Over the past 30 years as inpatient and outpatient mental health services decreased across the United States, more and more adults and youth with mental health or neurodevelopmental disabilities such as ADHD have been incarcerated usually for crimes involving substance abuse, sensation seeking, impulsive behavior. At the present time it is conservatively estimated that over 25% of all adults who are incarcerated in US adult correctional facilities have ADHD. Many of these prisoners are also substance abusers and may also have a major mental health disorder such a major depression or bipolar disorder.
Within the correctional facilities, adults are usually screened for health problems but mental health screening can be somewhat haphazard depending on the facility and rarely does the history or adult diagnosis of ADHD lead to appropriate counseling or pharmaceutical treatment during the inmates stay.
There are a number of reasons why adults with ADHD in correction facilities are not treated including:
- Many adults with ADHD are not diagnosed or have not been treated as an adult.
- ADHD behavioral symptoms, impulsivity, drug seeking, sensation seeking, inattentiveness, are judged as "bad and noncompliant" behavior and not related to the treatable neurodevelopmental problem of ADHD.
- 80% of adults in correctional facilities also have a history of substance abuse; most facilities limit the use of medications that can be abused or used as contraband within the facility.
- Physicians practicing within adult correctional facilities rarely are expert at diagnosing or treating adult ADHD.
- The effective psychotropic and ADHD medications are generally expensive and access to all expensive medications and other treatment services is limited by the economic costs of treating medical and mental health problems in a correctional setting where the major priority is public safety and containment. The rehabilitation of offenders is not a major goal widely supported by the public.
- The regimented setting of a jail or prison may mask the symptoms of ADHD but adults with ADHD frequently fail probation and parole because of symptoms of ADHD impairment such as poor emotional regulation, impulsivity, failure to complete tasks and poor time management. In some cases, the adult is in and out of the correctional facility for short periods of time for relatively minor infractions and never are in jail long enough to qualify for a full medical or mental health evaluation.
Other correctional professionals such as those working in the facilities and probation/parole officers, lawyers and law enforcement professionals must become more knowledgeable about neurodevelopmental problems and their treatment and the high societal costs of not evaluating and treating offenders. This is a matter of conservation of human potential.
For those wanting to learn more about ADHD in the criminal justice system refer to the paperback, Spinning out of Control by Patrick J. Hurley and Robert Eme available through most bookstores.
Janet Kramer, MD ADDA Board Member, www.adda.org
Published On: November 17, 2008