Study marks increase of people with mental health and substance use disorders in British Columbia prisons

The prevalence of people in British Columbia prisons with co-occurring mental health needs and substance use disorders increased dramatically in less than a decade, according to a new Simon Fraser University study.

The study, published in the journal Psychiatric Services, found that people who suffer from both conditions comprised 32 percent of the prison population in 2017, up from 15 percent in 2009.

At the same time, the prevalence of people with methamphetamine use disorder increased nearly fivefold (from six percent to 29 percent), and those with heroin use disorder increased from 11 percent to 26 percent.

Overall, the proportion of people with any kind of mental health need or substance use disorder in prison increased to 75 percent, from 61 percent.

The marked increase signals a failure of the social safety net in the face of unaffordable housing, precarious/low wage employment, and worsening mental health at a population level, according to SFU health sciences researcher Amanda Butler, the lead author of the study.

"I think we have seen the continued erosion of a social safety net," Butler says. "What the findings say is that there are major gaps and that the criminal justice system is at the bottom of the funnel, often where people end up after being failed by every other part of the system."

The study calls for more treatment and efforts to address social and structural inequities for people with complex mental health and substance use needs. People should not need to end up in prison before they can access appropriate care.

"The people who experience the highest risk of criminalization are those with co-occurring substance use disorder and mental illness," says Butler. "We need to focus on how we can prevent those people from ending up in the prison system in the first place, since we know incarceration only tends to exacerbate symptoms and lead to further marginalization.

"I think the strongest call to action is increasing funding and access to high-quality, community-based care."

To calculate the prevalence of mental health needs and substance use disorders, researchers looked at the intake assessments of more than 47,000 people admitted to any of the 10 provincial prisons in B.C. between 2009 and 2017. The Jail Screening Assessment Tool is used to rapidly identify the health needs of people entering prison.