Mental Health and Treatment of Inmates and Probationers U.S. Department of Justice Bureau of Justice Statistics July 1999, NCJ 174463 By Paula M. Ditton BJS Statistician ************************************************ ********** Highlights ********** Over a quarter million mentally ill incarcerated in prison or jail State Federal Reported a... prison prison Jail Probation Mental or emotional condition 10.1% 4.8% 10.5% 13.8% Overnight stay in a mental hospital 10.7 4.7 10.2 8.2 Estimated to be mentally ill* 16.2% 7.4% 16.3% 16.0% *Reported either a mental or emotional condition or an overnight stay in a mental hospital or program. *About 10% of prison and jail inmates reported a mental or emotional condition; and 10% said they had stayed overnight in a mental hospital or program. *Together, 16% or an estimated 283,800 inmates reported either a mental condition or an overnight stay in a mental hospital, and were identified as mentally ill. Mentally ill inmates were more likely than others to be in prison for a violent offense State prisoners Offense Mentally ill Other Violent 52.9% 46.1% Property 24.4 21.5 Drug 12.8 22.2 Public-order 9.9 9.8 Criminal history None 18.8% 21.2% Priors 81.2 78.8 *About 53% of mentally ill inmates were in prison for a violent offense, compared to 46% of other inmates. *Mentally ill offenders were less likely than others to be incarcerated for a drug related offense (13% versus 22%). Nearly 6 in 10 mentally ill offenders reported they were under the influence of alcohol or drugs at the time of their current offense. State prisoners Mentally ill Other Before entering prison inmates inmates Homeless in 12 months prior to arrest 20.1% 8.8% Physical/sexual abuse Male 32.8% 13.1% Female 78.4 50.9 Alcohol/drug use At time of offense 58.7% 51.2% Drug use In month before offense 58.8% 56.1% *Mentally ill State prison inmates were more than twice as likely as other inmates to report living on the street or in a shelter in the 12 months prior to arrest (20% compared to 9%). *Nearly 8 in 10 female mentally ill inmates reported physical or sexual abuse. Males with a mental condition were more than twice as likely as other males to report abuse. Mentally ill inmates State prison Jail Mental health treatment Any treatment 60.5% 40.9% Medication 50.1 34.1 Counseling 44.1 16.2 *6 in 10 mentally ill State inmates reported receiving mental treatment since admission to prison. ****************End of Highlights***************** At midyear 1998 an estimated 283,800 mentally ill offenders were incarcerated in the Nation's prisons and jails. In recent surveys completed by the Bureau of Justice Statistics, 16% of State prison inmates, 7% of Federal inmates, and 16% of those in local jails reported either a mental condition or an overnight stay in a mental hospital. About 16%, or an estimated 547,800 probationers, said they had had a mental condi- tion or stayed overnight in a mental hospital at some point in their lifetime. Based on information from personal interviews, State prison inmates with a mental condition were more likely than other inmates to be incarcerated for a violent offense (53% compared to 46%); more likely than other inmates to be under the influence of alcohol or drugs at the time of the current offense (59% compared to 51%); and more than twice as likely as other inmates to have been homeless in the 12 months prior to their arrest (20% compared to 9%). Over three-quarters of mentally ill inmates had been sentenced to time in prison or jail or on probation at least once prior to the current sentence. Over 30% of male mentally ill inmates and 78% of females reported prior physical or sexual abuse. Since admission 61% of mentally ill inmates in State prison and 41% in local jails reported they had received treatment for a mental condition in the form of counseling, medication, or other mental health services. *********************Box****************************** ******************************************* Survey items used to measure mental illness ******************************************* Do you have a mental or emotional condition? (prison and jail inmates only) --Yes --No Have you ever been told by a mental health professional such as a psychiatrist, psychologist, social worker, or psychiatric nurse, that you had a mental or emotional disorder? --Yes --No (probationers only) Because of an emotional or mental problem, have you ever-- Taken a medication prescribed by a psychiatrist or other doctor? --Yes --No Been admitted to a mental hospital, unit or treatment program where you stayed overnight? --Yes --No Received counseling or therapy from a trained professional? --Yes --No Received any other mental health services? --Yes --No ****************End of questionnaire box*************** **************************Box************************** ************************************************ Previous studies of the prevalence of severe mental illness in prison or jail ************************************************ Study Sample Mentally ill* Guy, Platt, Zwerling, Philadelphia jail and Bullock (1985) pretrial admissions 16% Teplin (1990) Cook County jail admissions (males) 10% Steadman, Fabisiak, Dvoskin, New York State and Holohean (1987) prisoners 8% *Generally includes schizophrenia, bipolar disorder, and major depression. See individual studies for variations in definition. *****************End of studies box********************* **************************** Prevalence of mental illness among correctional populations based on offender self reports **************************** The findings in this report are based on the 1997 Survey of Inmates in State or Federal Correctional Facilities, the 1996 Survey of Inmates in Local Jails, and the 1995 Survey of Adults on Probation. In each survey, offenders selected through nationally representative samples were asked a series of mental health related questions. Respondents were asked if they have a mental or emotional condition and whether they had ever received treatment for a mental or emotional problem, other than treatment related to drug or alcohol abuse. (See survey questions in the box above.) **************************** 16% of State prisoners identified as mentally ill **************************** For this report, offenders were identified as mentally ill if they met one of the following two criteria: they reported a current mental or emotional condition, or they reported an overnight stay in a mental hospital or treatment program. An estimated 1 in 10 State prison inmates reported a current mental or emotional condition (table 1). ****************************************************************************** Measures of mental illness