Mental health problems are more prevalent among prisoners than the general population both in the United States and in other countries.[21] Whether or not being in prison exacerbates the mental health problems of a prisoner is not known, but it is clear that having mental health problems is one of the causative factors in imprisonment. Moreover, prisoners with mental health problems pose a greater risk to correctional staff and to other prisoners than inmates without mental health problems.[22] Prisoners who have mental health problems are at higher risk of suicide, a fact recognized by the WHO in its resource document for prison officers.[23]

The U.S. Department of Justice reports that more than half of all prison and jail inmates were found to have a mental health problem defined as a recent history of a mental health problem or recent history of mental health problems including a clinical diagnosis or treatment by a mental health professional. Findings represent inmates’ reporting symptoms rather than an official diagnosis of a mental illness. Mental health problems primarily were associated with violence and past criminal activity and inmates with a mental health problem also had high rates of substance abuse or dependence in the year before their admission. Furthermore, among inmates who had mental health problems, approximately 15 percent said that they were homeless in the year before their incarceration.

The study found that half of all prison and jail inmates had symptoms of mania, one-third had major depression, and one-fifth had psychotic disorders such as delusions or hallucinations. Female inmates had higher rates of mental health problems than male inmates. Only one in three had received health treatment for their mental illness since admission.[24]

In the early 1980s, suicides had been the leading cause of inmate deaths, but, over time, prison suicide rates have dropped sharply. Yet, small jails (fewer than 50 inmates) had a suicide rate five times higher than the largest jails (2,000 or more inmates).[25] Almost half of the jail suicides occurred during the inmate’s first week in custody with 80 percent of suicides occurring in the inmate’s cell. In some instances, inmates attempt suicide with no intention of ever completing the act.

In other cases, individuals use more lethal methods until they are successful. Of note is that in the United States, the suicide rate among juvenile offenders who are placed in adult detention facilities is almost eight times greater than the rate in juveniles housed in juvenile detention facilities. Most who attempt suicide slash their wrists (as opposed to hanging or overdosing on medication, which are common methods used by completers). Both suicide attempters and completers are generally younger than 25, previously have attempted suicide, have a history of psychiatric treatment, and are likely to be addicted to opiates or other substances.[26]

A national survey conducted in England and Wales in 1999 to 2000 focused on self-inflicted deaths within the prison system.[27] Findings showed that one-third of all suicides occurred within seven days of reception into prison with 11 percent occurring during the first day. Hanging was the most common method of death.

Fully trained mental health and correctional staff in prisons are rare because of the lack of qualified professionals working in the system as well as because of budgetary constraints. In fact, prison staff are rarely given adequate training in recognizing, dealing with, and understanding the motivations behind suicidal behavior. A U.K. study on mental health problems in prisons found that no prison doctors in their study had specialist training and less than a quarter of nurses had mental health training. The authors concluded that the mental health services offered to prisoners fell below the standard of the National Health Service. Given the high incidence of mental health problems among prisoners, this is a matter of great concern.[28]

Assessment is an important factor in addressing mental health problems in prisoners. Calls for action in this regard date from the mid-1990s when Birmingham et al. called for assessing prisoners for mental health problems as soon as they enter the prison system and Metzner et al. called for the use of standardized assessment procedures to screen for mental illness.[29, 30]

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Madelon L. Finkel, PhD
Madelon L. Finkel, PhD, is professor of clinical public health and director of the Office of Global Health Education at the Weill Cornell Medical College in New York City, NY. Dr Finkel is an epidemiologist whose work focuses on women’s health issues. Her interests also include global public health issues with ongoing research projects in rural India and Peru. Dr. Finkel has published extensively, including Praeger’s Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening and Truth, Lies, and Public Health: How We Are Affected When Science and Politics Collide.

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REFERENCES

1. Walmsley R. World prison population list. 7th ed.
2. Wikipedia. Prisoner population rate 2007-2008.
3. Mauer M. Comparative international rates of incarceration: an examination of causes and trends: Presented to the US Commission on Civil Rights; June 20, 2003; Washington, DC.
4. US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Correction statistics.
5. Ibid.
6. Federal Bureau of Investigation. FBI uniform crime report.
7. Maruschak LM for US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Medical problems of prisoners.
8. Griefinger RB, Heywood NJ, Glaser JB. Tuberculosis in prison: balancing justice and public health. J Law Med Ethics. 1993;21:332-341.
9. World Health Organization. Tuberculosis in prisons.
10. Shalit M, Lewin MR. Medical care of prisoners in the USA. Lancet. 2004;364:34-35.

Full References  »