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Major psychiatric disorders linked to multiple incarcerations

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Major psychiatric disorders linked to multiple incarcerations


Investigating the risk for repeat incarceration among inmates with major psychiatric disorders.

MedWire News: Prison inmates with major psychiatric disorders, particularly those with bipolar disorders, are at markedly increased risk for multiple incarcerations compared with other inmates, say US researchers.

Half of all inmates in the USA have at least one mental health condition, and 15–24% have a severe mental illness. Despite the magnitude of this public health crisis, few studies have examined the links between psychiatric disorders and recidivism.

To investigate whether mental illness is a risk factor for multiple incarcerations, Jaques Baillargeon, from the University of Texas Medical Branch in Galverston, and colleagues studied all 79,211 Texas Department of Criminal Justice inmates who began their sentence between 2006 and 2007.

Using state-wide medical information systems, the team gathered data on demographic characteristics, history of incarceration for the preceding 6-year period, and the presence of major depressive disorder, bipolar disorder, schizophrenia, and nonschizophrenia psychotic disorders.

Among the 71,333 inmates without any of the four major psychiatric illnesses, the vast majority were male, aged under 50 years, incarcerated for non-violent offences, had no history of violent offense and a current prison sentence of less than 2 years, at 87.2%, 90.1%, 79.2%, 79.4%, and 60.1%, respectively. The racial/ethnic groups of nonHispanic Caucasian, Hispanic Caucasian, and African American were distributed fairly evenly.

In contrast, the 7878 inmates diagnosed with a major psychiatric disorder had substantial variations in demographic characteristics. Inmates with major depressive disorder and bipolar disorder were more likely to be female and nonHispanic Caucasian than other inmates, while inmates with schizophrenia and nonschizophrenic psychotic disorder were more likely to be African American, aged 50 years or older, and have violent offense records, the team notes in the American Journal of Psychiatry.

Inmates were more likely to have a record of assault if they had any psychiatric disorder, bipolar disorder, schizophrenia, or a nonschizophrenic psychotic disorder. Schizophrenia patients or those with nonschizophrenic psychotic disorder had increased rates of homicide, while robbery was associated with any psychiatric disorder, schizophrenia, and nonschizophrenic psychotic disorder.

Taking into account gender, age, race, current criminal offense classification, and length of current sentence, the team found that inmates with bipolar disorder, schizophrenia, or nonschizophrenic psychotic disorder were, respectively, 3.3, 2.0, and 2.4 times more likely to have had at least four previous incarcerations than inmates without psychiatric disorders.

Inmates with major depressive disorder were 1.6 times more likely to have had at least four previous incarcerations than those with psychiatric disorders.

The team concludes: “Addressing this public health crisis adequately will require the continued development of novel and integrated interventions, such as mental health courts, continuity of care programs, and the development of specialized corrected mental health facilities.

“It is likely that a coordinated effort among criminal justice, mental health, and public health systems will be necessary to reduce the widespread criminalization of the mentally ill in America.”

  a.. Am J Psychiatry 2008; Advance online publication

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