The effects of treatment exposure on prison misconduct for female prisoners with substance use,mental health,and co-occurring disorders

Inmates with mental health and co-occurring mental health and substance use disorders present difficult challenges for correctional institutions and treatment providers. The complex nature of co-occurring disorders further exacerbates these difficulties and is associated with poor treatment compliance and increased likelihood of engaging in institutional misconduct. The current study examines whether exposure to prison-based treatment reduces involvement in prison misconduct among a sample of female prison inmates controlling for disorder types (i.e. mental health disorder only, substance use disorder only, and co-occurring mental and substance use disorders). Findings revealed that with exposure of more than 181?days of treatment, the odds of misconduct involvement among females with co-occurring disorders more than doubled compared to receiving no treatment. This finding is at odds with treatment retention literature that suggests that a minimum period of time in treatment is needed to affect post-treatment success. Possible explanations for these findings and policy implications are discussed.     

Variations in mental health problems, substance use, and delinquency between African American and Caucasian juvenile offenders: implications for reentry services

The incarceration of young people is a growing national problem. Key correlates of incarceration among American youth include mental health problems, substance use, and delinquency. The present study uses a statewide sample of incarcerated youth to examine racial differences in African American and Caucasian juvenile offenders' outcomes related to mental health, substance use, and delinquency. The data indicate that relative to Caucasian offenders, African American offenders report lower levels of mental health problems and substance use but higher levels of delinquent behavior such as violence, weapon carrying, and gang fighting. The data further reveal that African American offenders are more likely than Caucasian offenders to be victims of violence and to experience traumatic events such as witnessing injury and death. Recognition of these patterns may help to improve postrelease services by tailoring or adapting preexisting programs to patterns of risk factors and their relative magnitudes of effect.     

Substance use,health, and mental health: problems and service utilization among incarcerated women

This article profiles self-reported substance use, health, and mental health problems among a sample of incarcerated women in Kentucky as well as lifetime service utilization. Findings indicate that a high percentage of women reported use of alcohol, cocaine, and multiple substances during the month before incarceration. In addition, participants reported common health problems such as dental, female reproductive, physical injuries, and mental health problems including depression and anxiety. Participants reported moderate use of emergency room and mental health treatment but limited substance abuse treatment utilization. Implications for criminal justice programs and linkages with community-based aftercare services for women are recommended based on findings that health and mental health problems are associated with service utilization before incarceration.     

The right to refuse treatment and the movement for mental health reform

The right to refuse treatment is the most controversial of the rights of mental patients, and usually polarizes the movement for mental health reform between providers of care and external activist reformers. A broad alliance supported earlier struggles for recognition of patients' rights, but most professionals oppose recognizing this most extreme right of treatment refusal. Professional opposition to treatment refusal is not based on a wide extent of actual refusal; rather it derives from a defense against challenges to professional and institutional autonomy, an opposition to legal interference, and a belief that the community as well as the patient must be protected. These three reasons for opposition are examined by reviewing studies of attitudes toward patients' rights, knowledge about patients' rights, and implementation of patients' rights. Finally, the implications of these studies for future directions in the movement for patients' rights are examined.     

Reducing out-of-community placement and recidivism: diversion of delinquent youth with mental health and substance use problems from the justice system

For a number of reasons, researchers and policy makers are now focusing on diversion of youth from the juvenile justice system. This study examines New York State's diversion efforts focused on youth with mental health and substance abuse problems who are at risk of out-of-community placement (N = 2,309). Twelve counties participated in the Mental Health Juvenile Justice (MH/JJ) Diversion Project. Overall, the initiative was successful in reducing out-of-community placement and recidivism for diverted youth. In regression analysis site, services received, and problem-profile variables were important predictors of out-of-community placement. Prior record, prior placement, and significant mental health problems were statistically significant predictors of recidivism. This suggests some contrasts in explaining the results of two important goals of the MH/JJ project. Study results and implications for future research and intervention are discussed.     

Toward an agenda for reform of justice and mental health systems interactions

This article presents an agenda for reform of the justice and mental health systems interactions, which includes policy, management, and research strategies related to the systemic and interorganizational issues facing the two systems. The strategies are divided into six major categories: (a) base decisions, procedures, and policies on empirical data; (b) improve communications between system; (c) ensure dignity and respect are afforded all individuals involved in both systems; (d) ensure the availability and delivery of mental health services and treatment prorams; (e) inform others about issues related to the intereactions of the justice and mental health systems; and (f) periodically review and reformulate policies, management strategies, and research efforts for improving systems interactions. The article also presents a summary of the problems and possible goals associated with mental health and justice systems interactions. The summaries as well as the agenda are based on the results of a symposiuum attended by practitioners and scholars in the justice and mental health fields.     

Mental health,substance use,and offending patterns among Native American youth in juvenile detention

Research has shown that youthful offenders in the juvenile justice system report an array of substance use and emotional and other mental health needs. The current study closely examined these issues in a large national sample (n = 539) of Native American youth drawn from the Survey of Youth in Residential Placement. Results demonstrated that frequent substance use was associated with the likelihood of being detained for a drug offense, while emotional and mental health needs were associated with detention for the most serious offenses. These results highlight the need for comprehensive substance use and other mental health assessments for Native American youth in the juvenile justice system.     