among State prison State prison inmates Cumu- lative Percent percent Reported a mental or emotional condition 10.1 % 10.1 % Because of a mental or emotional problem, inmate had -- Been admitted to a hospital overnight 10.7 % 16.2 % Taken a prescribed medication 18.9 23.9 Received professional counseling or therapy 21.8 29.7 Received other mental health services 3.3 30.2 ****************************************************************************** A slightly larger percentage (11%) of State inmates said they had been admitted overnight to a mental hospital or treatment program at some point in their life. Overall, nearly a third of all inmates reported they had a current mental condition or they had received mental health service at some time. To take into account underreporting of current mental or emotional problems, past admission to a mental hospital was included as a measure of mental illness. Overall, 16% of State prisoners met these criteria, including 10% who reported a current mental condition and an additional 6% who said they did not have a mental condition but had stayed overnight in a mental hospital, unit, or treatment program. Previously estimated rates of mental illness among incarcerated populations vary, depending on the methodology of the study, the institution, and the definition of mental illness. Estimates range from 8% to 16% among studies with more rigorous scientific methods, including random sampling and a standardized assessment or psychological testing. (See the box on this page.) Past estimates of the rate of mental illness among incarcerated populations are higher than those for the U.S. general population. Among a sample of male jail detainees in Cook County (Chicago), Teplin found 9.5% had experienced a severe mental disorder (schizophrenia, mania, or major depression) at some point in their life, compared to 4.4% of males in the U.S. general population. The Epidemiologic Catchment Area program found that 6.7% of prisoners had suffered from schizophrenia at some point, compared to 1.4% of the U.S. household population (Robins and Regier). **************************** 283,800 mentally ill in prison or jail; 547,800 on probation **************************** Using the same criteria described for State prison inmates, 16% of offenders in local jails or on probation and 7% of inmates in Federal prisons were identified as mentally ill in recently completed BJS surveys (table 2). ************************************************************************************** Table 2. Mental health status of inmates and probationers State prison Federal prison Jail inmates, Probationers, inmates, 1997 inmates, 1997 1996 1995 Identified as mentally ill* 16.2 % 7.4 % 16.3 % 6.0% Reported a mental or emotional condition 10.1 4.8 10.5 13.8 Admitted overnight to a mental hospital or treatment center 10.7 4.7 10.2 8.2 *Reported either a mental condition or an overnight stay in a mental hospital or treatment program. *************************************************************************************** Probationers were somewhat less likely than inmates in State prisons or local jails to report an overnight stay in a mental hospital or treatment program but more likely to report a mental or emotional problem. Federal inmates had lower rates on both measures. Assuming these rates have not changed since the surveys were conducted, an estimated 283,800 inmates in prison or jail were mentally ill as of June 30, 1998 (table 3). ************************************************************************* Table 3. Estimated number of mentally ill inmates and probationers, 1998 Estimated number of offenders* State Federal Local prison prison jail Probation Identified as mentally ill 179200 7900 96700 547800 Reported a mental or emotional condition 111300 5200 62100 473000 Admitted overnight to a mental hospital 118300 5000 60500 281200 *Based on midyear 1998 counts from the National Prisoner Statistics and Annual Survey of Jails and preliminary yearend 1998 counts from the Annual Probation Survey. ************************************************************************** State prisons held an estimated 179,200 mentally ill offenders; Federal prisons held 7,900; and local jails, 96,700. Of those on probation at yearend 1998, an estimated 547,800 were mentally ill. **************************** White inmates more likely than blacks or Hispanics to report a mental illness **************************** Nearly a quarter of white State prison and local jail inmates and a fifth of white offenders on probation were identified as mentally ill (table 4). ************************************************************************** Table 4. Inmates and probationers identified as mentally ill, by gender, race/Hispanic origin, and age Percent identified as mentally ill Offender State Federal Jail characteristic inmates inmates inmates Probationers Gender Male 15.8 % 7.0 % 15.6 % 14.7 % Female 23.6 12.5 22.7 21.7 Race/Hispanic origin White* 22.6 % 11.8 % 21.7 % 19.6 % Black* 13.5 5.6 13.7 10.4 Hispanic 11.0 4.1 11.1 9.0 Age 24 or younger 14.4 % 6.6 % 13.3 % 13.8 % 25-34 14.8 5.9 15.7 13.8 35-44 18.4 7.5 19.3 19.8 45-54 19.7 10.3 22.7 21.1 55 or older 15.6 8.9 20.4 16.0 *Excludes Hispanics. ************************************************************************** The rate of mental illness among black and Hispanic inmates and probationers was much lower. Among black offenders, 14% of those in State prison and local jails, and 10% of those on probation were identified as mentally ill. About 11% of Hispanic State prison and local jail inmates, and 9% of Hispanic offenders on probation had a mental illness. Black and Hispanic inmates in Federal prison were half as likely as white inmates to report a mental illness. About 6% of black inmates and 4% of Hispanic inmates reported a mental condition or an overnight stay in a mental hospital, compared to 12% of white Federal prison inmates. The prevalence of mental illness also varied by gender, with females reporting a higher rate of mental illness than males. Nearly 24% of female State prison and local jail inmates, and 22% of female probationers were identified as mentally ill, compared to 16% of male State prison and jail inmates and 15% of male probationers. **************************** Offender mental illness highest among the middle-aged **************************** Offenders between ages 45 and 54 were the most likely to be identified as mentally ill. About 20% of State prisoners, 10% of Federal prisoners, 23% of jail inmates, and 21% of probationers between ages 45 and 54 had a mental illness, compared to 14% of State inmates, 7% of Federal inmates, 13% of jail inmates, and 14% of