Correctional Mental Health

Carla Hamand, MSW, LicSW, Forensic Social WorkerOlmsted County Sheriff’s Office and Behavioral Health Unit

Jail Diversion and Re entry Coordinator

Crisis Intervention Team Coordinator

Crisis Negotiations Unit Mental Health Professional

Megan Vogel, MA, Forensic Social WorkerOlmsted County Sheriff’s Office and Behavioral Health Unit

Operations Behavioral Health Coordinator

ObjectivesWhat are mental health professionals doing

in the criminal justice system? What population do we serve?What mental health issues are most

commonly seen in this population?Diagnostic assessmentOpen Discussion/Questions

Working Within Criminal Justice System or in a Correctional Facility

Balance the needs and interests:◦Individual in conflict with the law◦The mandate and of the various

correctional agencies and organizations◦The perspective of victims◦Obligations to the community◦With an overriding emphasis on both

public and personal safety

A Social Worker’s Scope of Practice Within Corrections

Highly dynamic Intense workloadsManagement of sensitive informationParticipation on interdisciplinary teamsBuilding community partnershipsEvidence-based best practices

Olmsted County ADC Mental Health Team

To provide those programs and services which are designed to evaluate, prevent, and treat mental health problems and which contribute to safe, humane corrections environments.

Interdisciplinary Team: ◦ Operations Social Worker◦ Forensic Social Worker◦ Forensic Psychologist◦ Psychiatrist◦ Nursing◦ Operations Staff

Forensic Social WorkerJail Diversion-forensic assessmentRe entry-Assess, Plan, Identify, CoordinateCITCNUCourt Commitments/Civil/Forensic EducatorSupervise InternsResearch

Operations Social WorkerMorning meetingBrief Jail Mental Health Screening

ToolPrioritize dayAssessmentTreatment planningEducatorStatistics

http://psychservices.psychiatryonline.org/content/vol57/issue4/images/large/ij17f1.jpeg

Levels of Service1-2-3

Mandated Services◦ Suicide Risk and Assessment◦ Screening for Mental Health

Needs◦ Crisis Intervention ◦ Medication

Services offered to Specific Target Groups◦ Substance

Abuse/Dependence◦ Anger Management◦ Voluntary Programs◦ Voluntary

Psychiatric/Psychological Services

◦ Case Management

Level Three◦ Training for

Correctional Staff◦ Open Dialogue

Between Correctional Staff and Correctional Mental Health Staff

◦ Assisting Administrators with Policy

Define Mental Illness Most Commonly Seen in ADC

Most Common Disorders Bio Psycho Social Environmental Cultural

IssuesCo-morbiditySubstance Abuse/DependenceAdjustment DisorderPersonality DisordersMood DisordersAnxiety DisordersPsychotic DisordersSexual Disorders

Examine the Population Being Served

2.3 million housed in US prisons and jails5 million on probation or parole6% have a serious and persistent mental

illness 20% have a serious mental illness30-60% have substance abuse problems

*US Census 311,915,120

Bio Psycho Social Environmental Cultural

Factors ◦Problems related to interaction with the legal

system/crime ◦Problems with primary support group ◦Educational problems ◦Occupational problems ◦Housing problems ◦Economic problems ◦Problems with access to health care services ◦Problems related to the social environment◦Other biopsychosocial and environmental

problems

DiagnosisAxis IAxis IIAxis IIIAxis IVAxis V

Axis I vs. Axis IIComplicated Diagnostic Picture

◦When the psychotic symptoms are controlled with medication, the underlying personality disorder becomes primary, resulting in behaviors that are difficult to treat and possibly unpleasant to work with.

◦Misinterpretation of behavior.

Dual Disorders, Co-morbidity or Co-occurring

◦The presence of one or more disorders (or diseases) in addition to a primary disease or disorder.

Substance Use Dependence

Polysubstance Dependence

Alcohol Dependence

Amphetamine Dependence

Opioid Dependence

Personality Disorders

Cluster A: • Avoidant• Dependent• Obsessive-

Compulsive

Cluster B: • Antisocial*• Borderline*• Histrionic• Narcissistic

Cluster C: • Paranoid• Schizoid• Schizotypal

Personality Disorders

Distinctive set of traits, behavior styles and patterns that make up our character or individuality. How we perceive the world, our attitudes, thoughts, and feelings are all part of our personality. People with healthy personalities are able to cope with normal stresses and have no trouble forming relationships with family, friends, and co-workers.

