U.S. Department of Justice
Office of Justice Programs

Bureau of Justice Statistics

Special Report
Mental Health and Treatment
of Inmates and Probationers
By Paula M. Ditton
BJS Statistician
At midyear 1998, an estimated 283,800
mentally ill offenders were incarcerated
in the Nation’s prisons and jails.
In recent surveys completed by the
Bureau of Justice Statistics, 16% of
State prison inmates, 7% of Federal
inmates, and 16% of those in local jails
reported either a mental condition or an
overnight stay in a mental hospital.
About 16%, or an estimated 547,800
probationers, said they had had a
mental condition or stayed overnight
in a mental hospital at some point in
their lifetime.
Based on information from personal
interviews, State prison inmates with a
mental condition were more likely than
other inmates to be incarcerated for a
violent offense (53% compared to
46%); more likely than other inmates to
be under the influence of alcohol or
drugs at the time of the current offense
(59% compared to 51%); and more
than twice as likely as other inmates to
have been homeless in the 12 months
prior to their arrest (20% compared to
9%). Over three-quarters of mentally ill
inmates had been sentenced to time in
prison or jail or on probation at least
once prior to the current sentence.
Over 30% of male mentally ill inmates
and 78% of females reported prior
physical or sexual abuse. Since admission 61% of mentally ill inmates in State
prison and 41% in local jails reported
they had received treatment for a
mental condition in the form of counseling, medication, or other mental health
services.

July 1999, NCJ 174463

Highlights
Over a quarter million mentally ill incarcerated in prison or jail
ù About 10% of prison and jail
Proba- inmates reported a mental or
State Federal
tion
prison prison Jail
Reported a...
emotional condition; and 10%
Mental or emotional
10.1% 4.8%
10.5% 13.8% said they had stayed overnight
condition
Overnight stay in a
in a mental hospital or program.
mental hospital

10.7

4.7

10.2

8.2

Estimated to be
mentally ill*
16.2% 7.4%
16.3% 16.0%
*Reported either a mental or emotional condition or
an overnight stay in a mental hospital or program.

ù Together, 16% or an estimated
283,800 inmates reported either a
mental condition or an overnight
stay in a mental hospital, and
were identified as mentally ill.

Mentally ill inmates were more likely than others to be in prison
for a violent offense
Offense
Violent
Property
Drug
Public-order
Criminal history
None
Priors

State prisoners
Mentally ill Other
inmates inmates
52.9%
46.1%
24.4
21.5
12.8
22.2
9.9
9.8
18.8%
81.2

21.2%
78.8

ù About 53% of mentally ill inmates
were in prison for a violent offense,
compared to 46% of other inmates.
ù Mentally ill offenders were less
likely than others to be incarcerated
for a drug-related offense
(13% versus 22%).

Nearly 6 in 10 mentally ill offenders reported they were under the
influence of alcohol or drugs at the time of their current offense

Before entering prison
Homeless in 12 months
prior to arrest
Physical/sexual abuse
Male
Female
Alcohol/drug use
At time of offense
Drug use
In month before offense
Mental health treatment
since admission
Any treatment
Medication
Counseling

State prisoners
Mentally ill Other
inmates inmates
20.1%

8.8%

32.8%
78.4

13.1%
50.9

58.7%

51.2%

58.8%

56.1%

Mentally ill inmates
State prison Jail
60.5%
40.9%
50.1
34.1
44.1
16.2

ù Mentally ill State prison inmates
were more than twice as likely as
other inmates to report living on the
street or in a shelter in the 12 months
prior to arrest (20% compared to 9%).
ù Nearly 8 in 10 female mentally ill
inmates reported physical or sexual
abuse. Males with a mental condition
were more than twice as likely as
other males to report abuse.
ù 6 in 10 mentally ill State inmates
reported receiving mental treatment
since admission to prison.

Survey items used to measure mental illness

Table 1. Measures of mental illness
among State prison inmates, 1997

Do you have a mental or emotional condition?
(prison and jail inmates only)

* Yes
* No

Have you ever been told by a mental health professional
such as a psychiatrist, psychologist, social worker, or
psychiatric nurse, that you had a mental or emotional disorder?
(probationers only)

* Yes
* No

Because of an emotional or mental problem, have you ever &
Taken a medication prescribed by a psychiatrist or other doctor?
Been admitted to a mental hospital, unit or treatment program
where you stayed overnight?

Received counseling or therapy from a trained professional?

* Yes
* No
* Yes
* No
* Yes
* No

State prison inmates
Cumulative
Percent percent
Reported a mental
or emotional condition

10.1% 10.1%

Because of a mental
or emotional problem,
inmate had —
Been admitted to
a hospital overnight

