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Advancing Corrections Journal – Edition 9

As this Edition of Advancing Corrections is released, the world will likely still be suffering from an unparalleled ‘collective’ mental health crisis. Other than the deniers among us who choose to remain blissfully uninformed or misinformed, the spread of an invisible virus has slammed most of us into a state of acute and uncomfortable mental distress – fear, anxiety, depression, isolation, loneliness and even paranoia and panic. Millions of us have had to endure (or perhaps are still enduring) home confinement, separation from family and friends, boredom, restlessness, and gnawing uncertainty. We can ‘feel’ what it is doing to us. But, of course, there are millions of people we confine involuntarily for much lengthier periods of time and who are now facing similar anxieties but with even much less control over their lives. We often fail to ‘feel’ what confinement is doing to these millions of other individuals. Compound the effect of confinement with the psychic vulnerabilities of mental illness, and it becomes almost impossible to conceive what it might ‘feel’ like for these individuals. Correctional services all over the world are working feverishly to mitigate the effects of Covid-19 and the dedication of staff members in-the-line of fire is deserving of our utmost respect. But when this crisis is over, the management and treatment of the mentally ill in our prisons, jails, and community centers will continue as one of the most persistent, complicated and resource-taxing issues facing correctional services worldwide.

It is interesting to speculate that perhaps one silver lining from this emotional pandemic that we are going through is that it may arouse a bit more empathy and compassion for the mentally ill and mentally unwell who we incarcerate in growing numbers. Yet correctional services can’t rely on this possible silver lining. The challenge will remain for years to come and this Edition of Advancing Corrections will hopefully inspire some further refinement and innovation in practice in how we Manage and Treat the Mentally Ill and Mentally Unwell in Corrections.

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FEATURED ARTICLES
ARTICLE 1: AN OVERVIEW OF BEST PRACTICE STRATEGIES FOR MANAGING AND TREATING THE MENTALLY ILL IN CORRECTIONS

Frank J. Porporino

This paper outlines some possible practical responses to the challenge of managing the mentally ill in corrections. Part I helps us contextualize the issue, especially as it pertains to the origins and prevalence of the problem of the mentally ill in corrections. Part II then attempts to sketch out some current best practice examples of: (a) appropriate and encompassing evidence-informed policies and strategies for dealing with the mentally ill and other special needs offenders; (b) programmatic alternatives, before imprisonment as diversionary measures, during incarceration and after release into the community, (c) systematized approaches for assessing needs, monitoring behavior and evaluating impact of interventions; and finally, (d) training and skills development of staff members both to sensitize them to the unique needs and characteristics of these offenders and equip them to respond more professionally.
 

ARTICLE 2: THE ROLE OF MENTAL HEALTH RISK FACTORS IN PREDICTING PAROLEE PERFORMANCE IN THE COMMUNITY: AN EMPIRICAL EXAMINATION IN A LARGE US JURISDICTION

Vîlcicâ, E. Rely, Kimberly Houser, & Veronica Nelson

Correctional facilities hold a disproportioned percentage of society’s mentally ill. Research also shows that incarcerated individuals afflicted with mental health disorders are more likely to be charged with prison infractions and to serve longer periods of incarceration. Despite deeply rooted stereotypes, the research is mixed, however, on whether mental illness is a risk factor for criminal behavior. Yet, individuals with mental health problems tend to fare worse in criminal justice risk assessments. This study specifically addresses the role that mental health risk factors used in correctional assessment instruments play in explaining prisoner performance upon release in the community. The research draws on rich empirical data on a large sample of persons released from prisons in Pennsylvania, United States, followed for a period of two and a half years to record two main recidivism outcomes: re-arrest for any crime and re-arrest for violent crime. The main data were provided by the Department of Corrections and the Parole Board. The analyses tested for both direct and indirect effects of mental health factors on parolee performance upon release. These factors were derived from the risk instruments employed by the correctional agencies providing the data. Other risk factors usually considered in the prediction of recidivism literature (e.g., prior criminal history) were used for control purposes. Among the eleven mental health factors tested, only a couple significantly predicted the reoccurrence of arrest, but only in the presence of other predictors of re-arrest, which fully mediated the impact of the mental health factors.

