Treatment prospects for persons with severe mental illness in an urban county jail.
OBJECTIVE
A retrospective study of inmates with severe mental illness in a large, urban county jail aimed to obtain information about their psychiatric and criminal histories and status, the psychiatric services they used while incarcerated, and the challenges they might present in psychiatric treatment after release.


METHODS
The authors ascertained demographic characteristics, diagnoses, psychiatric and legal histories, and current psychiatric condition and treatment from jail psychiatric records of a random sample of 104 male inmates with mental illness and from electronic county mental health records and state records of criminal histories.


RESULTS
Seventy-eight inmates (75%) were diagnosed as having a severe mental illness. Of these, 59 (76%) required inpatient care or its equivalent for part of their time in jail for the current offense. Of the inmates with severe mental illness, 92% had a history of nonadherence to medications before this arrest, 95% had prior arrests, 72% had prior arrests for violent crimes against persons, and 76% were known to have a history of substance abuse.


CONCLUSIONS
A large percentage of persons with severe mental illness received their acute psychiatric inpatient treatment in the criminal justice system rather than in the mental health system. The persons with severe mental illness in this study would present a major challenge in treatment in any setting given their psychiatric and criminal histories. The resources of the mental health system need to be greatly expanded, with priority given to treating persons who are criminalized or who are in danger of becoming criminalized.
Lamb
H Richard
HR
Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA 90086-0125, USA. hlamb@usc.edu
Weinberger
Linda E
LE
Marsh
Jeffrey S
JS
Gross
Bruce H
BH
D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data; D015897:Comorbidity; D003415:Crime / Q000523:psychology / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D015141:Los Angeles; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011330:Prisons / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000534:rehabilitation; D012008:Recurrence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D016312:Treatment Refusal / Q000523:psychology / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data; D014754:Violence / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data