PREVALENCE OF SERIOUS MENTAL ILLNESS IN THE CORRECTIONAL FACILITIES OF THE UNITED STATES

__________

A Research Proposal

Presented to

Dr. Katherine M. Brown

JUS 3320-001D Research Methods Course

Methodist University

__________

In Partial Fulfillment

of the Requirements for the Course

__________

by

Kelsey Harrington

April 23, 2015

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Introduction

Statement of Problem

Mental illness is a commonly abstract concept to most citizens in our nation; everyone

knows about this topic, but most don’t comprehensively understand the grand restrictions and

everyday difficulties one endures while suffering from a mental illness. All of our perceptions of

reality are distorted if abnormalities in our brain are present, thus putting individuals at immense

disadvantages to cope with reality and qualities of life. Most mental illnesses require some sort

of intervention or counseled treatment, especially the more severe disorders that some of our

fellow citizens have to work through within their lives.

In order to improve all ranges of mental functioning, proper environments, relationships,

and professional involvement must be necessary. What most individuals do not understand is that

mental illness is common and extremely natural in human nature; abnormalities and mutations

occur within our biological and psychological design. People need to be educated in order for

improvements to be made within our society. One large area where improvements need to be

made is when mental illnesses cross with our criminal justice system.

When looking at our nation, history has repeated itself dating back to the 1800’s in

regards to the percentage and rates of mentally ill individuals incarcerated and behind bars in our

local jail and prisons. Rates have all but fluctuated, but have increased throughout the years since

deinstitutionalization occurred within the 1960’s when the states began discharging psychiatric

patients and closed state hospitals. Through this process officials have forced severely mentally

ill individuals to the streets with no stability or treatment, leaving them with no choice but to

deteriorate in their psychiatric conditions and therefore increasing the chance of deviance from

society’s laws. Studies are conducted to examine and analyze just how significant these rates

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have actually become when comparing correctional facilities within our nation’s justice system

to that of hospitals where mentally ill should be treated and cared for.

Purpose of the Study

The objective of this research study is to analyze and compare the high percentages of

mentally ill individuals within the criminal justice system to the percentages that are in actual

psychiatric care. It is known by researchers of this field that we as a nation are repeating history

by housing the mentally ill within our nation’s prisons and jails and the evidence is

overwhelming; to the effect that officials refer to these facilities as the “new mental asylums of

the nation.” The public cannot even begin to imagine the catastrophic occurrences that happen

every single day within local jails and state and federal prisons due to the overcrowding and lack

of treatment options for mentally ill offenders. This study looks at rates of individuals suffering

from schizophrenia, bipolar disorder, major depression, as well as substance abuse or

dependence and this population recorded within correctional facilities compared to hospitals has

increase by a tenfold. Studies like this should continue to occur to realize the problem in our

correctional facilities that has been growing exponentially since deinstitutionalization of the

1960’s and eventually lead to the correct plan to fix this social issue at large.

Review of Relevant Literature

Introduction

An extremely informational review of found literature was conducted before this study in

order to examine all defining factors that go into mental illness within correctional facilities and

hospitals. There are endless amounts of studies conducted in order to gather data to exemplify

the shocking amounts of mental illness confined behind bars in jails and prisons. The topics to be

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covered will be history of mental illness environments before and after deinstitutionalization,

issues that are commonly seen during incarceration of mentally ill individuals, definitions of

measured mental illnesses within this particular study, screening and assessment procedures

“conducted” upon admin of offenders into the facilities, and finally current rates and findings.

