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Mental Health and Co-Occurring Treatment Needs

of Individuals in the

Criminal Justice System

American Psychiatric Association 2007 Annual Meeting

May 23, 2007 San Diego, California

Roger H. Peters, Ph.D., University of South Florida, Tampa, Florida; Peters@fmhi.usf.edu

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Goals of this Presentation

Review:• Prevalence rates in justice settingsPrevalence rates in justice settings• Challenges in screening, assessment, Challenges in screening, assessment,

and treatment of CODsand treatment of CODs• Considerations for adapting COD Considerations for adapting COD

services in criminal justice settingsservices in criminal justice settings

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Challenges in Addressing CODs

• At risk for relapseAt risk for relapse• Criminality/criminal Criminality/criminal

thinkingthinking• Housing needsHousing needs• Transportation needsTransportation needs• Family reunification Family reunification

• Job skills deficitsJob skills deficits• Educational deficitsEducational deficits• Stigma related to Stigma related to

criminal history and criminal history and SA and MH disordersSA and MH disorders

• Scarce prevention and Scarce prevention and treatment resourcestreatment resources

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Outcomes Related to CODs

• More rapid progression from initial use to More rapid progression from initial use to substance dependence substance dependence

• Poor adherence to medicationPoor adherence to medication• Decreased likelihood of treatment Decreased likelihood of treatment

completioncompletion• Greater rates of hospitalizationGreater rates of hospitalization• More frequent suicidal behaviorMore frequent suicidal behavior• Difficulties in social functioningDifficulties in social functioning• Shorter time in remission of symptoms Shorter time in remission of symptoms

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0.10.9 11.8 1.4

2.73.9

6.4

1.4 2

10.512.2

02468

101214

GeneralPopulation -

Males

Jail - Males Jail - Females

Prevalence of Mental Illness

Mania Schizophrenia Major Depression Any Serious Disorder

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Prevalence of Mental Problems in Justice Settings by Gender

GenderGender State PrisonState Prison Fed. PrisonFed. Prison JailJail

MaleMale 55% 55% 44% 63% 44% 63%

FemaleFemale 73% 73% 61% 75% 61% 75%

* Based on a modified clinical interview for the DSM-IV, describing experiences * Based on a modified clinical interview for the DSM-IV, describing experiences during the “past 12 months”. (U.S. Department of Justice, 2006)during the “past 12 months”. (U.S. Department of Justice, 2006)

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Co-Occurring Substance Abuse Problems among Offenders

51%62%

74%

36%43%56%

0%

25%

50%

75%

100%

MH Problems No MH Problems

Alcohol DrugsEither

74% of state prisoners with mental problems also have substance abuse or dependence problems

(U.S. Department of Justice, 2006)

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Unique Needs among Offenders who have CODs

• Ingrained criminal belief systems and related Ingrained criminal belief systems and related behaviorsbehaviors

• Corrosive peer supportsCorrosive peer supports• Need for structured therapeutic activities, Need for structured therapeutic activities,

supervision, and monitoring supervision, and monitoring • Interrelated nature of MH and SA disorders Interrelated nature of MH and SA disorders • Managing the transition between institutional Managing the transition between institutional

and community settingsand community settings

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Clinical Considerations • Cognitive impairmentCognitive impairment

• Reduced motivationReduced motivation

• Impairment in social functioningImpairment in social functioning

(Bellack, 2003)(Bellack, 2003)

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Challenges in Developing COD Services in the Justice System

• Contrasting goals of treatment and justice Contrasting goals of treatment and justice systems systems

• Resources and administrative support Resources and administrative support • Site-specific data to identify COD needsSite-specific data to identify COD needs• Implementing evidence-based practices Implementing evidence-based practices • Moving from sequential to integrated servicesMoving from sequential to integrated services• Continuity of services Continuity of services

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Key Features of Correctional COD

Treatment Programs • Highly structured therapeutic approachHighly structured therapeutic approach• Destigmatize mental illness illness Destigmatize mental illness illness • Focus on symptom management vs. cure Focus on symptom management vs. cure • Education regarding individual diagnoses Education regarding individual diagnoses

and interactive effects of CODsand interactive effects of CODs• ““Criminal thinking” groups Criminal thinking” groups • Basic life management and problem-Basic life management and problem-

solving skillssolving skills

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Structural Components of COD Treatment Programs

• Therapeutic communities Therapeutic communities • Isolated treatment units Isolated treatment units • Program phasesProgram phases• Blending of MH and SA servicesBlending of MH and SA services• AssessmentAssessment• Specialized mental health servicesSpecialized mental health services• Transition and reentry servicesTransition and reentry services

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Phases of COD Treatment Programs

• Orientation Orientation • Intensive treatment Intensive treatment • Relapse prevention/transition Relapse prevention/transition

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0

10

20

30

40

50

MH

33%

TC only

16%

5%

TC +after-care

Total n= 139 n=64 n=32 n=43

Effectiveness of Prison COD Treatment and Reentry – 1 Year

Reincarceration

Sacks, S., Sacks, J., et al. 2004

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• Intermediate care programs in prisonsIntermediate care programs in prisons• Pre-release intensive case management and Pre-release intensive case management and

transition planning transition planning • Outreach services from jails and prisonsOutreach services from jails and prisons• Videoconferencing to institutions in remote areasVideoconferencing to institutions in remote areas• Community-based residential treatmentCommunity-based residential treatment

Evidence-Based Approaches for Offender Mental Health Services