Prevalence of Addiction and Mental Health Issues in Jails

During a conversation with Haywood County's Sheriff Greg Christopher, he mentioned that he probably ran the largest behavioral health facility in the rural North Carolina county due to the prevalence of problems in his local detention center. The daily census in the jail tended to be more than 100 inmates, and the impression of the staff was that a lot of them had substance use and mental health issues. His dilemma was that he could not prove it.

Having a psychology graduate student interested in correctional populations and a colleague in the criminology department at the local university, we put together a project to document the prevalence of common mental health and substance use disorders using the CAAPE-5 (Comprehensive Addiction And Psychological Evlauation-5) interview. For her thesis project, the graduate student did the interviews and extracted arrest and other data from the jail record. A small grant from C4 Recovery Solutions covered the graduate student’s time so she could focus on the project instead of other employment.

We collected data on 200 males and 83 females in the jail. The findings confirmed some of the sheriff’s impressions and provided some surprises. The confirmation was a high prevalence of substance use disorders and mental health conditions. More than 85% of the inmates had one or more substance use disorder, and 67% had at least one severe SUD. Previous studies of correctional populations tended to find alcohol as the most prevalent substance use disorder, but it slipped to third place behind stimulants and opioids. The real surprise was the prevalence of stimulant use disorders (meth).

More than 85% of the inmates had one or more substance use disorder, and 67% had at least one severe SUD.

Meth and opioids were also related to injecting drugs. Almost 40% had injected drugs and about a third reported regular injecting. Injection poses a public health concern not just for overdose risk, but also transmission of infectious diseases.

The most prevalent mental health conditions were probable PTSD (48%) and major depression (35%). Antisocial personality disorder (35%), panic attacks (29%) and possible bipolar disorder (11%) rounded out the top mental health conditions identified.

We also found that those positive for opioids or meth were more likely to have multiple arrests both in they year prior to the interview and the year after. When we looked at days of incarceration, we found that those without a meth or opioid diagnosis cost the county about $3,800 in incarceration costs in the jail. Those who had both diagnoses cost the county more than $6,500. Needless to say, Sheriff Christopher has used a report we generated for him on the findings to educate local community leaders and to make the case for a variety of initiatives to address the problems.

Since then we have worked with other sheriffs in North Carolina and Florida. One of the Florida sheriffs used his data to support a funding request from the legislature for a behavioral health program in his county. Other counties are also checking out prevalence rates of behavioral conditions in their communities.

A recent report on four counties can be found at the Addiction Professional e-newsletter:
The article does a comparison of the similarities and differences among four rural jails in North Carolian and Florida.

With the advent of the online CAAPE-5 administration and scoring on a HIPAA compliant website, the data can be collected more economically. Any appropriate staff person can now do the administration without the need for an experienced clinician to administer the interview. For clinical applications a clinician can review the findings and make recommendations or referrals. Also the item level data are automatically stored in a de-identified data file for analyses.

Photo by Bill Oxford on Unsplash