Mental disorders and criminal legal involvement: Evidence from a national diagnostic epidemiological survey

Large numbers of adults with mental disorders in the United States are incarcerated or otherwise involved with the criminal legal system. Evidence is lacking on prevalence of specific psychiatric diagnoses in this population. This article presents results from the Mental and Substance Use Disorders Prevalence Study (MDPS), a national epidemiological survey that assessed lifetime prevalence of schizophrenia-spectrum disorder, and past-year prevalence of bipolar 1, obsessive-compulsive, major depressive, generalized anxiety, and post-traumatic stress disorders using the Structured Clinical Interview for DSM-5 (SCID 5). Diagnoses and demographic characteristics are compared among three populations: (1) imprisoned adults (N=321), (2) adults not incarcerated but with justice involvement in the past year (N=269), and (3) adults with no criminal legal history in the past year (N=5,004). The weighted sample included households, prisons, hospitals, and homeless shelters. About 4 in 10 people with any past-year criminal legal involvement had at least one of these mental disorders. The cumulative prevalence of these disorders was highest among those in prison (41.8%; 95% Confidence Interval (CI): 33.1-50.9%), lower in the community resident population with criminal legal involvement (37.0%; 95% CI: 25.1-50.6%), and lowest among those with no criminal legal involvement in the past year (24.4%; 95% CI: 21.9-27.0%). Findings for schizophrenia-spectrum disorder followed this pattern: prevalence in prison was 6.3% (95% CI 2.7-14.0%), while among community residents with criminal legal involvement prevalence was 4.4% (95% CI: 1.9-10.0%), and among those with no criminal legal involvement it was 1.7% (95% CI: 1.2-2.4%).