History

Last century, the public found the ill-treatment of mentally ill persons being held in local

jails and prisons to be very shocking and called such conditions “inhumane.” This led to a reform

movement led by Dorothea Dix in the 1840’s when she visited and documented the mistreatment

of mentally ill prisoners in Massachusetts. The following year she took her findings to the many

state legislatures and led to the building of many new state mental hospitals. In addition, during

this time there was found to be only 1 psychiatric bed available for 5,000 people in the American

population. With her work and influence, that ratio got down to 1 for every 300 Americans a

century later. Within these time periods, changes were made to the Diagnostic Statistic Manual

of Mental Illness (DSM) which included diagnostic nomenclature and criteria; these recorded

psychiatric hospital beds were mainly reserved for high priority, serious mental illness patients

who suffered from schizophrenia, bipolar disorder, major depression, and schizoaffective

disorder. During this time, the United States identified a total of 40,942 mentally “insane”

individuals, with only a record number of 397 in jails and prisons which was less than 1 percent

of the jail and prison population. This time period was a successful and beneficial time for

mentally ill individuals being that they were not treated as criminals, but patients who needed

medical aid and attention to better their qualities of life (Fuller Torrey, Kennard, Eslinger, Lamb,

& Pavle, 2010).

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Venturing into the 1960’s, deinstitutionalization began which can be claimed as one of

the most poorly planned social changes the country has every endured; the closing and emptying

of state mental hospitals. This change came about by officials that believed since new

medications were significantly improving horrid mental illness symptoms they could now save

funds by shutting down these hospitals and this would also “liberate” the patients by heightening

their civil rights. Already by 1972, Marc Abramson, a psychiatrist in San Mateo County,

conducted a study to find that the number of mentally ill individuals within the county jail had

increased by 36% and there was 100% increase in the number of mentally ill individuals judged

to be incompetent to stand trial (Fuller Torrey, Kennard, Eslinger, Lamb, & Pavle, 2010). The

increase of mentally ill being administered into the criminal justice system is due to the fact that

deinstitutionalization was catastrophic for these individuals; it left them with no security or

stability in their lives. The majority of these discharged patients did not receive follow-up

psychiatric care, relapsed into psychosis, therefore leading to law-breaking actions and arrests

(The Treatment of Persons with Mental Illness in Prison and Jails: A State Survey, 2014). To

exemplify the effects of this drastic change, a report completed by the Treatment Advocacy

Center states:

In 2000 the American Psychiatric Association estimated that about 20% of prisoners were

seriously mentally ill, with 5% actively psychotic at any given time. In 2002 the National

Commission on Correctional Health Care issued a report to Congress in which it

estimated that 17.5% of inmates in state prisons had schizophrenia, bipolar disorder, or

major depression. In 2003 Human Rights Watch, based on interviews and visits to state

and federal prisons, estimated that approximately 20% of the prisoners were seriously

mentally ill. A 2006 Department of Justice survey, based on selected sampling of

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inmates, reported that 24% of jail inmates and 15% of state prison inmates “reported at

least one symptom of a psychotic disorder” (Fuller Torrey, Kennard, Eslinger, Lamb, &

Pavle, 2010).

Therefore, the entirety of these studies proved that the percentage of mentally ill inmates in jails

and prisons had increased from less than 1% after Dorothea Dix’s movement in the late 1800’s to

an overwhelming range of 15-20%. Looking back, ironically, a British psychiatrist and

mathematician coined the “balloon theory” in 1939 (before deinstitutionalization even began)

regarding prisons and jails connecting with psychiatric hospitals. This theory explains that the

two are inversely related, if one decreases in numbers then the other increases; thus when you

push on one side of the balloon, the other side budges out (Fuller Torrey, Kennard, Eslinger,

Lamb, & Pavle, 2010). The rates only heighten the accuracy of this theory because 40% of

individuals with a mental illness have been in jail or prison at some point of their lives and a

study done in 2005 found that there were now only one psychiatric bed available for every 3,000

Americans and most of these beds are occupied by court-order forensic cases. (Fuller Torrey,

Kennard, Eslinger, Lamb, & Pavle, 2010)

Looking at the history, an observer can blatantly notice that the country has repeated

history in regards the percentages of mentally disabled individuals administered to jails and

prisons and the lack of psychiatric hospital beds.

