Pamela M. Diamond

THE PREVALENCE OF MENTAL ILLNESS IN PRISON

Over the last decade state prisons have experienced unprecedented growth and many demographic changes. At the same time, courts are requiring states to provide mental health screening and treatment to prisoners. Findings from recent studies indicate that the prevalence of mental illness is higher in prisons than in the community, and comorbidity is common. Our ability to generalize from these studies is limited, however, because of major shifts in the demographic mix in prisons during the past decade. New studies on the prevalence of mental illness in prisons, which consider these recent changes would help planners allocate funds and staff to more effectively meet the needs of these individuals.

A pilot study of the personality assessment inventory (PAI) in corrections: assessment of malingering, suicide risk, and aggression in male inmates

Provision of mental health services to correctional populations places considerable demands on clinical staff to provide efficient and effective means to screen patients for severe mental disorders and other emergent conditions that necessitate immediate interventions. Among the highly problematic behaviors found in correctional settings are forms of acting out (e.g., suicide and aggression towards others) and response style (e.g., motivations to malinger). The current study examined the usefulness of the Personality Assessment Inventory (PAI) in assessing problematic behaviors in a corrections-based psychiatric hospital. As evidence of criterion related validity, selected PAI scales were compared to (a) evidence of malingering on the Structured Interview of Reported Symptoms (SIRS), (b) suicidal threats and gestures, and (c) ratings of aggression on the Overt Aggression Scale (OAS). In general, results supported the use of the PAI for the assessment of these problematic behaviors.

Empirically identifying factors related to violence risk in corrections

The authors used structural modeling to predict institutional aggression among male mentally ill offenders using the predictors of anger, antisocial personality style, current violent offense, ethnicity, and impulsivity. Measures included the Barratt Impulsiveness Scale, the Buss-Perry Aggression Questionnaire, the Personality Assessment Inventory, age, ethnicity, current violent offense, victim injury from current offense, and institutional incidents of physical and verbal aggression. The model fit the data, and accounted for 94% and 87% of the variance of physical and verbal aggression, respectively. Results indicated anger, antisocial personality style, and impulsivity are stronger predictors of institutional aggression than are ethnicity and current violent offense; anger was the best predictor. Results suggest dynamic variables such as anger can be targeted for clinical intervention to reduce institutional violence.

A comparison of instrument sensitivity to negative symptom change

Accurate assessment of negative symptom changes in schizophrenic patients is crucial to determining the efficacy of new treatments. The present study examined the sensitivity to change over the course of hospitalization in negative symptomatology assessed by the Scale for the Assessment of Negative Symptoms (SANS), the Negative Symptom Assessment (NSA), and an expanded version of the Brief Psychiatric Rating Scale (BPRS) in a sample of 60 schizophrenic patients. Symptoms were assessed when the patients were acutely ill and again when they were stabilized. Effect sizes were compared across all three rating scales. The retardation factor of the BPRS had a relatively small effect size (0.32). Effect size for the total NSA was 0.78 and ranged from 0.38 to 0.87 for the SANS. Individual factors had moderate to large effect sizes that ranged from 0.18 to 0.91 for both scales. Separate analyses were performed to calculate effect sizes for a five-factor version of the NSA and to examine only those symptoms specified in DSM-IV (alogia, affective flattening, and avolition). Effect sizes relatively comparable to those found for the entire SANS and NSA scales were found for the separate calculations. Results indicate that the addition of a negative symptom assessment instrument to research protocols increases the ability to detect changes in negative symptoms with substantially fewer subjects than would be required with the BPRS retardation factor alone.

An exploration of social policy and organizational culture in jail-based mental health services

Mental health staff encounter difficulties delivering services to mentally ill offenders in the criminal justice system environment. This manuscript explores administrative and clinical policy changes made in a mental health program in a mega jail environment resulting in improved inter-agency communications and access to services for mentally impaired offenders. The authors use attribution theory to explain changes in the social policy and organizational culture of the program. The authors suggest the use of two value-based schema as tools to prompt discussions about and improve the relationship between the criminal justice and mental health service systems.

cumulative continuity and injection drug use among women: a test of the downward spiral framework

