Bruce B. Way

Personality Disorders in Prison: Aren't They All Antisocial?

The provision of mental health services in the correctional system is challenging at best for various clinical, administrative, and structural reasons. Among the complicating factors is the assessment and management of character pathology which either confounds the treatment of more “serious” mental illnesses, e.g. Axis I disorders, and/or presents itself as the primary focus for intervention. In this paper we review the prevalence of personality disorders on the prison mental health services caseload in New York State. We compare inpatient and outpatient rates among the various disorders documented in the prison system, as well as look at these rates within the context of the rates of personality disorder in the state mental health system generally. Assessment of personality disorder will be addressed with particular attention to the confounding influence of the prison environment. Finally, treatment options will be discussed, including discussion of new initiatives that attempt to address inmates with serious mental illness and personality traits that lead to disciplinary housing.

Reducing suicides in New York State correctional facilities.

In an effort to identify modifiable risk factors for suicide in New York State prisons, the authors reviewed available statistical data and also examined a series of 40 psychological autopsies conducted on suicides of inmates who had received mental health services during their incarceration. Factors associated with suicide included substance abuse, history of prior suicide attempts, mental health treatment prior to incarceration, recent “bad news,” recent disciplinary action, and manifestation of agitation and/or anxiety. This review led to changes in certain clinical policies and procedures, environmental modifications and hazard reduction in observation cells, and an improved process for quality assurance reviews of suicides.

Predictors of the use of restraint and seclusion in public psychiatric hospitals

The authors report on the replication of a 1984 study of the use of restraint and seclusion at psychiatric hospitals operated by the New York State Office of Mental Health. The results of this study confirm the earlier finding that the hospital itself was the greatest predictor of the use of these interventions, when controlling for patient characteristics associated with the use of restraint and seclusion, such as age, gender, ethnicity legal status, length of stay, and diagnosis. Recent and current attention to these findings has already resulted in reduced rates at high-rate New York State facilities.

Constructing an efficient inpatient incident reporting system

SummaryThe NYS Office of Mental Health invests significant staff resources in documenting, investigating, and reviewing minor incidents. This process generates an enormous amount of paperwork. A study by the NYS Commission on Quality of Care revealed that this investment, in fact, compromised the intended positive outcomes. A major flaw they cited was the requirement for identical reporting procedures for both major and minor incidents. A logging system for reporting minor incidents was developed and pilot tested in three OMH psychiatric hospitals.The study revealed that utilization of a log system for the reporting of minor incidents greatly reduced paperwork and staff time, and that these reductions were accomplished without detriment to the quality of care. In fact, the quality of patient care may have improved. More incidents were being reported, a stable record was available on wards for clinical review, staff were enthusiastic about the log system, perhaps improving their morale, and direct care staff had more time available to spend with patients.This type of logging system for the reporting of minor incidents would appear applicable to practically all inpatient psychiatric settings, and, if employed as intended, could be expected to contribute to an improved quality of patient care.

State Prison Mental Heath Services Recipients Perception of Care Survey

BackgroundStudies have demonstrated the importance of patient perceptions’ of mental health service quality. No studies, however, could be found that surveyed recipients in prison, despite the rapid growth of patients, and litigation in these settings.MethodPatients were asked to complete an anonymous survey in private, and sealed it in an envelope.ResultsOf 613 respondents, most were satisfied (79%), agreed they had sufficient access to therapists (78%), were involved with treatment decisions (84%), and thought the MH services they had received would help them better deal with a crisis and emotional stress (75%). There were differences among mental health programs/housing units. Several of perception questions were significantly correlated with medication compliance, admission to crisis observation cells, and receiving disciplinary infractions.DiscussionRandom samples were requested, but likely only a convenience sample was obtained. However, the positive results suggest the need to strive to enhance patient quality of care ratings.

Incident Reporting: Evaluation of New York’s Pilot Incident Logging System

A revised incident reporting system that combined an abbreviated logging procedure for documenting minor incidents and a more comprehensive and detailed procedure for documenting major incidents was pilot tested in three New York State adult psychiatric centers. The pilot test had two major goals: to reduce the volume of work associated with current reporting procedures, and to facilitate even more thorough investigation of incidents warranting prompt and comprehensive review. Evaluation of pilot study data showed that a logging procedure is viable for the management of minor incidents.

Mental health service recipients and prison work release: how do the mentally ill fare compared to other inmates in prison work release programs?

Abstract:  The objective of this study was to compare the success rate of the mentally ill and other inmates on prison work release within gender groups. Mentally ill (MI) men (n = 42) had a higher success rate (79%) than other men (NMI) (61%) (n = 49), but this difference only approached statistical significance (p = 0.07), and mental illness did not distinguish male success/failures in regression analyses. Mentally ill women (n = 51) had a statistically significant lower success rate (58%) than other women inmates (n = 49) (83%) on work release. The difference in rates, however, only occurred in the group of women who were currently in prison due to a parole violation, not new court commitments. Regression analysis confirmed the importance of mental illness and current commitment as a parole violator. A greater number of MI men should be allowed to participate in work release. Women with mental health issues who had prior trouble on parole may need enhanced services.

Correctional mental health services in New York: then and now.

This article chronicles the legislation, litigation, and the agency initiatives which have shaped the New York State correctional mental health system into what it is today. An historical perspective provides a context and framework for the examination of the current and future salient issues and challenges in providing a comprehensive range of mental health services in a correctional setting. The Central New York Psychiatric Center organization, which is comprised of a 206 bed maximum-security forensic hospital and a community support network of 23 prison-based mental health units was established in 1977. This article takes an in-depth look at the organizations 25-year growth and development, the implementation and outcome of some innovative treatment programs, and the unique partnership between the New York State Office of Mental Health (OMH) and the New York State Department of Correctional Services (DOCS).

Trends in New York State secure care patients: 1980-1982.

Demographic and clinical characteristics of patients in special security units in New York State psychiatric centers are examined over time. The percentage of recently dangerous patients increased dramatically over the first three years of “official” operation. In addition, there were increases in the percentages of patients with physical problems, alcohol/drug problems, and mental retardation diagnoses.Demographic and clinical characteristics of patients in special security units in New York State psychiatric centers are examined over time. The percentage of recently dangerous patients increased dramatically over the first three years of “official” operation. In addition, there were increases in the percentages of patients with physical problems, alcohol/drug problems, and mental retardation diagnoses.