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Trends in State Prison Admission of Offenders with Serious Mental Illness. Psychiatric Services

by Mindy S. Bradley-Engen, Gary S. Cuddeback, Mathew D. Gayman, Joseph P. Morrissey, & David Mancuso (2010). , 61(12): 1262-1265.

In this article, a team of university- and government-based mental health researchers from Arkansas, Georgia, North Carolina, and Washington explore the proposition that the number of state prisoners with serious mental illness has increased in recent years. Using a sample of 41,440 men and women incarcerated in Washington from 1998 through 2006, Bradley-Eigen et al. pay particular attention to "two distinct processes that have not been carefully distinguished in the scientific literature." The first of these involves an expanded admission base rate of mentally ill offenders, and the second involves giving entry to larger an overall number of offenders, which would result in the incarceration of more mentally ill offenders. "Although it is clear that more people with serious mental illness are being imprisoned," the authors note, "it is difficult to know from published studies whether the 'increasing rates' or 'increasing numbers' interpretation is more consistent with recent trends." This difficulty arises because of "gaps in the periods covered by published studies as well as differences in sample size, types of facilities studied, and criteria for defining mental illness."

In this study, Bradley-Eigen et al. use admissions data and ICD-9 diagnoses from the Washington Department of Corrections to identify the rates and numbers of offenders with serious mental illness, as well as those with co-occurring substance use disorders. "The two data sources are complimentary," the authors' note, "in that Medicaid is the principal payer of community-based services for persons with serious mental illness and the Department of Corrections may identify large numbers of uninsured persons with serious mental illness who would not show up in the Medicaid claims. Combining data sources allowed for a more comprehensive count of prisoners with serious mental illness or co-occurring disorders."

Over the nine-year study period, the number of offenders admitted to Washington state prisons increased 37%. Over the same period, the number of prisoners with serious mental illness with or without a co-occurring substance use disorder increased 23%. The authors report three features of these statistics:

  • For any given year, both the numbers and rates of admissions of offenders with co-occurring disorders were twice as large as those for offenders with a serious mental illness alone. This means that offenders with co-occurring substance use disorders made up roughly two-thirds of persons admitted with serious mental illness each year;
  • Although the number of admissions increased, the annual rate of persons admitted who received a diagnosis of serious mental illness alone before, during, or after  incarceration was in the range of 5%-6% each year and did not significantly change over the study period; and
  • Noticeable increases (were evident) in both the number and rate of persons who received a diagnosis of co-occurring disorders before, during, or after incarceration.

In finding that "growth in the numbers of prisoners with serious mental illness and co-occurring substance use disorders was not due primarily to increases in admission base rates," Bradley-Eigen et al. attempt to calm any contemporary or emerging alarmism about prisons become "new mental hospitals." Still, it is worth noting the challenge they say faces state prison, as well as community corrections, officials: "Improved coordination and information sharing across justice and community mental health systems are essential to ensure that individuals with serious mental illness obtain appropriate treatment during their incarceration and continue to receive care as they enter the community. Future work must also devise ways to move beyond simply describing these problems to offering solutions to them."

For further information, contact Mindy S. Bradley-Eigen, Ph.D., Department of Sociology and Criminal Justice, University of Arkansas, 211 Old Main, Fayetteville, AR 72701, (email)

Posted Thu, Aug 4 2011 4:52 PM by Tracey Vessels


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