Correctional Mental Health Collaboration

Publications

Coping with Mental Illness in Prisons, by D. Lovell & R. Jemelka. Family & Community Health, 1998, 21(3): 54-66.

Persons with mental illness reside in America's jails and prisons in ever-increasing numbers. This article traces developments that have led to the incarceration of large numbers of persons with mental illness; discusses related legal, political, and social issues; and describes one state's response to this dilemma. An innovative residential treatment program within a prison setting is described. Results indicate that intermediate care options are both clinically successful and cost-effective. Difficulties in maintaining such a program within a criminal justice setting are discussed. The authors' experience suggests specific recommendations for maintaining the clinical momentum of a correctional mental health program.
Evaluating the Effectiveness of Residential Treatment for Mentally Ill Prisoners, by D. Lovell, D. Allen, C. Johnson, & R. Jemelka. Criminal Justice & Behavior, 2001, 28(1): 83-104. (CJB is available on-line to institutional subscribers).

An intermediate-care residential program for mentally ill male prison inmates in Washington provides medication monitoring, skills training, and a supportive milieu to help participants cope with life in prison. Participants were substantially less symptomatic when they left the program then when they entered. Comparisons of preprogram and postprogram behavior showed significant reductions in staff assaults, infractions, and use of expensive resources, as well as higher rates of work and school participation. A minority of inmates continued to be difficult to manage despite program interventions. Effectiveness measures are discussed in relation to the obligation to provide medically necessary care to inmates with severe mental illness.
Living in Prison After Residential Mental Health Treatment: A Program Follow-up, by D. Lovell, C. Johnson, R. Jemelka, V. Harris, & D. Allen. Prison Journal (In Press).

Sixty-one inmates with mental illness who had been treated in a medium-security residential mental health program were interviewed and assessed in other prison units after they left the program: 43 (70%) in general population units, and 18 in special living units. Participants showed a decrease in psychiatric symptoms and expressed appreciation for the program. A minority of participants had adjustment problems that persisted in every prison setting. The coping abilities of inmates with mental illness, and program implications are discussed in relation to differences in individuals and in settings.
Measuring Level of Function in Mentally Ill Prison Inmates, by V. Harris & D. Lovell. Journal of the American Academy of Psychiatry and Law. (In Press)

The need to accurately portray the level of functioning and severity of psychiatric symptoms among mentally ill offenders (MIO) is paramount from several perspectives. The prison environment may adversely affect the reliability and validity of commonly used functional assessment tools. Male MIOs (n=61) who had been treated for at least three months in a (male) Washington state prison mental health program were evaluated using clinical assessment tools, data abstraction from medical records, and structured assessments from correctional officers. Clinical assessments occurred at their current site of incarceration. The semi-structured clinical assessments had high construct validity and correlation for psychiatric symptoms and diagnosis. In general, the officers did not recognize lack of program participation and reclusive behavior as potential signs of mental illness. Despite a significant history of psychiatric symptoms severe enough to warrant in-patient treatment, 70% of individuals were functioning reasonably well in general population. A fully informed functional assessment of a MIO likely requires input from both clinicians and correctional officers.
Mobile Consultation: Crossing Correctional Boundaries to Cope With Disturbed Offenders, by D. Lovell & L. Rhodes. Federal Probation, 41(3): 40-45 (September, 1997).

Reports on a 1-yr pilot project in the State of Washington Department of Corrections that used interdisciplinary, cross-institutional teams of prison staff members to consult on the complex problems posed by disturbed inmates. The authors describe development of the mobile consultation program, its successes, and the obstacles it encountered and offer recommendations for instituting such programs. The experiment showed that interdisciplinary teams of front-line employees can work creatively together to address the fundamental challenges of their work.
Panoptical Intimacies, by L. Rhodes. Public Culture; Winter, 1998, 10(2): 285-311.

