Psychiatric Disorders in the Population and in Prisoners

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Introduction

Those who commit the most offensive of crimes are regarded by some as inevitably mentally ill, since their actions defy comprehension by the rest of society. On the other hand, some consider that certain people are just very bad and that only truly bad persons would perform such horrendous crimes. Such criminal activity, however, is rare in comparison with the vast body of people (and their acts) who come into conflict with the law.

Of wider interest is the proportion of those in various legal difficulties who have mental disorders. Are those with mental disorders over-represented in this group as compared with the general population? Only in the last 15 to 20 years has it been possible to examine that question in a reasonably scientific manner. The ability to show the proportion of people in the population with a mental disorder depends on agreement on the definitions of disorder (that is, clear diagnostic criteria) and the ability to accurately examine large populations using explicit diagnostic criteria. Thus, the Diagnostic and Statistical Manual of Mental Disorders, Third Edition ([DSM-III-R] American Psychiatric Association, 1987), provided detailed operational criteria for diagnosis, and the subsequent development of structured interview questionnaires such as the Diagnostic Interview Schedule (DIS) (Robins, Helzer, Croughan, Williams, & Spitzer, 1981), suitable for use by trained lay interviewers, allowed examination of large populations. These developments were the basis for Epidemiologic Catchment Area (ECA) investigations in the United States Eaton & Kessler 1985, Robins & Regier 1991 and similar investigations in many other locations including Edmonton (Bland, Newman, & Orn, 1988), and form the basis for this paper.

Offenders give special problems concerning which subpopulation should be the subject for investigation. Possibilities include those charged with an offense; those convicted; those sentenced to prison1 terms of less than 2 years; those sentenced to prison terms greater than 2 years (in Canada, those sentenced to prison terms of less than 2 years are kept in provincial jails, whereas those receiving longer sentences serve them anywhere in the Federal system); those who receive nonprison sentences (e.g., fines or probation); those for whom an insanity defence is used; those who are remanded for examination; and those found unfit to stand trial.

Obviously, examination of each of these groups for mental disorders is likely to be lead to different findings. In an earlier paper we reviewed some of the studies on psychiatric disorders in prisoners and commented on the methodological problems (Bland, Newman, Dyck, & Orn, 1990). Teplin (1990) summarizes these as problems of sample selection (nonrandom), measurement (diagnostic problems), and sample size (inadequate). She provides an appendix tabulating recent (mostly United States) studies and highlights that none of them provides a comparison of rates with those found in the general population.

In this paper we report the results from examination using standardized diagnostic interviews of a random sample of those who received prison sentences of less than 2 years, and compare those with the results from a community survey using similar methods for diagnosis and case detection. The sentence time of less than 2 years was selected because, in the Canadian system, such persons serve their sentences in the provincial prison system. Those serving longer sentences are in the Federal system and may be incarcerated outside of the province where the offense was committed, thus making them difficult to access for interview.

Section snippets

Methods

The population study used a random sample of 3,258 community residents of Edmonton who were interviewed by trained lay interviewers using the Diagnostic Interview Schedule (DIS), which yields DSM-III diagnoses. Diagnoses were produced hierarchy-free (that is, without exclusion criteria) by a standard computer program. The results originally reported were adjusted to the census population on the basis of age, sex, and household size. Those interviewed are 72% of those with whom an interview was

Inmate Characteristics

Inmates are young: only about 8 to 10% are over age 45 (compared with 32.5% of the population), and of the remainder, 44% are under age 25 (compared with 28% of the population). About 90% of inmates are men. Whereas 11.7% of inmates are aboriginal, aboriginals make up only 1.8% of the comparable male population (that is, aboriginals are represented among inmates at 6.5 times the expected rate). Racial groups other than aboriginal or Caucasian constitute only 4.5% of inmates and 11.2% of the

Discussion

Provincial correctional facilities accommodate inmates serving sentences of under 2 years who are drawn from the same population as our population sample. The inmates of the provincial correctional facilities are poorly educated single young men, serving short sentences for repeat offences. They are far more likely to have both social and psychiatric problems than comparable members of the general population. They show the same social and psychiatric problems that are frequently associated with

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References (9)

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders. (3rd ed., revised)....
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    Prevalence of psychiatric disorders and suicide attempts in a prison population

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  • Bland, R. C., Newman, S. C., & Orn, H. (1988). Epidemiology of psychiatric disorders in Edmonton. Acta Psychiatrica...
  • Eaton, W. W., Kessler, L. G. (Eds.) (1985). Epidemiologic field methods in psychiatry: The NIMH Epidemiologic Catchment...
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    The percentage average daily population in special beds within institutions ranged between 0.4% and 7.3% (Blaauw et al., 2000). The prevalence of the consumption of alcohol and illicit drugs among mentally disordered patients and prisoners is quite high (Bland et al., 1998; Regnier et al., 1990). One question that has not yet been examined is the effect of such addictions upon transinstitutionalization, the movement of individuals between the mental healthcare system, and the correctional system, as a result of the “revolving door” mechanism.

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