CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 35TREATMENT INJAILS AND PRISONSROGER H. PETERSPATTIE B. SHERMANFRED C. OSHERIn 2004, over 2 million prisoners were held in Federal or state prisons and local jails, andover 3% of the U.S. adult population was under some form of correctional supervision.Jails and prisons have grown dramatically in the past 15 years as a result of a significantincrease in arrests and incarceration for drug offenses, mandatory sentencing guidelines,and the erosion of public services for homeless persons, persons with mental illnesses,and the indigent. For example, the number of inmates in U.S. jails increased from405,000 in 1990 to 691,000 in 2003, and the prison population increased from 793,000to 1,394,000 during this period. Jails are typically operated by county sheriffs and are locallyoperated correctional facilities that confine persons on either a pretrial or short-termpostsentence basis. Jails are usually for inmates confined for sentences of 1 year or less,whereas prisons are designed for offenders with sentences of more than 1 year, and areoperated under the authority of state and Federal governments.The increasing number of offenders with mental illness confined in jails and prisonshas been of significant concern to correctional and health care administrators. Approximately16% of inmates report major mental health problems or an overnight stay in amental hospital, and more precise diagnostic estimates of persons with mental illnesses injails and prisons range from 10 to 15% of the correctional populations. Rates of mentalillness among offenders are significantly higher than rates among the general population.For example, 6.7% of prisoners reported a history of schizophrenia, compared to 1.4%of the general population. Over 70% of inmates with severe mental disorders have cooccurringsubstance use disorders. Persons with mental illnesses in jails and prisons aremore likely than other inmates to have a history of physical and sexual abuse, to be unemployedprior to their arrest, to have a family history of incarceration and substanceabuse, and to have a history of incarceration for violent offenses.354