Jail and Correctional Services

Pilot Survey of Persons with Mental Illnesses in SC Jails
July 1, 2007June 30, 2008

Introduction

At mid year 2005 more than half of all prison and jail inmates had a mental health problem (Bureau of Justice Statistics Special Report:  Mental Health Problems of Prison and Jail Inmates, 2006).  There is a much higher percentage of severe mental disorder among female detainees than among male detainees.  Women have higher rates of depression and Post-Traumatic Stress Disorder, (The Prevalence of Co-Occurring Mental Illness and Substance Use Disorders in Jails. SAMHSA, Spring 2002/Revised Winter2004).

South Carolina Jail Administrators (1994) reported the presence of persons with mental illness in SC jails as an increasing problem for local jails.  Jail administrators cited inadequate community resources and a lack of community treatment and supports as reasons for many persons with mental illnesses cycling in and out of local jails (Biennial Forensic Forum, 1999).   Jail medical staff report inmates are no sooner released, after serving a thirty day sentence, only to be rearrested and return to jail on more misdemeanor offenses – breaking city or county ordinances (Sumter County Detention Center 2007).  The impact of the jail cycling has resulted in overcrowding and increased pharmacological costs and jail staff are not equipped to handle the behaviors symptomatic of the illness (SC Jail Administrators Conference, 2006).

A survey of South Carolina jails in 1994 revealed, on any given day, the local jails held 5,492 inmates.  One half (1/2) of the jails were over their rated capacity and approximately ten (10) percent of the inmate population was reported by jail administrators to have a mental illness. A repeat survey in 2004 reveal the average daily census of the jails, on any given day, had more than doubled to 10,440.   By 2006, the average daily population had grown to 12,616 inmates.  The literature continues to support that on the average 6 – 10 percent of the inmate population in jails have serious mental illnesses.  A recent survey “Prevalence of Serious Mental Illness Among Jail Inmates” by Hank Steadman, et.al. (2007) using the Brief Jail Mental Health Screen developed by Steadman, H. et.al. report 14.5% for males and 31.0% for females.

Purpose of Pilot Survey

The pilot was undertaken to 1) obtain data regarding the numbers of inmates with mental illnesses receiving mental health treatment at selected jail sites, 2) identify repeat offenders with mental illness, 3) improve referrals and linkage to community treatment and supports, 4) develop guidelines for referrals from jail/detention facilities to community mental health centers/clinics, and to promote continuity of services.

Participating Sites (Table 1)

Eight (8) jails and community mental health centers were initially selected to participate in the pilot.  Common among all 8 of the sites – Aiken, Charleston, Kershaw, Lexington, Marlboro, Orangeburg, and Sumter – were:  1) agreement and interest in participation 2) willingness to allocate staff resources to collect the data, 3) mental health services were provided on site at the jail by mental health professional(s) either by contract or MOA, and 4) staff willingness to collect and submit the data.

Two of the community mental health centers (Kershaw, Sumter) withdrew from the pilot during the first month.  Marlboro submitted 2 months of data, but discontinued due to staff turnover.  The data collected from these three sites was not included because of the small number of cases assessed and treated during the pilot period.

The pilot data was obtained by onsite mental health professional between July 1, 2007 and
June 30, 2008.  Five hundred and sixty-two (562) inmates received treatment during the pilot period.  Duplicated numbers (persons released and re-arrested during the pilot period) were not identified. 

Demographics of Participating Sites

Table 1 


Jail Site

County Populace
Source:
 (2000, Census)

Rated Capacity of Jail
(Source:  SCDC, February 2003 )

Average Daily Population

Number Inmates Assessed/Treated for Mental Illness During Pilot Period

Mental Health Service Provided by

Aiken

142,552

364

300

21

Contract

Charleston

309,969

661

842

174

Contract

Lexington

216,014

682

723

270

Contract

Marlboro

28,818

94

88

3

MOA

Orangeburg

91,582

362

380

89

MOA

Charleston

309,969

661

842

174

Contract

Two (2) of the jails (Marlboro and Orangeburg) had memorandums of agreements with the local community mental health centers to provide mental health services to the inmates on site or at the center.  Four (4) of the jails contracted for mental health services through county contracts with private entities.  In these instances services were provided on site at the jail upon request and referral of jail staff.

