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.     

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.     

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 social,relational and mental health characteristics of justice-involved men in the south-west England

The aim of this article is to describe the social, relational and mental health characteristics of a sample of offenders serving prison or community sentences in the south-west England. About 100 adult male offenders were screened for anxiety and depressive disorders, post-traumatic stress disorder (PTSD), drug and alcohol dependence, and likely personality disorder using validated instruments. Fifty-eight per cent of the sample reported at least one common mental health problem, of these only 26% reported receiving treatment. Participants exposed to traumatic events and/or participants with past mental health problems were more likely to score positive for current common mental health problems. Our study identified factors that may increase the risk of a first episode or recurrent anxiety and/or depression for offenders. Health and criminal justice services should create partnerships and develop interventions that address the risk factors which lead and/or contribute to offenders' mental health difficulties.     

Developmental Impacts of Child Abuse and Neglect Related to Adult Mental Health, Substance Use, and Physical Health

This study examined the association between officially recorded child abuse and neglect and adult mental health, substance use, and physical health outcomes. Data are from a longitudinal study of more than 30 years in which individuals were interviewed most recently in their mid—30s. Analyses consisted of group comparisons using chi-square tests for categorical variables and independent samples t-tests for continuous measures. Logistic and linear regressions controlled for gender and childhood SES, adult age, marital status, and education. Adults maltreated in childhood reported more symptoms of adult depression, anxiety, and more impairment due to mental and physical health problems. A higher percentage of those with maltreatment histories reported lifetime alcohol problems and appear at greater risk for substance abuse. Most findings of these bivariate analyses remained significant after accounting for gender and childhood socioeconomic status. Somewhat fewer significant results were observed after controlling for adult age, marital status, and education.     

Incorporating a Healthy Living Curriculum within Family Behavior Therapy: A Clinical Case Example in a Woman with a History of Domestic Violence,Child Neglect,Drug Abuse,and Obesity

Women reported to child protective service agencies frequently report problems that significantly interfere with the health and well-being of their children and themselves. Behavioral treatment programs appear to be effective in managing these co-existing problems, such as domestic violence and substance abuse. However, evidence-supported interventions are rarely exemplified in complicated clinical cases, especially within child welfare settings. Therefore, in this case example, we describe the process of adapting an evidence-supported treatment to assist in managing significant co-existing health-related problems in a mother who was referred due to child neglect and drug abuse. At the conclusion of therapy, the participant reported improvements in perceived family relationships, illicit drug use, child maltreatment potential, whereas other health-related outcomes were mixed. Most improvements were maintained at 4-month follow-up. Issues relevant to implementing evidence-based treatments within community contexts are discussed, including methods of increasing the likelihood of valid outcome assessment, managing treatment integrity, and adjusting standardized treatments to accommodate co-occurring problems.     

Social Connection to Neighbors,Multiple Victimization,and Current Health Among Women Residing in High Crime Neighborhoods

This study assessed current health [physical health, bodily pain, global distress, posttraumatic stress-related disorder (PTSD) symptoms, and illicit substance use] among 160 minority women residing in high crime areas with varying numbers of different types of victimization histories and varying levels of social connections (SCs) to neighbors. Multivariate analyses of covariance indicated a main effect for number of different types of victimization and for SC to neighbors, after considering ethnicity, immigration, and marital status. Women with two or three+ different types of victimization reported higher global distress, PTSD symptoms, and illicit substance use than women with zero or one type of victimization. Likewise, women with low levels of SC to neighbors reported higher bodily pain than women with high levels of SCs to neighbors.     

Effects of Pre-release Services on Access to Behavioral Health Treatment after Release from Prison

Using the Serious and Violent Offender Reentry Initiative data-set, substance use and mental health needs of released inmates are examined to explore whether there is a positive relationship between pre-release services and behavioral health treatment access at three months post-release. Two weighted hierarchical linear models were run testing the effects of three key pre-release services: pre-release needs assessment, pre-release linkage with inmates’ post-release case managers, and pre-release assistance with accessing post-release health insurance. Results demonstrate that pre-release needs assessment significantly increases the odds of receiving post-release substance abuse treatment, and case management linkage and assistance with accessing health insurance significantly increase the odds of mental health treatment after release. Policy implications for reentry service provision targeting behavioral health needs, and directions for future research, are discussed.     