probationers age 24 or younger. The highest rates of mental illness were among white females in State prison. An estimated 29% of white females, 20% of black females, and 22% of Hispanic females in State prison were identified as mentally ill. Nearly 4 in 10 white female inmates age 24 or younger were mentally ill. Percent of females in State prison identified as mentally ill Age White Black Hispanic Total 29 % 20 % 22 % 24 or younger 37 17 23 25-34 23 20 21 35 or old 33 21 23 **************************** Mentally ill more likely than other offenders to have committed a violent offense **************************** Fifty-three percent of mentally ill State prisoners, compared to 46% of other State prisoners, were incarcerated for a violent crime (table 5). ******************************************************************************************************************************************** Table 5. Most serious current offense of inmates and probationers, by mental health status State prison Federal prison Local jail Probation Mentally ill Other Mentally ill Other Mentally ill Other Mentally ill Other Most serious offense inmates inmates inmates inmates inmates inmates probationers probationers All offenses 100 % 100 % 100 % 100 % 100 % 100 % 100 % 100 % Violent offenses 52.9 % 46.1 % 33.1 % 13.3 % 29.9 % 25.6 % 28.4 % 18.4 % Murder* 13.2 11.4 1.9 1.4 3.5 2.7 0.5 0.9 Sexual assault 12.4 7.9 1.9 0.7 5.2 2.8 6.8 4.1 Robbery 13.0 14.4 20.8 9.1 4.7 6.9 2.0 1.4 Assault 10.9 9.0 3.8 1.1 14.4 11.0 14.0 10.5 Property offenses 24.4 % 21.5 % 8.7 % 6.7 % 31.3 % 26.0 % 30.4 % 28.5 % Burglary 12.1 10.5 1.0 0.3 9.1 7.4 6.4 4.3 Larceny/theft 4.6 4.1 1.3 0.4 8.4 7.9 5.3 8.8 Fraud 3.1 2.6 5.0 4.9 5.2 4.4 11.7 9.2 Drug offenses 12.8 % 22.2 % 40.4 % 64.4 % 15.2 % 23.3 % 16.1 % 20.7 % Possession 5.7 9.4 3.9 11.9 7.3 12.3 7.2 11.0 Trafficking 6.6 12.2 35.7 46.6 7.0 9.6 6.7 9.2 Public-order offenses 9.9 % 9.8 % 17.0 % 14.6 % 23.2 % 24.6 % 24.7 % 31.6 % Note: Detail does not sum to total because of excluded offense categories. *Includes nonnegligent manslaughter. ********************************************************************************************************************************************* Approximately 13% of the mentally ill in State prison had committed murder; 12%, sexual assault; 13%, robbery; and 11%, assault. Among inmates in Federal prison, 33% of the mentally ill were incarcerated for a violent offense, compared to 13% of other Federal inmates. More than 1 in 5 mentally ill Federal prisoners had committed robbery (predominantly bank robbery). Among inmates in local jails, 30% of the mentally ill had committed a violent offense, compared to 26% of other jail inmates. An estimated 28% of mentally ill probationers and 18% of other probationers reported their current offense was a violent crime. Nearly 1 in 5 violent offenders incarcerated or on probation were identified as mentally ill. Percent mentally ill among violent offenders State prison inmates 18.2 % Federal prison inmates 16.6 Jail inmates 18.5 Probationers 22.8 Unlike those in State prisons, the majority of mentally ill offenders in jail or on probation had committed a property or public-order offense. Almost a third of mentally ill offenders in jail and on probation had committed a property offense, and a quarter had committed a public-order offense. **************************Box**************************** ******************************** 6 in 10 violent mentally ill State prisoners knew their victim ******************************** Mentally ill inmates who were incarcerated for a violent offense were more likely to report that the victim of the offense was a woman, someone they knew, and under age 18. Nearly 61% of mentally ill State prison inmates who had committed a violent offense knew their victim. An estimated 16% had victimized a relative and 12% an intimate, such as a spouse, ex-spouse, boyfriend, or girlfriend. More than half of the mentally ill reported that they had victimized a female during the current offense. An estimated 15% reported that their youngest victim was a child, age 12 or under, and 12% reported the victim to be between ages 13 and 17. A weapon was used by 44% of the violent State prisoners who were mentally ill. **************************** Victim characteristics and use of weapon, by mental health status of violent State prisoners **************************** Mentally ill Other inmates inmates Gender of victim(s) Male 44.3 % 51.5 % Female 44.0 37.5 Both males and female 11.7 10.9 Age of youngest victim 12 or younger 15.4 % 10.2 % 13-17 11.6 11.0 18-24 17.3 20.7 25-34 25.7 30.9 35-54 23.8 22.8 55 or older 6.2 4.3 Victim-offender relationship Knew victim/a 60.8 % 52.1 % Relative 15.6 10.3 Intimate/b 11.6 8.6 Friend/acquaintance 29.8 27.7 Other/c 6.5 6.9 Knew none of victims 39.1 47.9 Use of weapon Yes 44.0 % 41.9 % No 56.0 58.1 a/More than one victim may have been reported. b/Includes spouse, ex-spouse, boyfriend, girlfriend, ex-boyfriend, and ex-girlfriend. c/Includes those known by sight only. *********End of victim characteristic box************ Mentally ill offenders were less likely than other inmates to be incarcerated for a drug offense. About 13% of mentally ill inmates and 22% of other inmates in State prison were incarcerated for a drug offense. In Federal prison, where the majority of inmates are incarcerated for a drug offense, 40% of those identified as mentally ill and 64% of other Federal inmates were in prison for a drug-related crime. **************************** Half of mentally ill inmates reported 3 or more prior sentences **************************** Mentally ill inmates reported longer criminal histories than other inmates. Among mentally ill inmates, 52% of State prisoners, 54% of jail inmates and 49% of Federal inmates reported three or more prior sentences to probation or incarceration (table 6). ********************************************************************************************************* Table 6. Criminal history of inmates, by mental health status State prison Federal prison Local jail Mentally ill Other Mentally ill Other Mentally ill Other inmates inmates inmates inmates inmates inmates Criminal history None 18.8 % 21.2 % 24.3 % 38.8 % 21.0 % 28.4 % Priors 81.2 78.8 75.7 61.2 79.0 71.6 Violent recidivists 53.4 44.9 43.7 21.6 46.0 31.6 Other recidivists 27.8 33.8 32.0 39.6 33.0 40.0 Number of prior probation/ incarceration sentences 0 18.8 % 21.2 % 24.3 % 38.8 % 21.0 % 28.4 % 1 15.5 19.4 14.0 18.2 14.7 17.9 2 13.8 17.0 12.9 14.7 10.1 11.5 3 to 5 26.3 25.5 23.6 18.9 23.5 19.7 6 to 10 15.6 11.6 15.4 7.3 17.6 14.6 11 or more 10.0 5.3 9.7 2.2 13.2 7.8 ********************************************************************************************************* Among other inmates, 42% of State prisoners and jail inmates and 28% of Federal inmates had three or more prior sentences. About 10% of mentally ill prison inmates and 13% of jail inmates reported 11 or more prior sentences. **************************** Mentally ill more likely than other inmates to be violent recidivists **************************** Among repeat offenders, 53% of mentally ill State inmates had a current or past sentence for a violent offense, compared to 45% of other inmates. Forty- six percent of mentally ill jail inmates and 32% of other jail inmates with a criminal history had a current or past sentence or a current charge for a violent crime. Among Federal prisoners with a prior sentence, the mentally ill (44%) were twice as likely as other inmates (22%) to have a current or prior sentence for a violent offense. Although offenders on probation had shorter criminal histories, nearly 3 in 10 of the mentally ill were recidivists with a current or past sentence for violence. Probationers Mentally ill Other Criminal history None 43.4 % 54.1 % Priors 56.6 45.9 Violent recidivists 29.1 17.1 Other recidivists 27.6 28.8 **************************** Homelessness more prevalent among mentally ill offenders **************************** Mentally ill offenders reported high rates of homelessness, unemployment, alcohol and drug use, and physical and sexual abuse prior to their current incarceration. During the year preceding their arrest, 30% of mentally ill inmates in jail and 20% of those in State or Federal prison reported a period of homelessness, when they were living either on the street or in a shelter (table 7). ***************************************************************************************************** Table 7. Homelessness, employment, and sources of income of inmates, by mental health status State prison Federal prison Local jail Mentally ill Other Mentally ill Other Mentally ill Other inmates inmates inmates inmate inmates inmates Homeless In year before arrest 20.1 % 8.8 % 18.6 % 3.2 % 30.3 % 17.3 % At time of arrest 3.9 1.2 3.9 0.3 6.9 2.9 Employed in month before arrest Yes 61.2 % 69.6 % 62.3 % 73.0 % 52.9 % 66.6 % No 38.8 30.4 37.7 28.0 47.1 33.4 Sources of income/a Wages 56.7 % 65.6 % 54.0 % 66.0 % 62.9 % 77.1 % Family/friends 22.0 17.7 20.1 12.0 19.7 15.4 Illegal sources 23.4 27.0 22.5 29.0 19.4 14.4 Welfare 15.4 7.8 13.7 3.9 21.9 12.3 Pension/b 17.3 4.1 16.5 3.7 18.4 4.9 Compensation payments 3.1 1.9 4.7 1.8 3.0 2.1 a/Detail sums to more than 100% because offenders may have reported more than one source of income. For prisoners detail includes any income received in the month prior to arrest. For jail inmates, For jail inmates, detail includes any income received in the year prior to arrest. b/Includes Supplemental Security Income, Social Security, or other pension. **************************************************************************************************** About 9% of other State prison inmates, 3% of other Federal inmates and 17% of other jail inmates reported a period a homelessness in the year prior to their arrest. Fewer inmates reported they were homeless at the time of arrest. About 4% of mentally ill State and Federal prison inmates and 7% of jail inmates reported they were living on the street or in a shelter when arrested for their current offense. These rates were at least double those for inmates who were not mentally ill. **************************** About 4 in 10 inmates with a mental condition unemployed before arrest **************************** Mentally ill offenders were less likely than others to report they were working in the month before arrest. About 38% of mentally ill State and Federal prison inmates and 47% of mentally ill jail inmates were not employed in the month before arrest, while 30% of other State inmates, 28% of other Federal inmates, and 33% of other jail inmates were unemployed. An estimated 30% of mentally ill and 13% of other inmates in State prison received some type of financial support from government agencies prior to their arrest. More than 15% of the mentally ill received welfare, 17% supplemental security income or other pension, and 3% compensation payments, such as unemployment or workman's compensation. r half of mentally ill prison and jail inmates reported wages as their source of income prior to arrest, 23% of prison inmates and 20% of jail inmates reported income from illegal sources. Offenders on probation were asked about their current employment and sources of income in the past year. Over half of mentally ill probationers and three-quarters of other probationers were currently employed. An estimated 52% of mentally ill probationers and 27% of other probationers said they received income from government agencies in the past year. Probationers Mentally ill Other Currently employed Yes 55.9 % 75.9 % No 44.1 24.1 Sources of income* Wages 69.3 % 86.8 % Family/friends 17.9 16.3 Welfare 26.4 15.5 Pension 24.5 7.6 Compensation payments 10.2 7.7 *More than one source of income may have been reported. Family history of incarceration and alcohol or drug use prevalent among mentally ill Overall, 55% of mentally ill State prison inmates, 42% of Federal prisoners, 52% of jail inmates, and 40% of probationers reported a family member had been incarcerated at some point (table 8). ******************************************************************************************************************* Table 8. Family background of inmates and probationers, by mental health status State prison Federal prison Local jail Probation Mentally ill Other Mentally ill Other Mentally ill Other Mentally Other inmates inmates inmates inmates inmates inmates probation probationers Family member ever incarcerated 54.9 % 46.5 % 41.5 % 38.5 % 51.5 % 45.1 % 40.3 % 34.0 % Parent 23.4 17.4 13.4 11.1 23.7 18.9 29.6 11.1 Brother/sister 41.8 36.5 29.5 29.9 36.2 32.8 25.7 25.6 While growing up Ever lived in a foster home, agency, or institution 26.1 % 12.2 % 18.6 % 5.8 % 24.0 % 11.5 % 15.9 % 6.5 % Parent or guardian abused alcohol or drugs Alcohol only 30.6 % 22.2 % 24.6 % 16.0 % 29.3 % 21.9 % 32.4 % 19.2 % Drugs only 2.0 1.8 1.2 0.8 1.7 1.2 1.0 0.4 Both 10.9 5.7 8.5 2.8 11.0 6.1 9.0 2.4 ******************************************************************************************************************** About 47% of other State prison inmates, 39% of other Federal inmates, 45% of other jail inmates, and 34% of other probationers reported a history of family incarceration. Nearly a quarter of mentally ill State inmates said their father or mother had served time in prison or jail; 42% said a brother