Definition of Mental Illnesses

Mental illness can be abstract to everyone in our culture even though it is extremely

prevalent in our society. The Diagnostic Statistic Manual of Mental Illness is now on its fifth

official edition (DSM-V) and diagnoses around 300 different mental disorders. These disorders

vary in their symptoms, causes, responsiveness to treatment, severity, course and duration, and

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the degree to which they deter from an individual’s quality of life (Hills, Siegfried, & Ickowitz,

2004). In this report, however, the “serious” mental disorders are focused on including

schizophrenias, bipolar disorder, and major depression because the symptoms and severity of

these disorders are alarming and negatively impact the individual who endures any of these

categories. These major disorders meet the criteria because they significantly affect thought or

mood which impairs judgement, behavior, and the ability to cope with reality or the regularities

of life especially within the prison environment. Substance abuse or dependency will be included

in this report as well due to the co-morbidity rates of these serious disorders with substance

abuse; the majority of these disordered individuals turn to alcohol or drugs as their own form of

treatment when not being intervened by mental health professionals.

Schizophrenia is characterized by disturbances in thought, perception, behavior, and

emotion. Thinking of schizophrenics is extremely illogical and usually includes delusional

beliefs. When their perceptions are distorted, it leads to hallucinations and emotions are either

flat or inappropriate. Having schizophrenia greatly impairs “thinking, judgement, reasoning,

emotional responses, memory, interpretations of reality, communication, and behaving

appropriately” (Hills, Siegfried, & Ickowitz, 2004).

Bipolar disorder, also referred to as manic depression, is a mood disorder that contains

mood swings that alternate between mania and deep depression. Mania is described as elevated

or irritable mood that is not “normal,” and while in a state of mania individuals are said to be

heightened with grandiosity and self-worth with speech that is quick and difficult to follow.

During a manic episode, patients’ energy skyrockets and the need for sleep is nowhere to be

found. Judgement is poor and reckless behavior is also commonly seen (Hills, Siegfried, &

Ickowitz, 2004).

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Major depression is another mood disorder that involves one or a series of severe

depression episodes. A depressed mood is portrayed and the individual appears to have a loss of

interest in life activities as well as being lethargic or fatigued. Majorly depressed individuals

normally have trouble with memory, focusing, simple decision-making, and concentrating, while

seeing their lives as hopeless and worthless. Suicidal risks are heightened within these

individuals because the topic of death is commonly seen on their minds (Hills, Siegfried, &

Ickowitz, 2004).

Issues during Incarceration

In our criminal justice system, prisoners have the constitutional right to proper health

care, which includes mental health treatment, and the issues of overcrowding in local

correctional populations limits this response. Therefore, this then alters the treatment response

and opportunities to aid the mentally ill offenders entering these correctional facilities

(Steadman, Osher, Robbins, Case, & Samuels, 2009). Mentally ill individuals entering the

criminal justice system normally are seen with a wide array of issues such as chronic health

problems, unemployment, homelessness, transient behavior, financial instability, and high-risk

behaviors. They commonly lack relationships filled with support, and stability that could

potentially increase their qualities of life as well as lack health coverage (Hills, Siegfried, &

Ickowitz, 2004). One of the biggest and most obvious issues with the fact that the percentage of

mentally ill Americans has increased is that jails and prisons are not structured like the needed

mental hospitals are. Within prisons and jails, individuals do have the right to receive medical

care pertaining to mental illness just as one would with diabetes or any physical disease and this

was affirmed by the Supreme Court according to The Treatment Advocacy Center (2014). The

stability, staffing, characteristics, treatment, daily schedules, etc. are not fit for a seriously

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mentally ill individual who needs to be individually attended to. Another issue is the fact that

mentally ill offenders are known to be “frequent flyers.” Most mentally ill persons receive little

(if any) psychiatric care after they leave the correctional facility they served their sentences at.

