Co-morbidity Across Levels of Hospital Security

Abstract

This study explores the prevalence of co-morbid mental illness and substance abuse across three levels of hospital security (non-secure, medium and high secure). The medical records of 428 individuals with a mental illness were examined for evidence of a history of co-morbid substance abuse and criminal convictions. Abuse of solvents, hallucinogens, cocaine and poly-substance abuse were all found to be more likely in the high secure mentally ill population compared to the non-forensic (non-secure) mentally ill population. Therefore not only was the prevalence of co-morbidity greater at higher levels of security but the type of substances abused by high secure patients were also different from the types abused by non-forensic patients. There were some unexpected findings, most notably high secure patients were significantly less likely to abuse alcohol than non-forensic patients. The validity of these findings is discussed. Across the whole sample violent crime was particularly associated with abuse of cannabis, solvents, hallucinogens and poly-substance abuse. However even after controlling for violent crime, significantly higher levels of substance abuse were found at higher levels of hospital security.