In search of the missing linkages: continuity of care in U.S. jails

Axis I Screens and Suicide Risk in Jails

Mental health professionals conducting screenings in jail settings face formidable challenges in identifying inmates at risk for major depression and suicide. Psychologists often rely on correctional staff to provide initial appraisals of those inmates requiring further evaluation. In a sample of 100 jail detainees, the effectiveness of two specialized screens (the Referral Decision Scale and Mental Disability/Suicide Intake Screen or MDSIS) and one general screen (Personality Assessment Screener or PAS) was evaluated. For suicidal ideation, the MDSIS composite score evidenced promise (sensitivity = 1.00; specificity = 0.71). In ruling out major depression, the PAS Negative Affect subscale was useful for the inmate participants.

The effectiveness of specialized legal counsel and case management services for indigent offenders with mental illness

BACKGROUND

In recent years, jurisdictions have recognized the strain placed on limited existing resources by criminal offenders with mental illness who frequently cycle through local jail facilities. In response, many locales have developed and implemented specialized programs to more effectively and efficiently manage these offenders, particularly the process of assigning defense attorneys to these often indigent defendants.

METHODS

The current study examined the impact of an Indigent Defense Counsel (IDC) program designed to provide specially trained defense attorneys, and enhanced case management services to 257 indigent jail inmates with a qualifying, major mental health diagnosis (e.g., major depression). These offenders were compared to 117 similar offenders who did not receive these services, on both their length of stay in the jail, and their likelihood of recidivism after release to the community.

RESULTS

Survival analyses revealed that program participants spent about 17 fewer days in jail; however, recidivism rates between groups, measured as return to the same county jail or as statewide re-arrest, did not differ.

CONCLUSIONS

These results suggest that defendants with mental illness can potentially be managed effectively in the community, with little added risk to public safety and at potential savings in jail bed days/costs. Implications for the processing of indigent criminal defendants with mental illness are presented.

A national survey of mental health services available to offenders with mental illness: who is doing what?

The purpose of this study was to examine the national practices of psychotherapy services for male offenders with mental illness (OMI) in state correctional facilities. Participants consisted of 230 correctional mental health service providers from 165 state correctional facilities. Results indicated that mental health professionals provided a variety of services to OMI that can be conceptualized by six goals considered important in their work: mental illness recovery, emotions management, institutional functioning, re-entry, risk-need, and personal growth. Mental health professionals in this study generally viewed mental illness recovery, institutional functioning, and personal growth as significantly more important and spent more time focused on these goals than emotions management, re-entry, and risk-need. Mental health professionals tended to believe the services they provided were effective across four key treatment foci including mental illness, skill development, behavioral functioning, and criminogenic needs with more progress perceived in areas related to mental illness and skill development than their ability to effectively change behavioral functioning. Implications of these findings and directions for future research are discussed.

Pedagogy of individual choice and female inmate reentry in the U.S. Southwest

Much of the mental health, substance use, and educational programming within a particular women's prison in the southwestern United States promotes individual choice and agency. Incarcerated women from rural areas are told that their ability to succeed outside of prison is primarily dependent upon their personal choices. Comparably little attention is given to preparing women for their upcoming release or to overcoming structural barriers that could undermine successful reentry within rural communities. As a result, these returning citizens, many of whom grapple with mental illness and alcohol or drug dependence, blame themselves for their inability to surmount these barriers. In this qualitative research, we draw upon the perspectives of 99 incarcerated women to clarify how ideologies of individual choice promulgated in reentry pedagogy clash with contextual factors within rural communities to derail the reentry process. We also consider community reentry from Amartya Sen's capabilities framework and discuss how this model could inform needed interventions.