Once they leave the facility, it can almost be guaranteed that their treatment plans stop as well;

therefore worsening their serious symptoms and increasing their chances of offending in the

future. For example, a man named Jonathan Good who was diagnosed with schizoaffective

disorder was charged 49 times in 40 months between 2006 and 2009 at Palm Beach County Jail

(Fuller Torrey, Kennard, Eslinger, Lamb, & Pavle, 2010). Repeat offenses and rearrests occur

due to the failure of mental health services to provide treatment to ex-offenders; when jail is the

only place that these offenders can receive proper (and free) treatment, they return ( (Thigpen,

Solomon, Keiser, & Ortiz, 2009).

Mentally ill inmates also cost more; estimating rates are $130 a day compared to a non-

mentally inmate at a cost of around $80 a day (Fuller Torrey, Kennard, Eslinger, Lamb, & Pavle,

2010). This cost difference is due to a lot of different factors such as increased staffing

necessities, medication and treatments, case management, and extra security (Hills, Siegfried, &

Ickowitz, 2004). These individuals also cost more because they usually stay longer as well. In

Florida’s Orange County Jail, the average for mentally ill inmates’ stay is 51 days compared to

almost a half of that for other inmates at 26 days. According to Thigpen, Solomon, Keiser, and

Ortiz (2009), the Department of Justice found that it costs American taxpayers a shocking $15

billion per year to house individuals with psychiatric disorders in correctional facilities. Due to

the mental and thinking impairment of the mentally ill, major management problems can also be

seen during incarceration, such as eating cell walls and clothes, throwing feces, and disturbing

staff and other inmates on a daily basis.

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According to Fuller Torrey, Kennard, Eslinger, Lamb, and Pavle (2010), a variety of

studies have proven that about half of all inmate suicides are committed by mentally ill inmates.

Studies of completed suicides in facilities found a range of 73%-77% to be committed by

mentally ill inmates (The Treatment of Persons with Mental Illness in Prison and Jails: A State

Survey, 2014). Mentally ill inmates are also more likely to be abused during incarceration for a

multitude of reasons including vulnerability and the fact that correctional staff do not understand

how to treat mentally ill individuals. Going along with these issues, the lack of treatment of

psychiatric conditions and symptoms inmates possess leads to the deterioration of their

remaining sanity as symptoms worsen in this unstable environment (The Treatment of Persons

with Mental Illness in Prison and Jails: A State Survey, 2014).

Screening and Assessment

In order to identify the increasing amount of mentally ill offenders that are being

administered into our nation’s jails and prisons, policies and procedures are required to take

practice upon admin. Through screening and assessing all offenders, staff members, inmates, and

the public are all benefited in regards to safety and security. In addition, if a uniformed screening

and assessing procedure is used throughout all jails and prisons, the opportunity for legal actions

against the facility are diminished and if administered correctly, the identification of mental

illness symptoms can increase individualized treatments and benefit the suffering individual as

well. These screens and assessments can pinpoint a risk for harm to themselves or others,

capability to function within the facility, if transfer to a mental health facility is necessary, and if

medical treatment is needed. The actual screening is an information gathering process that

includes an interview, reviewing existing records and any specialized tests deemed necessary. If

an individual is viewed as potentially suffering from any number of mental illness symptoms,

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then further assessment and evaluation should therefore take place due to the chance of a

psychiatric disorder. According to Hills, Siegfried, and Ickowitz (2004), this assessment will test

the severity and nature of their problems, look at their medical history, and determine what type

of intervention or treatment best suites the individual; this is all encompassed within a complete

mental status exam which describes the individual’s appearance, orientation, behavior, thought

quality, and thought content as well as looking for presence of severe psychiatric symptoms and

alters in lifestyle.