Those who struggle with a personality disorder have great difficulty dealing with other people.

Personality Disorder Tend to be inflexible, rigid, and unable to respond to the

changes and demands of life.

Although they feel that their behavior patterns are “normal”

or “right,” people with personality disorders tend to have a

narrow view of the world and find it difficult to participate

in social activities.

A deeply ingrained, inflexible pattern of relating,

perceiving, and thinking serious enough to cause distress

or impaired functioning.

Usually recognizable by adolescence or earlier, continue

throughout adulthood, and become less obvious

throughout middle age.

Antisocial Personality DisorderMost commonly found in males.Very high percentage of prison/jail

population.Characterized by:

◦ A pattern of disregard for others◦ Involvement with law enforcement◦ Fail to abide by social norms◦ Aggressiveness◦ Irritability◦ Lack of concern for safety of self/others

Fictional Character, Hannibal Lector

Actual Character, Ted Bundy

Random Character

Borderline Personality Disorder

Affects 2% of populationWomen tend to be most commonly diagnosed

with BPD.

Characterized by:◦ Instability in relationships◦ Impulsivity◦ Low self-image◦ Onset in early adulthood

Social Chameleon Someone who changes the way they

interact with people depending on who they're with.

Anxiety DisordersPTSD: Common in veterans of war,

victims/witnesses of violent crime, refugees, survivors of traumatic events.

10-20% incidence in law enforcement.Can occur at any age or time in life.Symptoms usually begin within 3 months

of trauma but there may be a delay of months or years before symptoms appear.

Symptoms may wax and wane throughout the disorder.

Mood Disorders

Depression◦ 15% lifetime

occurrence.◦ Symptoms that

interfere severely with the ability to work, sleep, eat, and the ability to enjoy pleasurable activities.

◦ Symptoms last longer than two weeks.

Bipolar Disorder ◦ Also known as manic-

depression◦ Characterized by a wide

swing in moods from high to low-each episode last about two weeks in a year-long period

◦ Others (10-30%) will develop rapid-cycling with four or more episodes in one year

◦ Type I and II◦ “Low” and “high”

symptoms◦ “Low” symptoms the same

as depression

Psychotic/Thought Disorders

SchizophreniaSchizophrenia Paranoid TypeSchizoaffective Disorder Delusional Disorder

SchizophreniaSchizophrenia is not “Split Personality”There is a common notion that

schizophrenia is the same as "split personality” – a Dr. Jekyll-Mr. Hyde switch in character◦ Affects 1% of the world’s population◦ 2.7 million is the United States◦ Treatment can result in 85% remission rates◦ Onset is between 17-30 for women◦ Onset is 20-40 for men◦ Irrational thought processes

AssessmentClient Interview Collateral:

◦Gathering information from other sources can often help in the assessment. Family Friends Witnesses Providers Other resources (social services, detox)

Bio Psycho Social Environmental Cultural Psychometric Testing

Assessment What brings them in? What is currently the matter? List all the symptoms that the client has experienced in their

lifetime. List the current symptoms that the client is reporting. Inquire about additional symptoms. Have a discussion about the severity of symptoms. What level of impairment do the symptoms bring to their

daily functioning? What substances have been used? Is there abuse or dependence? What are the symptoms? How do the symptoms interfere/affect symptoms of mental

illness? Criminogenic Factors—Determining Risk

WHY?GeneticsEnvironmentBio Psycho SocialMedicalBrain InjuryDrug InducedOther?

In the diathesis–stress model, a biological or genetic vulnerability or predisposition (diathesis) interacts with the environment and life events (stressors) to trigger behaviors or psychological disorders. The greater the underlying vulnerability, the less stress is needed to trigger the behavior or disorder. Conversely, where there is a smaller genetic contribution greater life stress is required to produce the particular result. Even so, someone with a diathesis towards a disorder does not necessarily mean they will ever develop the disorder. Both the diathesis and the stress are required for this to happen.

Websiteshttp://www.co.olmsted.mn.us/sheriff/

divisions/lec/Pages/cit.aspxhttp://psychservices.psychiatryonlin

e.org/cgi/content/full/57/4/544/F1

http://gainscenter.samhsa.gov/pdfs/reentry/apic.pdf

http://www.pbs.org/wgbh/pages/frontline/shows/asylums/

http://www.pbs.org/wgbh/pages/frontline/released/view/

http://longgonefilm.net/