tion received considerable attention in the workshop, as did the health profile of older adults, women, and youth in prisons and jails, and families of those incarcerated, as well as individuals recently released from prisons or jails.

MENTAL ILLNESS AND ADDICTION

Overrepresentation

The overrepresentation of people with behavioral disorders in the correction systems was the focus of a workshop presentation by Fred Osher (Council of State Governments’ Justice Center). Osher explained that 5 percent of the general population are estimated to have a serious mental illness (Kessler et al., 1996); and while the rates are not directly comparable, other studies have shown that the rate is much higher among the incarcerated population, and especially so among women. In state prisons, 24 percent of women and 16 percent of men have a serious mental illness (Ditton, 1999). In jails, 31 percent of women and 15 percent of men have a serious mental illness (Steadman et al., 2009). Osher noted, “We don’t understand that exactly, but we’ve clearly got a big challenge with this gender disparity and responding in appropriate ways to the needs of women in correctional settings.”

Osher also offered estimates for substance abuse among prisoners, observing that while less than 20 percent of the general population suffer addiction, the figure in prisons and jails approaches 50 percent (Karberg and James, 2005; Mumola and Karberg, 2006). Co-occurring mental disorder and substance abuse is also very high. In the general population, about 25 percent of those with a serious mental illness have a co-occurring disorder, while in jails, more than 70 percent of those with a serious mental illness have a co-occurring disorder (Kessler et al., 1996; Ditton, 1999; James and Glaze, 2006; Steadman et al., 2009). Again, the rates are not directly comparable across different studies and time periods, but the potential differences are striking. The co-occurrence of mental disorder and substance abuse can complicate the detection of either, particularly when staff or diagnostic instruments are insufficiently sensitive, or where overcrowding and/or understaffing reduces the time spent on medical screening. Osher termed such co-occurrence a “critical issue” that needs to be addressed at points of both entry and exit from the correctional system.

While Osher’s figures highlighted those with serious mental illness (e.g., major affective disorders or schizophrenia), Fellner broadened attention to inmates whose mental health problems are less severe but might still lead to significant functional disabilities. This describes over half the incarcerated population. Fellner provided figures indicating that 56



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