The importance of finding the severity of individuals’ symptoms has been brought to

upmost importance and therefore the American Psychological Association (APA) has created

policies and procedures in regards to screening and assessing offenders. These policies include

the following: observation and structured inquiry with a set of questions, standard questions for

all inmates, questions that are administered at the time of admission, and a qualified mental

health professional or trained correctional officer to conduct the screening (Hills, Siegfried, &

Ickowitz, 2004).

Current Findings

In 2008, the U.S. Department of Justice collected data and found that there were

2,310,984 prisoners in local jails and state and federal prisons in the nation. Estimates of severe

psychiatric disorders have reached up to 16% within this population depending on the state’s

numbers giving the data which would be 369,757 of that population of inmates in 2008

(Thigpen, Solomon, Keiser, & Ortiz, 2009). The total amount of individual patients in state,

private, and psychiatric units in general hospitals at this time was only around 100,000 across the

country. In 2012, it was estimated that 356,268 inmates had severe mental illnesses within

prisons and jails, compared to the approximation of 35,000 patients with severe mental illness in

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state psychiatric hospitals. Therefore, the number of these individuals incarcerated was 10 times

more likely when compared to the standing state hospitals (The Treatment of Persons with

Mental Illness in Prison and Jails: A State Survey, 2014). When looking at these alarming

numbers, it is commonly said that jails and prisons have become “the nation’s largest psychiatric

hospitals” (Thigpen, Solomon, Keiser, & Ortiz, 2009). In addition, according to Thigpen,

Solomon, Kesier, & Ortiz (2009), there are now more seriously mentally ill individuals in the

Los Angeles County Jail, Chicago’s Cook County Jail, or New York’s Rikers Island Jail then

there are in any single, given psychiatric hospital in the nation and there is not a single county (of

3,139 counties in the USA) in which the psychiatric facility in that county has as many

individuals as patients as does the county jail.

According the annual DMS survey that measures population mental illness rates with

structured interviews including questionnaires and data analysis about severity and duration of

symptoms, it is estimated that 1 in 17 Americans in the general population meet the criteria of

serious mental illness including schizophrenia, bipolar disorder, and major depression disorder,.

Studies also show that the percentage of individuals diagnosed with substance abuse or

dependence is estimated at about 9% of the general population, clearly varying in the type of

substance. These findings can be found in more detail on the American Psychological

Association website (www.apa.org).

Due to the alarming percentages of mentally ill offenders in the criminal justice systems,

The Mental Health America association has come up with a policy referred to as Position

Statement 56 and it deals with mental health treatment in correctional facilities. If an offender is

mentally ill they are entitled to the following: right to adequate medical and mental health care,

protection from harm including staff abuse, and a safe, sanitary, and humane environment in

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which the vulnerable can be protected. In order for these measures to be obtained, all offenders

must be screened upon admission for mental health and substance abuse conditions by trained

mental health personnel and required to endure further evaluation, assessment, and treatment if

the screening detects possible symptoms (Position Statement 56: Mental Health Treatment in

Correctional Facilities). The policy also goes into detail about the actual treatment plans and

conditions, as well as the right to refuse treatment. For length purposes and since actual

treatment does not regard this study, more information on Position Statement 56 can be found at

<http://www.mentalhealthamerica.net/positions/correctoinal-facility-treatment>.

Methodology

Introduction

The results of this study are based on recording data from the Survey of Inmates in State

and Federal Correctional Facilities (2004), and the Survey of Inmates in Local Jails (2002). The

Bureau of Justice Statistics also conduct surveys every 5 years regarding inmates and these are

the only source of information on criminal offenders with mental health in the nation. Due to

recordings of required screening and assessments conducted by local jails and prisons on all

entering inmates, the data of this survey thrives on the participating facilities that sent this

information forward for this study in order to analyze the estimated percentages of mentally ill

inmates.

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Research Design

The research question being asked and analyzed within this study is just how much does

the prevalence rate of serious mental illnesses within correctional facilities compare to hospitals

and the general population?

