Days Of Incarceration Research Articles

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

Effect of PACT on Inpatient Psychiatric Treatment for Adolescents With Severe Mental Illness: A Preliminary Analysis

This study examined whether inpatient psychiatric treatment and forensic treatment and incarceration were reduced among adolescents and young adults with severe and persistent mental illness after they received services in the Program of Assertive Community Treatment (PACT). The pre-post evaluation compared length of inpatient treatment and forensic treatment or incarceration for the year before and after PACT enrollment. Participants (N=15) were their own controls. Annual psychiatric hospitalization fell from 66.2 days before enrollment to 8.7 days in the first year of PACT (p=.025, Cohen's d=.54). Similarly, combined days of inpatient psychiatric treatment and forensic treatment or incarceration fell from 104.1 in the year before enrollment to 24.1 days in the year after (p=.015, Cohen's d=.61). PACT services significantly reduced time in inpatient psychiatric treatment. These preliminary results may have implications for long-term treatment, service delivery, and cost of care for adolescents and young adults with severe and persistent mental illness.

A Randomized Trial of a DWI Intervention Program for First Offenders: Intervention Outcomes and Interactions With Antisocial Personality Disorder Among a Primarily American‐Indian Sample

Randomized trial evidence on the effectiveness of incarceration and treatment of first-time driving while intoxicated (DWI) offenders who are primarily American Indian has yet to be reported in the literature on DWI prevention. Further, research has confirmed the association of antisocial personality disorder (ASPD) with problems with alcohol including DWI. A randomized clinical trial was conducted, in conjunction with 28 days of incarceration, of a treatment program incorporating motivational interviewing principles for first-time DWI offenders. The sample of 305 offenders including 52 diagnosed as ASPD by the Diagnostic Interview Schedule were assessed before assignment to conditions and at 6, 12, and 24 months after discharge. Self-reported frequency of drinking and driving as well as various measures of drinking over the preceding 90 days were available at all assessments for 244 participants. Further, DWI rearrest data for 274 participants were available for analysis. Participants randomized to receive the first offender incarceration and treatment program reported greater reductions in alcohol consumption from baseline levels when compared with participants who were only incarcerated. Antisocial personality disorder participants reported heavier and more frequent drinking but showed significantly greater declines in drinking from intake to posttreatment assessments. Further, the treatment resulted in larger effects relative to the control on ASPD than non-ASPD participants. Nonconfrontational treatment may significantly enhance outcomes for DWI offenders with ASPD when delivered in an incarcerated setting, and in the present study, such effects were found in a primarily American-Indian sample.

Long-term cost effectiveness of addiction treatment for criminal offenders*

This paper extends previous research that performed a cost-effectiveness analysis (CEA) of the Amity in-prison therapeutic community (TC) and Vista aftercare programs for criminal offenders in southern California. To assess the impact of treatment over time for this unique sample of criminal offenders, a 5-year follow-up CEA was performed to compare the cost of an offender's treatment—starting with the in-prison TC program and including any community-based treatment received post-parole—and the effectiveness of treatment in terms of days reincarcerated. The average cost of addiction treatment over the baseline and 5-year follow-up period was $7,041 for the Amity group and $1,731 for the control group. The additional investment of $5,311 in treatment yielded 81 fewer incarceration days (13%) among Amity participants relative to controls—a cost-effectiveness ratio of $65. When considering the average daily cost of incarceration in California ($72), these results suggest that offering treatment in prison and then directing offenders into community-based aftercare treatment is cost-effective policy tool.

Impact of new diagnostic criteria on the prevalence and incidence of pelvic inflammatory disease

