US Dept. of Health & Human Services (2012)
Public Health and the Epidemic of incarceration
Mental Health Profile of the Incarcerated
"Although not all overviews of the health profiles of the incarcerated include addiction (25, 97), it is among the primary conditions both determining involvement in the criminal justice system and requiring—though seldom receiving—treatment during incarceration.
"Estimates of the number of the incarcerated meeting DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for drug dependence or abuse vary widely but are well above 50%, and substantially higher among female inmates (12, 28, 37, 41).
"However, as few as 15% of inmates in need of drug treatment actually receive it during incarceration (11, 17, 27).
"Rates of comorbidity of substance abuse and mental illness are high, as people attempt to self-medicate for the latter or are subject to overlapping personal and environmental risk factors for both conditions.
"Both conditions are overrepresented in the criminal justice system; both are conditions that in white, middle-class communities are more likely to receive treatment than the attention of law enforcement (37).
"The emergence of prisons and jails as the largest institutions in the United States housing the mentally ill reflects the de facto criminalization of mental illness.
"The front line of that process is the police, who frequently determine whether someone will enter the mental health system or the criminal justice system.
Even police who are equipped and inclined to recognize mental illness and respond appropriately, however, find themselves constrained to redirect the mentally ill into the criminal justice system, frequently by the failures of the mental health system to which they attempt to turn (23, 47, 49).
Thus a primarily nonviolent, mentally ill population cycles repeatedly through correctional facilities (5, 8), with the result that well over half of inmates at any given time have a DSM-IV mental disorder.
Rates vary by facility type as well as by demographics, with local jails reflecting the highest prevalence: There, 63% of blacks and 71% of whites self-reported symptoms or diagnoses of mental illness (26, 37, 41). An estimated 16–24% have a serious mental illness (SMI) (47), among whom the comparatively small number of female inmates tends to be much worse off (7, 13).
Post traumatic stress disorder (PTSD) is common among incarcerated women, about one-third of whom were subject to physical abuse and one-third to sexual abuse prior to incarceration (51).
The potential for physical comorbidities is correspondingly heightened for this population because women with SMI are substantially more likely to engage in high-risk sexual behaviors (59).
Addictions and other mental illnesses also complicate treatment for comorbidities such as HIV and HCV, which require a sustained adherence regime and careful monitoring for adverse drug interactions (3).
"The emergence of prisons and jails as the largest institutions in the United States housing the mentally ill reflects the de facto criminalization of mental illness."
Colorado jail inmates with mental illness are still subject to solitary confinement, contrary to human rights standards.
Recently, an Irish Court refused to transfer an inmate back to the US due to the inhumane practices of solitary confinement in US prisons and jails.