Majority of mentally ill inmates don?t get treatment

April 12, 2010

ANN ARBOR— Roughly 65 percent of Michigan prisoners diagnosed with a severe psychiatric illness did not receive treatment while incarcerated, a new University of Michigan study found.

The Michigan Department of Corrections contracted with U-M to conduct the study in order to comply with Public Act 124 of 2007. PA 124 mandated that the MDOC conduct an independent study of its mental health services following the widely-publicized death of an inmate with a history of psychiatric problems.

The purpose of the U-M study was to independently assess how many prisoners suffered mental illness and how many of those diagnosed inmates actually received treatment within the correctional system, said Brant Fries, principal investigator of the study and professor of Health Management and Policy at the School of Public Health. Fries also has an appointment at the VA Ann Arbor Healthcare System.

Researchers interviewed 618 inmates across the state between May 1, 2008 and Sept. 30, 2009, and also reviewed MDOC mental health records, said Fries, who is also a research professor at the Institute of Gerontology. They found that overall 20 percent of males and 25 percent of females have severe psychiatric symptoms and that 16 percent and 29 percent, respectively, received mental health services.

However, when the study group compared its assessment with the MDOC’s mental health records, it found that 65 percent of prisoners with mental health symptoms, or an estimated 9,711 statewide, did not receive psychiatric services during the study. There were 47,888 inmates at the time of the study.

Using an alternate, conservative calculation still shows that 44 percent of mentally ill prisoners aren?t being treated. This conservative calculation uses the broad assumption that that all of the 8,155 prisoners with an MDOC diagnosis would have been detected by the U-M assessment if their symptoms weren’t controlled.

Other statistics from the report:

? The male general population had the highest percentage of untreated mental illness at 77 percent, the study showed. The female general population reported more depression and other mental illness, but also had a higher percentage of treated patients at 54 percent. The male special units had the lowest percentage of untreated mental illness at 12 percent, as many of those special units are mental health treatment programs.

? U-M assessments and MDOC records agree that 70 percent of inmates (33,461) don?t have mental illness and don?t have a mental health diagnosis recorded with the MDOC.

? When measuring the relationship between major offense, the presence of mental health symptoms, and whether symptoms were treated, the researchers found that 20 percent of crimes were committed by individuals with mental health symptoms, and 63 percent of those crimes were committed by prisoners who weren?t receiving treatment for symptoms.

Fries said the study recommends that the MDOC improve screening methods for identifying mental illness and use it to prioritize care for the most severely in need. It also notes that the MDOC implemented a new screening process in 2008, which was only used on only a small portion of the study sample.

“Our study shows that, no matter the level, mental health services can be targeted efficiently at those most in need,” Fries said.

Fries said this study could be applied nationally, and that all prisons should look at the issue of adequate mental health care. The report also recommends adopting a standardized mental health assessment tool, such as the interRAI for Correctional Facilities instrument used in the U-M study, to identify mental illness and monitor outcomes.

Finally, the report recommends further study to determine if the mental health services provided are effective and appropriate.

Team members included:
Philip Margolis, professor emeritus, Department of Psychiatry; Angela Schmorrow and Sylvia Lang, Institute of Gerontology. The Michigan Public Health Institute and Nipissing University in North Bay, Ontario served as subcontractors to the project.

FriesSchool of Public HealthInstitute of GerontologyMichigan Department of CorrectionsPublic Act 124 of 2007