Community mental health and prisons: A model for constitutionally adequate care in correctional mental health

The establishment of judicially acceptable standards of mental health care within a prison setting requires the adoption of a service-delivery model and a constant evaluation of that model in relation to individual and civil rights. This article reviews the experience of the department of corrections in one state in developing a constitutionally adequate mental health system. The report outlines the programs established, the legal basis for decisions, and recent constitutional challenges. Future trends in correctional mental health are also discussed.     

Psychosocial work environment, interpersonal violence at work and mental health among correctional officers

The main purpose of this study was to present changes occurring between 2002 and 2004 in the prevalence of psychosocial constraints and interpersonal violence at work among officers working in correctional facilities in Quebec. Results suggest that in the absence of specific organizational intervention aimed at improving a deleterious work situation, exposure to low decision latitude remained similar between 2002 and 2004, while exposure to high psychological demands improved somewhat, for both men and women. In 2000, rates of exposure of correctional officers in Quebec to high psychological demands, low decision latitude and the combination of high psychological demands and low decision latitude (job strain) were significantly higher than those obtained for the entire population of workers in Quebec in contact with the public. Exposure of correctional officers in Quebec to intimidation at work increased substantially between 2002 and 2004, among both men and women. Globally speaking, rates of exposure to intimidation by colleagues and superiors practically doubled between 2000 and 2004. Rates of exposure to intimidation among correctional officers in Quebec were particularly high in 2004 (71% among men 66% among women) compared to rates in another study conducted among federal correctional officers (48%) by Samak. The present study also showed that in 2004, correctional officers in Quebec were more likely to present signs of psychological distress linked with work when they were exposed to high psychological demands, low decision latitude, job strain and poor social support from superiors and colleagues. Psychological distress was also shown to be greater when reward at work was scarce and when there was an imbalance between effort and reward at work. Finally, in 2004, psychological distress among correctional officers was also associated with intimidation and psychological harassment at work.     

Court outcomes for clients referred to a community mental health court liaison service

Court liaison and diversion services come in a variety of forms, but the similarities and differences between these services are not well characterized. Findings from a six-year audit of the Newcastle (Australia) Mental Health Court Liaison (MHCL) service are reported, including client characteristics, offence and service contact profiles, court outcomes, and interrelationships among these variables. During the audit period, there were 2383 service episodes by 1858 clients (1478 males, 380 females). Drug and alcohol disorders (40.9%) and psychotic disorders (17.0%) were the most prevalent mental health problems, while assault (23.1%), theft (23.1%), offences against justice procedures (15.4%), driving offences (13.4%) and malicious damage to property (8.3%) were the most frequently recorded charges. Among service episodes with a finalized court outcome, 70.0% involved a punishment (bond: 49.5%; jail term: 29.7%). Females were less likely to be punished, but more likely to have their case dismissed under sections of the relevant Act that required further assessment and monitoring. Being married, or having an adjustment or drug and alcohol disorder, were also associated with an increased likelihood of punishment, while clients with a psychotic or bipolar disorder were less likely to be punished. Among clients who were punished, those referred from inpatient mental health services were more likely to receive a non-jail punishment, while unemployed clients were more likely to be jailed. A substantial proportion of clients had court outcomes that required an ongoing involvement with local mental health services. By being part of community mental health services, our MHCL service is able to work efficiently and effectively with the criminal justice system, while facilitating ready access to existing mental health services and continuation of care.     

Music therapy for improving mental health problems of offenders in correctional settings: systematic review and meta-analysis

Objectives

The aim of this review was to assess the effectiveness of music therapy on improving the mental health of offenders in correctional settings.

Methods

Multiple databases and journals were searched to identify randomized controlled trials and quasi-randomized controlled trials of music therapy for offenders in correctional settings.

Results

Five studies (n?=?409; predominantly male) were included in random-effects meta-analyses. Music therapy was effective for promoting offenders’ self-esteem (Hedges’ g?=?0.55, p?<?0.001) and social functioning (g?=?0.35, p?<?0.05). Effects on anxiety and depression depended on the number of sessions. For both outcomes, the studies with 20 or more sessions had larger effects than the study that had fewer than 20 sessions, and this difference was statistically significant (Q?=?11.88, df?=?1, p?<?0.001, anxiety; Q?=?9.16, df?=?1, p?=?0.002, depression). No significant effects were found on behavior management or between different music therapy approaches.

