Nancy Wolff

Physical victimization in prison: The role of mental illness

This study compares prison physical victimization rates (inmate-on-inmate and staff-on-inmate) for people with mental disorder to those without mental disorder in a state prison system. Inmate subjects were drawn from 14 adult prisons operated by a single mid-Atlantic State. A sample of 7,528 subjects aged 18 or older (7,221 men and 564 women) completed an audio-computer administered survey instrument. Mental disorder was based on self-reported mental health treatment ever for particular mental disorders. Approximately one-quarter of the sample reported some prior treatment for schizophrenia, bipolar disorder, depression, PTSD, or anxiety disorder. Rates of physical victimization for males with any mental disorder were 1.6 times (inmate-on-inmate) and 1.2 times (staff-on-inmate) higher than that of males with no mental disorder. Female inmates with mental disorder were 1.7 times more likely to report being physically victimized by another inmate than did their counterparts with no mental disorder. Overall, both males and females with mental disorder are disproportionately represented among victims of physical violence inside prison.

Physical Violence Inside Prisons Rates of Victimization

This study estimates prevalence rates of inmate-on-inmate and staff-on-inmate physical victimization. Inmate participants were drawn from 13 adult male prisons and 1 female prison operated by a single mid-Atlantic state. A total of 7,221 men and 564 women participated. Rates of physical victimization varied significantly by gender, perpetrator, question wording, and facility. Prevalence rates of inmate-on-inmate physical violence in the previous 6 months were equal for males and females. Men had significantly higher rates of physical violence perpetrated by staff than by other inmates. By facility, inmate-on-inmate prevalence rates ranged from 129 to 346 per 1,000, whereas the range for staff-on-inmate was 83 to 321 per 1,000 (but the difference was not statistically significant).

Beyond Criminalization: Toward a Criminologically Informed Framework for Mental Health Policy and Services Research

The problems posed by persons with mental illness involved with the criminal justice system are vexing ones that have received attention at the local, state and national levels. The conceptual model currently guiding research and social action around these problems is shaped by the “criminalization” perspective and the associated belief that reconnecting individuals with mental health services will by itself reduce risk for arrest. This paper argues that such efforts are necessary but possibly not sufficient to achieve that reduction. Arguing for the need to develop a services research framework that identifies a broader range of risk factors for arrest, we describe three potentially useful criminological frameworks—the “life course,” “local life circumstances” and “routine activities” perspectives. Their utility as platforms for research in a population of persons with mental illness is discussed and suggestions are provided with regard to how services research guided by these perspectives might inform the development of community-based services aimed at reducing risk of arrest.

Dynamics of Social Capital of Prisoners and Community Reentry: Ties That Bind?:

This paper focuses on the social capital of prisoners and the impact of criminal behavior and incarceration on its formation and mobilization. Emphasis is on the time-varying nature of four attributes of social capital: the strength of connections, the ability to mobilize them, the endowment of resources within these relationships, and their social context. The incarceration experience has the potential to alter the attributes of social capital in ways that reduce its ability to improve health and justice outcomes. To offset this effect, an investment strategy is recommended that could have a positive impact on the prisoners social capital and prospects for successful reentry.

Measuring The Effectiveness Of Mental Health Courts: Challenges and Recommendations

How will we know if mental health courts are effective? The answers provided by future evaluation research will reflect the extent to which the social and procedural complexity of mental health courts drives the research design and plan. This article identifies the research challenges associated with studying the effectiveness of an intervention that is nonstandardized by nature and highly dependent on macro and local influences within the environment as well as personal preferences and relationship dynamics within the intervention itself. Explored are the research challenges related to isolating the independent effects associated with mental health courts. The article concludes with recommendations for how best to evaluate mental health courts to inform best practice and policy.

Interactions between mental health and law enforcement systems: problems and prospects for cooperation.

This article examines the challenges posed by system specialization, as illustrated by the difficulties of coordinating the roles of the mental health and law enforcement agencies working with people with severe mental illness. Dealing with the needs of clients in one system when they are most appropriately served by the other may make both law enforcement and mental health systems appear ineffective and inefficient. This could increase the incidence of disorderly or violent behavior, which forments the myth that the seriously mentally ill are inherently dangerous. Despite the evident need to manage these issues, conventional methods of coordinating services have failed. This article concludes by developing a contracting model that creates more appropriate incentives for the two systems and bridges the gap between them.

Randomised trials of socially complex interventions: promise or peril?

In the spirit of evidence-based decision making, research findings are increasingly being used to inform practice guidelines and policy making. Whether research informs the process accurately and appropriately depends on the quality of the design. This article examines the assumptions underpinning the randomised trial in relation to its application to evaluating socially complex interventions. Because the properties of the randomised trial are not independent of the characteristics of the interventions being studied, researchers need to be more attentive to selection bias, unmeasured contextual variables and uncontrolled interaction effects that arise because the environment interacts with the intervention. It is recommended that evaluations of socially complex interventions be modified by adding a complex contextual evaluation and using multiple sites.

Patterns of victimization among male and female inmates: evidence of an enduring legacy.

People inside prison have above-average rates of childhood and adult victimization. Little is known, however, about the relationship between types of victimization inside prison and that experienced in childhood. This article estimates rates of victimization for male and female inmates by type of perpetrator and form of victimization (sexual, physical, either, or both) and their association with types of childhood victimization (sexual or physical). Data for these estimates are based on a random sample of approximately 7,500 inmates housed in 12 adult male prisons and one adult female prison in a single state. The significance of the findings for practice are discussed along with recommendations to improve the health and welfare of people inside prison.

Childhood and adult trauma experiences of incarcerated persons and their relationship to adult behavioral health problems and treatment.

Rates of childhood and adult trauma are high among incarcerated persons. In addition to criminality, childhood trauma is associated with the risk for emotional disorders (e.g., depression and anxiety) and co-morbid conditions such as alcohol and drug abuse and antisocial behaviors in adulthood. This paper develops rates of childhood and adult trauma and examines the impact of age-of-onset and type-specific trauma on emotional problems and behavior for a sample of incarcerated males (N~4,000). Prevalence estimates for types of trauma were constructed by age at time of trauma, race and types of behavioral health treatment received while incarcerated. HLM models were used to explore the association between childhood and adult trauma and depression, anxiety, substance use, interpersonal problems, and aggression problems (each model estimated separately and controlling for age, gender, race, time incarcerated, and index offense). Rates of physical, sexual, and emotional trauma were higher in childhood than adulthood and ranged from 44.7% (physical trauma in childhood) to 4.5% (sexual trauma in adulthood). Trauma exposure was found to be strongly associated with a wide range of behavioral problems and clinical symptoms. Given the sheer numbers of incarcerated men and the strength of these associations, targeted intervention is critical.

Caregiver burden and health in bipolar disorder: a cluster analytic approach.

To identify caregivers at risk for adverse health effects associated with caregiving, the stress, coping, health and service use of 500 primary caregivers of patients with bipolar disorder were assessed at baseline, 6, and 12 months. K-means cluster analysis and ANOVA identified and characterized groups with differing baseline stress/coping profiles. Mixed effects models examined the effects of cluster, time, and covariates on health outcomes. Three groups were identified. Burdened caregivers had higher burden and avoidance coping levels, and lower mastery and social support than effective and stigmatized caregivers; stigmatized caregivers reported the highest perceived stigma (p < 0.05). Effective and stigmatized groups had better health outcomes and less service use than the burdened group over time; stigmatized caregivers had poorer self-care than effective caregivers. Cluster analysis is a promising method for identifying subgroups of caregivers with different stress and coping profiles associated with different health-related outcomes.