Mailed and emailed surveys will be constructed and sent out to the entirety of the 1,800

state and federal prisons, as well as the 3,200 local county jails asking about their screening and

assessment results to estimate the prevalence rate of mental illness within these environments.

The data will depend entirely on volunteer participation of these correctional facilities and run all

data acquired. To potentially increase participation and create awareness of informed consent, a

description of the purpose of the study encasing the importance of this problem in our nation will

be enclosed with the survey. Data of total psychiatric hospital beds in the nation was taken from

reports conducted by The Treatment Advocacy Center (2012) and depends on its accuracy. This

is a cross-sectional design being that the study is acquiring data one time, and the units of

analysis are the recorded percentages of mentally ill individuals within a correctional facility as

well as non-mentally ill offenders.

Within the recorded prevalence rates gathered from participating facilities, records of

inmate surveys would also be extremely valuable for analysis to further interpret patterns and

correlational factors of mentally ill offenders. Symptoms of severe mental health disorders are

also recorded to be analyzed and the variety of symptoms are defined in the concepts section

below within the methodology of the study.

The results of the participating correctional facilities’ screening and assessment data of

offenders’ initial admin into the facilities are then scored originally as the opportunity for being

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mentally disordered (positive) compared to non-mentally ill individuals (negative). The data of

the individual questions evaluated upon the screening process conducted by the facilities will

then be scored in their appropriate categories (i.e. symptoms, criminal records, medical history,

etc.) to be analyzed to determine patterns or correlations between mentally ill patients.

Definitions of Concepts

The facilities to be included in this study are local jails, state and federal prisons. Local

jails are defined as locally operated correctional facilities that receive offenders after an arrest

and hold them for a short period of time, pending arraignment, trial, conviction, or sentencing.

They also hold mentally ill persons pending their movement to appropriate mental health

facilities. State and Federal prisons are known to hold offenders who typically are convicted and

sentenced to serve more than 1 year.

When the phrase “mental illness” is coined, it is defined as a substantial impairment of

one’s thought processes, sensory input, mood balance, memory, or ability to reason that

significantly interferes with one’s ability to cope with the ordinary demands of daily life (The

Treatment of Persons with Mental Illness in Prison and Jails: A State Survey, 2014). Within this

study, the mental illnesses to be recorded are symptoms of schizophrenia, bipolar disorder, major

depression, and substance abuse due to the high co-morbidity rates of these disorders and the

abuse of alcohol and/or drugs. Criteria of these serious mental illnesses are determined within the

DSM-V and laid out within the Review of Relevant Literature section of this study.

To be scored as “positive” an individual must have been told in the past 12 months that

they had a mental disorder by a mental health professional, stayed the night in a hospital due to a

mental health problem, used prescription medicine, or received professional health therapy in the

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past. An individual can also be scored as “positive” if they show or have recent signs of serious

mental illness symptoms. These symptoms are based on criteria described in the DSM-V and

operatized to include the following: major depressive disorder or mania disorder symptoms

including persistent sad, numb, or empty mood, loss of interest or pleasure in activities, increased

or decreased appetite, insomnia or hypersomnia, psychomotor agitation or retardation, feelings of

worthlessness or excessive guilt, diminished ability to concentrate or think, ever attempt suicide,

persistent anger or irritability, increased/decreased interest in sexual activities; psychotic

(schizophrenia) disorder symptoms include delusions and/or hallucinations; alcohol or drug use

symptoms include regular use, use in month before offense, at time of the offense, binge

drinking, and type of drug abused/depended on.

Individually recorded data voluntarily given by facilities summarizing their screening and

assessment data potentially includes the following nominal variables: age, gender, and race,

criminal record (current or past offenses, expected time to be served, and charged with violating

facility rules), homelessness in the past year, if ever received mental health treatment (had

overnight hospital stay, used prescribed medications, had professional mental health therapy),

received treatment during year before arrest (had overnight hospital stay, used prescribed

medications, on prescribed medication at time of arrest, had professional mental health therapy),

and if treatment had been received after admission (had overnight hospital stay, used prescribed

medications, had professional mental health therapy).

