DIAGNOSIS AND TREATMENT OF MENTAL

DISORDERS IN CORRECTIONAL FACILITIES

Sara Brzostowicz GardnerPSY 492

Argosy University

Why is this topic so important to our society?

In the 1980’s, many government run mental hospitals were shut down, forcing it’s patients on the streets. Over the years, prisons and jails have become the next best thing, with many inmates entering facilities with DSM-IV-TR Axis I and II disorders (Okasha, 2004).

Changes need to be made because: The need for control is

so strong that in the book Prison Madness, Terry Kupers argues that it’s the conditions of correctional facilities themselves that are inducing and heightening many of the disorders found amongst inmates (Kupers, 1999)

The increasing number of instances of illness in prisons may even have a positive correlation with levels of violence (Lamb, et.al, 1998).

There are two main points that researchers make regarding the care of the mentally ill in

our prisons:

1. Accurate diagnosis and appropriate treatment for those who first enter correctional facilities

2 . Providing proper on-going treatment programs for those with long-term mental disorders

Most inmates do not currently have access to favorable conditions and programs

Argument 1: Accurate diagnosis of incoming inmates

The effectiveness of prison medical staff and the diagnostic tools used to classify mental disorders may be ineffective

Studies show that the strained amount of time spent with incoming inmates, the inability to manage inmate behavior and overall facility conditions can limit the effectiveness of mental disorder diagnosis (Birmingham, Mason & Grubin, 1996)

Argument 1: Accurate diagnosis of incoming inmates

The researchers also mention the questionable validity of the screening tools used upon entrance

Biases may have occurred in such self-reporting tools with some inmates not qualifying for mental disorders, yet indicating that they have a need for treatment. On the other hand, some inmates who declined the need for assessments may have had a diagnosable mental illness (Birmingham, Mason & Grubin, 1996).

Argument 2: Maintaining care for those inmates with long-term disorders

Many of the current physical treatments for those diagnosed is inappropriate and can potentially increase symptomsSolitary Confinement

○ Isolating an out of order inmate has provided a form of punishment, but also a reprieve for overworked correctional staff. However, placing a mental ill inmate in solitary confinement has the potential to heighten depression, anxiety and neurosis due to schizophrenia (Stephey, 2007)

○ Additionally, this type of response to mentally ill inmates can cause decompensation, resulting in the individual mentally and emotionally shutting down (Yang, Kadouri, Revah-Levy, Mulvery, & Falissard, 2009).

Argument 2: Maintaining care for those inmates with long-term disorders

Strong impact on inmates mental disordersAn inmate with mental disorders can also have

an increased chance of being victimized by other inmates and staff, often viewed as an easy target

○ Furthermore, inmates with disorders are more likely to be physically and sexually abused (Blitz, Wolff, & Shi,

2008).

Argument 2: Maintaining care for those inmates with long-term disorders

Insufficient treatment can be found across gender lines: Blitz, Wolff and Paap determined that female inmates, similar to their males counterparts, were not receiving the necessary treatment for general mental disorders

Specifically, a large percentage of those in need were suffering from at minimum, a substance abuse issue, if not other mental disorders as well. Blitz, Wolff and Paap determined of those included in the study, 45% of those with substance disorders did not receive any treatment (Blitz, Wolff & Paap, 2006)

Argument 2: Maintaining care for those inmates with long-term disorders According to the study conducted by (Kjelsberg, et. al,

2009), in a sample population of 928, 52% of male and 17% of female inmates who were diagnosed with mental disorders were due to substance abuse.

Additionally, in a study by Blitz, a reported 50% of female inmates where under the influence of drugs or alcohol when they actually committed the crimes for which they were sentenced (Blitz, Wolff, & Paap, 2006).

Furthermore, of those who reported needing substance abuse treatment prior to prison, 45% did not receive any type of voluntary or mandatory counseling while incarcerated.

Argument 2: Maintaining care for those inmates with long-term disorders

Lack of trained staff can inhibit treatment in

facilities .