Measuring collaboration and integration activities in criminal justice and substance abuse treatment agencies

Individuals with substance abuse problems who are involved in the criminal justice system frequently need community-based drug and alcohol abuse treatment and other services. To reduce the risk of relapse to illicit drugs and criminal recidivism, criminal justice agencies may need to establish collaborations with substance abuse treatment and other community-based service providers. Although there are many variations of interorganizational relationships, the nature of these interagency collaborations among justice agencies and treatment providers has received little systematic study. As a first step,we present an instrument to measure interagency collaboration and integration activities using items in the National Criminal Justice Treatment Practices Surveys conducted as part of the Criminal Justice Drug Abuse Treatment Studies(CJ-DATS). Collaboration and integration activities related to drug-involved offenders were examined between substance abuse treatment providers, correctional agencies, and the judiciary. The measurement scale reliably identified two levels of collaboration: less structured, informal networking and coordination and more structured and formalized levels of cooperation and collaboration. An illustration of the use of the systems integration tool is presented.

Organizational factors and collaboration and integration activities in criminal justice and drug abuse treatment agencies

Despite strong interest in improving collaborations between correctional and substance abuse treatment organizations, there is a lack of empirical data describing the existing practices. The current study used a national survey of correctional administrators to examine organizational factors related to cross-agency collaboration and integration activities between corrections and substance abuse treatment organizations. Using a measure of collaboration that scaled cross-agency activities from less structured, informal networking and coordination to more structured and formalized levels of cooperation and collaboration, we found that different correctional settings (e.g., community corrections, jails, prisons) differed significantly in terms of their collaborative activities with substance abuse treatment agencies. We also found that the organizational characteristics that were associated with different levels of collaboration and integration differed across the correctional settings. Further research is needed to better understand how and why correctional agencies decide to formalize collaborative arrangements with treatment agencies and whether these efforts lead to more favorable outcomes.

Reintegrating young offenders into the community through discharge planning: a review of interventions and needs of youth in secure care

The health status of young offenders is often poorer than similar aged non-offenders. Addressing young offender needs is a key priority for their rehabilitation and reintegration into the community. The objectives were to identify programs and interventions that assist detained youth through focussed discharge planning by a systematic review of the literature. In addition, this review examined the identified health needs of young offenders in secure care. Our systematic review searched electronic databases using the keyword terms youth, secure care, health assessment and primary health care. Keyword browser terms were also entered as search strings, and only literature from 1997 onwards was retained. Twenty-two pieces of published literature were retained, and these documented the needs and service utilisation of young offenders. Mental health problems and trauma exposure were commonly identified in the literature, as was general physical health deficits and social and familial problems. Retrieved articles also made recommendations for health assessments and discharge planning, and some provided discharge planning models. Young offenders have diverse needs that can be ascertained from quality assessment measures. Effective discharge planning is important to attend to ongoing health issues and aid rehabilitation and reintegration into the community. By administering a comprehensive multidimensional screening measure upon admission to secure care, individualised care plans can be formulated with discharge planning measures. Recommendations for further study include the development and implementation of a needs assessment tool in youth secure-care facilities that complements the existing assessments and helps reintegrate young offenders to primary health care and community services.

Planning primary health-care services for South Australian young offenders: A preliminary study

Although many young offenders receive health care during periods of detention, addressing their health needs after release from secure care is a key strategy for successful rehabilitation and reintegration into the community. The purpose of this preliminary study was to examine current discharge planning practices for young offenders in Youth Training Centres in South Australia with a view to improving offenders' connection with primary health-care services on discharge. To determine the strengths and weaknesses of current discharge planning practices, this exploratory study involved in-depth review of literature and a semistructured focus group of stakeholders. Findings were discussed with an expert advisory group before final recommendations were made. This study identified a service model approach to discharge planning that recommended a nurse located within the Divisions of General Practice as the coordinator. The study found that trusted staff in detention centres, with an awareness of services available in the location of release, influence young offenders' decision-making in relation to health-care services. Awareness and recognition of young offenders' health beyond periods of juvenile detention and into their adult lives is valuable in that it has the potential to establish lifelong healthy behaviours. Bonding with young offenders and gaining their trust increases their likelihood of attending primary health-care services.