10.7% 16.2%

Taken a prescribed
medication

18.9

23.9

Received professional
counseling or therapy

21.8

29.7

Received other
mental health services

3.3

30.2

To take into account underreporting of
current mental or emotional problems,
past admission to a mental hospital
was included as a measure of mental
illness. Overall, 16% of State prisoners
Prevalence of mental illness among 16% of State prisoners identified
met these criteria, including 10% who
correctional populations based on
as mentally ill
reported a current mental condition and
offender self reports
an additional 6% who said they did not
For this report, offenders were identiThe findings in this report are based on fied as mentally ill if they met one of the have a mental condition but had stayed
overnight in a mental hospital, unit, or
the 1997 Survey of Inmates in State or following two criteria: they reported a
treatment
program.
Federal Correctional Facilities, the
current mental or emotional condition,
1996 Survey of Inmates in Local Jails,
or they reported an overnight stay in a
Previously estimated rates of mental
and the 1995 Survey of Adults on
mental hospital or treatment program.
illness among incarcerated populations
Probation. In each survey, offenders
An estimated 1 in 10 State prison
depending on the methodology of
vary,
selected through nationally representa- inmates reported a current mental or
the institution, and the definithe
study,
tive samples were asked a series of
emotional condition (table 1). A slightly
tion
of
mental
illness. Estimates range
mental health related questions.
larger percentage (11%) of State
from 8% to 16% among studies with
Respondents were asked if they have a inmates said they had been admitted
more rigorous scientific methods,
mental or emotional condition and
overnight to a mental hospital or treatincluding random sampling and a
whether they had ever received treatment program at some point in their
standardized assessment or psychoment for a mental or emotional
life. Overall, nearly a third of all
logical testing. (See the box on this
problem, other than treatment related
inmates reported they had a current
page.)
to drug or alcohol abuse. (See survey
mental condition or they had received
questions in the box above.)
mental health service at some time.
Past estimates of the rate of mental
illness among incarcerated populations
Previous studies of the prevalence of severe mental illness in prison or jail
are higher than those for the U.S.
general population. Among a sample
Study
Sample
Mentally ill*
of male jail detainees in Cook County
Guy, Platt, Zwerling,
Philadelphia jail
(Chicago), Teplin found 9.5% had
and Bullock (1985)
pretrial admissions
16%
experienced a severe mental disorder
(schizophrenia, mania, or major
Teplin (1990)
Cook County jail
admissions (males)
10%
depression) at some point in their life,
compared
to 4.4% of males in the U.S.
Steadman, Fabisiak, Dvoskin,
New York State
general
population.
The Epidemiologic
and Holohean (1987)
prisoners
8%
Catchment Area program found that
*Generally includes schizophrenia, bipolar disorder, and major depression.
6.7% of prisoners had suffered from
See individual studies for variations in definition.
schizophrenia at some point, compared
to 1.4% of the U.S. household population (Robins and Regier).
Received any other mental health services?

2 Mental Health and Treatment of Inmates and Probationers

* Yes
* No

283,800 mentally ill in prison or jail;
547,800 on probation
Using the same criteria described for
State prison inmates, 16% of offenders
in local jails or on probation and 7% of
inmates in Federal prisons were identified as mentally ill in recently completed
BJS surveys (table 2). Probationers
were somewhat less likely than inmates
in State prisons or local jails to report
an overnight stay in a mental hospital
or treatment program but more likely to
report a mental or emotional problem.
Federal inmates had lower rates on
both measures.
Assuming these rates have not
changed since the surveys were
conducted, an estimated 283,800
inmates in prison or jail were mentally
ill as of June 30, 1998 (table 3). State
prisons held an estimated 179,200
mentally ill offenders; Federal prisons
held 7,900; and local jails, 96,700. Of
those on probation at yearend 1998,
an estimated 547,800 were mentally ill.
White inmates more likely than
blacks or Hispanics to report a
mental illness

14% of those in State prison and local
jails, and 10% of those on probation
were identified as mentally ill. About
11% of Hispanic State prison and local
jail inmates, and 9% of Hispanic offenders on probation had a mental illness.
Black and Hispanic inmates in Federal
prison were half as likely as white
inmates to report a mental illness.
About 6% of black inmates and 4%
of Hispanic inmates reported a mental
condition or an overnight stay in a
mental hospital, compared to 12%
of white Federal prison inmates.
The prevalence of mental illness also
varied by gender, with females reporting a higher rate of mental illness than
males. Nearly 24% of female State
prison and local jail inmates, and 22%
of female probationers were identified
as mentally ill, compared to 16% of
male State prison and jail inmates
and 15% of male probationers.

Identified as mentally ill*

Admitted overnight
to a mental hospital

118,300

Percent of females in State
prison identified as mentally ill
Age
White
Black
Hispanic
Total
29%
20%
22%
24 or younger
37
17
23
25-34
23
20
21
35 or older
33
21
23

5,200
5,000

State prison
Federal prison Jail inmates, Probationers,
1995
inmates, 1997 inmates, 1997 1996
16.2%
7.4%
16.3%
16.0%
10.1

4.8

10.5

13.8

Admitted overnight to a mental
hospital or treatment program

10.7

4.7

10.2

8.2

*Reported either a mental condition or an overnight stay in a mental hospital
or treatment program.

Table 4. Inmates and probationers identified as mentally ill,
by gender, race/Hispanic origin, and age

Estimated number of offenders*
State
Federal
Local
Probation
prison
jail
prison
179,200
7,900 96,700
547,800
111,300

The highest rates of mental illness
were among white females in State
prison. An estimated 29% of white
females, 20% of black females, and
22% of Hispanic females in State
prison were identified as mentally ill.
Nearly 4 in 10 white female inmates
age 24 or younger were mentally ill.

Reported a mental
or emotional condition

Table 3. Estimated number of mentally ill inmates
and probationers, 1998

Reported a mental or
emotional condition

Offenders between ages 45 and 54
were the most likely to be identified as
mentally ill. About 20% of State prisoners, 10% of Federal prisoners, 23% of
jail inmates, and 21% of probationers
between ages 45 and 54 had a mental
illness, compared to 14% of State
inmates, 7% of Federal inmates, 13%
of jail inmates, and 14% of probationers age 24 or younger.

Table 2. Mental health status of inmates and probationers

Nearly a quarter of white State prison
and local jail inmates and a fifth of
white offenders on probation were
identified as mentally ill (table 4). The
rate of mental illness among black and
Hispanic inmates and probationers was
much lower. Among black offenders,

Identified as mentally ill

Offender mental illness highest
among the middle-aged

62,100
60,500

Offender
characteristic
Gender
Male
Female

Percent identified as mentally ill
State
Federal
Jail
Probainmates
inmates
tioners
inmates
15.8%
23.6

7.0%
12.5

15.6%
22.7

14.7%
21.7

22.6%
13.5
11.0

11.8%
5.6
4.1

21.7%
13.7
11.1

19.6%
10.4
9.0

14.4%
14.8
18.4
19.7
15.6

6.6%
5.9
7.5
10.3
8.9

13.3%
15.7
19.3
22.7
20.4

13.8%
13.8
19.8
21.1
16.0

473,000
281,200

*Based on midyear 1998 counts from the National Prisoner Statistics
and Annual Survey of Jails and preliminary yearend 1998 counts from
the Annual Probation Survey.

Race/Hispanic origin
White*
Black*
Hispanic
Age
24 or younger
25-34
35-44
45-54
55 or older
*Excludes Hispanics.

