The prevalence of self-reported mental illness among those imprisoned in New South Wales across three health surveys, from 2001 to 2015.

OBJECTIVE: The prevalence of mental illness among those in prison is much higher than in the community; however, very few studies have examined whether rates have changed over time, in line with increasing self-reported rates in the community. METHODS: This study compares the prevalence of self-reported mental illness, self-harm and suicidal thoughts/behaviours, and drug and alcohol use across three waves (2001, 2009 and 2015) of health surveys involving men and women in New South Wales prisons and compared these rates with published community-level findings. RESULTS: The prevalence of those reporting any mental health diagnosis increased significantly across the three surveys, even after adjustment for socio-demographic and criminal justice variables that also changed over time. Individuals surveyed in 2015 were more likely to report a mental health diagnosis than those surveyed in 2001 (adjusted odds ratio = 2.66, 95% confidence interval = [2.16, 3.27]). The prevalence of self-harm and suicidal thoughts and behaviours remained stable across the three surveys, while self-reported regular drug use decreased over the period. Women experienced a far greater burden of mental illness than men across all three surveys and experienced more growth in the prevalence of most psychiatric disorders. CONCLUSION: These findings have important implications for public and prison health systems given the poor social, health and criminal justice outcomes of those imprisoned with mental illness, both in custody and post-release.

The full spectrum of clinical stages of psychosis among mentally ill prisoners in New South Wales (NSW), Australia.

Research on the association between psychosis and criminal offending has typically focused on violent offenders with chronic psychotic illness. This stages of psychosis in prison (SOPP) study used a clinical staging approach to identify adult men referred to prison mental health services who had an at-risk mental state (ARMS), first episode of psychosis (FEP) or an established psychotic illness. Of the 105 participants included, 6% were determined to have FEP, 6% met ARMS criteria and the remainder had an established psychotic illness. Compared to a prison control sample, individuals on the psychosis spectrum were found to have higher levels of social disadvantage and other co-occurring mental health and substance use problems but were not more likely to have committed a violent offence. These findings support the notion that risk of criminal justice contact and complex illness burden exist across the full spectrum of psychotic illness.

Continuity of mental health care during the transition from prison to the community following brief periods of imprisonment.

Purpose: The prison-to-community transition period is one of high risk and need, particularly for those with mental illness. Some individuals cycle in and out of prison for short periods with little opportunity for mental health stabilization or service planning either in prison or the community. This study describes the socio-demographic, clinical and criminal justice characteristics of individuals with mental illness and frequent, brief periods of imprisonment, examines continuity of mental health care between prison and the community for this group, and reports on their post-release mental health and criminal justice outcomes. Design/methodology/approach: This study examined a sample of 275 men who had recently entered prison in New South Wales (NSW), Australia, who had been charged with relatively minor offenses and had been identified on reception screening as having significant mental health needs. Baseline demographic and mental health information was collected via interview and file review and contacts with the prison mental health service were recorded for the period of incarceration. Follow-up interviews were conducted 3 months post-release to determine level of health service contact and mental health symptoms. Information on criminal justice contact during the 3 month period was also collected. Findings: The majority (85.5%) of the sample had contact with a mental health professional during their period of incarceration. Mental health discharge planning was, however, lacking, with only one in 20 receiving a referral to a community mental health team (CMHT) and one in eight being referred for any kind of mental health follow-up on release. Of those followed up 3 months post-release (n = 113), 14.2% had had contact with a CMHT. Of those released for at least 3 months (n = 255), one in three had received new charges in this period and one in five had been reincarcerated. Conclusion: Continuity of mental health care for those exiting prison is poor, particularly for those with mental health needs experiencing brief periods of imprisonment, and rates of CMHT contact are low in the immediate post-release period. These findings suggest a need for early identification of individuals in this group for timely commencement of intervention and release planning, and opportunities for diversion from prison should be utilized where possible.

Self-harm risk screening on prison entry: assessing the predictive validity of self-harm history and recent ideation in men and women.

PURPOSE: Rates of self-harm are elevated in prison, and there is limited evidence to support the efficacy of brief risk screening at reception to predict and prevent self-harm. This study aims to examine the predictive validity of the self-harm/suicide screening items embedded in a prison mental health screening tool from two key domains strongly associated with risk: previous suicidal/self-harm behaviour, and recent ideation. DESIGN/METHODOLOGY/APPROACH: A sample of men and women were screened on entry to prison, with eight screening items covering the two key domains of risk. Follow-up data on self-harm incidents were collected for 12 months post-screening. The predictive validity of individual screening items, item combinations and cumulative screening score was examined for the overall sample and for men and women separately. FINDINGS: Individual screening items across the two domains were all strongly associated with self-harm in the follow-up period, with odds ratios varying from 2.34 to 9.24. The predictive validity of both individual items, item scores and item combinations demonstrated high specificity but low to moderate sensitivity, and modest area under the curves (AUCs). Predictive validity was generally better for men than women; however, differences were not statistically significant. PRACTICAL IMPLICATIONS: Identifying those at risk of self-harm in prisons remains challenging and brief universal screening at prison entry should be only one component of a broader prison risk assessment and management strategy. ORIGINALITY/VALUE: To the best of the authors' knowledge, this study is one of very few to prospectively examine self-harm behaviour following risk screening. Predictive validity was examined in a representative sample of individuals in custody, and for men and women separately.

A meta-analysis of the relationship between psychosis and any type of criminal offending, in both men and women.

BACKGROUND: Psychosis is known to be associated with an increased risk of violent offending, but the risk of criminal offending of any type is not so well understood, including the nature and extent of any differences in offending risk for men and women with psychosis. METHODS: A systematic search of electronic databases from 1970 to March 2020 was conducted to identify studies comparing criminal offending amongst those with psychosis to a general population sample. A meta-analysis was performed, with separate analyses undertaken for men and women. RESULTS: Eight studies, with a total of 15,446 individuals with psychosis and 186,752 controls from general population sources, met our inclusion criteria. The pooled odds ratio for any type of criminal offending for men with psychosis was 2.42 (95% CI = 1.63-3.59), and for women it was 2.81 (95% CI = 2.11-3.76). Substantial between study heterogeneity was identified. CONCLUSIONS: Although the pooled odds ratio for all types of offending was not as high as has been found for violence, those with psychotic illness were more than twice as likely to have had contact with the criminal justice system for any type of criminal offence, compared to the general population. Little difference in risk was seen for women compared to men with psychosis. Clinical risk assessments and the development of interventions to reduce risk of contact with the criminal justice system should consider that risk of offending for those with psychosis extends right across the spectrum of offence types.