Lexington detention facility had the highest number (273) of persons treated for mental illnesses during the pilot period followed by Charleston (175) and Orangeburg (89).  It is noted all three facilities were over their rated capacity.  Inmates at Lexington detention facility were more frequently diagnosed with depression when compared to inmates at Charleston and Orangeburg who were more often diagnosed with substance abuse.

Inmate Profile

Table 2


Site

Average Age

Race

Gender

Average Years
of Education

W

B

O

M

F

Aiken

32

17

4

0

19

6

10.2

Charleston

36

83

89

1

132

42

10.8

Lexington

37

201

69

2

175

98

11.6

Marlboro

20

2

1

0

3

0

10.5

Orangeburg

34

27

62

0

71

18

11.5

The average age of the survey population was thirty-two (32) years.  Three hundred and thirty (330) were white, two-hundred and twenty five (225) were African Americans, and three (3) were other (Hispanic and Asian, 2 and 1 respectively).  Four hundred (400) were males and 164 were female.  The average educational attainment level was 10.9 years of education.  The majority of Charleston’s inmates reported having below a fifth (5th) grade education level. 

Presenting Complaint of Inmate and/or Observation and Referral of Jail Staff Compared to Diagnoses by Mental Health Professional
                                               
Table 3                       


Presenting Complaint

Final Diagnoses

Anxiety

Depression

Schizophrenia

Bipolar

MR

PTSD

Substance

Other

Agitation

4%

13%

16%

32%

11%

0

19%

6%

Depression

6%

58%

4%

15%

<1%

3%

11%

3%

Psychoses

0%

5%

61%

9%

2%

2%

20%

0

Suicidal

0%

25%

15%

10%

5%

0

45%

0

Persons reporting or referred with complaints of agitation when and treated by the mental health staff were diagnosed as having a bipolar disorder (32%), a substance abuse disorder (19%), and Schizophrenia (16%) respectively.  For those presenting or referred by jail staff with depressive symptoms/behaviors 58% were diagnosed as having depression.  It is noted that the surveys of jails/detention facilities in 2004 and 2006 also reflected a high level of depression among inmates referred for mental health services. 

Sixty one percent (61%) of persons presenting or referred by jail staff with symptoms and behaviors of psychosis were diagnosed with schizophrenia.  For inmates who presented with complaints of substance use or abuse 51% were diagnosed with substance abuse and 19% were diagnosed with a depressive disorder followed by 16% who were diagnosed as having a bipolar disorder.

Diagnoses by Jail/Detention Facility

Table 4

Facility

Schizophrenia

Bipolar Disorder

Depression

Substance Abuse

Anxiety

Other

Aiken (n=25)

 4%

 24%

 16%

 36%

 8%

 12%

Charleston (n=75)

 20%

 21%

 24%

 25%

 6%

 4%

Lexington (n=273

 18%

 19%

 38%

 18%

 5%

 9%

Orangeburg (n=89)

 13%

 13%

 18%

 29%

 5%

 23%

The most frequent diagnoses were schizophrenia, bipolar disorder, depression, substance abuse, anxiety and other.  Symptoms and behaviors reported in the “other” category were primarily reported as drug seeking behaviors – physical aches, sleeplessness, agitation, headaches, etc.

Orangeburg and Aiken had a higher percentage of individuals diagnosed as “other” as well as a higher percentage of persons diagnosed with substance abuse.  A significant number of inmates treated at the Lexington facility were diagnosed with depression.  The diagnoses of inmates at Charleston were across the spectrum of the major mental illnesses.