Mental Health and Treatment of Inmates and Probationers 3

Mentally ill more likely than other
offenders to have committed a
violent offense
Fifty-three percent of mentally ill State
prisoners, compared to 46% of other
State prisoners, were incarcerated for a
violent crime (table 5). Approximately
13% of the mentally ill in State prison
had committed murder; 12%, sexual
assault; 13%, robbery; and 11%,
assault. Among inmates in Federal
prison, 33% of the mentally ill were
incarcerated for a violent offense,
compared to 13% of other Federal
inmates. More than 1 in 5 mentally ill
Federal prisoners had committed
robbery (predominantly bank robbery).
Among inmates in local jails, 30% of
the mentally ill had committed a violent
offense, compared to 26% of other jail
inmates. An estimated 28% of mentally
ill probationers and 18% of other probationers reported their current offense
was a violent crime.
Nearly 1 in 5 violent offenders incarcerated or on probation were identified as
mentally ill.

6 in 10 violent mentally ill State
prisoners knew their victim

Victim characteristics and use
of weapon, by mental health status
of violent State prisoners

Mentally ill inmates who were incarcerated for a violent offense were
more likely to report that the victim of
the offense was a woman, someone
they knew, and under age 18. Nearly
61% of mentally ill State prison
inmates who had committed a
violent offense knew their victim.
An estimated 16% had victimized a
relative and 12% an intimate, such
as a spouse, ex-spouse, boyfriend,
or girlfriend.

Mentally
ill
Other
inmates inmates

More than half of the mentally ill
reported that they had victimized a
female during the current offense.
An estimated 15% reported that their
youngest victim was a child, age 12
or under, and 12% reported the
victim to be between ages 13
and 17. A weapon was used by 44%
of the violent State prisoners who
were mentally ill.

Percent mentally ill
among violent offenders
State prison inmates
18.2%
Federal prison inmates
16.6
Jail inmates
18.5
Probationers
22.8

or on probation had committed a
property or public-order offense.
Almost a third of mentally ill offenders
in jail and on probation had committed
a property offense, and a quarter had
committed a public-order offense.

Unlike those in State prisons, the
majority of mentally ill offenders in jail

Mentally ill offenders were less likely
than other inmates to be incarcerated

Gender of victim(s)
Male
Female
Both males and females

44.3%
44.0
11.7

51.5%
37.5
10.9

Age of youngest victim
12 or younger
13-17
18-24
25-34
35-54
55 or older

15.4%
11.6
17.3
25.7
23.8
6.2

10.2%
11.0
20.7
30.9
22.8
4.3

Victim-offender relationship
Knew victima
60.8%
Relative
15.6
Intimateb
11.6
Friend/acquaintance
29.8
Otherc
6.5
Knew none of victims
39.1

52.1%
10.3
8.6
27.7
6.9
47.9

Use of weapon
Yes
44.0% 41.9%
No
56.0
58.1
a
More than one victim may have been
reported.
b
Includes spouse, ex-spouse, boyfriend,
girlfriend, ex-boyfriend, and ex-girlfriend.
c
Includes those known by sight only.

for a drug offense. About 13% of
mentally ill inmates and 22% of other
inmates in State prison were incarcerated for a drug offense. In Federal
prison, where the majority of inmates
are incarcerated for a drug offense,
40% of those identified as mentally ill
and 64% of other Federal inmates were
in prison for a drug-related crime.

Table 5. Most serious current offense of inmates and probationers, by mental health status

Most serious offense
All offenses

State prison
Mentally ill
Other
inmates
inmates
100.0 %
100.0%

Federal prison
Local jail
Mentally ill
Other
Mentally ill
Other
inmates
inmates
inmates
inmates
100.0%
100.0%
100.0%
100.0%

Probation
Mentally ill Other
probationers probationers
100.0%
100.0%

Violent offenses
Murder*
Sexual assault
Robbery
Assault

52.9 %
13.2
12.4
13.0
10.9

46.1%
11.4
7.9
14.4
9.0

33.1%
1.9
1.9
20.8
3.8

13.3%
1.4
0.7
9.1
1.1

29.9%
3.5
5.2
4.7
14.4

25.6%
2.7
2.8
6.9
11.0

28.4%
0.5
6.8
2.0
14.0

18.4%
0.9
4.1
1.4
10.5

Property offenses
Burglary
Larceny/theft
Fraud

24.4 %
12.1
4.6
3.1

21.5%
10.5
4.1
2.6

8.7%
1.0
1.3
5.0

6.7%
0.3
0.4
4.9

31.3%
9.1
8.4
5.2

26.0%
7.4
7.9
4.4

30.4%
6.4
5.3
11.7

28.5%
4.3
8.8
9.2

Drug offenses
Possession
Trafficking

12.8 %
5.7
6.6

22.2%
9.4
12.2

40.4%
3.9
35.7

64.4%
11.9
46.6

15.2%
7.3
7.0

23.3%
12.3
9.6

16.1%
7.2
6.7

20.7%
11.0
9.2

9.9 %

9.8%

17.0%

14.6%

23.2%

24.6%

24.7%

31.6%

Public-order offenses

Note: Detail does not sum to total because of excluded offense categories.
*Includes nonnegligent manslaughter.

4 Mental Health and Treatment of Inmates and Probationers

Half of mentally ill inmates reported
3 or more prior sentences
Mentally ill inmates reported longer
criminal histories than other inmates.
Among the mentally ill 52% of State
prisoners, 54% of jail inmates, and 49%
of Federal inmates reported three or
more prior sentences to probation or
incarceration (table 6). Among other
inmates, 42% of State prisoners and
jail inmates and 28% of Federal
inmates had three or more prior
sentences. About 10% of mentally ill
prison inmates and 13% of jail inmates
reported 11 or more prior sentences.
Mentally ill more likely than other
inmates to be violent recidivists
Among repeat offenders, 53% of
mentally ill State inmates had a current
or past sentence for a violent offense,
compared to 45% of other inmates.
Forty-six percent of mentally ill jail
inmates and 32% of other jail inmates
with a criminal history had a current or
past sentence or current charge for a
violent crime. Among Federal prisoners with a prior sentence, the mentally
ill (44%) were twice as likely as other
inmates (22%) to have a current or
prior sentence for a violent offense.
Although offenders on probation had
shorter criminal histories, nearly 3 in 10
of the mentally ill were recidivists with
a current or past sentence for violence.
Probationers
Mentally ill
Other
Criminal history
None
Priors
Violent recidivists
Other recidivists