Examines the paradoxical & complex nature of the panoptical relationship, based on Jeremy Bentham's panopticon, which dissociates the subject from the object, as expressed in the US prison system. Focus is on the intent behind & operation of intensive management units (IMUs), where attempts are made to modify the behavior of particularly disruptive, troublesome, & often mentally ill inmates. Drawing on observations from prison visits & conversations with inmates, health care & social workers, & prison personnel, the relationships created & strategies followed in IMUs are analyzed. It is shown how inmates struggle against the IMU through using their bodies, by throwing feces, refusing to move, & self-mutilation, simultaneously pursuing an act of protest while inviting further control. Issues of agency & control between inmates & prison personnel are discussed, with conflict over the body of the prisoner as key. It is concluded that the "perfect" version of a panoptical relation offered by the prison also diagnoses the society that created it.
Razor Wire and Clozapine: A University/Prisons Collaboration on Mentally Ill Offenders, by D. Allen, D. Lovell, and L. Rhodes. Archives of Psychiatric Nursing (In Press).

An overview of a 6-year, ongoing collalboration between a team of university faculty and a department of corrections. The primary goal of the collaboration is to address treatment of mentally ill offenders; secondary goals include system-building and working with behaviorally disturbed inmates. Programs, policies, and system issues are analyzed.
What Happens to Mentally Ill Offenders Released from Prison? Findings From Washington's Community Transitions Study, by D. Lovell, G. Galliardi and P. Peterson. Psychiatric Services (In Press).

Objective. Despite large numbers of mentally ill offenders (MIOs) in prisons, there are few studies of MIOs released from prison. This study describes such a population of MIOs, their post-release services, new offenses, and factors associated with recidivism. Methods. We reviewed electronic files and archived medical charts to identify 337 MIOs who left Washington state prisons in 1996 and 1997, and then compiled data provided by several public agencies. Subjects and post-release outcomes were described statistically, and logistic regression was used to identify variables that predicted new felonies and new crimes against persons. Results. Male and female subjects differed in offenses, diagnosis, rates of drug abuse, and use of mental health resources. Though most subjects (73%) received post-release social or mental health services, few received clinically meaningful levels of service during the first year after release. New crimes or supervision violations were common (70% of subjects), but only 10% committed new felonies against persons, and 6 (2%) committed very serious crimes. Youth, frequency of past felonies, and variables such as prison misbehavior were associated with new offenses. Conclusions. Whether community mental health treatment affects recidivism cannot be fairly assessed in the absence of higher levels of service during the first months after prison release. This study also identifies actuarial risk factors that predict new offenses at a level comparable with published risk assessment instruments. Furthermore, less serious offenses that usually precede felonies may provide an early warning of risk for new felonies and an opportunity for strategic intervention. Finally, the low rate of serious community violence among MIOs released from prison argues that violence risk may provide a weak, potentially counterproductive, rationale for community support and mental health treatment of MIOs.
This study was conducted by the Washington Institute for Mental Illness Research and Training (WIMIRT) and funded by the Washington Department of Social and Health Services-Mental Health Division (DSHS-MHD) and the Department of Corrections (DOC).

When Inmates Misbehave: The Costs of Discipline, by D. Lovell, R. Jemelka. Prison Journal, 1996, 76(2): 165-179.

Reduction of infraction rates may serve as one measure of the efficacy of in-house treatment programs for psychologically disturbed inmates. To address the related issue of cost-effectiveness, the costs of infractions at a medium-security prison in WA were analyzed, yielding an estimated average cost of $970 per infraction. These fixed costs do not respond to marginal changes in numbers of infractions, but help to estimate the additional system costs that successful treatment may prevent in the long run. Like the costs of imprisonment in the free community, these costs need to be considered in disciplinary & treatment policies.
Who Lives in Super-Maximum Custody? A Washington State Study, by D. Lovell, K. Cloyes, D. Allen, & L. Rhodes. Federal Probation, 2000, 64(2): 33-38.

Intensive Management Unit (aka super-maximum custody) residents from Washington state prisons are profiled in terms of criminal history, demographices, sentence characteristics, prison behavior, and mental health issues. The authors describe a variety of prison career patterns among IMU residents and consider the policy implications of their findings.

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