or sister had been incarcerated. When compared with other inmates and probationers, the mentally ill also reported higher rates of alcohol and drug abuse by a parent or guardian while they were growing up. Approximately 4 in 10 mentally ill State prisoners, jail inmates, and probationers, and 1 in 3 Federal inmates reported their parent or guardian had abused alcohol or drugs while they were growing up. About 42% reported alcohol abuse by a parent or guardian, and 13% reported drug abuse. At some point while growing up, a quarter of mentally ill State prisoners and local jail inmates lived in a foster home, agency, or institution. One in six mentally ill probationers reported living in a foster home or institution for a period of time during their childhood. **************************** Mentally ill report high rates of past physical and sexual abuse **************************** Mentally ill male State prisoners were more than twice as likely as other males to report physical abuse prior to admission to prison (27% versus 11%) and nearly four times as likely to report prior sexual abuse (15% versus 4%, table 9). **************************************************************************************************************** Table 9. Prior physical or sexual abuse of inmates and probationers, by mental health status State prison Federal prison Local jail Probation Mentally Mentally Mentally Mentally ill Other ill Other ill Other ill Other Reported by offender inmates inmates inmates inmates inmates inmates probationers probationers Ever abused before admission 36.9 % 15.2 % 34.1 % 7.6 % 36.5 % 12.5 % 38.8 % 12.1 % Male 32.8 13.1 30.0 5.5 30.7 9.6 31.0 6.5 Female 78.4 50.9 64.1 36.1 72.9 40.3 59.4 35.7 Physically abused 31.0 % 12.5 % 27.5 % 6.4 % 30.0 % 10.1 % 28.1 % 9.8 % Male 27.4 10.8 24.5 4.7 25.3 8.0 21.0 5.1 Female 67.6 40.2 50.0 29.4 59.8 30.8 46.7 29.7 Sexually abused 19.0 % 5.8 % 15.6 % 2.7 % 23.5 % 5.9 % 21.9 % 5.8 % Male 15.0 4.1 11.6 1.5 17.2 3.4 14.2 2.4 Female 58.9 33.1 45.0 19.3 63.4 29.6 42.3 19.9 ****************************************************************************************************************** Among male inmates 25% of the mentally ill in Federal prisons or in jails reported prior physical abuse, compared to 5% of other male Federal inmates and 8% of other male jail inmates. Mentally ill male pro- bationers were 4 times as likely as other probationers to report prior physical abuse (21% and 5%, respectively). The rate of physical abuse reported by mentally ill female inmates was over twice that reported by males. Nearly 70% of female State prisoners, 50% of female Federal prisoners, 60% of female jail inmates, and 47% of female probationers reported a history of physical abuse. Nearly 60% of female mentally ill State prisoners, 45% of female Federal prisoners, 63% of female jail inmates and 42% of female probationers reported prior sexual abuse. **************************** 6 in 10 mentally ill State inmates under the influence of alcohol or drugs at time of offense **************************** Mentally ill inmates were more likely than others to be under the influence of alcohol or drugs while committing their current offense. About 60% of mentally ill and 51% of other inmates in State prison were under the influence of alcohol or drugs at the time of their current offense (table 10). ******************************************************************************************************************************* Table 10. Prior alcohol and drug use of inmates and probationers, by mental health status State prison Federal prison Local jail Probation Alcohol/drug use Mentally ill Other Mentally ill Other Mentally ill Other Mentally ill Other reported by offender inmates inmates inmates inmates inmates inmates probationers probationers Alcohol/drug use At time of offense 58.7 % 51.2 % 46.5 % 33.0 % 64.6 % 56.5 % 49.0 % 46.4 % Drug use In month before of 58.8 % 56.1 % 48.1 % 44.6 % 57.6 % 47.3 % 39.5 % 30.3 % At time of offense 36.9 31.7 29.3 21.9 38.8 30.4 18.1 12.6 Alcohol use At time of offense 42.7 % 36.0 % 27.9 % 19.8 % 44.3 % 36.0 % 41.4 % 39.7 % ******************************************************************************************************************************* Rates of alcohol and drug use at the time of the offense were even higher among mentally ill jail inmates, where 65% of the mentally ill and 57% of other jail inmates were under the influence. Among probationers, 49% of the mentally ill and 46% of others reported alcohol or drug use at the time of the offense. Like other inmates and probationers, the mentally ill were more often under the influence of alcohol than drugs at the time of the current offense. About 43% of mentally ill State prison inmates and 44% of jail inmates had been drinking when they committed their current offense. Thirty-six percent of other inmates in prison and jail reported they were drinking at the time of the offense. **************************** A third of mentally ill offenders alcohol dependent **************************** Based on the CAGE diagnostic instrument, 34% of mentally ill State prison inmates, 24% of Federal prisoners, 38% of jail inmates and 35% of mentally ill probationers exhibited a history alcohol dependence (table 11). ********************************************************************************************************************************* Table 11. Alcohol dependence and experiences of inmates and probationers while under the influence of alcohol, by mental health history State prison Federal prison Local jail Probation Mentally ill Other Mentally ill Other Mentally ill Other Mentally ill Other inmates inmates inmates inmates inmates inmates probationers probationers History of alcohol dependency* 34.4 % 22.4 % 23.9 % 15.6 % 37.9 % 24.3 % 34.8 % 22.1 % Because of your drinking, have you ever -- Lost a job? 16.7 % 9.0 % 8.7 % 4.7 % 18.0 % 10.3 % 19.4 % 5.3 % Had job or school trouble (such as demotion at work or dropping out of school) 24.0 13.8 15.4 7.1 -- -- 25.2 10.5 Been arrested or held at a police station? 