Clinical and legal characteristics of inmates with bipolar disorder.

Individuals with bipolar disorder are at an increased risk of criminal arrest compared with those in the population at large. The combination of manic symptoms and substance abuse seem to be the primary illness factors for this increased risk, and the public mental health system has faced challenges in treating these patients successfully in community settings. To decrease the risk for arrest in bipolar patients, clinicians can screen and refer patients for substance use disorders, stabilize mania in hospital settings, and take measures to improve outpatient adherence in the postmanic hospitalization period. Psychiatric advance directives, new developments in civil commitment law, and mental health courts are legal mechanisms that may be critical in preventing the criminalization of those with bipolar disorder.