Research highlights prevalence of mental health conditions in young male offenders

A new study looking at the mental health of young male prisoners has found that more than 85% had a current mental health condition; however, less than 3% had received a clinical assessment (i.e., a comprehensive assessment of mental health and neurodevelopment) while in prison.

The University of Glasgow study looked at 110 male prisoners aged 16–23 in HMP & YOI Polmont, Scotland's national facility for young people, and examined the prevalence of, and associations between, adverse childhood experiences (ACEs), neurodevelopmental and mental health conditions.

While it is understood that a high proportion of young people in prison also have a history of abuse and neglect, this research included, for the first time, two conditions specifically associated with abuse and neglect—Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED).

The research, which was supported by the Scottish Prison Service, is the first comprehensive prevalence study of mental health, neurodevelopmental conditions, RAD and DSED, in a young offender population.

The study, "Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, adverse childhood experiences, and mental health in an imprisoned young offender population," is published in the journal Psychiatry Research.

The study showed that more than half of the young men studied (53.6%) had RAD and/or DSED symptoms, along with a wide range of other psychiatric and neurodevelopmental conditions. Nearly 75% of the young men in the study (74.5%) had experienced abuse and neglect, and virtually all the young men (96%) had one or more lifetime neurodevelopmental or mental health conditions, with nearly half (48.2%) having had four or more mental health conditions.

As well as being screened for RAD and DSED related to trauma, the recruited participants were seen in semi-structured interviews for screening related to conditions including mood and anxiety disorders, psychotic symptoms, obsessive compulsive disorders, eating disorders, and were also screened for autism, ADHD and Tic Disorder.

The study found that while only 2.7% of participants had received a clinical assessment, 49 participants (44.6%) had received input from prison mental health services: 10% for drugs and alcohol counseling; 14.5% had received medication; 7.3% had received talking therapy; 8.2% had a trauma-related service (psychotherapy/ art therapy/ trauma counseling); and 15.5% had advice from a mental health nurse.

Prof Helen Minnis, Professor of Child and Adolescent Psychiatry at the University's School of Health and Wellbeing, said, "Sadly we know that a high proportion of young male offenders in prison have a history of abuse and neglect, a high prevalence of adversity, especially maltreatment, and it's common to see neurodevelopmental or psychiatric conditions.

"By including conditions specifically associated with abuse and neglect in our study—Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED)—we were able to see a comprehensive picture of the high prevalence of these conditions, alongside other mental health conditions, within this group.

"We hope these new findings can help pave the way for more comprehensive clinical assessments for these young men in prison, and to help develop appropriate support and staff training—all of which is vitally needed to ensure that the full implications of the high prevalence of these mental health conditions are understood as part of trauma informed care to enable treatment and rehabilitation."

Dr. Kate Moran, Assistant Professor in Psychology (now at Trinity College Dublin), added, "Our study shows that the most commonly unmet need for mental health intervention in young men in prison is that of an assessment. Given the knowledge that abused and neglected children are at much higher risk of having heritable neurodevelopmental problems, which increases their risk of severe mental illness, our study demonstrates yet another strong argument for offering the prison population a comprehensive neurodevelopmental and mental health assessment."

"Building on this research, we are fortunate to be currently collaborating with Polmont to develop an understanding of mental health and relationships from the young person's perspective. This will inform future intervention to ensure a greater awareness of the specific and nuanced needs of this population. Going forward, if we can address this unmet need, and provide a robust psychological assessment to these young men, we may be able to reduce the high suicide rate in this population, as well as improve recidivism and societal costs."

Professor Minnis added, "In future, we would like to research the prevalence of mental health conditions in female prisoners and older prison populations, to understand how these psychiatric and neurodevelopmental conditions manifest according to gender and age in prisoners. It will also be important, in future research, to examine how conducting more detailed psychiatric and neurodevelopmental formulations might inform treatment and intervention approaches."