New research shows that women detained in jails have substantially higher rates of psychiatric disorders_especially substance abuse and major depression_than women in general.

The results, published in the June issue of the AMA's Archives of General Psychiatry, showed that jailed women aged 26 to 50 had a lifetime prevalence of substance abuse four times greater than that for women in general and had about twice the rate of major depression.

Furthermore, about one-third of the jailed women met the criteria for PTSD regardless of their race, age, ethnicity, or education, which may be attributable to the fact that many of the women were victims of rape or other assaults.

The research subjects were 1,272 women detained in the Cook County jail in Chicago.

According to Cassandra Newkirk, M.D., a correctional mental health consultant in Caldwell, N.J., and former chair of APA's Committee on Psychiatric Services in Jails and Prisons, "PTSD has been greatly overlooked in incarcerated women. There has been a total insensitivity to a history of trauma."

The authors note that untreated trauma can have severe psychological and behavioral repercussions. Because PTSD in jailed women has been relatively unexplored, more in-depth research is needed, the authors state.

Providing adequate substance abuse services is critical because of the high rate_about 64 percent_of drug dependency or abuse in jailed women; heroin and cocaine use are serious problems in this population. The six-month prevalence rate was over 50 percent. The authors point out that underreporting of symptoms is endemic, especially for disorders such as drug abuse, so the true picture may be even more bleak.

In addition, the lifetime prevalence of major depressive episodes among jailed women (17 percent) is a significant problem because suicide is the second most common cause of death among inmates.

Newkirk commented, "This is the kind of information policymakers need when requesting more money for psychiatric services."

Although women make up a smaller percentage of the incarcerated population than men, they consume more services, said Newkirk. Moreover, the national female jail census has reached an all-time high of 50,000. There was a 138 percent increase between 1983 and 1989 compared with 78 percent for males during the same period, the researchers point out.

They suggest that the national "war on drugs" strategy mandating harsh penalties for drug crimes may be the reason for the high number of arrested women with substance abuse disorders. Twenty-three percent of the research subjects were arrested for drug-related offenses, noted the study.

Coauthor Karen Abram, Ph.D., emphasized to Psychiatric News that the majority of women with psychiatric disorders, including substance abuse disorders, committed nonviolent crimes involving property, prostitution, or traffic violations. "This is important because there are more treatment options for nonviolent offenders," said Abram, an assistant professor in the department of psychiatry at Northwestern University Medical School in Chicago.

The American Bar Association recommends that persons with mental disorders arrested for misdemeanors be diverted to a mental health facility, according to the authors. With appropriate community programs, nonviolent felons could be treated outside the jail after pretrial hearings.

Nonetheless, Abram noted that female detainees arrested for misdemeanors often remained in jail because they couldn't afford to pay the low bail or to hire an attorney.

Moreover, treatment outside of jails may be less available because "money is drying up in the community mental health sector, which usually provides care for this population," said Newkirk. "As a result, a lot more people end up in jail."

The authors conclude that since jails do not have the financial resources to address the growing mental health problems of inmates, "psychiatry and the criminal justice system must allocate resources and design programs to reach women diverted at arrest, who need treatment while in jail, and who need liaison with community programs after they are released."

(Psychiatric News, September 20, 1996)