Study ObjectiveThe Centers for Disease Control and Prevention (CDC) recently changed the recommended criteria for the clinical diagnosis of pelvic inflammatory disease (PID). The purpose of this study was to assess the impact of this change on the frequency with which we made a diagnosis of PID. Designprospective cohort study. Settingjuvenile detention center. Participantsadolescent females. InterventionsWe used the new diagnostic criteria to determine the prevalence and incidence of PID. We then compared these values to those in a previous study of a similar cohort of youth who were evaluated with the CDC's old, more stringent clinical criteria. Main Outcome MeasuresPrevalence and incidence of PID. Incidence measuresIncidence density and cumulative incidence, using the Kaplan-Meier method. Results between studies were compared using prevalence and incidence ratios. ResultsIn sexually active adolescents (N=315), the prevalence of PID (95% confidence interval) at admission was 8.6% (5.7–12.2%). During the first 31 days of incarceration, the cumulative incidence was 7.9% (5.0–12.3%) and the incidence density was 11.1 cases/100 person-months (6.5–16.4). Comparison of these results with those of our previous study that used old diagnostic criteria yielded a prevalence ratio of 2.0 (1.0–4.2), a risk ratio (comparing cumulative incidence) of 3.6, and a rate ratio (comparing incidence density) of 3.4 (1.2–11.2). All differences were statistically significant (P<0.05). ConclusionThe new diagnostic criteria for PID doubled the prevalence and more than tripled the incidence of this disease in this high risk population of incarcerated adolescents.

Funding Woes Thwart Access to Quality MH Care

Back to table of contents Previous article Next article APA InstituteFull AccessFunding Woes Thwart Access to Quality MH CareEve BenderEve BenderSearch for more papers by this authorPublished Online:5 Dec 2003https://doi.org/10.1176/pn.38.23.0013APA President Marcia Goin, M.D., told attendees at this year’s Institute on Psychiatric Services in Boston that there is “no short, easy, dollarless way” to change the mental health care crisis in America.While closer than ever to being able to meet the complex mental health care needs of their patients, today’s psychiatrists are often stymied by a system that is riddled with problems and short on funds, APA President Marcia Goin, M.D., emphasized at the Opening Session of APA’s 55th Institute on Psychiatric Services in Boston in October.“We are hampered in our ability to make use of today’s knowledge by the tragic situation that exists in terms of patients’ access to care,” Goin told attendees, evoking the theme of this year’s meeting, “Access to Integrated Mental Health Care.”Goin said many of these problems were highlighted in the July 2003 report of the President’s New Freedom Commission on Mental Health. They include stigma surrounding mental illness, discrimination in insurance coverage for mental health care, and inadequate and fragmented mental health services (Psychiatric News, August 15).The commission report and an October report issued by Human Rights Watch (see Original article: page 5) also recognize “the distressing role handed by default to our criminal justice system,” Goin said, and have brought national attention to the fact that “the number of people with mental illness in the nation’s prisons and jails far outnumbers the number of mentally ill in our psychiatric hospitals.”A more comprehensive mental health system can be established with legislatively mandated mental health parity, closer coordination between mental health and primary care, accessibility and affordability of mental health services, and support for evidence-based practices, Goin said.The mental health commission recommended in its report that treatments should help patients to “successfully cope with life’s challenges by facilitating recovery and building resilience—not just managing symptoms,” Goin noted. This advice resonates with APA’s “Vision for the Mental Health System,” which, she said, should be “community-based, culturally sensitive, and easily accessible.”However, conspicuously absent from the commission’s report is the need for increased funding for mental health services, Goin pointed out, which “is absolutely critical if these changes are to be implemented successfully.”She praised the success of a California law known as AB 34, which funds mental health services for homeless people in the state and is one of the model programs listed in the commission’s report.The three-year-old initiative began with three pilot programs and has since spawned programs in 38 counties.Data from the AB 34 pilot programs show that it brought about a 66 percent decrease in psychiatric hospitalization days, an 82 percent decrease in days of incarceration, and 80 percent fewer days of homelessness.“The program, which is relatively small, reaches about 5,200 of the state’s 50,000 homeless people with severe mental illness,” Goin noted.It also costs money—$54.9 million a year, to be exact.“The government must accept the fact that there is no short, easy, dollarless way to change this situation,” she said, referring to the mental health crisis in America. “Psychiatric illness is a physical illness, and treatment a basic public health need.” ▪ ISSUES NewArchived

The Commission's report and its implications for psychiatry.

The Commission's report and its implications for psychiatry.

