Effectiveness of a jail-based treatment program for individuals with co-occurring disorders
ABSTRACT This study examines the effectiveness of a county jail program for individuals with co-occurring disorders (COD) in reducing rates of recidivism and increasing rates of engagement in community-based treatment following discharge.
Over a period of 30 months, between 2002 and 2004, 261 individuals who screened positive for COD voluntarily entered an in-jail treatment program. The program provided integrated treatment for both mental health and substance abuse by therapists who had attended a state sponsored COD core training curriculum. The same program staff provided outpatient services once individuals were discharged. An observational study design was used to examine jail recidivism and community care as a function of intensity of treatment while in jail. All study participants had a minimum one year follow-up. Data was obtained from a baseline comprehensive screening instrument, administrative claims data and county jail records. Logistic regression models were used to determine the likelihood of re-incarceration and community engagement in treatment as a function of the number of treatment sessions provided by the jail program.
County jail records indicated that 47.5% were re-incarcerated within 12 months of discharge. During the four and a half year period following the inception of the COD program 67% were re-incarcerated, which was similar to the national three year recidivism rate. Fifty-two percent (52%) attended a community-based treatment program post discharge. The results of the regression analysis showed that a higher number of treatment sessions in the jail COD program was significant in reducing the rate of re-incarceration but was not significant in predicting who would engage in outpatient treatment post discharge.
Although the findings are promising, the evidence suggests that the jail treatment intervention may need to be more intense than the outpatient model used in this project given that the average length of stay in the jail program was 8 weeks due to release to the community. An alternative consideration would be to only provide the program to those inmates who are sentenced for at least 90 days.
Article: Mental disorders in prisons.[Show abstract] [Hide abstract]
ABSTRACT: The existence of people with mental disorders in prisons is a reality found worldwide. The purpose of this article is not only to review the publications on this subject in 2009 but also to stimulate discussions that could contribute to its further scientific study. Most studies published in 2009 related to drug use among inmates and its consequences made it clear that this kind of disorder has a closer relationship with the crime than with mental illness. The existence of the mentally ill in prisons is a complex issue and the studies attempt to analyze aspects such as the type of disorder, sex of criminals, the opposition between incarceration and treatment, policy, harm reduction and stigma. A further study on the variables raised in this work is required, as well as examining others, to the extent that they are relevant to the various socio-economic and cultural realities.Current opinion in psychiatry 09/2010; 23(5):463-6. DOI:10.1097/YCO.0b013e32833bb32f · 3.55 Impact Factor
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ABSTRACT: Psychiatry residents at the University of Texas Southwestern Medical Center were surveyed to investigate their attitudes towards inmates, towards various aspects of correctional psychiatry and whether rotating at the local jail is associated with these attitudes. The overall opinion towards correctional psychiatry was fairly neutral though significantly more negative than towards inpatient psychiatry. While citing a high need for psychiatrists at correctional facilities, residents reported they are not likely to work there when they complete residency. No statistical differences were found between those residents who had rotated at the local jail and those who had not. Given the severe shortage of mental health providers in correctional facilities it is important to expose residents to this and understand ways to promote correctional psychiatry as a career.Community Mental Health Journal 03/2012; 48(6). DOI:10.1007/s10597-012-9512-3 · 1.03 Impact Factor
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ABSTRACT: Using hierarchical logistic regression with a nationally representative sample of state prisoners (n = 12,504), we found inmates with dual severe psychiatric and substance abuse disorders to be at higher risk of being assaulted and to assault others in prison than nonmentally ill inmates. Dually disordered inmates may be “importing” characteristics that put them at more risk of involvement in assaults. Next, more than 50% of assault victims were themselves the perpetrators of assault, and significant percentages of inmates reported posttraumatic stress disorder (PTSD) diagnoses and physical and sexual victimizations. With other studies linking PTSD and being assaulted with revictimization and violence toward others, substance abuse, and poorer psychiatric outcomes, a study implication is providing inmates with effective trauma-relevant treatments.Crime & Delinquency 06/2013; 59(4):510-535. DOI:10.1177/0011128712470318 · 1.75 Impact Factor