35.2 28.3 30.7 18.3 41.5 30.7 45.7 41.1 While drinking have you ever -- Gotten into a physical fight 45.7 % 37.0 % 36.4 % 21.7 % 49.8 % 34.1 % 43.9 % 30.3 % Had as much as a fifth of liquor in 1 day, 20 drinks, 3 six-packs of beer, or 3 bottles of wine 48.8 39.5 43.9 29.2 52.9 38.0 45.7 33.7 --Not asked of jail inmates. *Measured by 3 or more positive CAGE responses. For description of the CAGE diagnostic measure see text. *********************************************************************************************************************************** CAGE is an acronym for four questions used by the diagnostic instrument to assess alcohol dependence or abuse. Respondents are asked if they have ever attempted to (C)ut back on drinking; ever felt (A)nnoyance at others' criticism of their drinking; ever experienced feelings of (G)uilt about drinking; and ever needed a drink first thing in the morning as an (E)ye opener or to steady their nerves. A person's likelihood of alcohol abuse is assessed by the number of positive responses to these four questions. Clinical tests involving hospital admissions, found three or more positive CAGE responses carried a .99 predictive value for alcohol abuse or dependence. (See Substance Abuse and Treatment, State and Federal Prisoners, 1997, BJS Special Report, NCJ 172871, for additional information on the CAGE instrument.) Mentally ill inmates and probationers were more commonly alcohol dependent, reporting three or more positive CAGE responses. About 38% of mentally ill jail inmates reported signs of alcohol dependence, while 24% of other jail inmates reported signs of dependence. Among State prison inmates, 34% of the mentally ill and 22% of other inmates reported three or more positive responses. **************************** Mentally ill offenders report negative life experiences related to drinking **************************** In response to questions concerning their life experiences with alcohol, about 17% of mentally ill and 9% of other inmates in State prison said they had lost a job due to drinking. Among jail inmates with a mental condition, 18% had lost a job due to drinking, while 10% of other jail inmates reported losing a job. Nearly 20% of mentally ill probationers had lost a job; 5% of other probationers. Amid other alcohol-related problems reported by the mentally ill, 35% of State prisoners had been arrested or held at a police station due to drinking, and 46% had gotten into a fight while drinking. Forty-nine percent of mentally ill State prison inmates, 44% of Federal inmates, 53% of jail inmates, and 46% of mentally ill probationers said they had consumed as much as a fifth of liquor (about 20 drinks) in 1 day. Mentally ill jail inmates more often reported a prior stay in a detoxification unit for alcohol or drugs. An estimated 22% of the mentally ill in jail and 11% of other inmates reported they had been put in a detoxification unit. **************************** Mentally ill expected to serve 15 months longer than other inmates in prison **************************** Overall, mentally ill State prison inmates were sentenced to serve an average of 171 months in prison, or about 12 months longer than other offenders (table 12). ************************************************************************************************* Table 12. Maximum sentence length and time served by inmates, by offense and mental health status Mean time served Mean maximum Total time to be served sentence length/a To date of interview until release/b Most serious Mentally ill Other Mentally ill Other Mentally ill Other offense inmates inmates inmates inmates inmates inmates Local jail inmates All offenses 20 mo 26 mo 6.5 mo 6.7 mo 8.7 mo 10.7 mo Violent 30 mo 37 mo 8.8 mo 9.3 mo 14.7 mo 16.0 mo Property 26 26 5.3 8.0 7.4 11.6 Drug 18 25 8.9 8.4 8.6 13.5 Public-order 8 20 5.0 3.3 7.0 5.7 Other 10 8 8.4 1.6 10.0 5.3 State prison inmates All offenses 171 mo 159 mo 54.4 mo 49.3 mo 103.4 mo 88.2 mo Violent 230 mo 225 mo 71.8 mo 69.7 mo 142.5 mo 130.7 mo Property 128 118 38.8 36.6 75.0 62.2 Drug 103 111 30.3 28.5 49.8 49.5 Public-order 83 81 29.1 27.8 50.8 47.6 Other 120 104 32.5 47.8 60.1 80.6 Note: Because data on sentence length and time served are restricted to persons in prison and jail, they overstate the average sentence and time to be served by those entering prison or jail. Persons with shorter sentences leave prison and jail more quickly, resulting in a longer average sentence among persons in the inmate samples. a/Based on the total maximum sentence for all consecutive sentences. b/Based on time served when interviewed plus time to be served until the expected date of release. ********************************************************************************************************* On average, violent offenders with a mental illness were sentenced to 230 months (5 months longer than other violent inmates) and property offenders 128 months (10 months longer than other inmates). Mentally ill jail inmates typically had sentences shorter than other jail inmates. On average, mentally ill inmates had a maximum sentence of 20 months, while other inmates an average of 26 months. Violent, drug, and property offenders identified as mentally ill had average sentences that were 6 to 12 months shorter than other offenders. On average, mentally ill inmates in State prison are expected to serve more time in prison than other inmates. From the time of admission to prison to the time of the survey, mentally ill offenders had served on average 5 months longer than other offenders in State prison. Based on the time of admission to the time of expected release, mentally ill offenders expected to serve a total of 103 months in prison, 15 months longer than other offenders. The largest differences in time served were among violent and property offenders. The mentally ill expected to serve an average of at least 12 additional months for violent and property offenses. Unlike State prisoners, mentally ill inmates in local jails expected to serve less time than inmates who are not mentally ill. Overall, both mentally ill jail inmates and other inmates had served about 6 1/2 months from the time of admission to the time of the survey. On average, mentally ill inmates expected to serve a total of 9 months in jail prior to release; other inmates expected to serve about 11 months. **************************** Disciplinary problems common among mentally ill inmates **************************** Mentally ill inmates in State or Federal prison, as well as those in jail, were more likely than others in those facilities to have been involved in a fight, or hit or punched since admission. Among State prisoners 36% of mentally ill inmates reported involvement in a fight, compared to 25% of other inmates (table 13). ***************************************************************************************** Table 13. Fights since admission and violation of prison or jail rules, by mental health status State prison Federal prison Local jail Discipline problem Mentally ill Other Mentally ill Other Mentally ill Other reported by inmate inmates inmates inmates inmates inmates inmates Number of fights since admission None 64.3 % 75.6 % 79.4 % 90.9 % 80.9 % 86.7 % 1 11.4 9.6 11.6 5.2 9.4 7.0 2 to 3 12.8 7.8 5.2 2.5 7.0 