The Effectiveness of an Integrated Treatment Approach for Clients With Dual Diagnoses

Objective: A randomized experiment tested the effectiveness of adding a psychoeducationally oriented group therapy intervention, Good Chemistry Groups, to standard inpatient chemical dependency services for clients dually diagnosed with mental and substance dependence disorders. Method: Ninety-seven clients were randomly assigned to an experimental group (n = 48) and a control group (n = 49). Outcome variables included drug and alcohol use, participation in self-help support group meetings, incarceration days, psychiatric symptoms, psychiatric inpatient admissions, compliance with prescribed psychotropic medication plans, and composite scores on the Addiction Severity Index. Results: No significant treatment effects were found on any of the outcome variables. The findings were generally consistent with those of prior controlled studies. Conclusion: Good Chemistry Groups did not add to the effects of standard treatments for dually diagnosed clients. Practitioners should continue to develop and evaluate alternative integrated treatment approaches that might prove to be more effective than this one.

Prevalence and incidence of pelvic inflammatory disease in incarcerated adolescents.

Few recent studies have determined the prevalence and incidence of pelvic inflammatory disease (PID) among adolescents. The goal of this study was to determine these parameters among incarcerated youths. Both on admission and during incarceration, consecutive adolescents entering the Harris County, Texas, Juvenile Detention Center were evaluated for symptoms of PID. One of two experienced clinicians examined adolescents with possible PID. For the diagnosis of PID, we used the minimal criteria of the CDC. In sexually active heterosexual or bisexual adolescents (N = 313), the prevalence of PID at admission was 4.5%; during the first 31 days of incarceration, the incidence density of PID was 3.3 cases/100 person-months, and the cumulative incidence was 2.2%. The prevalence among these youths of chlamydial and/or gonorrheal infection, as determined by urine or cervical testing, was 24.9%. The high prevalence and incidence of PID underscore the need for effective programs to eradicate chlamydial and gonorrheal infections in high-risk youths.

Reducing depression, anxiety, and trauma of male inmates: An HIV/AIDS psychoeducational group intervention

Although the growth rate for HIV/AIDS for incarcerated people is nearly six times the rate of the U.S. population, AIDS education programs within the corrections system have been slow to develop. A quasi-experimental research study found that a 1 O-session psychoeducational group intervention was effective in increasing knowledge of AIDS and decreasing depression, anxiety, and trauma symptoms among male inmates in a large southeastern jail facility. The group intervention consisted of both AIDS education topics and psychological support. Results indicated significant differences between the experimental and comparison group participants. Implications for research and practice are discussed. Keywords: group intervention; HIV/AIDS; incarcerated people; jails; psychoeducation Over the past two decades, there has been a 600 percent increase in the number of people incarcerated in U.S. jails and prisons (Bureau of Justice Statistics, 1996). This growth equates to a nationwide need for approximately 1,143 bed spaces per week (Gilliard, 1992). The jail and prison populations are increasing, and detainees axe held for longer periods, thus maintaining the increase in this population. The sources of difficulty for the prison and jail system encompass budgetary problems, overcrowding, and violence (McShane & Williams, 1989). With an increase in the incarcerated population, there is a corresponding need for effective rehabilitation programs. One main obstacle to improvement of the system is the dearth of suitable training programs and effective interventions (Gendrau, 1996). There have been some efforts to supply rehabilitation programs to offenders (that is, restitution, victim--offender mediation); however, the provision of psychosocial interventions has been a low funding priority to jail administrations. Immarigeon (1995) recommended putting offenders in programs that address problems they actually have and choose programs that fit into what's known about the most effective way to impact a given problem (p. 7). The majority of rehabilitation programs in jails and prisons focus on academic education and vocational training rather than mental health interventions (Gendrau & Andrews, 1994). A myriad of emotional and social issues confront inmates residing in correctional facilities in the United States (Anderson, 2000). Inmates entering a correctional facility are likely to be overwhelmed by the severely, restrictive environment, loss of personal freedom, and need to adapt to new cultural norms. This shock coupled with histories of childhood physical and emotional abuse, substances abuse, and often dysfunctional or traumatic relationship experiences of inmates creates depressive cognitions and affects that can potentially develop into suicidal ideation if not treated (Boterrell, 1984). Hopelessness, despair, and negative feelings about the future are some of the underlying factors resulting in depression, low self-esteem, and increased anger (Rees, 1989, p. 4). The majority of incarcerated men suffer from this psychological distress related to trauma, depression, and anxiety requiring mental health services and psychotropic medication (Morris, Steadman, & Veysey, 1997). In addition, high levels of depression and anxiety are often manifested by aggressive and hostile behavior in jail. These difficulties are further believed to have a causal relationship with offenders' criminal and antisocial behavior in the jail, leading to an increase in violence in correctional facilities (Blackburn, 1986). These high-risk behaviors, violent in nature, increase the likelihood of transmission of HIV infection. Ironically, HIV education and risk-reduction programs in correctional facilities often are brief lectures given to inmates during the first few days of incarceration when they are least able to absorb the information (Gendrau, 1996). The first week of incarceration is considered the most stressful for inmates and accounts for the majority of successful suicides carried out by new arrestees (Rees, 1989). …

Diversion from jail of detainees with substance abuse: the interaction with dual diagnosis.

