Study: 25% of St Pat’s inmates at risk of psychosis
Co-author Prof Harry Kennedy, clinical director of the Central Mental Hospital, described the finding as “startling”.
He said intensive intervention and a drug- free unit in the jail were urgently needed.
Such research had never been conducted in young offender populations before, and the diagnosis provides an opportunity for early intervention.
A team from the Central Mental Hospital assessed 171 young male offenders, aged 16 to 20, for ultra high risk (UHR) state on committal to St Patrick’s Institution.
Of these, 39, or about 23%, met UHR criteria during the research, conducted between Jun 2011 and May 2012.
The highest rate was among those aged 18 (36%).
“We found a startling high rate of UHR state, about 23%,” said Prof Kennedy.
“It does not mean they have severe mental illness, but they are at high risk of developing it.”
He said it was very difficult to predict how many would, but said some research indicated around one in five, or one in six, could do so.
He said a second major finding was the link between UHR and abuse of drugs, illegal and legal. The research, published in BMC Psychiatry, found that 85% had a substance misuse problem and that multiple substance misuse was common.
Prof Kennedy said: “Young people are consuming extraordinary amounts of drugs and there is very good evidence cannabis can increase the risk of psychosis.” He said there could be an interaction between the toxic effects of drugs and alcohol and a development vulnerability in the brain in late adolescence.
He said the mental hospital was keen to operate an early intervention programme, but was “in limbo” until the future of St Patrick’s was clear.
There have been no 16-year-old inmates there since last year and all those aged 17 will be gone next year.
Prof Kennedy said there was very limited evidence that medication was appropriate and that intensive education was more suitable.
He said there was now a “compelling argument” for creating drug-free wings in jails, particularly in young offender institutions.
Liam Herrick of the Irish Penal Reform trust said the research results were “extremely alarming” and that the violent, drug-fuelled, and stressful environment in St Patrick’s was the wrong place for such young people.
However, he said the research indicated that it provided a central place for early intervention and urged the authorities to respond.
Ultra high risk is a way of assessing a person’s chance of further advancing to certain states or conditions. It marks a recent advance in psychiatry, according to Prof Harry Kennedy, and is driven by Irish-born Patrick McGorry, professor of youth mental health at the University of Melbourne.
Prof McGorry looked at advances in long-term physical illnesses, such as cancer, and applied them to severe mental illness, by developing stages of the disease.
For example, in relation to cancer, stage 4 relates to terminal cancer, stage 3 refers to major intervention, stage 1-2 relates to localised cancer, and stage 0 is the pre-cancerous stage, such as cervical screening, which can pick up pre-cancerous changes.
This is applied to psychosis, where signs and symptoms are identified.
