Psychotropic prescription trends in jails from 2013 to 2023: findings from the REACH database

In light of escalating concerns about the increasing number of individuals in United States' jails with mental health conditions, the current investigation sought to examine population trends in psychotropic prescription patterns in 34 jails over an 11-year epoch. Leveraging data from a largescale, multisite database derived from 1,251,837 jail detainees' electronic health records (i.e., the Repository of Electronic Archives in Correctional Healthcare, or REACH, database), General Estimating Equations (GEE) models were used to estimate population-averaged probabilities of prescriptions for any psychotropic agent and specific agent classes (e.g., antianxiety, antidepressant, antipsychotic, anticonvulsant). While GEE analysis revealed year-to-year variability, overall significant increases (i.e., > 100%) in prescription probability were observed for all agent classes from 2013 to 2023 except lithium, which declined significantly over time. Notably, the prescription probability for antipsychotic agents increased 249% during the study epoch. These findings add further evidence of the increasing mental health needs of jail populations. To better understand the increase in psychotropic prescriptions among jail detainees, additional inquiries should explore the clinical justification, therapeutic value, and impact of treatment compliance.