Conclusions

Music therapy may be helpful for offenders to improve mental health. Future studies should consider including offenders of both genders, using larger sample sizes, and examining long-term effects. Publication bias may be an issue for this review given the small number of studies and the small sample sizes.

     

Integrating the American criminal justice and mental health service systems to focus on victimization

Although most research and policy in the mental health and criminal justice arenas have operated independently of one another, there is a growing consensus suggesting the need for an integration of these two disparate, yet complementary systems. Furthermore, in light of the adverse mental health consequences that often accompany victimization experiences, it is apparent that these two systems should develop and foster overlapping services for crime victims. The research reviewed herein provides an examination of issues such as these, identifies some of the barriers that stand in the way of a successful integration of the two systems, and attempts to provide some guidance and direction for future integrated mental health and criminal justice system approaches. An outline of research gaps and directions for future study are offered for the integration of criminal justice and mental health systems, as such collaborations are likely to alleviate some of the deleterious mental health outcomes evident among crime victims and at the same time reduce the occurrence of repeat victimization.     

The mental health service crisis of neoliberalism -- an antipodean perspective

Major transformations in forms of governance of the liberal state have been wrought over the course of the last century, including the rise of neoliberalism and 'new public management.' Mental health too has witnessed change, with pharmacological treatment displacing residential care, a shift to community-based services, mainstreaming with general health care, and greater reliance on civil society institutions such as the family or markets. This article considers whether mental health law, and its court/tribunal 'gatekeepers' have kept pace with those changes. It argues that the focus of the liberal project needs to shift to measures which will better guarantee access to mental health services, and keep a more watchful eye on both 'hidden' coercion of people on community treatment orders, and passive neglect of human need.     

Prevalence and screening of mental disorders in short-term correctional facilities

A majority of people incarcerated in correctional facilities have been affected by mental problems at least once in their lifetime. Among them, 12 to 25% suffer from severe and persistent mental disorders at the time of admission. Certain “profiles” are more likely to be detected than others. This is why the main objectives of this research are to establish, in both male and female offenders admitted in short-term detention facilities, the rate of those who have received medical diagnoses of mental disorders, the rate of screening for “mental health problems” at admission and the psychiatric diagnoses (last five years) most strongly associated with a positive screening. Using computerized medical and prison files, it can be established that 61% of the 671 offenders sent to a short-term correctional facility received, during 2002–2007, at least one diagnosis for mental disorder. A total of 227 subjects (33.8%) obtained a positive score to the indicator of mental health problem.” In the case of men, correctional services workers identified as mental health problems: psychotic disorders, adjustment reactions, «neurotic»/anxiety disorders, being coupled to drug dependence. Positively detected women tend to exhibit problems of anxiety, personality disorder and substance related disorders. This study highlights, the difficulties faced by correctional services workers in detecting recent depressive disorders both in men and women offenders and also difficulties to detect recent affective psychoses.     

Estimating mental health needs and service utilization among prison inmates.

A sample of 3,684 inmates in the New York State prison system was surveyed in May 1986 to determine the prevalence of psychiatric and functional disability and service utilization. It was estimated that 5 percent had a severe psychiatric disability, and 10 percent had significant psychiatric disability. The higher the level of disability, the greater the proportion of inmates that had received mental health services in the last 30 days and in the last year. Still, 45 percent of the severe disability group had no service contacts in the last year. Patterns of utilization differed significantly by sex (a greater proportion of women received services) and by race (a greater proportion of whites received services). The clinical factors associated with receipt of services varied considerably between men and women.     

An instructional aid for courses in corrections: The correctional institutions environment scale

This paper describes the use of Moos’ (1974) Correctional Institutions Environment Scale (CIES) as a supplemental instructional technique in criminal justice courses on corrections. Utilization of the CIES (Form I) provides students with feedback on their values and goal orientations toward correctional programs, and provides a means to organize class discussions on correctional environments. Sample CIES profiles of students are presented, and various instructional uses are delineated.     

Putting mental health into mental health law

This article critiques the traditional doctrinal approach to mental health law and compares the traditional approach with a new, interdisciplinary approach known as therapeutic jurisprudence. Therapeutic jurisprudence views the law itself as a potential therapeutic agent. Examples are given of how legal rules, procedures, and the roles of legal actors may produce therapeutic or antitherapeutic results and of how the law may improve therapeutic outcomes without sacrificing the interests of justice.     

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.