Preventing the reincarceration of prisoners with mental illness
Dr. Roland Jones identifies key factors and possible interventions
Many prisoners with mental illness end up back in prison after they’re released, and rates of mental illness are higher among inmates than the general population. Dr. Roland Jones and his team have identified risk factors that could provide the key to giving prisoners better support, preventing reincarceration, and vastly improving their quality of life. We spoke to Dr. Jones about his research and the impact it could have on how we treat prisoners with mental illness.
Which mental disorders are most prevalent among prisoners?RJ: There are around 11 million people in prison on any given day worldwide, and more than 30 million people pass through prisons each year. Even if the rate of mental illness among prisoners was the same as in the general population, this would translate to very large numbers of people with mental illness being incarcerated. However, rates of mental illness are much higher among prisoners than in the general population. Around 15% of prisoners have a serious mental illness. Nearly 1 in every 25 has a diagnosis of a psychotic illness and more than 1 in 10 has major depression. Substance use disorders are even more common, found in a quarter to a half of all prisoners.
What motivated this research?
RJ: This research arose from work with the Forensic Early Intervention Service (FEIS) in two jails (one detaining men, the other women). FEIS provides assessment and intervention for inmates who have mental illness and who are on remand. We observed that many of the people seen by the service return to jail again after release, some very frequently, and we wanted to investigate how often this happens, and what social, clinical and demographic factors are associated with reincarceration.
What was the most important finding of this study, in your opinion?
RJ: In our study of over 4,700 prisoners who had major mental illness, nearly a quarter were reincarcerated within one year. There was a small but significant number of people (around 7%) who were incarcerated 3 or more times within a year accounting for nearly 20% of all incarcerations. Those who had a diagnosis of schizophrenia or bipolar disorder or who were homeless were among the most likely to be reincarcerated. Those who used the street drugs crystal methamphetamine or crack were also significantly more likely to return to prison. Offences associated with reincarceration tended to be relatively minor, such as theft and failing to comply with conditions of release.
How does this change treatment services for prisoners with serious mental illnesses?
RJ: By identifying the factors that make those with mental illness in prison most at risk of returning to custody, we can find areas where more focussed treatment will make a major difference. We identified several opportunities for effective interventions, including better treatment for those with schizophrenia and bipolar disorder, greater continuity between mental health services in jail and in the community, and providing treatment for those with substance use problems (particularly those using stimulants). We also found that homelessness is a significant issue among prisoners with mental illness. Without stable housing, access to community resources is fragmented.
Any next steps?
RJ: We are working to develop community services that will support those who are most at risk during transitional periods, while evaluating how effective this approach is. We are also planning to evaluate whether focused interventions delivered before release will reduce the rate of reincarceration. In addition, people in the at-risk groups we study are often incarcerated for relatively minor offenses including crimes of poverty, offenses related to the use of illegal substances, or minor offenses against judicial orders. We believe alternatives to incarceration should be considered for these individuals.
What is the major take home message from your research?
RJ: Very large numbers of people with mental illness are incarcerated every year, and many fall into a pattern of frequent reincarceration. Investment in specific transition and community services and careful evaluation of their efficacy is required to address the challenges faced by people with serious mental illness who are released from jail to reduce reoffending.
The work was also carried out by Dr Sandy Simpson, Chief of Forensic Psychiatry, CAMH, Cory Gerritsen, Independent Scientist, CAMH, Madleina Manetsche, University Psychiatric Clinics, Basel, Switzerland, and assisted by all members of the Forensic Early Intervention Service, CAMH.
ImPACT Committee includes Krista Lanctôt, Alastair Flint, Meng-Chuan Lai and Simone Vigod.
Jones, R. M., Manetsch, M., Gerritsen, C., & Simpson, A. I. (2020). Patterns and Predictors of Reincarceration among Prisoners with Serious Mental Illness: A Cohort Study: Modèles et Prédicteurs de Réincarcération Chez les Prisonniers Souffrant de Maladie Mentale Grave : Une Étude de Cohorte. The Canadian Journal of Psychiatry, 070674372097082. doi:10.1177/0706743720970829