The mental health needs of incarcerated youth in British Columbia, Canada

The purpose of the study was to identify the current prevalence of mental disorders and mental health needs among incarcerated male and female youths in Canada, and to present these data in the context of rates found in other jurisdictions. One hundred forty male and 65 female incarcerated young offenders in British Columbia were screened with the Massachusetts Youth Screening Instrument Version 2 (MAYSI-2); provisional psychiatric diagnoses were assessed with the Diagnostic Interview Schedule for Children Version IV (DISC-IV); abuse history and aggressive symptoms of Conduct Disorder (CD) were coded from file information. Nearly all youths (91.9% of males and 100% of females) met the criteria for at least one mental disorder. Substance abuse and dependence disorders were highly prevalent (85.5% of males and 100% of females). Aggressive forms of CD were common (72.9% of males and 84.3% of females), as were exposure to physical abuse (60.8% of males and 54.3% of females) and sexual abuse (21.2% of males and 42.4% of females). Female youths had significantly higher odds of presenting with: (1) substance abuse/dependence disorders; (2) current suicide ideation; (3) sexual abuse; (4) PTSD; (5) symptoms of depression and anxiety; (6) Oppositional Defiant Disorder; and (7) multiple mental disorder diagnoses. Male youths had significantly higher odds of presenting with aggressive symptoms of CD. Overall, rates of mental disorder among this sample of serious and violent young offenders were higher than rates previously reported for incarcerated youths — both in Canada and in other jurisdictions.     

Determinants of prisoners’ perceived need for care in association with criminal recidivism

This study explored determinants of perceived need for care among male inmates of general prison wards in Amsterdam (N = 208) with a normative need for care. Also, it assessed the relation between perceived need for care and criminal recidivism. Normative need for care was defined as having a mental health problem, assessed with the Brief Jail Mental Health Screen, or being substance dependent. Perceived need for care was defined as a subjective problem experience and a wish to receive care. Mental health and/or addiction problems were highly prevalent (68%). Of those inmates, only 29% had a perceived need for care. Age and borderline personality disorder were associated with perceived need for care, prior care utilization intermediated these associations. No direct relation between perceived need for care and criminal recidivism was observed. All inmates should be well screened and the benefits of mental health care should be promoted.     

Traumatic Event Exposure and Behavioral Health Disorders among Incarcerated Females Self-Referred to Treatment

At least half of the women inside prison have mental health problems, have experienced physical, sexual, or emotional abuse during their formative years and often in adulthood, and have addiction problems. Only a minority of these women receive treatment for their behavioral health problems associated with trauma while incarcerated, even though these problems are risk factors for returning to prison after release. This study focuses on the traumatic experiences and behavioral health problems of a group of female inmates who volunteered in August 2009, to be screened for admission into an integrated trauma-reentry program implemented at an adult female correctional facility. Of the 278 women who self-referred for screening, 196 preliminarily met the time eligibility criterion of residing at the prison for eight to 24 more months. Half of these women (n?=?97) were actually time-eligible for screening and agreed to be screened. Of this sample of treatment-seeking soon-to-be-released female prisoners, the vast majority (93%) reported significant and complex histories of traumatic event exposure and high rates of either posttraumatic stress disorder (PTSD) or sub-threshold PTSD, past alcohol and other substance abuse or dependence, other axis I psychiatric disorders, and subjective distress. Identifying trauma exposure histories and associated behavioral health problems within this population and providing effective interventions holds potential promise for preparing incarcerated women to manage their post-release lives in ways that will keep them safe, healthy, and in the community.     

Exploring gender differences in constellations of problem behaviors and associated health-related factors during adolescence

Using data from the National Longitudinal Study of Adolescent Health (Add Health), this study expands on previous research on adolescent problem behavior by (1) examining gender differences in patterns or ‘subgroups’ of adolescents based on self-reported problem behaviors and (2) identifying differences in health-related factors including service utilization, physical and mental health, and violent victimization across the identified gender-specific subgroups. The data used in this study were taken from Wave 2 of the National Longitudinal Study of Adolescent Health (Add Health) data and includes respondents under the age of 18 (n?=?10,360). Based on 16 problem behavior items measuring delinquency, substance use, risky sexual practices, and status offending, latent class analyses identified a 4-class model for the male subsample and a 3-class model for the female subsample. Important differences in health-related factors were observed across the latent classes. However, these differences were fairly consistent for boys and girls. Implications for prevention and intervention strategies, specifically focusing on the intersection of juvenile justice and public health services, are discussed.     

MENTAL HEALTH AND JUVENILE ARRESTS: CRIMINALITY,CRIMINALIZATION, OR COMPASSION?*

Juveniles in secure confinement allegedly suffer from more mental health problems than their peers. This may reflect background and behavioral characteristics commonly found in clients of both mental health and juvenile justice systems. Another explanation is that mental disorders increase the risk of arrest. These interpretations were tested on a sample of Pittsburgh boys (n = 736). Findings indicate that arrested youth exhibit more attention deficit hyperactivity (ADH) problems, oppositional defiant (OD) problems, and nondelinquent externalizing symptoms prior to their first arrests compared to their never‐arrested peers. However, arrested and nonarrested youth score similarly on prior affective and anxiety problems and internalizing symptoms. Net of delinquency, substance use, and other selection factors, internalizing problems lower the risk of subsequent arrest, whereas OD problems and nondelinquent externalizing symptoms increase it. ADH problems have no effect on arrest net of delinquency and substance use. These findings lend only partial support to the criminalization hypothesis. Whereas some mental health symptoms increase the risk of arrest, others elicit more cautious or compassionate official responses.     

