

Detecting Mental Disorder in Juvenile Detainees: Who Receives Services

OBJECTIVES We determined whether or not juvenile detainees with major mental disorders received treatment, and the variables that predicted who received services. METHODS Our sample was 1829 randomly selected juvenile detainees taking part in the Northwestern Juvenile Project. To determine need for mental health services, independent interviewers administered the Diagnostic Interview Schedule for Children and rated functional impairment using the Child Global Assessment Scale. Records on service provision were obtained from the juvenile justice and public health systems. RESULTS Among detainees who had major mental disorders and associated functional impairments, 15.4% received treatment in the detention center and 8.1% received treatment in the community by the time of case disposition or 6 months, whichever came first. Significantly more girls than boys were detected and treated. Receiving treatment was predicted by clinical variables (having a major mental disorder or reported treatment history or suicidal behavior) and demographic variables. CONCLUSIONS The challenge to public health is to provide accessible, innovative, and effective treatments to juvenile detainees, a population that is often beyond the reach of traditional services.

Detecting disorder: the treatment of mental illness among jail detainees.

This article investigates the extent to which mentally ill jail detainees are treated while they are in the custody of the criminal justice system. A random sample of 728 subjects were administered the National Institute of Mental Health Diagnostic Interview Schedule (NIMH-DIS) during jail intake and then followed up throughout their stay in jail. Of those subjects who met criteria for severe mental illness (psychosis or major affective disorder), only one third were given treatment within 1 week of intake. Log-linear analysis revealed that treatment decisions were influenced by treatment history (the strongest predictor), the type of mental disorder (schizophrenia vs. depression), type of crime, and whether symptoms were documented by jail intake personnel.

Screening for severe mental disorder in jails

Despite the demonstrated prevalence of severe mental disorder among jail detainees and the legal mandate to provide mental health services, most jails do not have the resources to incorporate traditional, time-consuming psychological assessment techniques into their routine intake process. As a result, a number of mentally ill jail detainees remain undetected and untreated. This study outlines the development of the “Referral Decision Scale” (RDS), which detects persons who have a high probability of having a severe mental disorder so that they can be given a complete diagnostic evaluation. The 14-item RDS was statistically derived using discriminant analysis from data collected via the NIMH Diagnostic Interview Schedule on 728 randomly selected male jail detainees and then validated on 1,149 prison inmates. The final validated version of the RDS had an overall sensitivity of 0.791, specificity of 0.987, and positive and negative predictive value of 0.791 and 0.013, respectively. Since these statistics far exceed current detection rates, the RDS is likely to facilitate the diversion of mentally ill detainees in situations where it is impractical to administer psychological examinations to all incoming inmates. Training requirements for the RDS and directions for future research are discussed.

Mentally disordered women in jail: Who receives services?

OBJECTIVES Many jail inmates have severe psychiatric disorders (e.g., schizophrenia, major affective disorders). The courts have mandated that detainees have a constitutional right to treatment. We investigated what proportion of female jail detainees needed mental health services, what proportion received services, and what variables predicted who received services. METHODS Trained interviewers administered a psychiatric evaluation (the NIMH Diagnostic Interview Schedule) to 1272 randomly selected female jail detainees during jail intake in a large Midwestern city. Project staff then documented whether women subsequently received services, using records and case files. RESULTS Of the women who needed services, 23.5% received them while they were in jail. Type of disorder, treatment history, and socio-demographic variables all affected the odds of a mentally ill womans receiving services. CONCLUSIONS Correctional health care is a growing national public health problem. The magnitude of mental health service needs far exceeds current resources.

Early Violent Death Among Delinquent Youth: A Prospective Longitudinal Study

Objective. Youth processed in the juvenile justice system are at great risk for early violent death. Groups at greatest risk, ie, racial/ethnic minorities, male youth, and urban youth, are overrepresented in the juvenile justice system. We compared mortality rates for delinquent youth with those for the general population, controlling for differences in gender, race/ethnicity, and age. Methods. This prospective longitudinal study examined mortality rates among 1829 youth (1172 male and 657 female) enrolled in the Northwestern Juvenile Project, a study of health needs and outcomes of delinquent youth. Participants, 10 to 18 years of age, were sampled randomly from intake at the Cook County Juvenile Temporary Detention Center in Chicago, Illinois, between 1995 and 1998. The sample was stratified according to gender, race/ethnicity (African American, non-Hispanic white, Hispanic, or other), age (10–13 or ≥14 years), and legal status (processed as a juvenile or as an adult), to obtain enough participants for examination of key subgroups. The sample included 1005 African American (54.9%), 296 non-Hispanic white (16.2%), 524 Hispanic (28.17%), and 4 other-race/ethnicity (0.2%) subjects. The mean age at enrollment was 14.9 years (median age: 15 years). The refusal rate was 4.2%. As of March 31, 2004, we had monitored participants for 0.5 to 8.4 years (mean: 7.1 years; median: 7.2 years; interquartile range: 6.5–7.8 years); the aggregate exposure for all participants was 12944 person-years. Data on deaths and causes of death were obtained from family reports or records and were then verified by the local medical examiner or the National Death Index. For comparisons of mortality rates for delinquents and the general population, all data were weighted according to the racial/ethnic, gender, and age characteristics of the detention center; these weighted standardized populations were used to calculate reported percentages and mortality ratios. We calculated mortality ratios by comparing our sample’s mortality rates with those for the general population of Cook County, controlling for differences in gender, race/ethnicity, and age. Results. Sixty-five youth died during the follow-up period. All deaths were from external causes. As determined by using the weighted percentages to estimate causes of death, 95.5% of deaths were homicides or legal interventions (90.1% homicides and 5.4% legal interventions), 1.1% of all deaths were suicides, 1.3% were from motor vehicle accidents, 0.5% were from other accidents, and 1.6% were from other external causes. Among homicides, 93.0% were from gunshot wounds. The overall mortality rate was >4 times the general-population rate. The mortality rate among female youth was nearly 8 times the general-population rate. African American male youth had the highest mortality rate (887 deaths per 100000 person-years). Conclusions. Early violent death among delinquent and general-population youth affects racial/ethnic minorities disproportionately and should be addressed as are other health disparities. Future studies should identify the most promising modifiable risk factors and preventive interventions, explore the causes of death among delinquent female youth, and examine whether minority youth express suicidal intent by putting themselves at risk for homicide.

Does psychiatric disorder predict violent crime among released jail detainees? A six-year longitudinal study

The authors examined whether jail detainees with schizophrenia, major affective disorders, alcohol or drug use disorders, or psychotic symptoms (hallucinations and delusions) are arrested more often for violent crimes six years after release than detainees with no disorders. Trained interviewers assessed 728 randomly selected male jail detainees using the National Institute of Mental Health Diagnostic Interview Schedule and then obtained follow-up arrest data for six years. Neither severe mental disorder nor substance abuse or dependence predicted the probability of arrest or the number of arrests for violent crime. Persons with symptoms of both hallucinations and delusions had a slightly higher number of arrests for violent crime, but not significantly so. These findings held even after controlling for prior violence and age. The findings do not support the stereotype that mentally ill criminals invariably commit violent crimes after they are released. Future directions for research are suggested.