Mental disorders among offenders in correctional settings
James R. P. Ogloff
Incontrovertible evidence now exists to show that the prevalence of mental disorders among prisoners far exceeds that found in the general community. A surprising concordance is emerging from several large international studies to show that, in western developed societies at least, the rates of major mental disorders in prisons are quite consistent. This chapter will provide an overview of relevant research examining rates of mental illness in prisons with those found in the community. Some observations regarding trends and implications for prisons also will be provided.
At the outset it is useful to reflect on the scope of illnesses which have been subsumed under the ‘mental disorder’ umbrella as it has been applied to the prison research. Most of the research that exists has focussed serious mental illnesses within the Axis I disorders— namely psychotic illnesses, mood disorders, and anxiety disorders. Considerable attention has been paid regarding the prevalence of personality disorders within prisons. Over the past 20 years much of that work has investigated antisocial or dissocial personality disorder and psychopathy.(1) By comparison, relatively little attention has been paid to other personality disorders. A growing area of importance concerns substance abuse and dependence disorders and, of course, co-occurring substance use and mental illness disorders. Considerable research also exists exploring the prevalence of mental retardation or intellectual disabilities in prison. Thereafter, fragments of research exist exploring any number of mental syndromes and conditions. The focus of this chapter will be on the major mental disorders which fall into Axis I. Some mention will be made of substance use disorders and personality disorders. In addition, with the growing number of women in prisons, information will be provided regarding this important group.
The prevalence of mental illness among male and female prisoners
Recent research exists from Britain and Wales that shows that the prevalence of mental illness in prisons is many times greater than that found in the community. Brugha and colleagues(2) compared rates of mental illness among some 3,000 remanded and sentenced male and female prisoners in Britain and Wales and more than 10,000 community residents in Great Britain. The rate of psychotic illnesses in the community was 4.5 per 1,000 (0.045 per cent) compared with 52 per 1, 000 in prisons (0.52 per cent). While the ten-fold increase in prevalence from the community to the prisons was remarkable, the results revealed further that the prevalence rate of psychotic illness for female prisoners was an astonishing 110 per 1,000 (0.11 per cent), compared to 50 per 1,000 for males (0.05 per cent).
One of the key studies that has helped provide information regarding the rate of mental illness in gaols and prisons is a meta-analysis conducted by Fazel and Danesh(3) that was published in The Lancet. Their analyses included 62 studies that included 22, 790 prisoners. The majority of prisoners (81 per cent) were male. Nonetheless, enough studies that included women prisoners were available to provide information regarding the rate of mental disorder among them. Data from the Fazel and Danesh meta-analysis are presented in Table 11.4.1. The results show that approximately one in seven prisoners have a psychotic illness or major depression. As the authors report, this is between two and four times greater than would be expected in the general population.
With respect to personality disorders, half of males and approximately 20 per cent of females are found to have a personality disorder—which is ten times greater than would be seen in the community.
With respect to personality disorders, half of males and approximately 20 per cent of females are found to have a personality disorder—which is ten times greater than would be seen in the community.
Table 11.4.1 Representative prevalence of mental illness and personality disorder among male and female prisoners (international samples) | |||||||||||||||||||||
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There was some variability across studies, some (but not all) of which was explained by differences between research that used validated diagnostic procedures (3.5 per cent) and those that did not (4.3 per cent). Studies from the USA also showed higher prevalence rates than elsewhere. Psychosis among female prisoners was found to be slightly higher than that in males (4.0 per cent c.f. 3.7 per cent).(3)
A limitation of the Fazel and Danesh(3) meta-analysis is that relatively limited information was provided regarding the type and nature of mental illness. Brinded, Simpson, Laidlaw, Fairley, and Malcolm(4) reported the results of one of the most well conducted studies on the prevalence of mental illnesses among inmates ever published. All female sentenced and remanded inmates and a random sample of 18 per cent of sentenced male inmates in New Zealand were interviewed. Interviewers used standardized measures to identify inmates with mental illnesses and personality disorders. The final sample consisted of approximately 1 200 inmates. The results of prevalence rates for mental disorder in the last month are presented in Table 11.4.2.
As the results in Table 11.4.2 show, the prevalence rates obtained by Brinded and colleagues(4) in New Zealand essentially parallel those obtained by the Fazel and Danesh(3) meta-analysis. The New Zealand results, however, include data for post-traumatic stress disorder, substance abuse, and dependence disorders. As with psychosis and major depression, the prevalence rates of the other disorders is significantly greater than what would be seen in the general population.
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