Accuracy of Survey Estimates

Survey accuracy depends on sampling and measurement errors which can occur by

chance because of a sample of inmates and not all inmates were interviewed due to policies not

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being followed by the facilities. Measurement error can depend on many factors such as

nonresponse, recall difficulties, differences in interpretation of questions among inmates and

processing errors. The study attempts to diminish measuring error by sending out surveys to all

correctional facilities but yet the fact that it is based on volunteer activity has to be taken into

account. Some error could also occur due to the fact that original inmate surveys are conducting

depending on self-reporting of inmates and this study is just taking the records of these surveys

already conducted. Sampling error varies due to the size of the estimate and the size of the base

population. For example, a 95% Confidence interval of jail inmates in 2002 who had a mental

health problem was conducted and found to be approximately 62.6%-65.8%.

Limitations of this study include the fact that the sample population size depends on

voluntary responses from the various facilities. In order to increase generalization and validity,

the surveys were mailed and emailed to each jail and prison in the country. Time might be a

limitation as well depending on the response rate of participating facilities.

Expected Results

According to James and Glaze (2006) the Bureau of Justice Statistics conducts studies

every 5-6 years and has data based on Survey of Inmates in State and Federal Correctional

Facilities, 2004, and the Survey of Inmates in Local Jails, 2002. The findings will begin broadly

and then narrow down to specific correlational factors found within the screening surveys.

Symptoms of mental health problems (defined above) will be found in 60% of jail inmates, 49%

of state prisoners, and 40% of federal prisoners. About 4/10 jail inmates, 3/10 State and Federal

prisoners will be found to have symptoms of a mental disorder without recent history of mental

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illnesses before incarceration. 17% of State prisons, 9% in Federal prisons, and 17% in local jails

are expected to have both a recent history and current symptoms of mental disorders.

Mental health problems will be found to be more common among female, white, and young

inmates.73% of females and 55% of males in state prisons will have a mental health problem;

while in federal prison it’s expected to be 61% females and 44% males, and 75% female vs. 63%

males in local jails. In regards to race, in state prisons 62% of whites, 55% blacks, 46%

Hispanics are expected to have mental health problems while jail inmates with mental illnesses

will be 71% whites, 63% blacks, and 51% Hispanics. Those aged 24 years or younger within

state prisons will be 63% mentally ill while only 40% of adults 55 or older in these facilities are

mentally ill. In local jails 70% of 24 years or younger aged inmates and 52% of those 55 years or

older will be mentally ill.

Prevalence rates of the specific disorders will be as followed: 5% of prison inmates will be

schizophrenic compared to 1.3% of the general population, 6% will be bipolar, and 9% will be

diagnosed with major depression compared to 1.5% of adults aged 18 or older in the general

population (Hills, Siegfried, & Ickowitz, 2004). It will be estimated that 42% of state prisoners,

49% of local jail inmates will be found to have both a mental health problem alongside of

substance abuse or dependence. 24% of state prisoners and 19% of jail inmates will meet the

criteria for substance abuse or dependence alone. 75% of female inmates in state prisons who

have a mental health problem also will meet the criteria for substance dependence or abuse.

In state facilities 13% and in local jails 17% of inmates who have a mental health problem

will be twice as likely as inmates without a mental illness to be homeless in the year before their

incarceration. Among mentally ill state prisoners, majority of offenses will be due to violent

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offenses as their most serious offense (49%) and there will be a mean maximum sentence of 4

months longer for mentally ill prisoners compared to prisoners without a mental illness.

