Co-occurring disorders among mentally ill jail detainees: Implications for public policy.

Abram, Karen M.; Teplin, Linda A.

doi:10.1037/0003-066x.46.10.1036

Cited by 435 publications

(213 citation statements)

References 57 publications

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“…These relations with co-occurring disorders are well documented in single-site studies in mental health services, 2,7,60 as well as substance abuse treatment, 61,62 as is the high prevalence of mental disorders among people in correctional facilities. 63 Our data illustrate how endemic these behavioural challenges are in the overall mental health system and suggest close attention be paid to issues of patient and staff safety and risk assessment and management, including client self-harm. Speciality outpatient programs and community mental health services look to models of community mental health intended to support this population, for example, outpatient commitment, 64 jail diversion, 65 forensic case management or ACT teams, 66,67 and other models of practice that build bridges across mental health, substance abuse, and the criminal justice system, including housing supports.…”

Section: -14mentioning

confidence: 99%

Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System

Rush

Koegl

2008

Can J Psychiatry

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Objective: To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology.Method: Data were collected on cases (n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care.Results: Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm. Conclusion:The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems. Can J Psychiatry 2008;53(12):810-821Clinical Implications · Clinicians can use sociodemographic characteristics, such as male sex, younger age, and being unemployed, and clinical indicators, such as overall mental health severity and behavioural challenges, to help identify and support people with substance use disorders. · Treatment and support models for co-occurring mental and substance use disorders must include risk management strategies, given the higher prevalence of challenging behaviours within this population. · There is a need for system-wide planning regarding co-occurring mental and substance use disorders. Limitations· Although findings were based on a comprehensive mental health system, the results may not be applicable to every jurisdiction. · Study findings should not necessarily be generalized to acute care, consumer, or peer support programs because they were not included in our study. · Clinical diagnostic interviews were not feasible to validate study criteria for defining co-occurring disorders.

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Section: -14mentioning

confidence: 99%

Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System

Rush

Koegl

2008

Can J Psychiatry

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“…For this population, substance use disorders are common (1–5) and are associated with multiple adverse outcomes, including treatment dropout (23), recurrent hospitalization (24,25), violence (26), homelessness (27), incarceration (28), relapse (29), and victimization (30), as well as medical problems such as HIV and hepatitis (31). The course of substance use disorders in this population tends to be chronic and relapsing (32,33).…”

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confidence: 99%

Substance Use Disorder Among People With First-Episode Psychosis: A Systematic Review of Course and Treatment

Wisdom

Manuel²,

Drake³

2011

Psychiatric Services

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Objective People experiencing a first episode of psychosis frequently have co-occurring substance use disorders, usually involving alcohol and cannabis, which put them at risk for prolonged psychosis, psychotic relapse, and other adverse outcomes. Yet few studies of first-episode psychosis have addressed the course of substance use disorders and the re sponse to specialized substance abuse treatments. Methods The authors searched MEDLINE, PsycINFO, and other medical databases for English-language articles published between 1990 and 2009. Included studies addressed two research questions. First, do some clients become abstinent after a first episode of psychosis without specialized substance abuse treatments? Second, for clients who continue to use substances after a first episode of psychosis, does the addition of specialized substance abuse treatment enhance outcomes? Results Nine studies without specialized substance abuse treatment and five with specialized substance abuse treatment assessed the course of substance use (primarily cannabis and alcohol) after a first episode of psychosis. Many clients (approximately half) became abstinent or significantly reduced their alcohol and drug use after a first episode of psychosis. The few available studies of specialized substance abuse treatments did not find better rates of ab stinence or reduction. Conclusions Experience, education, treatment, or other factors led many clients to curtail their substance use disorders after a first episode of psychosis. Specialized interventions for others need to be developed and tested.

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“…Prisoners with schizophrenia, bipolar disorder, and antisocial personality disorder had an addictive disorder 92% of the time. Other reviews and studies confirm the high prevalence of co-occurring disorders (Abram 1991;Lamb & Weinberger 1998;Teplin, Abram & McClelland 1996). These authors echo the voices of clinicians urging more careful screening of incoming detainees and diversion to the mental health system of those who have committed minor offenses.…”

Section: Criminal Justice System Issuesmentioning

confidence: 72%

Severely and Persistently Mentally Ill Substance Abusers: Clinical and Policy Issues

Zweben

2000

Journal of Psychoactive Drugs

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Abstract-Communities that are struggling to provide effective treatment for the challenging population of severely mentally ill clients who use alcohol and drugs have a growing research base on which to make policy decisions. Integrating outpatient treatment for mental health and addictive disorders appears to be more effective than treatment in two separate systems. Integrated treatment at a single site allows for individualizing treatment priorities without fragmenting care. Harm reduction approaches provide a low threshold entry, which can be followed by interventions to enhance motivation. Managing patient benefits to discourage drug use reduces the likelihood of their becoming homeless, hospitalized or incarcerated. Inadequate treatment capacity plays a large role in the growing number of disturbed clients who end up in the criminal justice system. Effective community treatment requires vigorous collaboration between care providers. Ultimately, professional training programs need to produce clinicians who are competent and comfortable addressing alcohol and other drug use to implement effective treatment systems.

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Co-occurring disorders among mentally ill jail detainees: Implications for public policy.

Cited by 435 publications

References 57 publications

Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System

Prevalence and Profile of People with Co-Occurring Mental and Substance Use Disorders within a Comprehensive Mental Health System

Substance Use Disorder Among People With First-Episode Psychosis: A Systematic Review of Course and Treatment

Severely and Persistently Mentally Ill Substance Abusers: Clinical and Policy Issues

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