Psychiatric Annals

Mental Health Care in the Federal Bureau of Prisons 

Mental Health Research in the Federal Bureau of Prisons: Current Trends and Future Developments

Bernadette M M Pelissier, PhD

Abstract

The influence of mental health in corrections is relatively recent1 but the effects of a mental health perspective are substantial. This is shown historically by the rehabilitation ideology of the 1960s and 1970s that was based on a mental ilfness model. Often, the terms treatment and rehabilitation were used interchangeably. Although this model was questioned in 1974 in Lipton, Martinson, and Wilks' review of recidivism studies,2 others have recently suggested the need for a reconceptualization of the role of rehabilitation and the resulting correctional research needs.3'6 In conjunction with current issues in correctional treatment and research, the role of mental health professionals and the function of mental health research in corrections deserve attention. This article will provide a synopsis of how mental health professionals have been involved in research within the Federal Bureau of Prisons. An outline of the general function and importance of mental health research to the field of corrections and to mental health will also be presented.

HISTORY QF MEMTAL HEALTH RESEARCH IN THE FEDERAL BUREAU OF PRISONS

Although much of the correctional research in the Federal Bureau of Prisons has been conducted either by the research staffer outsiders, mental health professionals working within the Federal Bureau of Prisons do conduct research projects. To date this research has been conducted largely by individual treatment staff and by psychology interns completing dissertations.

Although all research conducted within the Bureau of Prisons must be reviewed and approved by a central research committee, historically there has been no concerted emphasis upon systematic mental health correctional research. Therefore, the topics pursued by Bureau of Prisons mental heahh staff have been initiated by individuals. The types of projects completed range from diag<nostic research to program evaluation. One project attempted to validate a Spanish version of the Minnesota Multiphasic Personality Inventory with Spanish-speaking inmates.7 Another attempted to assess the ability of this test to discriminate between inmates who are truly emotionally disturbed and those who are malingerers. A current project is evaluating the effects of two drug treatment programs. The relapse prevention model, a cognitive-behavioral approach that teaches a variety of coping skills, is being compared with a more traditional model of drug education for incoming inmates.

ORGANIZATIONAL SUPPORT FORRESEARCH

The internal organizational support for mental health research exists most clearly at the intern level; currently there are 10 pre-doctoral internships at various institutions in the federal prison system. These oneyear internships allow 4 to 8 hours per week for work on dissertation projects.

Research is not usually included in the daily job duties of other Federal Bureau of Prisons mental health professional staff; their primary duties are clinical and administrative in nature. However, there are various avenues by which research projects are initiated and supported. Several methods of collaboration to facilitate project completion with limited resources have been utilized successfully. Some projects are carried out in collaboration with graduate students completing dissertations. Others involve collaborating with local university staff to obtain outside funding for data collection and analysis. A small number of projects are conducted by mental health professionals with administrative funding for data collection from the central office (this type of project is generally supported to meet accreditation standards requiring documented program evaluation). Aside from collaboration with mental health professionals outside the Bureau of Prisons and limited financial support, assistance also exists in the form of consultation from the research department in the central office of the Bureau of Prisons.

RESEARCH ROLE OF THE MENTAL HEALTH PROFESSIONAL

Although the role of correctional mental health staff is primarily clinical and administrative, involvement in projects offers a variety of advantages to both the…

The influence of mental health in corrections is relatively recent1 but the effects of a mental health perspective are substantial. This is shown historically by the rehabilitation ideology of the 1960s and 1970s that was based on a mental ilfness model. Often, the terms treatment and rehabilitation were used interchangeably. Although this model was questioned in 1974 in Lipton, Martinson, and Wilks' review of recidivism studies,2 others have recently suggested the need for a reconceptualization of the role of rehabilitation and the resulting correctional research needs.3'6 In conjunction with current issues in correctional treatment and research, the role of mental health professionals and the function of mental health research in corrections deserve attention. This article will provide a synopsis of how mental health professionals have been involved in research within the Federal Bureau of Prisons. An outline of the general function and importance of mental health research to the field of corrections and to mental health will also be presented.

HISTORY QF MEMTAL HEALTH RESEARCH IN THE FEDERAL BUREAU OF PRISONS

Although much of the correctional research in the Federal Bureau of Prisons has been conducted either by the research staffer outsiders, mental health professionals working within the Federal Bureau of Prisons do conduct research projects. To date this research has been conducted largely by individual treatment staff and by psychology interns completing dissertations.