Facilitators and barriers to continuing healthcare after jail: a community-integrated program

A cooperative, community-oriented "public health model of correctional healthcare" was developed to address the needs of persons temporarily displaced into jail from the community, and to improve the health and safety of the community. It emphasizes 5 key elements: early detection, effective treatment, education, prevention, and continuity of care. In the program, physicians and case managers are "dually based"-they work both at the jail and at community healthcare centers. This, together with discharge planning, promotes continuity of care for inmates with serious and chronic medical conditions. This report characterizes the health status and healthcare in this group, and identifies facilitators and barriers to engagement in primary medical and mental health care after release from jail.

Detecting mental disorder in juvenile detainees: who receives services

OBJECTIVES

We determined whether or not juvenile detainees with major mental disorders received treatment, and the variables that predicted who received services.

METHODS

Our sample was 1829 randomly selected juvenile detainees taking part in the Northwestern Juvenile Project. To determine need for mental health services, independent interviewers administered the Diagnostic Interview Schedule for Children and rated functional impairment using the Child Global Assessment Scale. Records on service provision were obtained from the juvenile justice and public health systems.

RESULTS

Among detainees who had major mental disorders and associated functional impairments, 15.4% received treatment in the detention center and 8.1% received treatment in the community by the time of case disposition or 6 months, whichever came first. Significantly more girls than boys were detected and treated. Receiving treatment was predicted by clinical variables (having a major mental disorder or reported treatment history or suicidal behavior) and demographic variables.

CONCLUSIONS

The challenge to public health is to provide accessible, innovative, and effective treatments to juvenile detainees, a population that is often beyond the reach of traditional services.

Jail linkage assertive community treatment services for individuals with mental illnesses

Persons with mental illnesses who are released from jail or prison are at high risk of psychiatric decompensation and re-arrest. This paper describes an ACT jail linkage program for this population that won an American Psychiatric Association Gold Award (2001). Based on interviews with its first 24 participants, we illustrate how they experience factors that contribute to recidivism and decompensation. Pre- and post-data are examined to explore program outcomes. Results suggest that it is possible to identify, engage, and retain people in treatment who struggle with many risk factors. We conclude that this program should be expanded and replicated.

Jails, prisons, and the health of urban populations: a review of the impact of the correctional system on community health

This review examined the interactions between the correctional system and the health of urban populations. Cities have more poor people, more people of color, and higher crime rates than suburban and rural areas; thus, urban populations are overrepresented in the nation's jails and prisons. As a result, US incarceration policies and programs have a disproportionate impact on urban communities, especially black and Latino ones. Health conditions that are overrepresented in incarcerated populations include substance abuse, human immunodeficiency virus (HIV) and other infectious diseases, perpetration and victimization by violence, mental illness, chronic disease, and reproductive health problems. Correctional systems have direct and indirect effects on health. Indirectly, they influence family structure, economic opportunities, political participation, and normative community values on sex, drugs, and violence. Current correctional policies also divert resources from other social needs. Correctional systems can have a direct effect on the health of urban populations by offering health care and health promotion in jails and prisons, by linking inmates to community services after release, and by assisting in the process of community reintegration. Specific recommendations for action and research to reduce the adverse health and social consequences of current incarceration policies are offered.

Reintegrating women leaving jail into urban communities: a description of a model program

Women are the fastest-growing population in the criminal justice system, and jails reach more people than any other component of the correctional system. About 1 million women pass through US jails each year. Most return to their communities within a few weeks of arrest, and few receive help for the substance abuse, health, psychological or social problems that contribute to incarceration. We describe a model program, Health Link, designed to assist drug-using jailed women in New York City to return to their communities, reduce drug use and HIV risk behavior, and avoid rearrest. The program operates on four levels: direct services, including case management for individual women in the jail and for 1 year after release; technical assistance, training, and financial support for community service providers that serve ex-offenders; staff support for a network of local service providers that coordinate services and advocate for resources; and policy analysis and advocacy to identify and reduce barriers to successful community reintegration of women released from jail. We describe the characteristics of 386 women enrolled in Health Link in 1997 and 1998; define the elements of this intervention; and assess the lessons we have learned from 10 years of experience working with jailed women.