Mental health specialized probation caseloads: are they effective?

With the large and growing number of persons with mental illnesses under probation supervision, a form of specialized probation called specialized mental health caseload (SMHC) has been implemented. This study explores the effectiveness of a prototypic SMHC implemented statewide. A quasi-experimental design was used to compare criminal justice, mental health, and community engagement outcomes among three caseloads: a newly established SMHC supervising no more than 30 clients per officer (N=1367); an established SMHC supervising roughly 50 clients per officer (N=495); and a traditional caseload of clients receiving mental health treatment and supervised by officers with average caseloads of over 130 clients (N=5453). Using a mixed methods approach, we found that the SMHC was implemented with high adherence to fidelity, and comparisons based on different caseload samples generally support the effectiveness of the specialized mental health caseload, particularly on criminal justice outcomes. Future studies using random assignment are needed to examine the connection among mental health symptoms, compliance with treatment and probation supervision, and recidivism.

Effectiveness of cognitive-behavioral trauma treatment for incarcerated women with mental illnesses and substance abuse disorders.

An open trial design was used to examine the implementation and effectiveness of a cognitive-behavioral intervention (Seeking Safety) for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) for incarcerated women with Axis I mental disorders who self-referred for specialty trauma treatment. The study sample was female inmates aged 18 and old who were primarily minority, had experienced childhood-based trauma, committed violent crimes, had a serious mental illness, and resided in maximum, medium, and minimum compounds of a women's prison. A total of 74 women completed the group intervention, with the average attending 23 of the 28 sessions (82%). Implementation feasibility was demonstrated by the ability to recruit, screen, assign, and retain participation. Effectiveness was supported by changes pre-post intervention on the PTSD Checklist (ES=0.56) and Global Severity Index (ES=0.47). Of the 19 completers with PCL scores of 50 or higher pre-intervention, 16 (84%) had scores below 50, the "cut score" consistent with or supportive of a PTSD diagnosis. Three-quarters or more of participants reported that Seeking Safety was helpful in each of the following areas: overall, for traumatic stress symptoms, for substance use, to focus on safety, and to learn safe coping skills. Future directions include the need for larger scale randomized controlled trials in medium or maximum security prisons and fidelity evaluations of non-research dissemination efforts.

Obesity and weight-related medical problems of incarcerated persons with and without mental disorders.

This study examined weight and weight-related medical conditions of soon-to-be released inmates with and without a mental disorder. The sample included 4,204 males and females aged 18 or older residing in 11 state prisons. Three quarters or more of the inmates were overweight or obese. Mental health status was not found to be a significant factor in the presence or absence of overweight or obesity. Male inmates with mental disorders had higher rates of breathing, walking, and intense pain problems compared to those without mental disorders. Obese male inmates with schizophrenia or bipolar were more likely than those without a mental disorder to report medication treatment for diabetes, cardiovascular problems, arthritis, and intense pain. Evidence-based interventions are needed to monitor weight and obesity during incarceration and to teach weight management skills as part of an integrated psychiatric and medical program.

Reentry Preparedness among Soon-to-be-Released Inmates and the Role of Time Served.

PURPOSE: While reentry funding is flowing into states, its target efficiency and effectiveness depends on whether it goes to the right people in the right ways. The purpose of this study was to examine whether and how the amount of time incarcerated affects reentry readiness. MATERIALS AND METHODS: A population-based survey was conducted. Approximately 4000 soon-to-be-released male inmates were drawn from a state correctional system. Readiness is described in terms of feeling ready and material, social, and treatment resources available for reentry by time served on current conviction (episode effect) and since age 18 (cumulative effect). Generalized hierarchical linear models were used to estimate the effects of demographic, criminological, and time served variables on reentry readiness outcomes. RESULTS: Reentry vulnerability increased with time served since turning 18 (cumulative effect) but not with time served on the current conviction (episode effect). Inmates serving more than 10 years since turning 18 were at greatest reentry risk. CONCLUSIONS: The findings indicate that inmates who have served more prison time over their lifetime have more pronounced needs and risks suggesting that reentry funding be targeted towards those who have served more time over the course of their lifetime.

Trauma exposure and mental health characteristics of incarcerated females self-referred to specialty PTSD treatment.

OBJECTIVES: This study examined the traumatic and stressful event exposure history and psychiatric health characteristics of soon-to-be released female inmates who self-referred to specialty posttraumatic stress disorder (PTSD) treatment. METHODS: The final sample (N=209) included female prison inmates aged 18 or older who were assessed for trauma exposure and axis I disorders with standardized clinical instruments. RESULTS: The rate of serious mental disorders was high. Presence of psychiatric disorders was significantly associated with a history of traumatic event exposure and full or subthreshold PTSD, and high rates of overall traumatic event exposure (88%) and childhood sexual or physical trauma (74%). Descriptive profiles of specific lifetime traumatic and stressful events were associated with psychiatric disorders. CONCLUSIONS: Findings suggest strong behavioral effects associated with lifetime traumatic and stressful event histories and indicate major psychiatric health care needs among female prison inmates that are likely unmet by existing services.