Chronic Mental Illness in Prisons

It has been known that psychiatric disorders are highly prevalent among prisoners. Many people with identifiable psychiatric illness do conflict with the law, often by no fault of their own but because of symptoms of their psychiatric illness and end up in jails. Poor communication between the prison, court, and hospital systems hinders the assessment and management of the mentally disordered offender, and medical intervention can actually delay release from custody. In conclusion Prisons are detrimental to mental-health, and the standards of psychiatric care are significantly lower than those for the general public. Certain remedial measures are to be implemented for a better future of prison and community because ultimately these prisoners will be released from prison and become a part of community. Beginning of reforms is the immediate need as a long journey ahead.

Psychometric Examination of Treatment Change Among Mentally Disordered Offenders: A Risk–Needs Analysis

The present study examined the association of psychiatric symptomatology, criminal attitudes, and treatment changes within these domains to violent and general recidivism in a sample of 614 mentally disordered offenders. Significant pre–post changes were found on multiple measures of criminal attitudes, symptomatology, and readiness for change. Antisocial Intentions and Attitudes Toward Associates (from the Measure of Criminal Attitudes and Associates [MCAA]) predicted general recidivism and covaried with the Big Four criminogenic need domains on the Level of Service Inventory–Ontario Revision; none of the remaining psychometric measures significantly predicted violent or general recidivism. Although pre–post changes were seldom linked to changes in recidivism, positive changes in Antisocial Intentions (MCAA) significantly predicted reductions in general recidivism via Cox regression survival analysis, controlling for baseline risk and pretreatment attitudes score. Risk and need implications of psychometric assessments of treatment change in mentally disordered offender populations are discussed.

The law in England and Wales on mental health treatment in the community

This chapter examines the legal framework for the treatment of the mentally disordered offender in the community in England and Wales. It examines both some of the ideological questions underlying the care of this group and the legal mechanisms within which treatment can be provided. The chapter begins by examining the principle, endorsed by the Mental Capacity Act 2005, that voluntary treatment will usually be the norm, regardless of setting. It then considers exceptions to these norm situations where legally mandated treatment in the community is permitted. In England and Wales, most of these exceptions are to be found in three pieces of legislation: the Mental Health Act 1983, as amended in 2007 to include community treatment orders; the Mental Capacity Act 2005, with its associated Deprivation of Liberty Safeguards (DOLS); and the Criminal Justice Act 2003.

The Community Mental Health Team and the mentally disordered offender

There is a long-standing policy of diversion of mentally disordered offenders (MDOs) from the criminal justice system to care by mental health services. Care of the MDO presents specific challenges to the non-forensic practitioner. These include the need to understand the workings of the criminal justice system and the specific legal issues presented by an offender, the salience of risk, and its management in the mind of the courts and novel additional ethical dilemmas that arise. The importance of substance misuse as a factor in offending behaviour is emphasized, and its implications are explored. In addition, the MDO may present with clinical problems that are unfamiliar. Key principles of management are set out. These include developing a clear understanding of the patient and their world, excellent communication between all those involved, and rapid intervention when there is cause for concern. Staff working with an MDO require adequate supervision and support.

Care of the Mentally Disordered Offender in the Community

This book examines the care of the mentally disordered offender in the community from a number of perspectives: the social, administrative, and clinical context; clinical aspects of care; and the relationships between psychiatric services for mentally disordered offenders and other agencies. It incorporates recent developments in treatment and policy, including an international analysis of the use of community treatment orders, which remain controversial and divide opinion. In the United States, efforts to improve treatment have focussed on improving continuity of care between prison and the community, and the book examines US jail and prison policy. Current UK health policy as applied to the mentally disordered offender is explained. Risk and risk thinking is a theme that runs through the book and is considered in terms of its effect on society, its influence on policy, and in terms of how risk assessment is applied in everyday clinical practice. Developments in psychodynamic psychotherapy and cognitive treatments for mentally disordered offenders are discussed, including consideration of the risk-need-responsivity model, which has become increasingly influential. The treatment of sex offenders and personality disorder offenders is considered specifically, as is pharmacological therapy. Most mentally disordered offenders are managed in the community by the Community Mental Health Team (CMHT). The role of the CMHT and its interface with specialist community forensic teams is considered, as is the interaction between mental health services and other agencies and the legal context within which they operate.

Lowering legal barriers to transitioning mentally disordered offenders into general mental health care

This chapter considers legal mechanisms for directing that the treatment of a mentally disordered offender should take place under the civil commitment scheme. Mentally disordered offenders should be dealt with in the least restrictive manner and receive timely transfer of their care to general mental health teams. We discuss factors likely to influence the responsible authorities when deciding whether to direct offenders to treatment under the civil scheme. The scope of the powers that would continue to be available over the person’s treatment is a key factor. With insufficient powers, authorities might be reluctant to direct an offender to the civil scheme. Yet, if strong powers were available, that would pose a threat to the rights of ordinary civil patients under that scheme. Some way must therefore be found to finesse the differing interests of offenders and ordinary civil patients in the design of the civil scheme. .

Forensic psychotherapy

Objectives: This paper describes the role forensic psychotherapy has in the assessment and treatment of mentally disordered offender patients, and its role in the supervision of individual therapists, staff groups or whole organisations which contain and manage this patient population. Conclusions: Forensic psychotherapy has a valuable role to play in the management of mentally disordered forensic patients. As forensic services continue to develop in Australia and New Zealand and interest in this field continues to grow, then the future of forensic psychotherapy looks bright.

Chronic Mental Illness in Prisons

It has been known that psychiatric disorders are highly prevalent among prisoners. Many people with identifiable psychiatric illness do conflict with the law, often by no fault of their own but because of symptoms of their psychiatric illness and end up in jails. Poor communication between the prison, court, and hospital systems hinders the assessment and management of the mentally disordered offender, and medical intervention can actually delay release from custody. In conclusion Prisons are detrimental to mental-health, and the standards of psychiatric care are significantly lower than those for the general public. Certain remedial measures are to be implemented for a better future of prison and community because ultimately these prisoners will be released from prison and become a part of community. Beginning of reforms is the immediate need as a long journey ahead.