Correctional mental health in the USA

Purpose – The purpose of this paper is to discuss five domains impacted by the transformation of correctional mental health care in the USA: public health, public safety, legal obligations, fiscal responsibility and ethical standards, as well as critical issues such as administrative segregation, suicide prevention and reentry planning. Design/methodology/approach – In the last four decades, the USA has seen a sizable growth in its criminal justice system and corrections population. It has also seen reductions in civil and community-based mental health care. Persons with mental disabilities have come to represent a highly disproportional segment of the corrections population. The paper discusses the implications and underlying causes of these developments as well as recent responses to them. Findings – This set of circumstances is starting to change the mission of correctional health services from crisis intervention and suicide prevention to include preparation for the inmate's almost inevitable return to the community. Originality/value – Such changes have led to further developments in correctional mental health care, in particular, policy designed to treat mental illness, reduce its destructive outcomes such as suicide, and facilitate successful reentry into the community in attempts to reduce recidivism and improve clinical outcomes. Mental health care professionals working within corrections have likewise faced ethical challenges in effectuating treatment.

Gender and Racial Differences for Suicide Attempters and Ideators in a High-Risk Community Corrections Population

Background: Community corrections populations are a high-risk group who carry multiple suicide risk factors. Aims: To identify factors correlated with historical suicide attempts and ideation among African-American men, African-American women, White men, and White women in a community corrections population. Method: Self-report data from 18,753 enrollees in community corrections were analyzed. Multinomial logistic regression analyses were conducted to determine associations between historical suicidal ideation and attempts among the four demographic groups. Results: Participants with historical suicide attempts tended to be younger, White, female, be taking psychotropic medication, have a history of physical or sexual abuse, and meet criteria for dependence on alcohol, amphetamines, cocaine, opioids, or sedatives. Five variables were commonly associated with suicide attempts for all four race/gender groups: younger age, being on disability or retirement, taking psychotropic medication, history of sexual or physical abuse, and cocaine dependence. Other demographic variables had race or gender specificities as risk factors for suicide attempts. Conclusions: Participants had high rates of historical suicide attempts with unique correlates differentiating attempters from ideators among different racial and gender groups. Cocaine dependence was universal predictor of suicide attempts, while other substance dependencies show specific racial and gender profiles associated with suicide attempts.