43.4%
56.6
29.1
27.6

54.1%
45.9
17.1
28.8

Homelessness more prevalent
among mentally ill offenders
Mentally ill offenders reported high
rates of homelessness, unemployment,
alcohol and drug use, and physical and
sexual abuse prior to their current
incarceration. During the year preceding their arrest, 30% of mentally ill
inmates in jail and 20% of those in
State or Federal prison reported a
period of homelessness, when they
were living either on the street or in a

shelter (table 7). About 9% of other
State prison inmates, 3% of other
Federal inmates and 17% of other jail
inmates reported a period a homelessness in the year prior to their arrest.
Fewer inmates reported they were
homeless at the time of arrest. About
4% of mentally ill State and Federal
prison inmates and 7% of jail inmates
reported they were living on the street
or in a shelter when arrested for their
current offense. These rates were at
least double those for inmates who
were not mentally ill.
About 4 in 10 inmates with a mental
condition unemployed before arrest

in the month before arrest. About 38%
of mentally ill State and Federal prison
inmates and 47% of mentally ill jail
inmates were not employed in the
month before arrest, while 30% of other
State inmates, 28% of other Federal
inmates, and 33% of other jail inmates
were unemployed.
An estimated 30% of mentally ill and
13% of other inmates in State prison
received some type of financial support
from government agencies prior to their
arrest. More than 15% of the mentally
ill received welfare, 17% supplemental
security income or other pension, and
3% compensation payments, such as
unemployment or workman’s compensation.

Mentally ill offenders were less likely
than others to report they were working
Table 6. Criminal history of inmates, by mental health status
State prison
Federal prison
Mentally ill
Other Mentally ill
Other
inmates
inmates inmates
inmates
Criminal history
None
Priors
Violent recidivists
Other recidivists

Local jail
Mentally ill
Other
inmates
inmates

18.8%
81.2
53.4
27.8

21.2%
78.8
44.9
33.8

24.3%
75.7
43.7
32.0

38.8%
61.2
21.6
39.6

21.0%
79.0
46.0
33.0

28.4%
71.6
31.6
40.0

Number of prior probation/
incarceration sentences
0
18.8%
1
15.5
2
13.8
3 to 5
26.3
6 to 10
15.6
11 or more
10.0

21.2%
19.4
17.0
25.5
11.6
5.3

24.3%
14.0
12.9
23.6
15.4
9.7

38.8%
18.2
14.7
18.9
7.3
2.2

21.0%
14.7
10.1
23.5
17.6
13.2

28.4%
17.9
11.5
19.7
14.6
7.8

Table 7. Homelessness, employment, and sources of income of inmates,
by mental health status
State prison
Mentally ill
Other
inmates
inmates

Federal prison
Local jail
Mentally ill
Other
Mentally ill Other
inmates
inmates inmates
inmate

Homeless
In year before arrest
At time of arrest

20.1%
3.9

8.8%
1.2

18.6%
3.9

3.2%
0.3

30.3%
6.9

17.3%
2.9

Employed in month
before arrest
Yes
No

61.2%
38.8

69.6%
30.4

62.3%
37.7

72.5%
27.5

52.9%
47.1

66.6%
33.4

Sources of incomea
Wages
Family/friends
Illegal sources
Welfare
Pensionb
Compensation payments

56.7%
22.0
23.4
15.4
17.3
3.1

65.6%
17.7
27.0
7.8
4.1
1.9

54.0%
20.1
22.5
13.7
16.5
4.7

66.4%
12.3
28.8
3.9
3.7
1.8

62.9%
19.7
19.4
21.9
18.4
3.0

77.1%
15.4
14.4
12.3
4.9
2.1

a

Detail sums to more than 100% because offenders may have reported more than one
source of income. For prisoners detail includes any income received in the month prior
to arrest. For jail inmates, detail includes any income received in the year prior to arrest.
b
Includes Supplemental Security Income, Social Security, or other pension.

Mental Health and Treatment of Inmates and Probationers 5

Over half of mentally ill prison and jail
inmates reported wages as their source
of income prior to arrest, 23% of prison
inmates and 20% of jail inmates
reported income from illegal sources.
Offenders on probation were asked
about their current employment and
sources of income in the past year.
Over half of mentally ill probationers
and three-quarters of other probationers were currently employed. An
estimated 52% of mentally ill probationers and 27% of other probationers said
they received income from government
agencies in the past year.
Probationers
Mentally ill
Other
Currently employed
Yes
No

55.9%
44.1

75.9%
24.1

Sources of income*
Wages
69.3%
86.8%
Family/friends
17.9
16.3
Welfare
26.4
15.5
Pension
24.5
7.6
Compensation
payments
10.2
7.7
*More than one source of income may have
been reported.

Family history of incarceration and
alcohol or drug use prevalent
among mentally ill

or drugs while they were growing up.
About 42% reported alcohol abuse by a
parent or guardian, and 13% reported
drug abuse.

Overall, 55% of mentally ill State prison
inmates, 42% of Federal prisoners,
52% of jail inmates, and 40% of probationers reported a family member had
been incarcerated at some point (table
8). About 47% of other State prison
inmates, 39% of other Federal inmates,
45% of other jail inmates, and 34% of
other probationers reported a history
of family incarceration. Nearly a
quarter of mentally ill State inmates
said their father or mother had served
time in prison or jail; 42% said a brother
or sister had been incarcerated.
When compared with other inmates
and probationers, the mentally ill also
reported higher rates of alcohol and
drug abuse by a parent or guardian
while they were growing up. Approximately 4 in 10 mentally ill State prisoners, jail inmates, and probationers, and
1 in 3 Federal inmates reported their
parent or guardian had abused alcohol

At some point while growing up, a
quarter of mentally ill State prisoners
and local jail inmates lived in a foster
home, agency, or institution. One in six
mentally ill probationers reported living
in a foster home or institution for a
period of time during their childhood.
Mentally ill report high rates of past
physical and sexual abuse
Mentally ill male State prisoners were
more than twice as likely as other
males to report physical abuse prior to
admission to prison (27% versus 11%)
and nearly four times as likely to report
prior sexual abuse (15% versus 4%,
table 9). Among male inmates 25% of
the mentally ill in Federal prisons or in
jails reported prior physical abuse,
compared to 5% of other male Federal
inmates and 8% of other male jail
inmates. Mentally ill male probationers

