Abstract
Background: The prevalence of mental illness, substance use disorders, and their dual diagnosis is disproportionately high among people in prisons compared to the community. Accurate prevalence estimates are required to inform resourcing of prison health services and reduce the risk of harm to people experiencing these conditions. Existing estimates, where available, often rely on only one data source.
Method: We used three data sources – self-reported history of diagnoses, in-prison medical records, and administrative data to estimate the prevalence of mental illness, substance use disorder, and dual diagnosis among two large cohorts of non-Indigenous and Aboriginal and Torres Strait Islander people in Australian prisons. We calculated population-weighted proportions of the samples with each condition. Inter-rater reliability metrics inform data source agreement.
Results: The prevalence of mental illness only, substance use disorder only, and dual diagnosis was 17.0% (95%CI 12.0–24.5), 14.8% (95%CI 9.6–18.1), and 44.2% (95%CI 33.2–54.7), respectively, for incarcerated, non-Indigenous adults. For incarcerated Aboriginal and Torres Strait Islander adults, our corresponding estimates were 7.0% (95%CI 4.3–11.5), 26.8% (95%CI 18.9–33.5), and 40.9% (95%CI 30.1–48.2). These estimates differed significantly from those derived from singular data sources. Individual data sources’ agreement was weakest for substance use disorder diagnoses and strongest for dual diagnoses.
Conclusions: Individual data sources likely have high specificity and low sensitivity, thus under-ascertaining diagnoses. We recommend using multiple data sources to estimate prevalence to ensure adequate ascertainment of these conditions among people in prison and to ensure in-prison and transitional health services are appropriately resourced."
Abstract
Background: The prevalence of mental illness, substance use disorders, and their dual diagnosis is disproportionately high among people in prisons compared to the community. Accurate prevalence estimates are required to inform resourcing of prison health services and reduce the risk of harm to people experiencing these conditions. Existing estimates, where available, often rely on only one data source.
Method: We used three data sources – self-reported history of diagnoses, in-prison medical records, and administrative data to estimate the prevalence of mental illness, substance use disorder, and dual diagnosis among two large cohorts of non-Indigenous and Aboriginal and Torres Strait Islander people in Australian prisons. We calculated population-weighted proportions of the samples with each condition. Inter-rater reliability metrics inform data source agreement.
Results: The prevalence of mental illness only, substance use disorder only, and dual diagnosis was 17.0% (95%CI 12.0–24.5), 14.8% (95%CI 9.6–18.1), and 44.2% (95%CI 33.2–54.7), respectively, for incarcerated, non-Indigenous adults. For incarcerated Aboriginal and Torres Strait Islander adults, our corresponding estimates were 7.0% (95%CI 4.3–11.5), 26.8% (95%CI 18.9–33.5), and 40.9% (95%CI 30.1–48.2). These estimates differed significantly from those derived from singular data sources. Individual data sources’ agreement was weakest for substance use disorder diagnoses and strongest for dual diagnoses.
Conclusions: Individual data sources likely have high specificity and low sensitivity, thus under-ascertaining diagnoses. We recommend using multiple data sources to estimate prevalence to ensure adequate ascertainment of these conditions among people in prison and to ensure in-prison and transitional health services are appropriately resourced."
Background
Mental health conditions, substance use disorders, and their combined occurrence are more common in prisons than in the general public. Accurate estimates are needed to properly fund prison health services and reduce harm to people with these conditions. Current estimates, when available, often use only one type of data.
Method
This study used three data sources: self-reported diagnoses, medical records from within prisons, and administrative information. These sources helped estimate how common mental illness, substance use disorder, and both conditions were among two large groups of individuals in Australian prisons – both non-Indigenous and Aboriginal and Torres Strait Islander people. The proportion of people with each condition was calculated, adjusted for population weighting. Measures of how well the data sources agreed with each other were also determined.
Results
For non-Indigenous adults in prison, the rates were: mental illness only at 17.0% (95%CI 12.0–24.5), substance use disorder only at 14.8% (95%CI 9.6–18.1), and dual diagnosis at 44.2% (95%CI 33.2–54.7). Among incarcerated Aboriginal and Torres Strait Islander adults, the corresponding estimates were: mental illness only at 7.0% (95%CI 4.3–11.5), substance use disorder only at 26.8% (95%CI 18.9–33.5), and dual diagnosis at 40.9% (95%CI 30.1–48.2). These figures significantly differed from estimates that used only one data source. Agreement between individual data sources was lowest for substance use disorder diagnoses and highest for dual diagnoses.
Conclusions
It is likely that single data sources are good at confirming a condition when it exists (high specificity) but not good at identifying all cases (low sensitivity), leading to an undercounting of diagnoses. To properly identify these conditions among people in prison and ensure that health services within prisons and during transitions are well-funded, it is recommended that multiple data sources be used for prevalence estimation.
