The proposed study will augment another NIMH project, """"""""Mental Disorder in an Urban Jail"""""""" (MH45583), which was approved for three years and is scheduled to begin Summer, 1990. MH45583 will investigate the prevalence and detection/treatment of mentally-disordered female jail detainees. MH45583 examines only singular disorders; it will not investigate multiple disorders. To date, no study of female jail detainees has examined comorbidity. This omission is critical because both the volume of female criminal activity and the-number of incarcerated females are increasing at a substantially faster rate than among males. Female crime rates are at an all time high. We have enlarged MH45583 to enable us to examine the same two questions -- prevalence and detection/treatment -- in relation to multiple alcohol/drug/mental (ADM) disorders.
Our specific aims are: (1) to ascertain the prevalence of multiple ADM disorders in female jail detainees (N - 1200). As in MH45583, we will contrast the jail rates with the Epidemiologic Catchment Area (ECA) data. We will also describe the sample's level of functioning prior to arrest; our goal is to compare the relative disability of persons with singular disorders to those with multiple ADM disorders, and to determine which diagnostic profiles have particularly low levels of functioning. (2) To determine the extent to which persons with multiple ADM disorders are detected and treated while in jail. Of particular interest is if persons with multiple ADM disorders are more or less likely to be treated than those with singular disorders. The proposed study has four methodological advantages over prior work: (1) a random sample; (2 a large enough N (1200) to generate reliable rates of comorbidity; (3) a reliable instrument (the NIMH Diagnostic Interview Schedule); and (4) baseline comparisons with the NIMH ECA Project. The prevalence data will help us put the system's scarce resources to their best use. Psychiatric treatment of mentally ill jail detainees is mandated by law. Treating persons with multiple ADM disorders, however, is complicated. They require different treatments and are more resistent to treatment than those with singular disorders. Accurate prevalence rates of comorbidity will point to appropriate rehabilitation strategies designed to treat the most common diagnostic profiles. The detection and treatment information will document how persons with dual diagnoses are managed while in the custody of the criminal justice system. Before making public policy changes, we need to know how persons with dual diagnoses are currently treated. These data will aid in planning modifications in health delivery strategies within the mental health and criminal justice systems, as well as suggest viable alternatives to incarceration for female detainees who are mentally ill and also have a substance abuse disorder.
| Choe, Jeanne Y; Teplin, Linda A; Abram, Karen M (2008) Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns. Psychiatr Serv 59:153-64 |
| Teplin, Linda A; McClelland, Gary M; Abram, Karen M et al. (2005) Crime victimization in adults with severe mental illness: comparison with the National Crime Victimization Survey. Arch Gen Psychiatry 62:911-21 |
| Abram, Karen M; Teplin, Linda A; McClelland, Gary M (2003) Comorbidity of severe psychiatric disorders and substance use disorders among women in jail. Am J Psychiatry 160:1007-10 |