4.1 4 or more 11.5 7.1 3.8 1.4 2.6 2.3 Charged with breaking prison or jail rules 62.2 % 51.9 % 41.2 % 32.7 % 24.5 % 16.0 % ***************************************************************************************** Mentally ill inmates in Federal prison were over twice as likely as others to report involvement in a fight (21% compared to 9%). Twenty-four percent of mentally ill State prison inmates had been involved in two or more fights since admission, and 12% reported involvement in four or more fights. Among jail inmates 10% of the mentally ill had been involved in two or more fights, compared 6% of those not mentally ill. Consistent with their more frequent involvement in fights, disciplinary problems were more common among mentally ill inmates than other inmates. More than 6 in 10 mentally ill State prison inmates had been formally charged with breaking prison rules since admission. About half of other inmates reported they had been charged with breaking the rules. Among Federal prison inmates 41% of the mentally ill had been charged with a rule violation, compared to 33% of inmates not identified as mentally ill. **************************** 6 in 10 mentally ill received treatment while incarcerated **************************** An estimated 60% of the mentally ill in State and Federal prison received some form of mental health treatment during their current period of incarceration (table 14). ******************************************************************** Table 14. Mental health treatment in prison or jail or on probation for those identified as mentally ill Percent of mentally ill offenders State Federal Local prison prison jail Probation Since admission, the offender had -- Been admitted overnight to a mental hospital or treatment program 23.6 % 24 % 9.3 % 12.2 % Taken a prescribed medication 50.1 49.1 34.1 36.5 Received counseling or therapy 44.1 45.6 16.2 44.1 Received any mental health services 60.5 59.7 40.9 56.0 ******************************************************************** Fifty percent said they had taken prescription medication; 44% had received counseling or therapy; and 24% had been admitted overnight to a mental hospital or treatment program. Among jail inmates, 41% of those identified as mentally ill had received some form of mental health services since admission. The majority of those receiving treatment (34%) had been given medication. Fewer jail inmates (16%) than State prisoners (44%) said they had received counseling or therapy since admission. Just over half of mentally ill probationers had received treatment since their sentence to community supervision. Counseling was the most common form of treatment (44%), followed by medication (37%), and an overnight stay in a mental hospital or treatment program (12%). When sentenced to probation, an offender may be required by the court or probation agency to meet various conditions of the sentence, such as maintaining employment, submitting to drug testing, or participating in treatment. An estimated 13% of probationers were required to seek mental health treatment as a condition of their sentence. Forty-three percent of those required to participate in treatment had done so by the time of the survey. **************************** Female mentally ill more likely than males to report treatment **************************** Nearly 70% of mentally ill females in State prison, 77% of those in Federal prison, and 56% in local jails received mental health services while incarcerated, while 60% of males in State prison, 57% in Federal prison, and 38% in local jails reported treatment. White mentally ill inmates reported higher rates of treatment than black or Hispanic offenders. About 64% of white State prison inmates identified as mentally ill had received treatment, compared to 56% of black offenders and 60% of Hispanic offenders. Percent of mentally ill receiv- ing mental health services State Federal Local prison prison jail Gender Male 59.9 % 57.4 % 38.4 % Female 67.3 76.5 56.2 Race/ Hispanic origin White 64.1 % 65.4 % 44.7 % Black 56.4 50.0 34.2 Hispanic 59.9 62.5 40.6 Overall, 17% of inmates in State prison, 10% in Federal prison, 11% in local jails, and 12% of those on probation had received some form of mental health services since their current admission to prison or jail or sentence to probation. The most common form of treatment in local jails was medication, reported by 9% of inmates. Probationers were more likely to have received counseling (10%) than to have taken medication (6%) while under supervision. Among State prison inmates 12% said they received medication while incarcerated, and 12% participated in counseling or therapy. Percent of all offenders who received mental treatment State prison inmates 17.4 % Federal prison inmates 10.0 Local jail inmates 11.4 Probationers 11.5 *************************************************************************************** Appendix table 1. Standard errors of mental health status for inmates and probationers Estimated standard errors State prison Federal prison Jail inmates inmates inmates Probationers Identified as mentally ill 0.40 % 0.55 % 0.61 % 0.89 % Reported a mental or emotional condition 0.33 0.45 0.54 0.84 Because of a mental or emotional problem, inmate had -- Been admitted to a hospital overnight 0.34 0.45 0.47 0.67 *************************************************************************************** *************************************************************************************** Appendix table 2. Standard errors of selected characteristics of mentally ill inmates and probationers Estimated standard errors State prison Federal prison Local jail Probation Selected Mentally ill Other Mentally ill Other Mentally ill Other Mentally ill Other characteristic inmates inmates inmates inmates inmates inmates probationers probationers Current offense Violent 1.36 % 0.60 % 3.65 % 0.75 % 1.7 % 0.84 % 2.74 % 1.03 % Property 1.17 0.49 2.19 0.55 1.6 0.76 2.79 1.20 Drug 0.91 0.50 3.81 1.05 1.2 0.72 2.23 1.08 Public-order 0.81 0.36 2.92 0.78 1.6 0.83 2.62 1.24 Criminal history Any priors 1.06 0.49 3.33 1.07 1.5 0.89 3.03 1.35 Alcohol/drug use at time of offense 1.35 0.60 3.88 1.04 2.2 1.14 3.04 1.33 History of alcohol dependency 1.29 0.50 3.32 0.79 1.7 0.74 2.89 1.10 Ever abused Males 1.37 0.43 3.92 0.52 2.1 0.52 3.24 0.72 Females 1.93 1.30 5.63 4.03 2.4 1.46 5.92 3.03 Involved in fight or was hit or punched after admission 1.31 0.52 3.16 0.63 1.5 0.60 -- -- Homeless In year before arrest 1.09 0.34 3.01 0.38 0.9 0.26 -- -- At time of arrest 0.52 0.13 1.50 0.12 1.7 0.63 -- -- *************************************************************************************** *************************************************************************************** Appendix