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June 12, 2011

"Medicine and the Epidemic of Incarceration in the United States"

The title of this post is the title of this short "perspective" piece appearing in The New England Journal of Medicine.  Though much of the ground covered by the piece will be familiar to regular readers of this blog, I thought these passages added some new data to the usual discussions of mass incarceration:

The largest facilities housing psychiatric patients in the United States are not hospitals but jails. More than half of inmates have symptoms of a psychiatric disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM­IV), and major depression and psychotic disorders are four to eight times as prevalent among inmates as in the general population — yet only 22% of state prisoners and 7% of jail inmates receive mental health treatment while in­carcerated....

Substance use and dependence are highly prevalent in the incar­cerated population.  More than 50% of inmates meet the DSM­IV criteria for drug dependence or abuse, and 20% of state prisoners have a history of injection­ drug use.  Up to a third of all heroin users — approximately 200,000 — pass through the crim­inal justice system annually.  With growing numbers of drug users in correctional facilities, the prevalence of infectious diseases has increased correspondingly.  As many as a quarter of all Ameri­cans infected with HIV and one in three with hepatitis C pass through a correctional facility each year.  Chronic noninfectious diseases are also disproportionately prevalent in correctional facilities.

June 12, 2011 at 11:45 AM | Permalink


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Would be a lot more meaningful if we didn't declare that every aberrant behavior qualifies as a psychiatric disorder. Not to say that there are not people in the prison system with serious mental illness that are being neglected, just that the DSMIV is over inclusive junk.

Posted by: Monty | Jun 12, 2011 1:18:23 PM

I think it would be a good idea to check out the data quality of prison and jail drug and mental health screens. Normally the screening is done at the time of admission and a person using drugs can give a false positive on a mental health screen.

Another problem is that developmental disabilities are often combined with mental health disabilities. About all they can do for the developmentally disabled prisoners is to try to protect them from the other prisoners.

I asked one of the old time corrections staff when the mentally ill prisoners first started to appear and he said they were always there but in the old days there was no program for them and the guards and other prisoners had to learn by trial and error how to manage them.

Posted by: John Neff | Jun 12, 2011 5:53:26 PM

New England J of Medicine is a notorious left wing propaganda outlet. The implication of the article? Hire more doctors by prisons. It does not bother to disclose this economic conflict of interest.

Posted by: Supremacy Claus | Jun 13, 2011 6:37:36 AM

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