Table 8. Family background of inmates and probationers, by mental health status
State prison
Federal prison
Local jail
Probation
Mentally ill
Other
Mentally ill
Other
Mentally ill
Other
Mentally ill Other
inmates
inmates
inmates
inmates inmates
inmates probationers probationers
Family member ever incarcerated
51.5%
45.1%
54.9%
46.5%
41.5%
38.5%
40.3%
34.0%
Parent
23.4
17.4
13.4
11.1
23.7
18.9
19.6
11.1
Brother/sister
41.8
36.5
29.5
29.9
36.2
32.8
25.7
25.6
While growing up —
Ever lived in a foster home,
agency, or institution

26.1%

12.2%

18.6%

5.8%

24.1%

11.5%

15.9%

6.5%

Parent or guardian abused
alcohol or drugs
Alcohol only
Drugs only
Both

30.6%
2.0
10.9

22.2%
1.8
5.7

24.6%
1.2
8.5

16.0%
0.8
2.8

29.3%
1.7
11.1

21.9%
1.2
6.1

32.4%
1.0
9.0

19.2%
0.4
2.4

Table 9. Prior physical or sexual abuse of inmates and probationers, by mental health status
State prison
Federal prison
Local jail
Probation
Mentally ill
Other
Mentally ill
Other
Mentally ill
Other
Mentally ill
Other
Reported by offender
inmates
inmates inmates
inmates inmates
inmates probationers
probationers
Ever abused before admission
36.9%
15.2%
34.1%
7.6%
36.5%
12.5%
38.8%
12.1%
Male
32.8
13.1
30.0
5.5
30.7
9.6
31.0
6.5
Female
78.4
50.9
64.1
36.1
72.9
40.3
59.4
35.7
Physically abused
Male
Female

31.0%
27.4
67.6

12.5%
10.8
40.2

27.5%
24.5
50.0

6.4%
4.7
29.4

30.0%
25.3
59.8

10.1%
8.0
30.8

28.1%
21.0
46.7

9.8%
5.1
29.7

Sexually abused
Male
Female

19.0%
15.0
58.9

5.8%
4.1
33.1

15.6%
11.6
45.0

2.7%
1.5
19.3

23.5%
17.2
63.4

5.9%
3.4
29.6

21.9%
14.2
42.3

5.8%
2.4
19.9

6 Mental Health and Treatment of Inmates and Probationers

Table 10. Prior alcohol and drug use of inmates and probationers, by mental health status
Alcohol/drug use
reported by offender
Alcohol/drug use
At time of offense

State prison
Mentally ill
Other
inmates
inmates

Federal prison
Mentally ill
Other
inmates
inmates

Local jail
Mentally ill
Other
inmates
inmates

Probation
Mentally ill Other
probationers probationers

58.7%

51.2%

46.5 %

33.0%

64.6%

56.5%

49.0%

46.4%

Drug use
In month before offense
At time of offense

58.8%
36.9

56.1%
31.7

48.1 %
29.3

44.6%
21.9

57.6%
38.8

47.3%
30.4

39.5%
18.1

30.3%
12.6

Alcohol use
At time of offense

42.7%

36.0%

27.9 %

19.8%

44.3%

36.0%

41.4%

39.7%

were 4 times as likely as other probationers to report prior physical abuse
(21% and 5%, respectively).
The rate of physical abuse reported
by mentally ill female inmates was over
twice that reported by males. Nearly
70% of female State prisoners, 50%
of female Federal prisoners, 60% of
female jail inmates, and 47% of female
probationers reported a history of
physical abuse.
Nearly 60% of female mentally ill State
prisoners, 45% of female Federal
prisoners, 63% of female jail inmates
and 42% of female probationers
reported prior sexual abuse.
6 in 10 mentally ill State inmates
under the influence of alcohol or
drugs at time of offense
Mentally ill inmates were more likely
than others to be under the influence of
alcohol or drugs while committing their

current offense. About 60% of mentally
ill and 51% of other inmates in State
prison were under the influence of
alcohol or drugs at the time of their
current offense (table 10). Rates of
alcohol and drug use at the time of the
offense were even higher among mentally ill jail inmates, where 65% of the
mentally ill and 57% of other jail
inmates were under the influence.
Among probationers, 49% of the
mentally ill and 46% of others reported
alcohol or drug use at the time of the
offense.

A third of mentally ill offenders
alcohol dependent
Based on the CAGE diagnostic instrument, 34% of mentally ill State prison
inmates, 24% of Federal prisoners,
38% of jail inmates and 35% of
mentally ill probationers exhibited a
history alcohol dependence (table 11).

CAGE is an acronym for four questions
used by the diagnostic instrument to
assess alcohol dependence or abuse.
Respondents are asked if they have
ever attempted to (C)ut back on drinkLike other inmates and probationers,
ing; ever felt (A)nnoyance at others’
the mentally ill were more often under
criticism of their drinking; ever experithe influence of alcohol than drugs at
enced feelings of (G)uilt about drinking;
the time of the current offense. About
and ever needed a drink first thing in
43% of mentally ill State prison inmates the morning as an (E)ye opener or to
and 44% of jail inmates had been drink- steady their nerves. A person’s likeliing when they committed their current
hood of alcohol abuse is assessed by
offense. Thirty-six percent of other
the number of positive responses to
inmates in prison and jail reported they these four questions. Clinical tests
were drinking at the time of the offense. involving hospital admissions, found

Table 11. Alcohol dependence and experiences of inmates and probationers while under the influence of alcohol,
by mental health history

History of alcohol dependence*

State prison
Federal prison
Local jail
Probation
Mentally ill
Other
Mentally ill
Other
Mentally ill
Other
Mentally ill
Other
inmates
inmates
inmates inmates
inmates
inmates probationers Probationers
34.4%
22.4%
23.9%
15.6%
37.9%
24.3%
34.8%
22.1%

Because of your drinking, have you ever &
Lost a job?
16.7%

9.0%

8.7%

4.7%

18.0%

10.3%

19.4%

5.3%

Had job or school trouble
(such as demotion at work or
dropping out of school)?

