PowerPoint for review paper

1. Sara Brzostowicz Gardner
PSY 492
Argosy University

2. In the 1980’s, many government run mental
hospitals were shut down, forcing it’s patients
on the streets. Over the years, prisons and jails
have become the next best thing, with many
inmates entering facilities with DSM-IV-TR Axis I
and II disorders (Okasha, 2004).

3. Changes need to be made
because:
 The need for control is
so strong that in the
book Prison Madness,
Terry Kupers argues
that it’s the conditions
of correctional
facilities themselves
that are inducing and
heightening many of
the disorders found
amongst inmates
(Kupers, 1999)
 The increasing
number of instances
of illness in prisons
may even have a
positive correlation
with levels of violence
(Lamb, et.al, 1998).

4. There are two main points that researchers
make regarding the care of the mentally ill in
our prisons:
1. Accurate diagnosis and
appropriate treatment for
those who first enter
correctional facilities
2 . Providing proper on-going
treatment programs for
those with long-term
mental disorders
Most inmates do not currently have access
to favorable conditions and programs

5. Argument 1: Accurate diagnosis of
incoming inmates
 The effectiveness of prison medical staff and the diagnostic
tools used to classify mental disorders may be ineffective
 Studies show that the strained amount of time spent with
incoming inmates, the inability to manage inmate behavior and
overall facility conditions can limit the effectiveness of mental
disorder diagnosis (Birmingham, Mason & Grubin, 1996)

6. Argument 1: Accurate diagnosis of
incoming inmates
 The researchers also mention the
questionable validity of the screening tools
used upon entrance
 Biases may have occurred in such self-reporting tools with some
inmates not qualifying for mental disorders, yet indicating that
they have a need for treatment. On the other hand, some
inmates who declined the need for assessments may have had
a diagnosable mental illness (Birmingham, Mason & Grubin,
1996).

7. Argument 2: Maintaining care for those
inmates with long-term disorders
 Many of the current physical treatments for those
diagnosed is inappropriate and can potentially
increase symptoms
 Solitary Confinement
○ Isolating an out of order inmate has provided a form of punishment,
but also a reprieve for overworked correctional staff. However,
placing a mental ill inmate in solitary confinement has the potential to
heighten depression, anxiety and neurosis due to schizophrenia
(Stephey, 2007)
○ Additionally, this type of response to mentally ill inmates can cause
decompensation, resulting in the individual mentally and emotionally
shutting down (Yang, Kadouri, Revah-Levy, Mulvery, & Falissard,
2009).

8. Argument 2: Maintaining care for those
inmates with long-term disorders
 Strong impact on inmates mental
disorders
 An inmate with mental disorders can also have
an increased chance of being victimized by
other inmates and staff, often viewed as an easy
target
○ Furthermore, inmates with disorders are more likely to
be physically and sexually abused (Blitz, Wolff, & Shi,
2008).

9. Argument 2: Maintaining care for those
inmates with long-term disorders
 Insufficient treatment can be found across gender
lines: Blitz, Wolff and Paap determined that female
inmates, similar to their males counterparts, were
not receiving the necessary treatment for general
mental disorders
 Specifically, a large percentage of those in need were suffering from
at minimum, a substance abuse issue, if not other mental disorders
as well. Blitz, Wolff and Paap determined of those included in the
study, 45% of those with substance disorders did not receive any
treatment (Blitz, Wolff & Paap, 2006)

10. Argument 2: Maintaining care for those
inmates with long-term disorders
 According to the study conducted by (Kjelsberg, et.
al, 2009), in a sample population of 928, 52% of
male and 17% of female inmates who were
diagnosed with mental disorders were due to
substance abuse.
 Additionally, in a study by Blitz, a reported 50% of
female inmates where under the influence of drugs
or alcohol when they actually committed the crimes
for which they were sentenced (Blitz, Wolff, & Paap,
2006).
 Furthermore, of those who reported needing
substance abuse treatment prior to prison, 45% did
not receive any type of voluntary or mandatory
counseling while incarcerated.