Abstract
Background: The prevalence of mental illness, substance use disorders, and their dual diagnosis is disproportionately high among people in prisons compared to the community. Accurate prevalence estimates are required to inform resourcing of prison health services and reduce the risk of harm to people experiencing these conditions. Existing estimates, where available, often rely on only one data source.
Method: We used three data sources – self-reported history of diagnoses, in-prison medical records, and administrative data to estimate the prevalence of mental illness, substance use disorder, and dual diagnosis among two large cohorts of non-Indigenous and Aboriginal and Torres Strait Islander people in Australian prisons. We calculated population-weighted proportions of the samples with each condition. Inter-rater reliability metrics inform data source agreement.
Results: The prevalence of mental illness only, substance use disorder only, and dual diagnosis was 17.0% (95%CI 12.0–24.5), 14.8% (95%CI 9.6–18.1), and 44.2% (95%CI 33.2–54.7), respectively, for incarcerated, non-Indigenous adults. For incarcerated Aboriginal and Torres Strait Islander adults, our corresponding estimates were 7.0% (95%CI 4.3–11.5), 26.8% (95%CI 18.9–33.5), and 40.9% (95%CI 30.1–48.2). These estimates differed significantly from those derived from singular data sources. Individual data sources’ agreement was weakest for substance use disorder diagnoses and strongest for dual diagnoses.
Conclusions: Individual data sources likely have high specificity and low sensitivity, thus under-ascertaining diagnoses. We recommend using multiple data sources to estimate prevalence to ensure adequate ascertainment of these conditions among people in prison and to ensure in-prison and transitional health services are appropriately resourced."
Background
Individuals in prisons exhibit a significantly higher rate of mental illness, substance use disorders, and the co-occurrence of both (dual diagnosis) when compared to the general community. Accurate data on these conditions are essential for proper allocation of resources to prison health services. This accuracy also helps minimize potential harm to those experiencing these conditions. Current estimates, when available, often rely on only one source of information.
Method
This study utilized three distinct data sources: self-reported histories of diagnoses, medical records from within the prison system, and administrative data. The aim was to estimate the prevalence of mental illness, substance use disorder, and dual diagnosis. The research focused on two large groups of incarcerated adults in Australia: non-Indigenous individuals and Aboriginal and Torres Strait Islander individuals. To account for variations within the population samples, proportions for each condition were calculated using population-weighted methods. The consistency and agreement between the different data sources were evaluated using inter-rater reliability metrics.
Results
Among incarcerated non-Indigenous adults, the prevalence of mental illness alone was 17.0% (with a 95% confidence interval of 12.0–24.5%). Substance use disorder alone was observed in 14.8% (95%CI 9.6–18.1%), and dual diagnosis was found in 44.2% (95%CI 33.2–54.7%). For incarcerated Aboriginal and Torres Strait Islander adults, the corresponding estimates were 7.0% (95%CI 4.3–11.5%) for mental illness only, 26.8% (95%CI 18.9–33.5%) for substance use disorder only, and 40.9% (95%CI 30.1–48.2%) for dual diagnosis. These findings showed notable differences compared to estimates derived from using only a single data source. The agreement between individual data sources was least consistent for diagnoses of substance use disorder and most consistent for dual diagnoses.
Conclusions
Individual data sources likely possess high specificity, meaning they are good at confirming a condition when present, but low sensitivity, indicating they may miss many cases where a condition exists. This suggests that single sources tend to underestimate the true number of diagnoses. Therefore, the use of multiple data sources is recommended for estimating the prevalence of these conditions among people in prison. This approach would ensure that these conditions are adequately identified and that both in-prison and post-release health services receive appropriate resources.
Abstract
Background: The prevalence of mental illness, substance use disorders, and their dual diagnosis is disproportionately high among people in prisons compared to the community. Accurate prevalence estimates are required to inform resourcing of prison health services and reduce the risk of harm to people experiencing these conditions. Existing estimates, where available, often rely on only one data source.
Method: We used three data sources – self-reported history of diagnoses, in-prison medical records, and administrative data to estimate the prevalence of mental illness, substance use disorder, and dual diagnosis among two large cohorts of non-Indigenous and Aboriginal and Torres Strait Islander people in Australian prisons. We calculated population-weighted proportions of the samples with each condition. Inter-rater reliability metrics inform data source agreement.
Results: The prevalence of mental illness only, substance use disorder only, and dual diagnosis was 17.0% (95%CI 12.0–24.5), 14.8% (95%CI 9.6–18.1), and 44.2% (95%CI 33.2–54.7), respectively, for incarcerated, non-Indigenous adults. For incarcerated Aboriginal and Torres Strait Islander adults, our corresponding estimates were 7.0% (95%CI 4.3–11.5), 26.8% (95%CI 18.9–33.5), and 40.9% (95%CI 30.1–48.2). These estimates differed significantly from those derived from singular data sources. Individual data sources’ agreement was weakest for substance use disorder diagnoses and strongest for dual diagnoses.
