The Prevalence of Co-Occurring Mental Illness and Substance Use Disorders in Jails

The criminal justice system has experienced substantial growth over the past decade. Currently, over 1.9 million individuals are incarcerated in our nation’s jails and prisons; this represents a 76.8% increase since 1990 (Beck & Harrison, 2001). In addition, approximately 4.5 million adult men and women are on probation or parole (Bureau of Justice Statistics, 2001). In total, roughly 3% of all adult residents in the U.S. are under some form of correctional supervision (Bureau of Justice Statistics, 2001). The growing correctional population includes a large number of individuals with special treatment needs.

Jails
Jails are locally operated facilities that hold persons awaiting trial or sentencing, serving a sentence of generally 1 year or less (some jurisdictions allow detention for up to 2 years), or those awaiting transfer to state prison. There were an estimated 11.4 million admissions to local jails in 1999 (Stephan, 2001). At midyear 2000, 621,149 persons were housed in the nation’s 3,365 jails (Beck & Karberg, 2001).

Mental Disorders
The most rigorous research estimating the prevalence of mental illness and substance use disorders for individuals admitted to urban jails is data collected from male and female detainees entering the Cook County Department of Corrections (Chicago jail) (Teplin, 1990a; Teplin, 1994; Teplin, Abram, & McClelland, 1996). Two-week prevalence data revealed that the rate of current severe mental disorder was 6.4% for male detainees entering jail (Teplin, 1990) and 12.2% for female detainees (personal communication with Abram,Teplin, & McClelland, 2001).

These figures are based on Diagnostic Interview Schedule criteria (Version III and III-R), and disorders were counted as present if the subject met criteria for the disorder and experienced at least one symptom within 2 weeks of the interview (Teplin et al., 1996). Among male detainees at intake, 2.7% met the criteria for schizophrenia/schizophreniform disorder, 1.4% for mania, and 3.9% for major depression (Teplin, 1990). The corresponding figures among female detainees were 2.0% for schizophrenia/schizophreniform disorder, 1.4% for mania, and 10.5 % for major depressive episode (Abram et al., 2001). The most dramatic difference in male and female detainee prevalence rates was for major depression, with females having almost 3 times the rate of males. (Direct comparison of male and female prevalence rates is compromised by the fact that the male and female studies were conducted years apart, and the studies used slightly different instruments with different scoring criteria. It is possible that these factors influenced the different rates.)

The high prevalence rates for severe mental disorders among jail detainees at intake represent a marked contrast to estimated general population rates. Teplin (1990) compared jail prevalence rates for male detainees with a demographically similar subsample (in terms of race and age) of the five-city Epidemiologic Catchment Area (ECA) Program (see Regier et al., 1988). Each of the three disorders was significantly more prevalent in the jail sample than in the five-city sample (see Figure 1).

Receipt of Needed Mental Health Services in Jail
Studies demonstrate that approximately one third of male detainees and one quarter of female detainees who needed services for severe mental disorders (schizophrenia and major affective disorders) reported receiving treatment in jail (Teplin, 1990b; Teplin, Abram, & McClelland, 1997).

Substance Use Disorders
Two-week substance use disorder prevalence rates were much higher than severe mental disorder rates for both male and female detainees entering jail (see Figure 2): 29.1% of male and 53.3% of female detainees had a substance use disorder (Teplin, 1994; Abram, et al. 2001). Male detainees had a slightly higher prevalence rate of alcohol abuse/dependence (19.1%) than drug abuse/dependence (15.3%), while the prevalence of drug use disorders (43.6%) for female detainees was almost double their prevalence rate of alcohol use disorders (22.1%) (Teplin, 1994; Abram et al., 2001). The 1999 Arrestee Drug Abuse Monitoring Program Annual Report indicates that over half of adult male arrestees at jail intake tested positive for drug use in 34 reporting cities.

Two-week prevalence rates for substance use disorders are unavailable for a comparable general population sample (ECA). However, Teplin et al. (1996) provide lifetime prevalence rates for African American, non-Hispanic white, and Hispanic women in 2 age groups (18-25 and 26-50) entering jail and in the ECA. Women entering jail had significantly higher rates of substance abuse/dependence than their general population counterparts. Across all race by age subgroups, the likelihood of women entering jail having a substance use disorder exceeded the likelihood of women in the community sample having such a disorder by at least 9 times (up to 48 times in the case of non-Hispanic white females ages 26-50).

Co-Occurring Mental Illness and Substance Use Disorders
Prevalence rates of co-occurring disorders in the jail population are striking. With regard to the prevalence of substance use disorders among those with severe mental disorders, research indicates that both male and female detainees have a 72% rate of co-occurring substance use disorders (Abram & Teplin, 1991; Abram et al., 2001) (see Figure 3). Notably, while prevalence rates for severe mental disorders and the distribution of those disorders are different for male and female detainees at intake, the prevalence of co-occurring substance use disorders is the same for male and female detainees at intake. Of female detainees with substance use disorders at jail intake, 14.9% had a co-occurring severe mental disorder (Abram et al., 2001). This statistic is not available for male detainees.

References

Abram, K. M., Teplin, L. A. (1991). Co-occurring disorders among mentally ill jail detainees. American Psychologist, 46(10), 1036–1045.

Beck, A. J. and Harrison, P. M. (2001). Prisoners in 2000 (NCJ No. 188207). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

Beck, A. J. & Karberg, J. C. (2001). Prison and jail inmates at midyear 2000 (NCJ No. 185989). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

Bureau of Justice Statistics. (2001). National corrections population reaches new high Grows by 117,400 during 2000 to total 6.5 million Adults. Washington, DC: U.S. Department of Justice, Office of Justice Programs.

Regier, D. A., Boyd, J. H., Burke, J. D., et al. (1988). One-month prevalence of mental disorders in the United States: Based on five epidemiologic catchment area sites. Archives of General Psychiatry, 45, 977–986.

Stephan, J. J. (2001). Census of Jails,1999 (NCJ No. 186633). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

Teplin, L. A. (1990a). The prevalence of severe mental disorder among urban male detainees: Comparison with the epidemiologic catchment area program. American Journal of Public Health, 80(6), 663–669.

Teplin, L. A. (1990b). Detecting disorder: The treatment of mental illness among jail detainees. Journal of Consulting and Clinical Psychology, 58, 233–236.

Teplin, L. A. (1994). Psychiatric and substance abuse disorders among male urban jail detainees. American Journal of Public Health, 84(2): 290–293.

Teplin, L. A., Abram, K. M., & McClelland, G. M. (1996). Prevalence of psychiatric disorders among incarcerated women. Archives of General Psychiatry, 53, 505–512.

Teplin, L. A., Abram, K. M., & McClelland, G. M. (1997). Mentally disordered women in jail: Who receives services? American Journal of Public Health, 87(4), 604–609.

The suggested citation for this fact sheet is: National GAINS Center for People with Co-Occurring Disorders in the Justice System. (2001). The prevalence of co-occurring mental illness and substance use disorders in jails. Fact Sheet Series. Delmar, NY: Author.

The National GAINS Center for People with Co-Occurring Disorders in the Justice System is a national center for the collection and dissemination of information about effective mental health and substance abuse services for people with co-occurring disorders who come in contact with the justice system. The GAINS Center is funded by the Substance Abuse and Mental Health Services Administration’s two centers—the Center for Substance Abuse Treatment (CSAT) and the Center for Mental Health Services (CMHS)—is operated by Policy Research Associates of Delmar, New York.

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