In sum, the study results provide support for the indirect effects hypothesis regarding the nature of the association between mental health conditions and crime involvement. The study also provides insights regarding the empirical validity and utility of the risk assessment tools used in corrections. Thus, the study holds significant theory, policy, and research relevance. The discussion focuses on immediate policy implications, most relevant for both institutional and community corrections.

ARTICLE 3: COMMUNITY TRANSITION FROM THE CRIMINAL JUSTICE SYSTEM FOR OLDER ADULTS WITH SCHIZOPHRENIA – A PILOT STUDY

Erin Hubbard & Heather Leutwyler

Older adults with schizophrenia who are involved in the criminal justice system have unique circumstances around community re-entry. The purpose of this paper is to describe the impact of programs and services addressing symptom management and transition to community integration for people with schizophrenia that have a history of criminal justice involvement in the United States and are currently successfully living in the community. An exploratory secondary analysis of semi-structured individual interviews was conducted with 7 older adults (mean age 59, sd= 2.9, range 56-65) with schizophrenia. Qualitative data were collected and analyzed with content analysis. Seven participants discussed involvement with the criminal justice system and emphasized the importance of ongoing access to medications and therapy to help maintain symptom management. Housing, case management, and social services were indicated as promoting community integration. A recurrent theme was the need for continuity of services and engagement in supportive programs as a means to successful community re-entry and avoiding additional contact with the criminal justice system. Our results suggest that time unlimited access to medications and therapy, in addition to programs providing housing, case management, and social support have a positive impact on successful community re-entry for older adults with schizophrenia. Programs that provide time unlimited, integrated services to meet the specific needs of this vulnerable population may increase successful transition to re-entry, ameliorate recidivism, and benefit the community at large.
ARTICLE 4: MENTAL HEALTH IN A REPRESENTATIVE COHORT OF PRISONERS IN NEW ZEALAND CORRECTIONS-ANALYSIS OF SEVERITY OF NEED AND ETHNICITY DIFFERENCES

Nick J. Wilson, Jill Lane, Shaun Sullivan, Emerald O’Neill-Murchison, & Suzette Poole

The focus of this article is research carried out into the mental health needs for those imprisoned at three prison sites in the New Zealand Corrections, Central Region. The picture of mental health needs from mild to serious was created to inform the services for New Zealand’s only within the wire dedicated 100 bed mental health facility, currently under construction. The review of mental health needs for the 2,000 men placed into these prison settings covered a 12 month period. It included those placed into special prison management (SM) units due to acute mental health or behavioural difficulties (At Risk, Management, and Directed Segregation units). Second, all the psychotropic medication prescribed across the participating prisons was analysed. Due to the over representation of the Indigenous people of New Zealand (52% of prison compared to 14% community), the analysis looked at Māori SM placement and prescribed medication. Key findings from the descriptive analysis were that those placed in special management units for mental health issues were younger; of moderate to high risk of reimprisonment, had repeated placement in these units; and the majority were Māori rather than other ethnicities. In terms of sentence status, the majority were placed in prison for violence but 50% were on remand rather than sentenced. An analysis of psychotropic medication distribution identified a group (n = 390) who were older, majority sentenced, and on lower security management due to compliant behaviour. Most were on antidepressant medication (77%), followed by antipsychotic (39%), stimulant (5.6%), and antianxiety (3.6%). Some differences based on ethnicity were found with higher use of antipsychotic medication for Māori after taking the higher number in prison in this region into account. The service implications of the different mental health needs for this prison population in relation to the proposed new service are discussed.
ARTICLE 5: IRISH EX-PRISONER REFLECTIONS ON THEIR PSYCHOLOGICAL WELLBEING WHILST IN PRISON IN ENGLAND AND WALES

Paul Gavin

Over the past 25 years the prison population of England and Wales has doubled and this has resulted in a significant proportion of the prisoner population suffering from mental ill-health. This paper considers the position of an under-researched group within the prison population in England and Wales, that of the Irish prisoner population. 37 semi-structured interviews were undertaken with recently released (within 2 years) Irish prisoners in England and Wales who were asked to reflect on their experiences of incarceration. It considers how themes of depression, paranoia and fear, and loneliness and isolation, all of which were identified as major factors within their experience of imprisonment in England and Wales, relate to the overall experience of incarceration.
ARTICLE 6: ARCHITECTURAL DESIGN FOR MENTAL HEALTH TREATMENT: PRELIMINARY FINDINGS OF SERVICE PROVISION USING A SPACE, LAYOUT, AND SETTING FRAMEWORK