Inmate Treatment History by Provider and Diagnoses
Table 5


Providers

Schizophrenia

Bipolar Disorder

Depression

Anxiety

Substance

Other

Non-SCDMH

16%

42%

56%

50%

24%

34%

No Prior Treatment

4%

2%

7%

7%

23%

27%

SCDMH

80%

56%

37%

43%

54%

39%

Table 5 reflects the percentage of individuals with a past history of mental health treatment provided by non-SCDMH facilities/centers, SCDMH centers/clinic (e.g., primary care physician, private psychiatrist, Veteran’s Administration), and no treatment provider.  SCDMH was the most frequent treatment provider for inmates diagnosed with schizophrenia and substance abuse, while non-SCDMH providers most frequently treated for affective disorders and substance abuse. 

More than half of the inmates who received treatment during the pilot were current or past clients of SCDMH (see table 6) and they were most likely to have a diagnosis of schizophrenia. 

Inmates who received services from a private provider most frequently were referred to a SCDMH center/clinic by the mental health professional rather than to their private provider upon release from the jail.  The data did not reflect how many of the inmates followed through with the referral or the impact on center/clinic client caseloads.

Table 6 presents a breakdown of the diagnoses of clients known to SCDMH and those who had no mental health history before arrest and incarceration but were seen by the mental health staff and referred for community treatment.  The percentage of inmates with depression and bipolar disorder was high in this group.

Table 6


Diagnoses

Current and Past Center Clients

No History of Treatment

Anxiety

4%

6%

Depression

21%

44%

Other

3%

5%

Schizophrenia

27%

8%

Bipolar

20%

21%

Mental Retardation

1%

1%

Post Traumatic Stress

3%

3%

Substance

20%

12%

Diagnoses by Alleged Offense

Table 7

Offense

Schizophrenia

Depression

Bipolar Disorder

Anxiety

Substance

Other

Violent crime (n=73)

 23%

 24%

 13%

 4%

 18%

 18%

Property crime (n=93)

 11%

 33%

 18%

 4%

 25%

 9%

Domestic offense (n=61)

 13%

 38%

 16%

 3%

 20%

 10%

Sex offense (n=21)

 14%

 19%

 38%

 5%

 19%

 5%

Warrants & holds (n=130)

 20%

 32%

 23%

 7%

 11%

 7%

Substance (n=56)

 14%

 38%

 18%

 9%

 18%

 4%

Ordinance
(n = 77)

 32%

 11%

 14%

 4%

 24%

 16%

Driving violation (n=37)

 11%

 32%

 8%

 5%

 30%

 14%

Findings:

  1. Pilot participants were known clients of the local community mental health center but they were not treatment compliant.  However the data did not identify these individuals as repeat offenders whose lack of treatment compliance was a factor in their incarceration.

  2. Identification of population would allow effective referral and linkage to
    community services.

    The data did not reflect the frequency of contacts with the mental health staff
    during the inmate’s confinement or their length of stay in the jail.  Staff resources
    did not allow time to track the inmates release and community follow-up even though
    most of the inmates who received mental health treatment most were referred to the local mental health center for follow-up.

  3. Housing and unemployment were service gaps and barriers that reinforced offending behaviors and lack of treatment compliance.

    The data indicated the majority of the inmates reported personal living residence prior to their arrest and incarceration.  The data did not address employment status at the time of arrest, however literature indicate many inmates report unemployment and homelessness at the time of arrest.

  4. Develop guidelines for referral and continuity of care for inmates released from jails.

    The data showed depression was the most frequent diagnosis (29%) followed by Substance Abuse and Bipolar Disorder 19% respectively, and Schizophrenia 17%.  The data support the need for the availability and provision of mental health services for inmates during confinement.

    The majority of the inmates who received mental health treatment were pretrial.  Of the alleged offenses 130 were being held on bench warrants and holds.  While the mental health professional recommended referral to the local community mental health center,  the data did not reflect the length of stay for these individuals nor the number of inmates released to the community and presented for community treatment.