Conclusions: Individual data sources likely have high specificity and low sensitivity, thus under-ascertaining diagnoses. We recommend using multiple data sources to estimate prevalence to ensure adequate ascertainment of these conditions among people in prison and to ensure in-prison and transitional health services are appropriately resourced."
Background
Mental health conditions, substance use disorders, and having both conditions at the same time (known as dual diagnosis) are much more common among people in prisons than in the general community. Getting accurate estimates of how widespread these conditions are is important. This information helps in properly funding prison health services and reduces potential harm to individuals experiencing these issues. Current estimates, when available, often depend on only one source of information.
Method
This study used three different sources of information to estimate how common mental illness, substance use disorder, and dual diagnosis are. The sources included self-reported histories of diagnoses, medical records from within the prison system, and administrative data. The study looked at two large groups of adults in Australian prisons: non-Indigenous adults and Aboriginal and Torres Strait Islander adults. Researchers calculated the proportion of people with each condition and assessed how consistently the different data sources showed the same information.
Results
Among non-Indigenous adults in prison, 17.0% had only a mental illness, 14.8% had only a substance use disorder, and 44.2% had both. For Aboriginal and Torres Strait Islander adults in prison, the estimates were 7.0% for only mental illness, 26.8% for only a substance use disorder, and 40.9% for both conditions. These findings were significantly different from estimates obtained using only a single data source. The various data sources showed the least agreement when identifying substance use disorders, but the strongest agreement for dual diagnoses.
Conclusions
Relying on individual data sources likely means that many cases of mental illness and substance use disorders are not being fully identified. Therefore, using multiple data sources is recommended to get a complete and accurate count of these conditions among people in prison. This approach helps ensure that prison health services and services assisting with the transition back to the community are properly funded and resourced.
Abstract
Background: The prevalence of mental illness, substance use disorders, and their dual diagnosis is disproportionately high among people in prisons compared to the community. Accurate prevalence estimates are required to inform resourcing of prison health services and reduce the risk of harm to people experiencing these conditions. Existing estimates, where available, often rely on only one data source.
Method: We used three data sources – self-reported history of diagnoses, in-prison medical records, and administrative data to estimate the prevalence of mental illness, substance use disorder, and dual diagnosis among two large cohorts of non-Indigenous and Aboriginal and Torres Strait Islander people in Australian prisons. We calculated population-weighted proportions of the samples with each condition. Inter-rater reliability metrics inform data source agreement.
Results: The prevalence of mental illness only, substance use disorder only, and dual diagnosis was 17.0% (95%CI 12.0–24.5), 14.8% (95%CI 9.6–18.1), and 44.2% (95%CI 33.2–54.7), respectively, for incarcerated, non-Indigenous adults. For incarcerated Aboriginal and Torres Strait Islander adults, our corresponding estimates were 7.0% (95%CI 4.3–11.5), 26.8% (95%CI 18.9–33.5), and 40.9% (95%CI 30.1–48.2). These estimates differed significantly from those derived from singular data sources. Individual data sources’ agreement was weakest for substance use disorder diagnoses and strongest for dual diagnoses.
Conclusions: Individual data sources likely have high specificity and low sensitivity, thus under-ascertaining diagnoses. We recommend using multiple data sources to estimate prevalence to ensure adequate ascertainment of these conditions among people in prison and to ensure in-prison and transitional health services are appropriately resourced."
Background
People in prison often have many more mental health problems, drug or alcohol problems, or both, than people outside of prison. It is important to know the correct numbers for these problems. This helps prison health services get the right amount of staff and supplies. It also helps keep people with these problems safe. Current numbers often come from only one source of information.
Method
The study used three ways to find out how common these problems were. These ways included asking people about their past health, looking at their prison health records, and checking other official files. This was done for two big groups of people in Australian prisons: those who are non-Indigenous and those who are Aboriginal and Torres Strait Islander. The study found the percentage of people in each group who had a mental illness, drug or alcohol problem, or both. It also checked how much the three sources of information agreed with each other.
Results
For non-Indigenous adults in prison:
About 17% had only a mental illness.
About 15% had only a drug or alcohol problem.
About 44% had both a mental illness and a drug or alcohol problem.
For Aboriginal and Torres Strait Islander adults in prison:
About 7% had only a mental illness.
About 27% had only a drug or alcohol problem.
About 41% had both a mental illness and a drug or alcohol problem.
These numbers were very different from numbers found using only one source of information. The different sources of information agreed least when checking for drug or alcohol problems. They agreed most when checking for both mental illness and drug or alcohol problems.
Conclusions
Using only one source of information likely misses many problems. The study suggests using many sources of information to find out how common these problems are. This will help make sure that people in prison get the right diagnosis. It will also help make sure that prison health services and services for people leaving prison have enough staff and supplies.