The objective of this retrospective study was to determine if a jail diversion program reduced days of incarceration over the year following arrest in a sample of detainees with substance abuse disorders who had been arrested for a minor (misdemeanor) crime (n = 252) compared to a group (n = 95) who were not diverted. Particular attention was paid to comparing those singly diagnosed to those dually diagnosed. Analyses indicated that 1) detainees with substance abuse alone were less likely to be diverted than those with a dual diagnosis; 2) jail diversion reduced incarceration time during the next year; and 3) the effect of diversion differed depending upon the level of criminal charge. Diversion significantly reduced jail time only among those who were arrested for the more serious of the minor offenses that are associated with longer jail sentences.

Outcomes of Methadone Maintenance 1 Year after Admission

The authors followed a cohort of 610 opioid users for 1 year after admission to methadone maintenance. At the end of the year, 52% were on methadone and 48% were off methadone. Among subjects on methadone, days of intravenous drug use, crime, and needle-sharing decreased markedly from the month preceding admission to the month preceding the first anniversary of admission. Among subjects off methadone, days of these activities also decreased, but the decreases appeared in large part to be an effect of increased days of incarceration. Among those on methadone, days of productive activity increased markedly. Subjects with more years of intravenous drug use were more likely to be on methadone at the end of the year, and subjects under compulsory supervision were less likely to be on methadone. The findings confirm previous reports of decreased illicit opioid use, decreased crime, and decreased needle risk for infection with the human immunodeficiency virus among opioid users who remain on methadone.

Multisystemic therapy treatment of substance abusing or dependent adolescent offenders: Costs of reducing incarceration, inpatient, and residential placement

The development of more effective and less costly family- and community-based services to serve as alternatives to out-of-home placements of children is an important priority in the reform of mental health services for children and adolescents. Within the context of a randomized trial with 118 substance abusing or dependent juvenile offenders, we examined the incremental costs of multisystemic therapy (MST) and related these costs to observed reductions in days of incarceration, hospitalization, and residential treatment at approximately 1 year postreferral. Results showed that the incremental costs of MST were nearly offset by the savings incurred as a result of reductions in days of out-of-home placement during the year. The need to validate effective treatments for youth with serious clinical problems and to link the costs of treatment

Trial and tribulations: Courts, ethnography, and the need for an evidentiary privilege for academic researchers

In a recent case that has been widely discussed in sociology and among field researchers, Rik Scarce was incarcerated after failing to comply with a federal grand jury subpoena. Scarce, a Ph.D. candidate at Washington State University, refused to provide legal authorities with confidential information from inter views with his research subjects, animal rights activists whom the federal gov ernment was investigating for break-ins and property damage in university labo ratories. As a result, Scarce was incarcerated from May 14 to October 19, 1993 under a charge of contempt of court. During his confinement, Scarce's case became a cause celebre: students in Pullman rallied in his support at campus demonstrations; regional media wrote editorials arguing for his release; the American Sociological Association contributed to his defense fund and filed an Amicus Curae (friend of the court) brief on his behalf; fellow sociologists discussed his case and its broader implications at professional meetings and wrote about it sympathetically in the ASA's professional newsletter, Footnotes', and ultimately Scarce's case was appealed to the Ninth U.S. Circuit Court of Appeals. Though the district court ruled against him, Scarce was eventually released after 159 days of incarceration. Scarce has eloquently and forcefully described his ordeal in this special issue, as well as elsewhere in the popular and academic press (see Scarce, 1994). Like Rik Scarce, I too was recently subpoenaed by a court seeking to compel disclosure of the confidential data I had collected as part of my dissertation research. Like Rik Scarce, I too was threatened with a contempt of court charge

An evaluation of legal outcome following pretrial forensic assessment.