11. Argument 2: Maintaining care for those inmates with long-
term disorders
Lack of trained staff can
inhibit treatment in
facilities
.
 Research conducted by Reed and
Lyne determined that in the 13
prisons studied, there was a
standard, to maintain a
proportionate number of prison
nurses with mental health training
to inmates. However, the studied
concluded that only 24% of
nursing staff had received any
clinical education. In addition, only
two of those prisons had sessions
available with a clinical
psychologist (Reed & Lyne, 2000).
 In studies conducted, personality and
substance abuse disorders were the
most prevalent amongst a sampled
population (Kjelsberg, Hartvig, Bowitz,
Kuisma, Norbech, Rustad, Seem, &
Vik, 2006).
 While many of these disorders may
be chronic, underdeveloped
knowledge of the conditions and
treatment procedures will only further
the progression of such illnesses.

12. Future Considerations
 Overall, conditions in most prison environments can be
deteriorating on the mental health of an inmate.
Overcrowding and insufficient funding for structured
programs, as well as limited availability of trained mental
health professionals becomes a breeding ground for
psychological malaise. The issue of diagnosis and treatment
of these disorders should become priority to state and
federal agencies, so as to limit levels of recidivism and
violence. Increasing education for staff, as well as treating
common disorders, may assist the already overcrowded
prisons in decreasing rates of mental disorders.

13. References
 Birmingham, L., Mason, D., Gruber, D. (1996). Prevalence of mental disorder in
remand prisoners: consecutive case study. British Medical Journal, 313: 1521.
Retrieved on September 10, 2010 from http://www.bmj.com/content/313/7071/1521.full
 Blitz, C. Wolff, N., & Paap, K. (2006). Availability of behavioral health treatment for
women in prison. Psychiatric Services. 57(3): 356-360. doi: 10.1176/appi.ps.57.3.356.
Retrieved on September 10, 2010 from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811040/pdf/nihms168256.pdf
 Blitz, C. Wolff, N., & Shi, J. (2008). Physical victimization in prison: The role of mental
illness. International Journal of Law and Psychiatry. 31(5):385-393. doi:
10.1016/j.ijlp.2008.08.005. Retrieved on September 10, 2010 from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836899/pdf/nihms-168253.pdf
 Gunn, J., Maden, A., & Swinton, M. (1991). Treatment needs of prisoners with
psychiatric disorders. British Medical Journal. 303(6798): 338–341. PMCID:
PMC1670792. Retrieved on September 10, 2010 from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1670792/
 Kjelsberg, E., Hartvig, P., Bowitz, H., Kuisma, I., Norbech, P., Rustad, A., Seem, M., &
Vik, T. (2006). Mental health consultations in a prison population: A descriptive study.
BMC Psychiatry. 6:27. doi: 10.1186/1471-244X-6-27. Retrieved on September 10, 2010
from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1534016/pdf/1471-244X-6-27.pdf
 Kuper, T. (1999). Prison Madness: The mental health crisis behind bars and what we
must do about it. Joey-Bass, Inc.: San Francisco

14. References
 Lamb, H. & Weinberger, L., (1998). Persons with severe mental illness in jails and
prisons: A review. Psychiatric Services, 49:483-492. Retrieved on September 10, 2010
from http://psychservices.psychiatryonline.org/cgi/content/full/49/4/483?eaf
 Okasha, A. (2004). Mental patients in prison: punishment versus treatment? World
Psychiatry. 3(1): 1-2. Retrieved on September 28, 2010 from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414650/
 Reed, J., & Lyne, M. (2000). Inpatient care of mentally ill people in prison: Results of a
year’s programme of semistructured inspections. British Medical Journal, 320, 1031-
1034. Retrieved on September 10, 2010 from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27341/pdf/1031.pdf
 Stephey, M., (2007). De-criminalizing mental illness. Retrieved on September 23, 2010
from http://www.time.com/time/health/article/0,8599,1651002,00.html
 Wolff, N., Blitz, C., & Shi, J. (2007). Rates of sexual victimization in prison for inmates
with and without mental disorders. Psychiatric Services. 58(5): 1087-1094. doi:
10.1176/appi.ps.58.8.1087. Retrieved on September 10, 2010 from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811043/pdf/nihms168251.pdf
 Yang, S., Kadouri, A., Revah-Levy, A., Mulvery, E., & Falissard, B. (2009). Doing time: A
qualitative study of long-term incarceration and the impact of mental illness.
International Journal of Law and Psychiatry. 32(5): 294-303. doi:
10.1061/j.ijlp.2009.06.003. Retrieved on September 10, 2010 from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758061/pdf/nihms-133713.pdf