24.0

13.8

15.4

7.1

--

--

25.2

10.5

Been arrested or held at a police
station?

35.2

28.3

30.7

18.3

41.5

30.7

45.7

41.1

45.7%

37.0%

36.4%

21.7%

49.8%

34.1%

43.9%

30.3%

48.8

39.5

43.9

29.2

52.9

38.0

45.7

33.7

While drinking have you ever &
Gotten into a physical fight ?
Had as much as a fifth of liquor
in 1 day, 20 drinks, 3 six-packs
of beer, or 3 bottles of wine?

--Not asked of jail inmates.
*Measured by 3 or more positive CAGE responses. For description of the CAGE diagnostic measure see text.

Mental Health and Treatment of Inmates and Probationers 7

three or more positive CAGE
responses carried a .99 predictive
value for alcohol abuse or dependence.
(See Substance Abuse and Treatment,
State and Federal Prisoners, 1997,
BJS Special Report, NCJ 172871, for
additional information on the CAGE
instrument.)
Mentally ill inmates and probationers
were more commonly alcohol dependent, reporting three or more positive
CAGE responses. About 38% of
mentally ill jail inmates reported signs
of alcohol dependence, while 24% of
other jail inmates reported signs of
dependence. Among State prison
inmates, 34% of the mentally ill and
22% of other inmates reported three or
more positive responses.
Mentally ill offenders report negative
life experiences related to drinking
In response to questions concerning
their life experiences with alcohol,
about 17% of mentally ill and 9% of
other inmates in State prison said they
had lost a job due to drinking. Among
jail inmates with a mental condition,
18% had lost a job due to drinking,
while 10% of other jail inmates reported
losing a job. Nearly 20% of mentally ill
probationers had lost a job; 5% of other
probationers.
Amid other alcohol-related problems
reported by the mentally ill, 35% of
State prisoners had been arrested or
held at a police station due to drinking,
and 46% had gotten into a fight while
drinking. Forty-nine percent of mentally
ill State prison inmates, 44% of Federal
inmates, 53% of jail inmates, and 46%
of mentally ill probationers said they
had consumed as much as a fifth of
liquor (about 20 drinks) in 1 day.
Mentally ill jail inmates more often
reported a prior stay in a detoxification
unit for alcohol or drugs. An estimated
22% of the mentally ill in jail and 11%
of other inmates reported they had
been put in a detoxification unit.

Table 12. Maximum sentence length and time served by inmates,
by offense and mental health status
Mean maximum
sentence lengtha
Most serious
Mentally ill Other
offense
inmates
inmates
Local jail inmates
All offenses
20 mo
26 mo
Violent
Property
Drug
Public-order
Other

Mean time served
Total time to be served
To date of interview
until releaseb
Mentally ill Other
Mentally ill Other
inmates
inmates
inmates
inmates
6.5 mo

6.7 mo

8.7 mo

10.7 mo

30 mo
26
18
8
10

37 mo
26
25
20
8

8.8 mo
5.3
8.9
5.0
8.4

9.3 mo
8.0
8.4
3.3
1.6

14.7 mo
7.4
8.6
7.0
10.0

16.0 mo
11.6
13.5
5.7
5.3

State prison inmates
All offenses
171 mo

159 mo

54.4 mo

49.3 mo

103.4 mo

88.2 mo

Violent
Property
Drug
Public-order
Other

225 mo
118
111
81
104

71.8 mo
38.8
30.3
29.1
32.5

69.7 mo
36.6
28.5
27.8
47.8

142.5 mo 130.7 mo
75.0
62.2
49.8
49.5
50.8
47.6
60.1
80.6

230 mo
128
103
83
120

Note: Because data on sentence length and time served are restricted to persons in prison
and jail, they overstate the average sentence and time to be served by those entering prison
or jail. Persons with shorter sentences leave prison and jail more quickly, resulting in a
longer average sentence among persons in the inmate samples.
a
Based on the total maximum sentence for all consecutive sentences.
b
Based on time served when interviewed plus time to be served
until the expected date of release.

Mentally ill expected to serve 15
months longer than other inmates
in prison
Overall, mentally ill State prison
inmates were sentenced to serve an
average of 171 months in prison, or
about 12 months longer than other
offenders (table 12). On average,
violent offenders with a mental illness
were sentenced to 230 months
(5 months longer than other violent
inmates) and property offenders 128
months (10 months longer than other
inmates).
Mentally ill jail inmates typically had
sentences shorter than other jail
inmates. On average, mentally ill
inmates had a maximum sentence of
20 months, while other inmates an
average of 26 months. Violent, drug,
and property offenders identified as
mentally ill had average sentences that
were 6 to 12 months shorter than other
offenders.

8 Mental Health and Treatment of Inmates and Probationers

On average, mentally ill inmates in
State prison are expected to serve
more time in prison than other inmates.
From the time of admission to prison to
the time of the survey, mentally ill
offenders had served on average 5
months longer than other offenders in
State prison. Based on the time of
admission to the time of expected
release, mentally ill offenders expected
to serve a total of 103 months in prison,
15 months longer than other offenders.
The largest differences in time served
were among violent and property
offenders. The mentally ill expected
to serve an average of at least 12
additional months for violent and
property offenses.
Unlike State prisoners, mentally ill
inmates in local jails expected to serve
less time than inmates who are not
mentally ill. Overall, both mentally ill jail
inmates and other inmates had served
about 6½ months from the time of
admission to the time of the survey.
On average, mentally ill inmates
expected to serve a total of 9 months
in jail prior to release; other inmates
expected to serve about 11 months.