Although researchers have examined injection drug use among women, the findings vary and remain inconclusive. We know very little about the career of IV drug-using women-specifically, what processes link injection drug use to events and situations prior to adulthood? Using detailed self-report data, we examine the route into injection drug use and its long-term consequences among a sample of incarcerated women. Comparisons are made between women who have and have not injected drugs within the conceptual framework developed by Rosenbaum (1981). We argue that IV drug using women live in social circumstances typified by a narrowing of lifes options that decreases their ability to assume conventional roles. The results of path analyses suggest that women who have injected drugs experienced child maltreatment, were inundated in the drug culture, had fewer options in the conventional world, had expanded options in the nonconventional world, and lived in a chaotic lifestyle. We also found that women who have injected drugs were amenable to substance treatment programming while in prison. Our results are consistent with the hypothesis that injection drug users have accumulated high levels of negative events across their life course that effectively narrows their access to conventional opportunities.Although researchers have examined injection drug use among women, the findings vary and remain inconclusive. We know very little about the career of IV drug-using women-specifically, what processes link injection drug use to events and situations prior to adulthood? Using detailed self-report data, we examine the route into injection drug use and its long-term consequences among a sample of incarcerated women. Comparisons are made between women who have and have not injected drugs within the conceptual framework developed by Rosenbaum (1981). We argue that IV drug using women live in social circumstances typified by a narrowing of lifes options that decreases their ability to assume conventional roles. The results of path analyses suggest that women who have injected drugs experienced child maltreatment, were inundated in the drug culture, had fewer options in the conventional world, had expanded options in the nonconventional world, and lived in a chaotic lifestyle. We also found that women who have in...

The Effectiveness of Rehabilitation with Persistently Violent Male Prisoners

In 1990, the Texas Department of Criminal Justice instituted a specialty aggression treatment program called the Program for the Aggressive Mentally Ill Offender (PAMIO). It has beds for 458 violent male offenders and offers multidisciplinary medical and behavioral treatment. This study examined the effectiveness of this treatment program by comparing the annual rates of disciplinary offenses (e.g., staff assaults, inmate assaults, and good time lost) of 66 offenders prior to and following treatment. Paired t tests showed a significant decrease after PAMIO treatment in the annual rates of total disciplinaries, staff assaults, inmate assaults, and good time lost. This improvement appeared to be directly related to treatment effects.

Ethnicity and negative symptoms in patients with schizophrenia

The purpose of this study was to assess ethnic differences in the negative symptom profile of 25 Anglo American and 26 Mexican American subjects with schizophrenia. Subjects were rated at the end of a 1-2-week medication washout period (time 1) and at discharge (time 2) with the Negative Symptoms Assessment (NSA), Brief Psychiatric Research Scale, (BPRS), the [Diagnostic and Statistical Manual of Mental Disorders (4th edition)] DSM-IV negative factor score and LAECA acculturation scale. Total NSA scores were significantly higher among Mexican Americans both at time 1 and time 2. Among the five subscales of the NSA, ethnic differences were significant only for the Cognition subscale at time 1. Results indicate no ethnic differences in core negative symptoms (alogia, avolition, flat affect), but do suggest that a cognition-related factor differs between Mexican American and Anglo American schizophrenic patients.

The impact of knowledge and opinions on the implementation of public policies for mentally ill offenders

New legislation may not always have its intended effect. Agencies targeted by the legislation must be aware of it, understand its demands, develop procedures to insure implementation, and monitor compliance. This paper reports a study of the extent to which several new state statutes impacted policy, procedures, and services for mentally ill offenders in a large urban Texas county. Key informant-interviews, document reviews and surveys of knowledge and opinions were used to assess implementation, understanding, and acceptance of these new statutes. Results were reported to local constituencies, and used to shape recommendations for local action. Following the study, the community formed a council that has made specific improvements in the system.

Staff Opinions of Mentally III Offenders in a Prison Hospital: Implications for Training and Leadership

Information from a staff survey of opinions about working with mentally ill prison inmates was used to enhance staff training and cooperation. The survey analysis used Attribution Theory to link the results with four dichotomous custody-therapy policy models typically applied in criminal justice settings: punishment as incarceration, the traditional medical treatment model, education and habilitation, and reparation as restitution. Security and support staff embraced incarceration and traditional treatment, whereas treatment staff supported habilitation. Within groups, all staff favored habilitation over other policies. Differences and shared opinions were used to improve understanding and cooperation between security and treatment roles.