Mental Health Disorders in Prison: Neuroethical and Societal Issues

Guest post by Barbara Sahakian, FMedSci, DSc, a professor in the department of psychiatry at the University of Cambridge, and president of the International Neuroethics Society.

INS LogoMore than half of all prison and jail inmates have a mental health problem.[i] In addition, according to a 2010 report released by the Treatment Advocacy Center and the National Sheriffs’ Association,[ii] more mentally ill persons are in jails and prisons than in hospitals, and many of those remain untreated. Those in prison have a higher risk of substance abuse, and suicide rates are four to five times higher than within the general population.[iii] Deaths are also increased upon release, with the most common reasons being drug overdose, cardiovascular disease, homicide, and suicide.[iv]

Many people in prison have lower than average IQs, and it is well-established that lower IQ is a known risk factor for mental health problems.[v] Rates of problems for children in the youth justice system are at least three times higher than within the general population, and are highest amongst children in custody.[vi] Almost a quarter of children who offend have very low IQs of less than 70.[vii]

At the International Neuroethics Society Annual Meeting 2015 in Chicago (Oct. 15-16), there will be a panel entitled, “Mental health disorders in prison: Neuroethical and societal issues,” which will consider vulnerabilities to mental health problems of those in prison, and whether there are inequalities in access to psychiatrists, psychologists, and other professionals for diagnosis and treatment. This panel will also reflect on what steps, in terms of improving cognition, functionality, and wellbeing, society should be taking to ensure better life trajectories when inmates with mental health problems are released.

For example, suicide mortality is reduced by antidepressant treatment,[viii] and there is evidence that for at least some disorders, such as attention deficit hyperactivity disorder (ADHD), treatment leads to a significant reduction in criminality rates in men (Lichtenstein et al, 2012).[ix] Effective treatment of neuropsychiatric disorders and education, including skill training in prisons, could help to increase cognitive reserve and resilience, helping prisoners successfully address the many challenges encountered on release.[x]

The highly distinguished panel includes Dr. James Blair, Dr. Laurie R. Garduque, and Professor Hank Greely. The panel’s moderator, Dr. Alan Leshner, has been director of the National Institute on Drug Abuse, deputy director and acting director of the National Institute of Mental Health, and chief executive officer of the American Association for the Advancement of Science. He was one of the first to highlight the neuroscientific evidence of brain changes in addiction.


[i] James DJ, Glaze LE (2006) Mental health problems of prison and jail inmates. Bureau of Justice Statistics, NCJ 213600

[ii] Torrey E, Kennard A, Eslinger D, Lamb R, Pavle J (2010) More Mentally Ill Persons are in Jails and Prisons than Hospitals: A Survey of the States. Treatment Advocacy Center.

[iii] Fazel S, Grann M, Kling B, Hawton K (2011) Prison suicide in 12 countries: An ecological study of 861 suicides during 2003–2007. Soc Psychiatry Psychiatr Epidemiol, 46, 191-195.

[iv] Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, Koepsell TD (2007) Release from prison: A high risk of death for former inmates. New England Journal of Medicine, 356, 157-165.

[v] Barnett JH, Salmond CH, Jones PB, Sahakian BJ (2006) Cognitive reserve in neuropsychiatry. Psychological Medicine, 36, 1053-1064.

[vi] Hagell A (2002) The mental health needs of young offenders—a report commissioned by the Mental Health Foundation MHF: London.

[vii] Harrington R, Bailey S (2005) Mental health needs and effectiveness of provision for young offenders in custody and in the community YJB: London.

[viii] Morgan OWC, Griffiths C, Majeed A (2004) Association between mortality from suicide in England and antidepressant prescribing: an ecological study. BMC Public Health, 4.

[ix] Lictenstein P, Halldner L, Zetterqvist J, Sjolander A, Serlachius E, Fazel S, Langstrom N, Larsson H (2012) Medication for attention deficit-hyperactivity disorder and criminality. The New England Journal of Medicine, 367.

[x] Beddington J, Cooper CL, Field J, Goswami U, Huppert FA, Jenkins R, Jones HS, Kirkwood TB, Sahakian BJ, Thomas SM (2008) The mental wealth of nations. Nature, 23, 1057-1060.

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