Inequality, privacy, and mental health

The state's mental health power is standardly understood in terms of the state's power to intervene with persons or populations to address mental health problems. This article advances a more expansive view of the state's mental health power, one which seeks to capture those exercises of state power that do not directly concern mental health but that nevertheless can have a profound effect on mental well-being. The article considers two features of contemporary American society that implicate the state in conditions that undermine, or threaten to undermine, mental health. The first concerns the impact of poverty and inequality on mental health. The second concerns the threat to the self posed by measures that would significantly erode privacy. The article argues that a greater commitment to liberal principles of equality and tolerance is crucial to overcoming the perils for mental health that poverty and losses of privacy generate.     

The mental health and substance misuse needs of male ex-armed forces personnel in prison

Ex-armed forces personnel constitute the largest known occupational group in prison but there is little evidence regarding their mental health, or substance misuse, needs. A total of 105 participants were interviewed and measures assessing symptoms of common mental health (CMH) problems and substance misuse were completed along with a review of their health care records. Forty (38%) participants screened for current CMH problems (CCMH) and high levels of dual symptomology and alcohol misuse were assessed. Thirty-nine (37%) had a mental health diagnosis recorded, most commonly for post-traumatic stress disorder (PTSD), depression and personality disorder. Those who screened for a CCMH problem were more likely to have pre-service vulnerability to negative health outcomes and those with dual symptomology were more likely to have experienced deployment during their service. Findings suggest the mental health needs of this group are similar to the general prison population. Potentially higher prevalences of PTSD and alcohol misuse may direct service provision.     

Special report on health care reform. ERISA preemption, Traveler's and health care reform

Although S. 308 reportedly has some bipartisan support, its passage is by no means certain. ERISA has for years provided employers with the freedom to design their own benefit plans without state interference, as well as the ability to operate such plans in a uniform manner throughout the country. large employers are thus not likely to cede the advantages of ERISA preemption without a battle. When strong business interests are pitted against the states' equally strong interests in enacting health care reforms, the outcome cannot be predicted.     

Risk avoidance and missed opportunities in mental health reform: the case of Israel

Passage of the National Health Insurance Law (NHI) [National Health Insurance Law (NHI) (1994). Israel Law Code, 1469, 156 (Hebrew).] provided a window of opportunity for mental health reform in Israel. The reform called for transfer, within a period of 3 years, of responsibility for psychiatric services formerly provided mostly by the Ministry of Health, to Israel's four major healthcare providers. Planners of mental health reform in Israel saw in the NHI Law an opportunity to bring about far-reaching structural changes in mental health policy and service provision, shifting the locus of care from psychiatric hospitals to the community. This paper reports results of a case study assessing factors that hindered or promoted the planned reform. The theoretical and conceptual framework of the study was derived from public policy theories and in particular on those related to public agenda and agenda setting processes. The study was also informed by organizational and interorganizational theories and exchange theory. Data was gathered from documents and interviews of key informants. Sources of data included official reports, proceedings of Knesset's Labor and Social Affairs (LSA) Committee, Ministry of Health documents, healthcare providers' reports, budget documents, newspaper analysis, and about 60 interviews with persons who played important roles in the process of the negotiations regarding the reform efforts. Analysis identified the major stakeholders and their concerns, distinguishing between the key stakeholders involved directly in the negotiations and secondary or additional stakeholders outside the main circle, some of whom were very involved and influential in the process. The study identified the major issues and the problems that emerged during the process of negotiations. Analysis of the failure of the attempt to implement the reform reveals a combination of obstacles emanating from the process of negotiation, on the one hand, and from the larger political, economic and social context, on the other. Findings show that conflict of interests and risk avoidance of the major stakeholders were major obstacles to reaching agreement on a formula for implementation. The major risks were related to the inability to predict future demand for ambulatory services, uncertainty regarding future costs, and disagreements regarding the reliability and validity of data. Contextual factors that undermined the chances for successful implementation of the reform included lack of a strong political commitment and a coalition supporting the reform, a financial crisis in the health system resulting from early stages of implementation of the National Health Insurance Law, and social turmoil created by the Rabin government's attempts to implement the Oslo agreements. This turmoil ultimately culminated in the assassination of the Prime Minister Yitzchak Rabin, creating a climate far from conducive to generating public interest in mental health reform and facilitating the planned change. As a result the mental health system remained virtually unchanged.     

The use and readability of mental health self-help in Scottish prisons

Prisoners are at higher risk of mental health problems than people in the general community. One possible way of optimising mental health care resources in prisons is to offer self-help materials. In order for these to be effective, they must be appropriate for the reading ability of the patient. This study aimed to determine, by way of a survey distributed to Scottish mental health care teams, how self-help resources are being used currently in the Scottish prison system, and to analyse the materials using four different readability tools: FRE, FKGL, SMOG and the Drivel Defence programme. It was found that there is currently widespread provision of self-help to Scottish prisoners; however, only 53% of these materials are suitable for the quoted average prisoner reading age. Mental health practitioners should be aware of this when providing self-help to patients, and consider easy-read options where available.