Disciplinary problems common
among mentally ill inmates
Mentally ill inmates in State or Federal
prison, as well as those in jail, were
more likely than others in those facilities to have been involved in a fight, or
hit or punched since admission.
Among State prisoners 36% of mentally
ill inmates reported involvement in a
fight, compared to 25% of other
inmates (table 13). Mentally ill inmates
in Federal prison were over twice as
likely as others to report involvement in
a fight (21% compared to 9%).
Twenty-four percent of mentally ill State
prison inmates had been involved in
two or more fights since admission, and
12% reported involvement in four or
more fights. Among jail inmates 10%
of the mentally ill had been involved in
two or more fights, compared 6% of
those not mentally ill.
Consistent with their more frequent
involvement in fights, disciplinary
problems were more common among
mentally ill inmates than other inmates.
More than 6 in 10 mentally ill State
prison inmates had been formally
charged with breaking prison rules
since admission. About half of other
inmates reported they had been
charged with breaking the rules.
Among Federal prison inmates 41%
of the mentally ill had been charged
with a rule violation, compared to 33%
of inmates not identified as mentally ill.
6 in 10 mentally ill received treatment while incarcerated
An estimated 60% of the mentally ill in
State and Federal prison received
some form of mental health treatment
during their current period of incarceration (table 14). Fifty percent said they
had taken prescription medication; 44%
had received counseling or therapy;
and 24% had been admitted overnight
to a mental hospital or treatment
program.

since admission. The majority of those
receiving treatment (34%) had been
given medication. Fewer jail inmates
(16%) than State prisoners (44%) said
they had received counseling or
therapy since admission.
Just over half of mentally ill probationers had received treatment since their
sentence to community supervision.
Counseling was the most common
form of treatment (44%), followed
by medication (37%), and an overnight
stay in a mental hospital or treatment
program (12%).
When sentenced to probation, an
offender may be required by the court
or probation agency to meet various
conditions of the sentence, such as
maintaining employment, submitting to
drug testing, or participating in treatment. An estimated 13% of probationers were required to seek mental health
treatment as a condition of their
sentence. Forty-three percent of those
required to participate in treatment had
done so by the time of the survey.

Female mentally ill more likely than
males to report treatment
Nearly 70% of mentally ill females in
State prison, 77% of those in Federal
prison, and 56% in local jails received
mental health services while incarcerated, while 60% of males in State
prison, 57% in Federal prison, and 38%
in local jails reported treatment.
White mentally ill inmates reported
higher rates of treatment than black
or Hispanic offenders. About 64%
of white State prison inmates identified
as mentally ill had received treatment,
compared to 56% of black offenders
and 60% of Hispanic offenders.
Percent of mentally ill receiving mental health services
State
Federal Local
prison prison
jail
Gender
Male
Female

59.9%
67.3

57.4%
76.5

38.4%
56.2

Race/
Hispanic origin
White
Black
Hispanic

64.1%
56.4
59.9

65.4%
50.0
62.5

44.7%
34.2
40.6

Table 13. Fights since admission and violation of prison or jail rules,
by mental health status
Discipline problem
reported by inmate
Number of fights
since admission
None
1
2 to 3
4 or more

State prison
Mentally ill
Other
inmates
inmates

Charged with breaking
prison or jail rules

Federal prison
Mentally ill
Other
inmates
inmates

Local jail
Mentally
Other
inmates
inmates

64.3%
11.4
12.8
11.5

75.6%
9.6
7.8
7.1

79.4%
11.6
5.2
3.8

90.9%
5.2
2.5
1.4

80.9%
9.4
7.0
2.6

86.7%
7.0
4.1
2.3

62.2%

51.9%

41.2%

32.7%

24.5%

16.0%

Table 14. Mental health treatment in prison or jail or on probation
for those identified as mentally ill
Percent of mentally ill offenders
State
Federal
Local
Probation
prison
prison
jail
Since admission, the offender had &
Been admitted overnight to a
mental hospital or treatment program

23.6%

24.0%

9.3%

12.2%

Taken a prescribed medication

50.1

49.1

34.1

36.5

Received counseling or therapy

44.1

45.6

16.2

44.1

Received any mental health service

60.5

59.7

40.9

56.0

Among jail inmates, 41% of those
identified as mentally ill had received
some form of mental health services

Mental Health and Treatment of Inmates and Probationers 9

Overall, 17% of inmates in State prison,
10% in Federal prison, 11% in local
jails, and 12% of those on probation
had received some form of mental
health services since their current
admission to prison or jail or sentence
to probation. The most common form
of treatment in local jails was medication, reported by 9% of inmates.
Probationers were more likely to have
received counseling (10%) than to have
taken medication (6%) while under
supervision. Among State prison
inmates 12% said they received
medication while incarcerated, and
12% participated in counseling or
therapy.
Percent of all offenders
who received mental
treatment
State prison inmates
Federal prison inmates
Local jail inmates
Probationers

Methodology

Accuracy of the estimates

Data in this report are based on
personal interviews conducted through
three BJS surveys, the 1997 Survey of
Inmates in State and Federal Correctional Facilities, the 1996 Survey of
Inmates in Local Jails, and the 1995
Survey of Adults on Probation.
Detailed descriptions of the methodology and sample design of each survey
can be found in the following:
Substance Abuse and Treatment of
Adults on Probation, 1995 (NCJ
166611); Profile of Jail Inmates, 1996
(NCJ 164629); and Substance Abuse
and Treatment of State and Federal
Prisoners, 1997 (NCJ 172871).

The accuracy of the estimates
presented in this report depends on two
types of error: sampling and nonsampling. Sampling error is the variation
that may occur by chance because a
sample rather than a complete numeration of the population was conducted.
Nonsampling error can be attributed to
many sources, such as nonreponses,
differences in the interpretation of
questions among inmates, recall difficulties, and processing errors. In any
survey the full extent of the nonsampling error is never known. The
sampling error, as measured by an
estimated standard error, varies by the
size of the estimate and the size of the
base population. Estimates of the
standard errors for selected characteristics have been calculated for each
survey (see appendix tables). These
standard errors may be used to
construct confidence intervals around
percentages. For example, the 95%
confidence interval around the percentage of State prison inmates who were
identified as mentally ill is approximately 16.2% plus or minus 1.96 times
0.40% (or 15.4% to 16.9%).