Gray Matters: Gender Differences in the Physical and Mental Health of Older Inmates

Although there has been a substantial increase in the number of older female inmates incarcerated in the United States, there has been little scholarly attention paid to this population. The purpose of this study is to extend the current understanding of older inmates by examining gender differences in their physical and mental health. Bivariate analyses of one of the largest known samples of older female inmates (n = 142) revealed significant gender differences. Older female inmates reported a greater number of physical health conditions and mental health disorders in all three time periods: in their lifetimes, since admission to prison, and in the previous year. This research informs the need for gender-specific health programming for older female inmates.     

Professional attitudes regarding treatment and punishment of incest: Comparing police,child welfare,and community mental health

Brief case histories involving incest were presented to police officers, child welfare workers, and community mental health practitioners in a rural area in Canada. Intervention priorities involving “treatment versus punishment” were assessed across the three professional groups for each specific case vignette. Attitudes were assessed on three factors: perpetrator mentally ill rather than criminal, view regarding treatment of victims and mothers, and support for court mandated treatment. Police and community mental health practitioners had significantly different attitudes as to whether perpetrators of child sexual abuse should be viewed more as criminals or as mentally disturbed. Both mental health and child welfare staff differed significantly from police with a less punitive view towards victims and their mothers. All three profressional groups showed no difference in their modest endorsement of the use of mandated treatment by the courts. Gender was not found to influence response to case vignettes.     

The Effect of Coercion on Aggression and Mental Health Among Reciprocally Violent Couples

Researchers have not investigated mental health outcomes among couples who are reciprocally violent towards each other. The present study investigated differences in partner violence (psychological, physical, and sexual) and mental health symptoms (depression, anxiety, hostility, and somatic) between two types of reciprocally violent couples: situational couple violence (SCV) and mutual control violence (MVC). SCV couples use violence to address stressful family conflicts, while MVC couples use violence as a tool to control each other. Participants (N = 609) completed surveys that contained several instruments that measured past violence, coercive behaviors, physical injuries, and mental health symptoms. Results revealed that MVC reported significantly higher levels of violent perpetration and worse physical and mental health than SCV. These findings have implications for understanding the role of coercion in partner violence and mental health, which can be used for the development of appropriate mental health services for couples who are mutually violent towards each other.     

Comparing male and female juveniles charged with homicide: child maltreatment, substance abuse, and crime details

This study examines a sample of 136 male and female juveniles charged with attempted homicide or homicide. The purpose of this study is to explore the differences between nondirect file male and female juvenile homicide offenders regarding individual, family, and crime circumstances. Findings suggest that compared to male juvenile offenders, female juvenile homicide offenders have higher rates of reported childhood abuse, more serious substance abuse, and mental health problems including suicidal ideations, depression, anxiety, anger, and irritability. Male juvenile homicide offenders reported higher rates of substance use than their female counterparts but the females had more serious substance abuse problems. Female juveniles were found to more often kill a person known to them and male homicide offenders were found to more often kill a stranger. These findings suggest strongly that male and female juvenile homicide offenders are dissimilar and require unique assessment and treatment.     

Elevated Risk of Arrest for Veteran's Administration Behavioral Health Service Recipients in Four Florida Counties

This paper examines the relative contribution of mental and substance abuse disorders to criminal justice involvement by examining the relative risk of arrest for three groups of adult male recipients of VA behavioral health care services. These groups include men served for both substance abuse and mental health, for only substance abuse, and for only mental health. The relative risk of multiple offences is compared to relative risk of a single offense for each group. Results indicated that relative risk of multiple arrests for the dual diagnosis group is substantially greater than for either of the single diagnosis groups, and greater than the relative risk for recipients of nonbehavioral health services. Relative risk of arrest for recipients of only mental health services is no different than the relative risk for other veterans living in the region under examination.     

The Relationship of Abuse to Women’s Health Status and Health Habits

The present study examined the relationship between exposure to abuse and women’s health status and health behaviors in a sample of rural women. One hundred forty-eight women visiting a community health care center completed survey packets that included measures that assessed: exposure to abuse, impairment associated with exposure to abuse, physical and mental health problems, health behaviors, and the extent of health care usage. Results indicated that exposure to abuse was positively and significantly related to the adoption of a negative psychological perspective, which in turn was negatively correlated with physical and mental health, as well as with the practice of healthy behaviors. Results also showed that women exposed to abuse engage in less healthy behaviors and utilize more health care resources than do women with no such exposure. Implications for improving the assessment and treatment of abuse in health care settings are discussed. This article is based on a thesis completed by the first author with the same title as this report.