Mental Disorder Among Prisoners ― Toward an Epidemiologic Inventory

On any day in the United States, about 2 percent of the population is in prison. What do we know about the mental health of these inmates? And what are the implications of what we know? Nathaniel Pallone characterizes opinion on these questions as falling into two broad camps: the “tender-hearted,” those who see an extensive overlap between mental illness and criminal behavior, and who are treatment oriented; and the “tough-minded,” those who have little confidence in psychiatric categories, do not really accept arguments about diminished responsibility, and who feel the emphasis should be on punishment. Which is closer to the truth?

The incidence of mental disorder among prisoners is nearly four times greater than among comparable groups in the general population. In part, this is related to the fact that prisoners are disproportionately drawn from demographic groups with a high incidence of mental disorder—nonwhite and from lower socioeconomic strata. But on other measures the data are dismaying: mental retardation is 50 percent higher in prison populations; alcohol and drug abuse is probably between five and eight times greater among imprisoned offenders; and neurogenic (organic) disorders may be 1700 times greater than in the general population. In fact, in all categories of mental illness, the incidence among prisoners is far higher than among the general population.

What are the policy implications of these findings? Pallone does not argue that criminal behavior is a byproduct of mental disorder, nor that rehabilitation rather than punishment is the purpose of imprisonment. He does assert that the evidence suggests that the design and implementation of mental health care needs serious reevaluation, particularly in view of recent Supreme Court decisions mandating mental health care (as distinct from treatment). He acknowledges the very real obstacles that will need to be addressed if this is to occur. But he sees mental health care as the primary issue for those responsible for the management of prisons. Criminologists, psychologists, policy-makers, and all those concerned with these questions will find Mental Disorder Among Prisoners essential.