Abstract
BackgroundThe ultra high risk state for psychosis has not been studied in young offender populations. Prison populations have higher rates of psychiatric morbidity and substance use disorders. Due to the age profile of young offenders one would expect to find a high prevalence of individuals with pre-psychotic or ultra-high risk mental states for psychosis (UHR). Accordingly young offender institutions offer an opportunity for early interventions which could result in improved long term mental health, social and legal outcomes. In the course of establishing a mental health in-reach service into Ireland’s only young offender prison, we sought to estimate unmet mental health needs.MethodsEvery third new committal to a young offenders prison was interviewed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to identify the Ultra High Risk (UHR) state and a structured interview for assessing drug and alcohol misuse according to DSM-IV-TR criteria, the Developmental Understanding of Drug Misuse and Dependence - Short Form (DUNDRUM-S).ResultsOver a twelve month period 171 young male offenders aged 16 to 20 were assessed. Of these 39 (23%, 95% confidence interval 18% to 30%) met UHR criteria. UHR states peaked at 18 years, were associated with lower SOFAS scores for social and occupational function and were also associated with multiple substance misuse. The relationship with lower SOFAS scores persisted even when co-varying for multiple substance misuse.ConclusionsAlthough psychotic symptoms are common in community samples of children and adolescents, the prevalence of the UHR state in young offenders was higher than reported for community samples. The association with impaired function also suggests that this may be part of a developing disorder. Much more attention should be paid to the relationship of UHR states to substance misuse and to the health needs of young offenders.
Highlights
The ultra high risk state for psychosis has not been studied in young offender populations
Young offender institutions often act as staging posts along pathways leading to mental health care, with young persons presenting via the criminal justice system
Our study is the first to report on the rates of psychosis and the Ultra High Risk mental state for psychosis (UHR) in a young offender prison
Summary
The ultra high risk state for psychosis has not been studied in young offender populations. Due to the age profile of young offenders one would expect to find a high prevalence of individuals with pre-psychotic or ultra-high risk mental states for psychosis (UHR). Young offenders have greater levels of psychiatric morbidity and substance use disorders than their peers in the general population [1,2,3,4]. While at liberty, they experience multiple social disadvantages which impede their ability to seek and access appropriate treatment [5]. Our study is the first to report on the rates of psychosis and the Ultra High Risk mental state for psychosis (UHR) in a young offender prison. Our rationale for focusing on UHR was based on the pragmatic aim of allocating a limited mental health resource toward identifying and treating the most serious mental disorders with the highest healthcare burden
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