Forensic Mental Health Counseling By: Sarah Blackburn, M.A., LMHCA & Ismael Concepcion Poo, MA., LMHCA
Introductions Sarah Blackburn, M.A., Ismael Concepcion Poo, M.A., LMHCA LMHCA Title: CMHC2 Title: CMHUS Correctional Mental Health Counselor 2 Correctional Mental Unit Supervisor Unit: Special Offenders Unit: Special Offenders Medium Custody Close Custody
DOC Quiz What do you know about prisons/corrections?
What color are offender ID cards? Green Offenders must wear their ID cards whenever they are out of their cell. Permanent staff members have blue ID badges while visitors are given a red ID badge upon entering a facility.
What are potential safety and security risks in the picture below?
What are potential safety and security risks in the picture below?
What are potential safety and security risks in the picture below?
What are potential safety and security risks in the picture below?
What are potential safety and security risks in the picture below?
95% of incarcerated individuals will release from prison at some point. True or False? True – The Bureau of Justice Statistics (BJS) a states 95% of all state prisoners will be released from prison at some point, and that nearly 80% will be released to parole supervision.
Most often, offenders release into the county of their most recent conviction. True or False? False – Policy states that offenders are to return to their county of FIRST conviction. However, this can change if there are victim concerns, no housing resources, etc.
How many mental health facilities in WA DOC? 3 Special Offender’s Unit, Minimum Security Unit (Camp), Washington State Penitentiary – BAR Units
Objectives • Understand challenges in providing residential treatment in correctional setting. • Learn about offender treatment, the treatment process and documentation required. • Balance between maintaining safety and security within therapeutic environment .
Prevalence • In 2006, the three largest psychiatric institutions in the country were L.A county jail, Riker’s Island and Cook County Jail (Adams & Ferrandino, 2008.) • In 2001, 10-15% of state prison inmates suffered from severe mental illness (Lovell, et.al, 2001). • From 2009-2012, the number of psychiatric beds in WA decreased from 1,759 to 1,507. • In 2014, the Washington State Supreme Court ruled that warehousing mentally ill patient’s in hospital emergency rooms was unlawful. • SMI offenders have higher rates of recidivism, returning to prison nearly 1 year sooner than non-SMI offenders (Cloyes, Wong, Latimer, & Abarca, 2010, p. 183).
The Need For SOU • While the number of individuals needing psychiatric care is growing many do not receive treatment until they are in prison. • Studies show SMI offenders are more likely to be infracted, have longer sentences, cost more and are more likely to recidivate. • SOU is tasked with balancing safety and security while also providing effective, evidence- based care.
Intake Process • Every offender in the state is sent to Washington Correctional Center (WCC) for initial screenings. • These screenings include: Mental health, medical/nursing, disabilities, needs/risks factors and appropriate housing. • Mental Health Assessment includes: - Mental Health Appraisal - S code Entered - If symptomatic, patient is referred to the Mental Health Teleconference for potential placement in a Residential Treatment Unit (RTU).
The “S” code
Case Example Mr. S is a 23-year-old self-identified Laotian male just received at WCC (Shelton) on his first admit to Prison. He was charged with two counts of assault with a deadly weapon and has an ERD of 2030. County of conviction is King. Mr. S has obtained his GED. **Further information provided on handout**
Housing
Everyday life • Movement periods • Infraction process • Property • Recreation opportunities • Incentive programs • Employment opportunities • Behavior observations • Other programming opportunities (SOTAP, IOP, Basic Skills)
Offender Unit Roster Callout Date: 03/16/2017 - Thursday Bed ID Offender Name DOC Number Start Time End Time Callout Location Callout Reason E145 DOE, JOHN 123456 1240 1530 VISIT ROOM MOVIE DAY E145 DOE, JOHN 123456 1730 1830 E UNIT POD 2 HEALTH SERVICES
Custody Facility Plan • Each person is assigned a classification counselor responsible for completing custody facility plans • These plans indicate offenders current custody score • Custody score designates housing options; Max, Close, Medium, Minimum • Overrides from within the institution and headquarters can assign someone to a more or less restrictive unit depending on individual’s needs.
Patient update Since arriving to SOU Mr. S has been going out to gym and yard regularly. He works as a unit porter and spends his earnings on coffee, tea and snacks. He receives phone calls from family and friends but no visits. He started one therapy group but rarely participates. He often forgets individual sessions and has to be reminded of appointments. He is currently prescribed Zyprexa. Behavior observation notes state Mr. S has been, “looking at the wall in his cell” for hours at a time. Other behavior observations include “poor work ethic while cleaning the showers” and “making bizarre comments to staff.”
Assessment Tools • The Department of Corrections has various assessment tools available to clinicians to ensure continuity of care and proper documentation . • Some examples include : • Mental Health Update(MHU)/Mental Health Appraisal (MHA) • PULHESDXT coding (S code) • Montreal Cognitive Assessment (MoCA) • Treatment Plans (updated every 90 days) • DSM 5 Cross Cutting Measures
Barriers to treatment • Restricted movement • Codes • Inherently dangerous environment • Separation between custody and health services • Limited resources • Disciplinary and prison rules • Offender “code”
Patient Update • Mr. S has recently stopped taking his medication and is displaying more bizarre behaviors, that include asking officers if they can hear “Bob” giving them instructions, and staring at the shower wall during porter duties. When assessed by mental health staff he reported thoughts of harming himself as the voices were “getting really bad.” He was unable to contract for safety on the unit…
Close Observation Area (COA) • If an offender is considered a danger to himself or others, or gravelly disabled, they can be placed in the COA under psychiatric or suicide watch. • Mental health and medical staff follow these offenders closely, assessing medications and mental health stability. • Once the offender as stabilized the offender can be discharged and returned to their unit.
References • Adams, K., & Ferrandino, J. (2008). Managing Mentally Ill Inmates in Prisons. Criminal Justice and Behavior, 35(8), 913-927. doi:10.1177/009385480831862 • Bloom, J. D., MD. (2015). Psychiatric Boarding in Washington State and the Inadequacy of Mental Health Resources. The Journal of the American Academy of Psychiatry and the Law, 218-222. Retrieved February 1, 2017 • Cloyes, K. G., Wong, B., Latimer, S., & Abarca, J. (2010). Time to Prison Return for Offenders With Serious Mental Illness Released From Prison: A Survival Analysis. Criminal Justice and Behavior, 37(2), 175-187. doi:10.1177/0093854809354370
References • Fellner, J. (2006). A Corrections Quandary: Mental Illness and Prison Rules. Harvard Civil Rights - Civil Liberties Law Review, 41, 391-412. Retrieved March 21, 2017. • Lovell, D., Johnson, C., Jemelka, R., Harris, V., & Allen, D. (2001). Living in Prison After Residential Mental Health Treatment: A Program Follow-Up. The Prison Journal, 81(4), 473-490 doi:10.1177/0032885501081004004. • Resources. (n.d.). Retrieved June 09, 2017, from http://www.doc.wa.gov/information/data/resources.htm#publication
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