17.4%
10.0
11.4
11.5

Appendix table 1. Standard errors of mental health status
for inmates and probationers
State prison
inmates

Estimated standard errors
Federal prison Jail
inmates Probationers
inmates

Identified as mentally ill

0.40%

0.55%

0.61%

0.89%

Reported a mental
or emotional condition

0.33

0.45

0.54

0.84

Because of a mental or emotional
problem, inmate had —
Been admitted to
a hospital overnight

0.34

0.45

0.47

0.67

These standard errors may also be
used to test the statistical significance
of the difference between two sample

Appendix table 2. Standard errors of selected characteristics of mentally ill inmates and probationers

Selected
characteristic
Current offense
Violent
Property
Drug
Public-order

State prison
Mentally ill
Other
inmates
inmates

Estimated standard errors
Local jail
Federal prison
Mentally ill
Other
Mentally ill
Other
inmates
inmates
inmates
inmates

Probation
Mentally ill Other
probationers probationers

1.36%
1.17
0.91
0.81

0.60%
0.49
0.50
0.36

3.65%
2.19
3.81
2.92

0.75%
0.55
1.05
0.78

1.71%
1.64
1.23
1.55

0.84%
0.76
0.72
0.83

2.74%
2.79
2.23
2.62

1.03%
1.20
1.08
1.24

Criminal history
Any priors

1.06

0.49

3.33

1.07

1.47

0.89

3.03

1.35

Alcohol/drug use
at time of offense

1.35

0.60

3.88

1.04

2.17

1.14

3.04

1.33

History of alcohol dependence

1.29

0.50

3.32

0.79

1.72

0.74

2.89

1.10

Ever abused
Males
Females

1.37
1.93

0.43
1.30

3.92
5.63

0.52
4.03

2.14
2.38

0.52
1.46

3.24
5.92

0.72
3.03

Involved in fight or was hit
or punched after admission

1.31

0.52

3.16

0.63

1.48

0.60

---

---

Homeless
In year before arrest
At time of arrest

1.09
0.52

0.34
0.13

3.01
1.50

0.38
0.12

0.91
1.69

0.26
0.63

---

---

10 Mental Health and Treatment of Inmates and Probationers

statistics by pooling the standard errors
of the two sample estimates. For
example, the standard error of the
difference between mentally ill State
prisoners and other inmates who were
incarcerated for a violent offense would
be 1.49% (or the square root of the
sum of the squared standard errors for
each group). The difference would be
1.96 times 1.49 (or 2.91%). Since the
difference of 6.8% (52.9% minus
46.1%) is greater than 2.91%, the
difference would be considered statistically significant.

Appendix table 3. Standard errors of mental health treatment in prison,
jail or on probation for those identified as mentally ill
Percent of mentally ill offenders
State
Federal
Local
Probation
prison
prison
jail
Since admission, the offender had &
Been admitted overnight to a
mental hospital or treatment program

1.15%

3.32%

1.01%

2.00%

Taken a prescribed medication

1.36

3.91

2.22

2.90

Received counseling or therapy

1.35

3.88

1.26

3.03

Received any mental health service

1.33

3.84

2.16

3.03

References

Estimating the number of mentally
ill offenders under correctional
supervision

Guy, Edward; Jerome Platt; Israel Zwerling; and Samuel Bullock.
“Mental health status of prisoners in an urban jail.” Criminal Justice and
Behavior. 12(1), 29-53, March 1985.

Estimates of the total number of
persons in prison, jail and on probation
with a mental illness were obtained by
multiplying the ratio of inmates or
probationers identified as mentally ill
from the personal interviews conducted
in the three BJS surveys referenced
above, by the total number of inmates
in State prison, Federal prison, and
local jails and the total number of
offenders on probation.

Monahan, John. “Clinical and Actuarial Predictions of Violence” in Faigman, D
and others, eds. Modern Scientific Evidence: The Law and Science of Expert
Testimony, vol. 1. St. Paul, MN: West Publishing Company, 1997.

For example, the total number of State
prison inmates with a mental illness
was estimated by multiplying the ratio
of mentally ill offenders in State prison
(16.2%) obtained from the 1997 Survey
of Inmates in State Correctional Facilities, by the total State prison custody
population at midyear 1998 (1,102,653)
from the National Prisoner Statistics
data collection.

Mumola, Christopher. Substance Abuse and Treatment, State and Federal
Prisoners, 1997. BJS Special Report, NCJ 172871, December 1998.
Powell, Thomas A.; John C. Holt; and Karen M. Fondacaro. “The Prevalence
of Mental Illness among Inmates in a Rural State.” Law and Human Behavior.
21(4), 427-438, August 1997.
Robins, Lee N., and Darrel A. Regier. Psychiatric Disorders in America: The
Epidemiologic Catchment Area Study. New York: Free Press, 1991.
Steadman, Henry; Stanley Fabisiak, Joel Dvoskin, and Edward Holohean.
“A Survey of Mental Disability among State Prison Inmates.” Hospital and
Community Psychiatry. 38(10), 1086-1090, 1989.
Teplin, Linda A. “The Prevalence of Severe Mental Disorder among Male
Urban Jail Detainees: Comparison with the Epidemiologic Catchment Area
Program.” American Journal of Public Health. 80(6), 663-669, 1990.

Mental Health and Treatment of Inmates and Probationers 11

The Bureau of Justice Statistics
is the statistical agency of the
U.S. Department of Justice.
Jan M. Chaiken, Ph.D., is director.

This report and others from the
Bureau of Justice Statistics are available through the Internet &
http://www.ojp.usdoj.gov/bjs/

BJS Special Reports address a
specific topic in depth from one
or more data sets that cover many
topics.
Paula M. Ditton wrote this report
under the supervision of Allen J.
Beck. Christopher Mumola provided
statistical assistance. Tina Dorsey
and Tom Hester produced and edited
the report. Marilyn Marbrook,
assisted by Yvonne Boston,
prepared the report for publication.

The data from the 1997 Surveys of
Inmates in State and Federal Correction Facilities, the 1995 Survey of
Adults on Probation, and the 1996
Survey of Inmates in Local Jails are
available from the National Archive of
Criminal Justice Data, maintained by
the Institute for Social Research at
the University of Michigan, 1-800999-0960. The archive may also be
accessed through the BJS Internet
site.

July 1999, NCJ 174463

12 Mental Health and Treatment of Inmates and Probationers