1. The Prevalence of Mental disorder among Convicted Adult Offenders in Kenyan Correctional Institutions Caleb Othieno, Associate Professor, Department of Psychiatry, University of Nairobi

2. Background In Kenya there are over 50,000 offenders in remands and prisons Minimal health provision in prisons despite reports of ill health and torture in prisons Mental illness ranked high among the problems identified by the service providers as having special needs

3. Background Studies done elsewhere and metaanalysis show that mental illness is common among prisoners Earlier limited scale studies in Kenya show the same trend Screening for mental illness is not routinely done at intake

4. Rationale In order to establish services for the mentally ill we needed data on the types of disorders found among the offenders and To determine easy methods of screening for the disorders

5. Aims To determine prevalence and types of mental health problems among offenders held in correctional institutions in Kenyan and their sociodemographic correlates To determine the psychometric properties of some common screening instruments such as GHQ, PHQ

6. Method Ethics: We obtained permission to carry out the study from the local (KNH/UON) ethics and review board Sampling: We used cluster sampling to select study participants from 50 institutions across Kenya. Data collection was done using a purpose designed sociodemographic questionnaire, Patient Health Questionnaire (PHQ), Centre for Epidemiological Studies (CES-D) and the Mini Neuropsychiatric Interview (MINI).

7. Preliminary Findings Categories sampled –Small: 31 –Medium: 8 –Main: 9 –Maximum: 2 Out of the intended sample of 1,000 we managed to interview 574 males and 262 females.

8. Duration of stay in the prison Majority 52.5% had stayed in the prison for a period of 1 – 3 years 43% had stayed for a period of less than 1 year

9. Age Distribution Variable Male N = 578 (%) Female N = 262 ( %) Total N = 840 ( %) Age group 10 – 1933 (5.7)16 (6.1)49 (5.9) 20 – 29239 (41.4)118 (45.1)357 (42.5) 30 – 39174 (30.1)75 (28.7)249 (29.7) 40 – 4965( 11.3)38 (14.5)103 (12.3) 50 – 5933 (5.7)9 (5)42(5.0) 60 – 6920 (5.5)5 (1.9)25(3.0) 70 – 795 (0.9)1(0.4)6(0.8) 80 – 891 (0.2)0 Not stated8 (1.4)08 1.0) Table 1: Demographic characteristics of the respondents

10. Education level MaleFemalesTotal None23 (4)26 (10)49 (5.0) Primary359 (62.2%)179 (68.4)538 (64.1) Secondary156 (27.0)46 (17.6)202 (24.1) Diploma12 (2.1)6 (2.3)18 (2.2) Degree8 (1.4)08 (1) Not stated20 (3.5)25 (3.0)

11. Psychiatric Diagnosis Diagnosis Male N = 578 Female N = 262 Total 840 Post – traumatic stress disorder113(19.6)76(29.0)189 (22.5) Obsessive compulsive disorder118(20.5)66(25.2)184(21.9) SuicidalityLow Risk94(16.3)68(26.0)162 (19.3) Moderate Risk02(0.8)2 (0.2) Adjustment disorders83 (14.4)42 (16.1)125 (14.9) Major depressive disorder with melancholic features 79(13.7)42(16.1)121(14.4) Panic Disorder Limited symptoms attack – lifetime 51(8.9)29(11.1)80 (9.5) Without agoraphobia33(5.7)25(9.6)58 (6.9) With agoraphobia38(6.6)28(10.7)66 (7.9) Somatization disorderLifetime50 (8.7)26 (10.0)76 (9.0) Alcohol Abuse and dependenceCurrent49(8.5)24(9.2)73 (8.7) Past4423(8.8)67 (8.0) Dysthymia43(7.5)26(10.0)69 (8.2) Manic episode – current42(7.3)22(8.4)64 (7.6) Agoraphobia currentWithout history of panic disorder 31(5.4)24(9.2)55(6.5%)

12. Psychiatric Diagnoses Generalized anxiety disorderCurrent34 (5.9)18 (6.9)52 (6.2) Attention deficit/hyperactivity disorder 35 (6.1)9 (3.5)44 (5.2) Premenstrual dysmorphic disorder current0 (0.0)40 (15.3)40 (4.8) Mixed anxiety depressive disorder current19 (3.3)20 (7.7)39 (4.6) Psychotic disorders Mood disorders with psychotic features - current 18 (3.2)1(0.4)19 (2.3) Antisocial personality disorderLifetime15 (2.6)10 (3.9)22 (2.6) current12 (2.1)4 (1.6)19 (2.3) Non – alcohol psycho active substance use disorders Drug dependence current 15 (2.6)1(0.4)16 (1.9) Drug abuse current 15 (2.6)3(1.2)18 (2.1)

13. Conclusion Psychiatric disorders are common in the prisons and much of it had not been recognised perhaps due to lack of appropriate screening instruments From earlier work we noted that there was lack of skills among the staff We hope to correlate the scores from the MINI with those from the screening instruments to determine their usefulness We plan to use this data as baseline as we embark on formulating appropriate prisons mental health services

14. Recommendations Urgent need to set up comprehensive mental health services in prisons Programmes should target specific disorders such as depression, suicidality and substance use disorders