Magazine article Clinical Psychiatry News

Inpatient Today, Inmate Tomorrow: 60% of Inpatients Arrested within 3 Months

Magazine article Clinical Psychiatry News

Inpatient Today, Inmate Tomorrow: 60% of Inpatients Arrested within 3 Months

Article excerpt

BOSTON -- The overrepresentation of bipolar disorder in prison populations may reflect gross defects in community treatment marked by frequent, brief hospitalizations and little outpatient care, Dr. Cameron Quanbeck said at the annual meeting of the American Academy of Psychiatry and the Law.

"These people seem to have fallen through the cracks of two systems," said Dr. Quanbeck of the University of California, Davis.

The high rate of psychiatric disorders in the corrections system is well documented: Various studies have shown that 13%-33% of jail and prison inmates are severely mentally ill. The prevalence of bipolar disorder is particularly striking in this population: 6%, compared with 1% in the community at large.

The connection isn't surprising, given that prominent bipolar symptoms, such as "agitation, impulsivity, poor judgment, and psychosis increase the risk of criminal behavior," and that substance use disorder comorbidity is higher than with any other Axis I diagnosis, Dr. Quanbeck said. He offered data on inmates at the Los Angeles County Jail, which has been described as "the largest mental health facility in America."

The 66 inmates included in the study had been diagnosed with bipolar disorder at intake and had been hospitalized previously for bipolar disorder in the Los Angeles County mental health system. All were symptomatic (three-fourths clearly in a manic or mixed state), and 59% percent were psychotic at the time of arrest, he said.

The offenses for which they were charged covered a broad spectrum, but violent crimes were twice as common as property or drug-use crimes and four times as frequent as "crimes of noncompliance," such as failure to heed police orders.

"The symptoms of bipolar disorder were associated with violent crime, and [although] the phase didn't matter, individuals who were psychotic were twice as likely as others to be charged with a violent crime," he said. There was no difference in violent crime rates among male and female inmates.

This was not a population with a history of "pervasive criminal behavior," he said. Only one-third had prior felony convictions; 42% had no prior convictions or a single misdemeanor. …

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