Merrill Rotter

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.

Targeting Criminal Recidivism in Mentally Ill Offenders: Structured Clinical Approaches

Decreasing criminal recidivism in justice-involved individuals with mental illness, is among the most consistently desired outcomes by programs, policy makers and funding agencies. Evidencebased practices with track records of effectiveness in treating mental illness and co-occurring substance abuse, while important clinically, do not necessarily address criminal recidivism. Addressing recidivism, therefore, may require a more targeted criminal justice focus. In this paper, we describe recent challenges to decriminalization approaches and review factors associated with recurrent criminal behavior. In particular, we focus on structured clinical interventions which were created or adapted to target the thoughts and behaviors associated with criminal justice contact.

An exploration of criminal thinking styles among civil psychiatric patients.

BACKGROUND Several studies have found a relationship between psychiatric illness and criminal behaviour. Despite this, few studies have examined the presence of criminal thinking among civil psychiatric patients. AIMS The aim of this study is to explore the patterns and correlates of criminal thinking, using the Psychological Inventory of Criminal Thinking Styles (PICTS), in a sample of civil psychiatric patients. METHOD The PICTS (Layperson Edition) and the Brief Psychiatric Rating Scale (Anchored Version; BPRS) were administered to 76 civil psychiatric patients. PICTS scores were compared with those of offenders from a previously published study. Bivariate tests were conducted between selected PICTS scales, BPRS factors, demographic and criminal history variables. Stepwise multiple regressions were performed to assess those variables that predicted the general criminal thinking, proactive and reactive composite scales of the PICTS. RESULTS Independent samples t-tests revealed that five PICTS thinking styles were significantly higher in the psychiatric sample compared with the comparison sample of criminal offenders. Bivariate correlations revealed that the PICTS proactive composite scale was significantly related to and predicted by substance abuse and arrest history. CONCLUSIONS/CLINICAL IMPLICATIONS: Thinking styles which are typically associated with criminality were found in this sample of civil psychiatric patients. Cognitive remediation strategies targeting these may help to prevent criminal activity in psychiatric patients.

Structured Assessment of Correctional Adaptation (SACA) A Measure of the Impact of Incarceration on the Mentally Ill in a Therapeutic Setting

Clinicians have observed that psychiatric patients with correctional histories evidence attitudes and behaviors that seem adaptive in penal environments but are maladaptive in mental health settings. This study sought to assess the reliability and concurrent validity of a rating scale designed to measure correctional adaptation using a sample of 64 patients from a state psychiatric hospital. Scale ratings were obtained through structured interviews, whereas predictor variables were gleaned from chart review and selfreport. The scale demonstrated good interrater reliability (ICC = .83) and acceptable internal consistency (α= .67). Of the variables evaluated, two were significantly correlated with Structured Assessment of Correctional Adaptation (SACA) total scores, total months sentenced to prison or jail (r = .26), and frequency of disciplinary tickets while in prison or jail (r = .31). Stepwise regression analyses revealed only the latter variable significantly predicted SACA score (R = .31), F(1, 58) = 6.27, p < .05. Clinical implications of these findings, the scale, and the construct of correctional adaptation are discussed.

An Exploration of the Relationship Between Criminal Cognitions and Psychopathy in a Civil Psychiatric Sample

The relationship between psychopathy and thinking styles that support and maintain a criminal lifestyle is examined using the Psychopathy Checklist: Screening Version (PCL:SV; Hart, Cox, & Hare, 1995) and the Psychological Inventory of Criminal Thinking Styles (PICTS; Walters, 1995). These measures are administered to a sample of 75 patients recruited from a state psychiatric hospital in the northeastern United States. Correlational analyses indicate that the PICTS General Criminal Thinking, Self-Assertion/Deception factor scale, and several criminal thinking style scales are significantly related to psychopathy. The significantly associated criminal thinking scales include Entitlement (r = .44) and Superoptimism (r = .43) with Factors 1 and 2 of the PCL:SV, respectively. Multiple regression analyses reveal that these two criminal thinking scales are the strongest predictors of Factors 1 and 2 of the PCL:SV, respectively. Implications for the cognitive basis of the construct of psychopathy, as well as potential treatment interventions, are discussed.