In addition, 34 % of state prisoners with mental illnesses, 24% of federal prisoners, and 17%

of jail inmates will report receiving treatment since admission into a facility. 58% of state

prisoners who had a mental health problem will be charged with rule violations compared to

43% of those without a mental disorder. 24% state prisoners with mental illnesses compared to

14% of those without will report getting charged with a physical or verbal assault on correctional

staff or another inmate. Also, jail inmates with mental health problems will show to be twice as

likely as those without to have been charged with facility rule violations, and four times as likely

to be charged with a physical or verbal assault on correctional staff or inmate.

In conclusion, the results expected to come from undergoing this research study will show

that there are now more than three times more seriously mentally ill persons in jail and prisons

than in hospitals. When looking at individual states, the rates will obviously differ and vary, but

overall there are more mentally ill disordered individuals found in our nation’s correctional

facilities than in hospitals (Fuller Torrey, Kennard, Eslinger, Lamb, & Pavle, 2010). Mentally ill

offenders are more prone to violence, behavioral issues during incarceration, and have longer

sentences when compared to other offenders. The prevalence rates of severe mental illnesses and

their symptoms are alarming to researchers when looking at the results and there is an obvious

problem with the structure and tendencies for the high rate of mental illness in correctional

facilities. This study will be a valuable tool in exemplifying the need for procedural changes in

the maintenance of prisons and jails in regards to mental health treatment, and it will also help

address the need for more space and funds allowed for psychiatric hospitals.

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Works CitedDitton, P. M. (1999). Mental Health and Treatment of Inmates and Probationers. U.S.

Department of Justice. Office of Justice Programs. Retrieved March 2015, from https://www.prisonlegalnews.org/media/publications/bojs_mental_health_and_treatment_of_inmates_and_probationers_1999.pdf

Fuller Torrey, E., Kennard, A. D., Eslinger, D., Lamb, R., & Pavle, J. (2010). More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States. Survey, National Sheriff's Association, Treatment Advocacy Center. Retrieved March 2015, from http://www.treatmentadvocacycenter.org/storage/documents/final_jails_v_hospitals_study.pdf

Hills, H., Siegfried, C., & Ickowitz, A. (2004, May). Effective Prison Mental Health Services. Washington, DC. Retrieved April 2015, from https://s3.amazonaws.com/static.nicic.gov/Library/018604.pdf

James, D. J., & Glaze, L. E. (2006). Mental Health Problems of Prison . Bureau of Justice Statistics. Washington, D.C : Office of Justice Programs. Retrieved March 2015, from http://www.bjs.gov/content/pub/pdf/mhppji.pdf

Pomerantz, J. M. (2003). Treatment of Mentall Ill in Prisons and Jails. (C. Publishing, Producer, & Division of CMP Healthcare Media) Retrieved March 2015, from Medscape Multispecialty: http://www.medscape.com/viewarticle/458600

Position Statement 56: Mental Health Treatment in Correctional Facilities. (n.d.). (Mental Health America) Retrieved April 2015, from MHA: http://www.mentalhealthamerica.net/positions/correctional-facility-treatment

Steadman, H. J., Osher, F. C., Robbins, P. C., Case, B., & Samuels, S. (2009, June). Prevalence of Serious Mental Illness Among Jail Inmates. 60(6), 761. Retrieved March 2015, from http://ps.psychiatryonline.org/doi/abs/10.1176/ps.2009.60.6.761

The Treatment of Persons with Mental Illness in Prison and Jails: A State Survey. (2014, April 8). Retrieved March 2015, from Treatment Advocacy Center: http://tacreports.org/storage/documents/treatment-behind-bars/treatment-behind-bars.pdf

Thigpen, M. L., Solomon, L., Keiser, G. M., & Ortiz, M. (2009, April). Jails and Prisons: The nation's largest psychiatric facilities. Retrieved March 2015, from Treatment Advocacy Center: http://www.treatmentadvocacycenter.org/resources/consequences-of-lack-of-treatment/jaiI/1371