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Level of mental health intervention and clinical need among inmates with mental illness in five English jails.

OBJECTIVE
This study examined associations between clinical, demographic, and criminological characteristics of inmates with mental illness and level of mental health intervention received during early custody.


METHODS
In a prospective study, 3,079 participants entering five English jails were recruited and screened for mental illness with a standardized tool. Individuals who screened positive were assessed for mental illness and symptom severity within one week of arrival. Clinical records of those who received a diagnosis of mental illness (N=409) were reviewed for one month (or until discharge, if sooner) to determine mental health care interventions received. Main outcomes were the level of mental health intervention received (none, primary, or secondary) and whether an intervention was received from substance misuse services.


RESULTS
Compared with individuals who did not receive services, those who received primary mental health care were more likely to have a diagnosis of major depressive disorder than another mental illness (OR=2.01, CI=1.20–3.36). Compared with those who received primary care services, those who received secondary mental health care were more likely to have a diagnosis of psychosis (OR=3.34, CI=1.81–6.17). However, 23% of the sample received no intervention. Offenders with mental illness who misused drugs were more likely than those who misused alcohol alone to receive an intervention from substance misuse services (OR=3.67, CI=1.91–7.05).


CONCLUSIONS
Level of intervention was not consistently linked with diagnoses or symptom severity among inmates with mental illness. Triage processes should be improved to ensure that mental health care resources in jails are appropriately matched to clinical need.