A Therapeutic Approach to Jurisprudence: A Differential Thinking Model of Sanctions and Rewards

With the goal of decreasing violations and promoting compliance, Mental Health Courts (MHCs) apply behavior modification principles through the use of sanctions and rewards, including jail as punishment. However, unlike Drug Treatment Courts where this model originated, the use of sanctions for violations in MHCs is more complex as identifying, understanding and addressing compliance are more difficult in mental health treatment. Jail as a sanction may not have any clinical utility, but can have detrimental effects for offenders in general and for those with mental illness in particular. This paper proposes that a pure sanction-and-reward model is undesirable for individuals in the legal context, and proposes an alternative approach to court violations that is consistent with the biopsychosocial, problem-solving and recovery models. This proposed approach includes “thinking differentially” about defendants’ violations, identifying possible explanations for what underlies the problematic behavior and administering more situation-specific clinical and judicial interventions.

Graphic depictions: portrayals of mental illness in video games

Although studies have examined portrayals of mental illness in the mass media, little attention has been paid to such portrayals in video games. In this descriptive study, the fifty highest‐selling video games in each year from 2011 to 2013 were surveyed through application of search terms to the Wikia search engine, with subsequent review of relevant footage on YouTube. Depiction categories were then assigned based on the extent of portrayal and qualitative characteristics compared against mental illness stereotypes in cinema. Twenty‐three of the 96 surveyed games depicted at least one character with mental illness. Forty‐two characters were identified as portraying mental illness, with most characters classified under a “homicidal maniac” stereotype, although many characters did not clearly reflect cinema stereotypes and were subcategorized based on the shared traits. Video games contain frequent and varied portrayals of mental illness, with depictions most commonly linking mental illness to dangerous and violent behaviors.

Determining When to Conduct a Violence Risk Assessment: Development and Initial Validation of the Fordham Risk Screening Tool (FRST).

Techniques to assess violence risk are increasingly common, but no systematic approach exists to help clinicians decide which psychiatric patients are most in need of a violence risk assessment. The Fordham Risk Screening Tool (FRST) was designed to fill this void, providing a structured, systematic approach to screening psychiatric patients and determining the need for further, more thorough violence risk assessment. The FRST was administered to a sample of 210 consecutive admissions to the civil psychiatric units of an urban medical center, 159 of whom were subsequently evaluated using the Historical Clinical Risk Management-20, version 3, to determine violence risk. The FRST showed a high degree of sensitivity (93%) in identifying patients subsequently deemed to be at high risk for violence (based on the Case Prioritization risk rating). The FRST also identified all of the patients (100%) rated high in potential for severe violence (based on the Serious Physical Harm Historical Clinical Risk Management-20, version 3, summary risk rating). Sensitivity was more modest when individuals rated as moderate risk were included as the criterion (rather than only those identified as high risk). Specificity was also moderate, screening out approximately half of all participants as not needing further risk assessment. A systematic approach to risk screening is clearly needed to prioritize psychiatric admissions for thorough risk assessment, and the FRST appears to be a potentially valuable step in that process.

Prediction of Institutional Misconduct Among Civil Psychiatric Patients Evaluating the Role of Correctional Adaptations

Research has shown that psychiatric patients with criminal histories report attitudes reminiscent of the prison culture that predict therapeutic alliance. This study examined the impact of these “correctional adaptations” on the behavior of a sample of 75 discharged civil psychiatric patients whose medical charts were reviewed for incidents of institutional misconduct including cigarette dealing, drug use, and weapons possession. Patients had been previously administered the Psychopathy Checklist–Screening Version (PCL-SV), Brief Psychiatric Rating Scale (BPRS), and Structured Assessment of Correctional Adaptation (SACA). Of the sample, 53% (n = 40) committed at least one act of misconduct, with an average of M = 2.8 (range = 0–18, SD = 4.27) incidents. Bivariate analyses revealed a significant relationship between incidents and the total SACA score, r s (74) = .33, p = .004. Ordinal regression analyses showed the SACA to be significantly predictive of misconduct, regardless of arrest history.

Recent violence and legal involvement among young adults with early psychosis enrolled in Coordinated Specialty Care

Individuals with serious mental illnesses have a small increased risk of engaging in violence or legal involvement compared to the general population. This seems to be particularly true for young adults experiencing early stages of psychosis. This study analysed the prevalence of and risk factors for reports of violence and legal involvement in a sample of young adults receiving Coordinated Specialty Care for early non‐affective psychosis.