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. 2017 Apr 20;17(1):342.
doi: 10.1186/s12889-017-4257-0.

Inside the nation's largest mental health institution: a prevalence study in a state prison system

Tala Al-Rousan  1 , Linda Rubenstein  2 , Bruce Sieleni  3 , Harbans Deol  3   4 , Robert B Wallace  2
Affiliations

Inside the nation's largest mental health institution: a prevalence study in a state prison system

Tala Al-Rousan et al. BMC Public Health. .

Abstract

Background: The United States has the highest incarceration rate in the world which has created a public health crisis. Correctional facilities have become a front line for mental health care. Public health research in this setting could inform criminal justice reform. We determined prevalence rates for mental illnesses and related comorbidities among all inmates in a state prison system.

Methods: Cross-sectional study using the Iowa Corrections Offender Network which contains health records of all inmates in Iowa. The point prevalence of both ICD-9 and DSM-IV codes for mental illnesses, timing of diagnosis and interval between incarceration and mental illness diagnosis were determined.

Results: The average inmate (N = 8574) age was 36.7 ± 12.4 years; 17% were ≥50 years. The majority of inmates were men (91%) and white (65%).Obesity was prevalent in 38% of inmates, and 51% had a history of smoking. Almost half of inmates were diagnosed with a mental illness (48%), of whom, 29% had a serious mental illness (41% of all females and 27% of all males), and 26% had a history of a substance use disorder. Females had higher odds of having both a mental illness and substance use disorder. Almost all mental illness diagnoses were first made during incarceration (99%). The mean interval to diagnosis of depression, anxiety, PTSD and personality disorders were 26, 24, 21 and 29 months respectively. Almost 90% of mental illnesses were recognized by the 6th year of incarceration. The mean interval from incarceration to first diagnosis (recognition) of a substance abuse history was 11 months.

Conclusions: There is a substantial burden of mental illness among inmates. Racial, age and gender disparities in mental health care are coupled with a general delay in diagnosis and treatment. A large part of understanding the mental health problem in this country starts at prisons.

Keywords: Aging; Correctional; Inmates; Mental health; Prisoners.

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Figures

Fig. 1
Fig. 1
All prevalence rates are cross-sectional. There were 2090 African American men, 64.1% of which has no mental illness. Women in general exhibited the highest burden of mental illness compared to other racial groups. Quarter of the female African American inmates had three or more mental illness diagnoses. These prevalence rates were similar to white women (n = 554) of which 24.7% had three or more mental illnesses. More than half of the white men (n = 5008) had a mental illness diagnosis which is the highest number compared to rates in other racial groups. Percentage of inmates diagnosed with mental illness in Iowa by race and gender
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