This paper constitutes the first stage of data analysis in a larger controlled study designed to assess the effect of a forensic psychiatric assessment on legal disposition defined in three ways: 1. the number of days spent in custody prior to trial; 2. the number of sentenced days of incarceration; and 3. the conviction rate. A historical cohort design was used to follow two cohorts of individuals remanded, pretrial, to Southern Alberta Provincial Correctional Centres between 1988 and 1989. The study cohort consisted of all offenders detained who received a forensic psychiatric assessment. The comparison cohort consisted of a random sample of persons detained who did not undergo a forensic assessment. Because of small numbers, individuals below the age of 18 and women were excluded from study. This paper compares socio-legal characteristics of study and comparison subjects in order to better understand forensic psychiatric referral patterns and identify potentially confounding factors that would need to be controlled in subsequent analyses of legal outcomes. No differences were noted with respect to educational level but forensic subjects were found to be slightly older (average of 31 years compared to 29 years). Aboriginal peoples (Native Indian, Inuit and Metis) were three times more common among non-forensic offenders. Forensic patients were more likely to have had a prior forensic assessment but less likely to have a prior criminal detention. In addition, forensic patients were three times more likely to be charged with a crime against a person and counted more offenses in the target episode than comparison subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Characteristics of suicides by inmates in an urban jail.

The authors' goals were to describe the characteristics of suicides committed by inmates in custody of the New York City Department of Correction between 1980 and 1988. Data on suicides were collected from records of the jail health services, the municipal medical examiner's office, and the city's prison death review board, as well as from reports of the New York State Commission of Correction and other documents. The authors identified 48 suicides committed by inmates during the study period. Forty-two percent of the suicides occurred within the first 30 days of incarceration, and 50 percent occurred within three days of a court appearance. More than 90 percent of suicides were by hanging. Ninety-one percent of suicides took place in cells in which the inmate was housed alone. Fifty-two percent of the inmates who committed suicide had a major psychiatric diagnosis, and 46 percent had a history of inpatient or outpatient psychiatric care. The authors recommend that all inmates with a psychiatric history or potential suicidality be identified and linked with ongoing mental health services while incarcerated, that potentially suicidal inmates never be housed alone in a cell, and that correctional staff be trained to recognize potentially self-destructive inmates and to prevent suicide.

Symptoms of Psychopathology among Jail Prisoners

This article examines the contribution of person and environment factors to symptoms of psychopathology among jail prisoners. The data challenge the conventional view that a disproportionate number of jail prisoners exhibit symptoms of psychological and psychiatric disorders because they are mentally ill before they enter jail. The SCL-90 was administered to a sample of jail prisoners (N = 339) within 72 hours of confinement. Initially, the respondents were asked to rate symptoms since then had been confined and the week prior to their arrest and confinement. The instrument was administered again to available members of the sample (N = 102) after 5 days of incarceration, at which time the respondents were asked to rate their symptoms since their initial interview. A repeated measures analysis of variance of prisoner symptom scores for the three rating intervals indicated that for several dimensions symptoms increase markedly during incarceration's initial period and then stabilize or diminish after five days of confinement. An examination of the symptom scores in conjunction with measures of history of psychological disorder suggested that although those with a history of disorder had higher symptom scores for most dimensions than those without such a history, for some dimensions, the symptom scores of those without a history of disorder showed a sharper increase in response to incarceration than did those of their psychologically troubled counterparts. The findings demonstrate that jail can have considerable effects on symptom levels, and these effects are not restricted to those who we normally view as susceptible. The results suggest that those who hold an exclusively person-centered view of psychological disturbance among jail prisoners should expand their view to include the contribution of the jail environment.

PRISONERS' ATTITUDES TOWARD COMPONENTS OF THE LEGAL AND JUDICIAL SYSTEMS

Abstract Prisoners' attitudes toward components of the legal and judicial systems are reviewed and analyzed with data collected from prisoners in their first several days of incarceration. These data are analyzed within subgroups of the prison population. In general, attitudes toward the police are negative, attitudes toward the law and the judicial system are mixed, and attitudes toward lawyers are positive. However, preprison and prison status factors influence the attitudes held by prisoners, and these different patterns of influence are discussed.