table 3. Standard errors of mental health treatment in prison or jail or on probation for those identified as mentally il Percent of mentally ill offenders State Federal Local prison prison jail Probation Since admission, the offender had --- Been admitted overnight to a mental hospital or treatment program 1.15 % 3.32 % 1.01 % 2.00 % Taken a prescribed medication 1.36 3.91 2.22 2.90 Received counseling or therapy 1.35 3.88 1.26 3.03 Received any mental health service 1.33 3.84 2.16 3.03 *************************************************************************************** **************************** Methodology **************************** Data in this report are based on personal interviews conducted through three BJS surveys, the 1997 Survey of Inmates in State and Federal Correctional Facilities, the 1996 Survey of Inmates in Local Jails, and the 1995 Survey of Adults on Probation. Detailed descriptions of the methodology and sample design of each survey can be found in the following: Substance Abuse and Treatment of Adults on Probation, 1995 (NCJ 166611); Profile of Jail Inmates, 1996 (NCJ 164629); and Substance Abuse and Treatment of State and Federal Prisoners, 1997 (NCJ 172871). **************************** Accuracy of the estimates **************************** The accuracy of the estimates presented in this report depends on two types of error: sampling and nonsampling. Sampling error is the variation that may occur by chance because a sample rather than a complete numeration of the population was conducted. Nonsampling error can be attributed to many sources, such as nonreponses, differences in the interpretation of questions among inmates, recall difficulties, and processing errors. In any survey the full extent of the nonsampling error is never known. The sampling error, as measured by an estimated standard error, varies by the size of the estimate and the size of the base population. Estimates of the standard errors for selected characteristics have been calculated for each survey (see appendix tables). These standard errors may be used to construct confidence intervals around percentages. For example, the 95% confidence interval around the percentage of State prison inmates who were identified as mentally ill is approximately 16.2% plus or minus 1.96 times 0.40% (or 15.4% to 16.9%). These standard errors may also be used to test the statistical significance of the difference between two sample statistics by pooling the standard errors of the two sample estimates. For example, the standard error of the difference between mentally ill State prisoners and other inmates who were incarcerated for a violent offense would be 1.49% (or the square root of the sum of the squared standard errors for each group). The difference would be 1.96 times 1.49 (or 2.91%). Since the difference of 6.8% (52.9% minus 46.1%) is greater than 2.91%, the difference would be considered statistically significant. **************************** Estimating the number of mentally ill offenders under correctional supervision **************************** Estimates of the total number of persons in prison, jail and on probation with a mental illness were obtained by multiplying the ratio of inmates or probationers identified as mentally ill from the personal interviews conducted in the three BJS surveys referenced above, by the total number of inmates in State prison, Federal prison, and local jails and the total number of offenders on probation. For example, the total number of State prison inmates with a mental illness was estimated by multiplying the ratio of mentally ill offenders in State prison (16.2%) obtained from the 1997 Survey of Inmates in State Correctional Facilities, by the total State prison custody population at midyear 1998 (1,102,653) from the National Prisoner Statistics data collection. ***********************Box**************************** **************************** References **************************** Guy, Edward; Jerome Platt; Israel Zwerling; and Samuel Bullock. "Mental health status of prisoners in an urban jail." Criminal Justice and Behavior. 12(1), 29-53, March 1985. Monahan, John. "Clinical and Actuarial Predictions of Violence" in Faigman, D and others, eds. Modern Scientific Evidence: The Law and Science of Expert Testimony, vol. 1. St. Paul, MN: West Publishing Company, 1997. Mumola, Christopher. Substance Abuse and Treatment, State and Federal Prisoners, 1997. BJS Special Report, NCJ 172871, December 1998. Powell, Thomas A.; John C. Holt; and Karen M. Fondacaro. "The Prevalence of Mental Illness among Inmates in a Rural State." Law and Human Behavior. 21(4), 427-438, August 1997. Robins, Lee N., and Darrel A. Regier. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press, 1991. Steadman, Henry; Stanley Fabisiak, Joel Dvoskin, and Edward Holohean. "A Survey of Mental Disability among State Prison Inmates." Hospital and Community Psychiatry. 38(10), 1086-1090, 1989. Teplin, Linda A. "The Prevalence of Severe Mental Disorder among Male Urban Jail Detainees: Comparison with the Epidemiologic Catchment Area Program." American Journal of Public Health. 80(6), 663-669, 1990. **************End of references box***************** *************Acknowledgments************************ The Bureau of Justice Statistics is the statistical agency of the U.S. Department of Justice. Jan M. Chaiken, Ph.D., is director. BJS Special Reports address a specific topic in depth from one or more data sets that cover many topics. Paula M. Ditton wrote this report under the supervision of Allen J. Beck. Christopher Mumola provided statistical assistance. Tina Dorsey and Tom Hester produced and edited the report. Marilyn Marbrook, assisted by Yvonne Boston, prepared the report for publication. July 1999, NCJ 174463 ***********End of acknowledgments box*************** ******************Archive*************************** This report and others from the Bureau of Justice Statistics are available through the Internet -- http://www.ojp.usdoj.gov/bjs/ The data from the 1997 Surveys of Inmates in State and Federal Correction Facilities, the 1995 Survey of Adults on Probation, and the 1996 Survey of Inmates in Local Jails are available from the National Archive of Criminal Justice Data, maintained by the Inter-university Consortium for Political and Social Research at the University of Michigan, 1-800-999-0960. The archive may also be accessed through the BJS Internet site. *****************End of box************************* End of ascii version Mental Health and Treatment of Inmates and Probationers NCJ 174463 Bureau of Justice Statistics 7/9/99 ih th