More than half of America's prison and jail inmates have symptoms of a mental health problem, the Justice Department estimated Wednesday. But fewer than one-third of those with problems are getting treatment behind bars.
The study by the department's Bureau of Justice Statistics also found the incidence of symptoms much higher among women than men. Compared to inmates without symptoms, these mentally troubled prisoners were more likely to have been jailed before, to get into a fight behind bars, to have been physically or sexually abused in the past and to have drug problems, the bureau said.
But troubled inmates were no more likely to have used a weapon during their offense (37 percent for troubled and nontroubled state prisoners) and only slightly more likely to have committed a violent offense (49 percent of state prisoners with symptoms but 46 percent among inmates without problems).
The results are "both a scandal and national tragedy," said Michael J. Fitzpatrick, executive director of the National Alliance on Mental Illness, a national grass-roots organization dedicated to improving the lives of the mentally ill. "The study reveals that the problem is two to three times greater than anyone imagined."
‘The mental health system is failing’
Fitzpatrick said the results indicate "that the mental health system is failing — long before people enter the criminal justice system and after they leave it." He said more resources devoted to mental health treatment on the outside would avoid "enormous costs shifted onto our police, courts, jails and prisons at all levels."
Other experts and officials said the survey methods may make the problem seem more serious than it is, but at least one agreed that solutions lie outside prisons themselves.
"As a society, we could do a better job dealing with the mentally ill — both in keeping people from coming to prison and how they do when they get out of prison," said Jeffrey Beard, Pennsylvania's secretary of corrections.
He said Pennsylvania has set up community correction centers to get mentally ill inmates out into the world. He said there has been additional money in the past few years at the federal and state level for such projects, "but we could move a little quicker."
State prisoners more likely to be treated
Based on a survey of nationally representative samples, the statistics bureau estimated that 56 percent of the nation's 1.25 million state prisoners, 64 percent of its 747,000 jail inmates and 45 percent of its 156,000 federal prisoners reported treatment for or symptoms of major depression, mania or psychotic disorders such as hallucinations or delusions in the last year.
Treatment behind bars was most common among state prisoners — 34 percent of those reporting symptoms, compared with 24 percent of the troubled federal prisoners and 17 percent of jail inmates with problems. The most common treatment was a prescribed medication, for 27 percent of state, 19 percent of federal and 15 percent of jail inmates with problems.
Female inmates had higher rates of symptoms in all three types of facilities: 73 percent of women and 55 percent of men in state prisons; 61 percent of women and 44 percent of men in federal facilities; 75 percent of women and 63 percent of men in jails.
Beard said that mental health problems among Pennsylvania inmates had leveled off in the last year or so after rising for five of six years. Now 18 percent of Pennsylvania inmates have a mental problem requiring some treatment, including just under 4 percent with serious mental illness including schizophrenics and psychotics.
"Every inmate in Pennsylvania gets a psychological profile," Beard said. "Our numbers are based on clinicians seeing everybody."
Earlier studies showed lower rates
Fred Osher, health service policy director in the criminal justice program of the Council of State Governments, noted that previous studies that focused on those diagnosed as mentally ill found fewer troubled inmates — closer to 20 percent.
The statistics bureau conducted interviews with samples of state, federal and jail inmates based on diagnostic questions in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, which is used by mental health professionals.
Inmates were asked if they had a history of mental health treatment or had symptoms of major depression, mania or psychotic orders in the previous year. State and federal prisoners were interviewed in 2004; jail inmates in 2002.
"This method shows what the high end of the problems might be," Osher said. The federal study did not look at clusters of symptoms over time or evidence of disability, important factors in deciding who requires treatment, Osher said.
So the difference between those with symptoms and those getting treatment may not be evidence of "how underserved people are in prisons, but a reflection of an increase in good screening in recent years to see that those who need treatment get it," Osher said.
Beard said Pennsylvania's prison system runs a mental health system with special needs units to separate those with low level mental illness from inmates who might harm them; licensed inpatient units for treatment of more seriously ill inmates; and a forensic hospital for treatment of the most chronic and seriously mentally ill prisoners.
"I feel comfortable we are dealing with the mentally ill coming into our system," Beard said.