Research conducted by Reed and Lyne determined that in the 13 prisons studied, there was a standard, to maintain a proportionate number of prison nurses with mental health training to inmates. However, the studied concluded that only 24% of nursing staff had received any clinical education. In addition, only two of those prisons had sessions available with a clinical psychologist (Reed & Lyne, 2000).

In studies conducted, personality and substance abuse disorders were the most prevalent amongst a sampled population (Kjelsberg, Hartvig, Bowitz, Kuisma, Norbech, Rustad, Seem, & Vik, 2006).

While many of these disorders may be chronic, underdeveloped knowledge of the conditions and treatment procedures will only further the progression of such illnesses.

Future Considerations Overall, conditions in most prison environments can be

deteriorating on the mental health of an inmate. Overcrowding and insufficient funding for structured programs, as well as limited availability of trained mental health professionals becomes a breeding ground for psychological malaise. The issue of diagnosis and treatment of these disorders should become priority to state and federal agencies, so as to limit levels of recidivism and violence. Increasing education for staff, as well as treating common disorders, may assist the already overcrowded prisons in decreasing rates of mental disorders.

References

Birmingham, L., Mason, D., Gruber, D. (1996). Prevalence of mental disorder in remand prisoners: consecutive case study. British Medical Journal, 313: 1521. Retrieved on September 10, 2010 from http://www.bmj.com/content/313/7071/1521.full

Blitz, C. Wolff, N., & Paap, K. (2006). Availability of behavioral health treatment for women in prison. Psychiatric Services. 57(3): 356-360. doi: 10.1176/appi.ps.57.3.356. Retrieved on September 10, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811040/pdf/nihms168256.pdf

Blitz, C. Wolff, N., & Shi, J. (2008). Physical victimization in prison: The role of mental illness. International Journal of Law and Psychiatry. 31(5):385-393. doi: 10.1016/j.ijlp.2008.08.005. Retrieved on September 10, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836899/pdf/nihms-168253.pdf

Gunn, J., Maden, A., & Swinton, M. (1991). Treatment needs of prisoners with psychiatric disorders. British Medical Journal. 303(6798): 338–341. PMCID: PMC1670792. Retrieved on September 10, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1670792/

Kjelsberg, E., Hartvig, P., Bowitz, H., Kuisma, I., Norbech, P., Rustad, A., Seem, M., & Vik, T. (2006). Mental health consultations in a prison population: A descriptive study. BMC Psychiatry. 6:27. doi: 10.1186/1471-244X-6-27. Retrieved on September 10, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1534016/pdf/1471-244X-6-27.pdf

Kuper, T. (1999). Prison Madness: The mental health crisis behind bars and what we must do about it. Joey-Bass, Inc.: San Francisco

References Lamb, H. & Weinberger, L., (1998). Persons with severe mental illness in jails and

prisons: A review. Psychiatric Services, 49:483-492. Retrieved on September 10, 2010 from http://psychservices.psychiatryonline.org/cgi/content/full/49/4/483?eaf

Okasha, A. (2004). Mental patients in prison: punishment versus treatment? World Psychiatry. 3(1): 1-2. Retrieved on September 28, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414650/

Reed, J., & Lyne, M. (2000). Inpatient care of mentally ill people in prison: Results of a year’s programme of semistructured inspections. British Medical Journal, 320, 1031-1034. Retrieved on September 10, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27341/pdf/1031.pdf

Stephey, M., (2007). De-criminalizing mental illness. Retrieved on September 23, 2010 from http://www.time.com/time/health/article/0,8599,1651002,00.html

Wolff, N., Blitz, C., & Shi, J. (2007). Rates of sexual victimization in prison for inmates with and without mental disorders. Psychiatric Services. 58(5): 1087-1094. doi: 10.1176/appi.ps.58.8.1087. Retrieved on September 10, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811043/pdf/nihms168251.pdf

Yang, S., Kadouri, A., Revah-Levy, A., Mulvery, E., & Falissard, B. (2009). Doing time: A qualitative study of long-term incarceration and the impact of mental illness. International Journal of Law and Psychiatry. 32(5): 294-303. doi: 10.1061/j.ijlp.2009.06.003. Retrieved on September 10, 2010 from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758061/pdf/nihms-133713.pdf