Victor J. St. John

In the United States, jails have become the largest mental health institutions and have come under public scrutiny regarding the accessibility and quality of the mental health services provided. Research supports that the architectural design of a correctional facility influences the behaviors and wellbeing of an incarcerated person, including the treatment and services received while incarcerated. This pilot study utilizes the Space, Layout, and Setting (SLS) framework to investigate the impact of New York City’s jail design on an incarcerated person’s access to mental health services. Results approaching statistical significance show that jails concentrated with mental health services are more likely to have mental health appointments completed compared to jails that are not. This holds true when controlling for jail capacity and the number of mental health appointments scheduled. Whilst it is best practice to have mental health services provided outside of the correctional setting, correctional administrators that seek to better serve their mental health population may consider exploring the designs of their facilities to be more treatment oriented.
VIEWS AND REVIEWS
ARTICLE 7: MENTAL HEALTH SERVICE DELIVERY IN CANADIAN FEDERAL PRISONS: A PRISON OMBUDSMAN’S PERSPECTIVE

Ivan Zinger & Emad E. Talisman

This article looks at the challenges faced by the federal correctional system in Canada as it responds to a growing population of inmates with mental health needs. Adopting the position that access to mental health care is a human rights issue, the article situates the legal, policy, and operational contexts (and constraints) in which mental health services are delivered in Canadian federal prisons. It then offers some reflections on prison health care reform in Canada, and how these reforms measure up to international standards, specifically, the Mandela Rules. The article draws from previous investigations conducted by the Office of the Correctional Investigator to identify areas of concern, and to offer practical directions for reform.
PRACTICE INNOVATION IN CORRECTIONS
ARTICLE 8: RAVENHALL CORRECTIONAL CENTRE: THE MASTER PLANNING AND ARCHITECTURAL DESIGN OF A MULTIFACETED, PEOPLE-ORIENTED PRISON FOR MEN WITH COMPLEX PHYSICAL AND MENTAL HEALTH NEEDS IN VICTORIA, AUSTRALIA

Elizabeth Grant

People with mental health issues are vastly overrepresented in the Australian prison system. This paper discusses the master planning and design of Ravenhall Correctional Centre in Victoria, Australia to increase outcomes for male prisoners living with physical, mental health disability and other conditions. Major innovations in the design of Ravenhall Correctional Centre have included a forensic mental health unit on site, and the master planning of the prison into separate communities with a variety of housing types to provide prisoners opportunities to experience various levels of self-care and greater autonomy. The prison was designed to increase feelings of wellness, to provide program and training spaces to service various groups, and to allow prisoners to experience greater levels of individual control. The project is discussed through an architectural lens to allow readers to understand the complexities of master planning and designing a major people-oriented, multi-faceted prison with a forensic mental health unit within the perimeter. The paper notes that large scale prisons may be designed in a more therapeutic manner where accommodation, facilities and programs can provide prisoners opportunities to connect with external environments, engage in meaningful activities and retain a level of autonomy and individual control. The integration of the forensic mental health unit means that greater numbers of prisoners are able to access in and outpatient services. The paper concludes that since the prison was commissioned in 2017, the prisoner cohort has changed, resulting in a deviation from the intended purpose of focusing on innovative programs for sentenced prisoners. This may have diminished the capacity for prisoners to effectively engage in the programs for which the prison was designed.
ARTICLE 9: MANAGING INMATES WITH MENTAL DISORDERS: THE PSYCHIATRIC HOUSING UNIT IN SINGAPORE PRISON SERVICE

Rashida Mohamed Zain, Georgina Tay, Jessie Yeung, Rossheema Binte Haniff & Padma D/O Jairam

Inmates with mental disorders present as a population that requires extensive resources to manage and treat. Furthermore, these individuals tend to commit disciplinary infractions and reoffend at a higher rate than the mainstream incarcerated population. This poses a challenge to correctional facilities all over the world and best practices on the management and treatment of this specialised population are widely sought after. In 2011, the Psychiatric Housing Unit under the Singapore Prison Service (SPS) commenced operations with the admission of inmates with mental disorders into the facility. This article seeks to document the background and key processes within this specialised housing unit, specifically in the management and treatment of inmates with mental disorders.

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