Although all research conducted within the Bureau of Prisons must be reviewed and approved by a central research committee, historically there has been no concerted emphasis upon systematic mental health correctional research. Therefore, the topics pursued by Bureau of Prisons mental heahh staff have been initiated by individuals. The types of projects completed range from diag<nostic research to program evaluation. One project attempted to validate a Spanish version of the Minnesota Multiphasic Personality Inventory with Spanish-speaking inmates.7 Another attempted to assess the ability of this test to discriminate between inmates who are truly emotionally disturbed and those who are malingerers. A current project is evaluating the effects of two drug treatment programs. The relapse prevention model, a cognitive-behavioral approach that teaches a variety of coping skills, is being compared with a more traditional model of drug education for incoming inmates.

ORGANIZATIONAL SUPPORT FORRESEARCH

The internal organizational support for mental health research exists most clearly at the intern level; currently there are 10 pre-doctoral internships at various institutions in the federal prison system. These oneyear internships allow 4 to 8 hours per week for work on dissertation projects.

Research is not usually included in the daily job duties of other Federal Bureau of Prisons mental health professional staff; their primary duties are clinical and administrative in nature. However, there are various avenues by which research projects are initiated and supported. Several methods of collaboration to facilitate project completion with limited resources have been utilized successfully. Some projects are carried out in collaboration with graduate students completing dissertations. Others involve collaborating with local university staff to obtain outside funding for data collection and analysis. A small number of projects are conducted by mental health professionals with administrative funding for data collection from the central office (this type of project is generally supported to meet accreditation standards requiring documented program evaluation). Aside from collaboration with mental health professionals outside the Bureau of Prisons and limited financial support, assistance also exists in the form of consultation from the research department in the central office of the Bureau of Prisons.

RESEARCH ROLE OF THE MENTAL HEALTH PROFESSIONAL

Although the role of correctional mental health staff is primarily clinical and administrative, involvement in projects offers a variety of advantages to both the mental health professional and the Federal Bureau of Prisons. Participation in research provides opportunities for continued professional growth. Designing research projects and interpreting results encourages staff to reflect upon their psychotherapeuric practices and programs. In addition, working with colleagues within or outside corrections can be helpful in preventing burnout. Research also provides mental health professionals with an opportunity to become part of the program planning process in the correctional system.

INMATE POPULATION AND MENTAL HEALTH PROBLEMS

A 1983 national survey of state and federal correctional facilities estimates that approximately 6% of the total inmate population can be classified as mentally ill.8 With the current federal inmate population of almost 44,000, the number of mentally ill inmates can be estimated to be over 2,600. Although the total number of inpatient mental health beds in the Federal Bureau of Prisons numbers fewer than 700, other inmates receive mental health services on an outpatient basis or for crisis intervention. The types of mental illness among the federal inmates include the range of diagnoses (such as schizophrenia, bipolar disorders, depression, and personality disorders) normally found in mental health inpatient facilities. The percentage of inmates with mental illness actually appears to be increasing, possibly due to the "criminalization" of mentally disordered behavior,9 The deinstitutionalization process, with its inadequate range and quantity of community facilities and programs, results in increasing numbers shifted into the criminal justice system.10 In addition, recent research on the criminal mental patient indicates this subgroup is chronically readmitted to state psychiatric facilities and is absorbing both mental health and criminal justice resources at an alarming rate." Therefore, the mentally ill within the prison system have treatment needs that must take into consideration their past and future treatment in the community.

While this estimated percentage of mentally ill inmates is small, other factors, sometimes unique to a particular prison system, indicate the existence of mental illness problems in a much larger portion of the inmate population. In addition, changes in federal laws have mandated specific attention to treatment for a subset of the prison population. The incidence of other mental health problems within prison facilities is often affected by changes in law enforcement efforts. For example, the percentage of inmates within the federal prison system admitted for drug-related offenses has increased from 24% in 1981 to 34% in 1986. This percentage is expected to increase even further as a result of the 1986 Anti-Drug Abuse act. Furthermore, initial admission screenings show that up to 40% of newly committed inmates admit to moderate to severe drug abuse histories.

Given the number of inmates with mental health problems and the limited treatment resources available within the correctional system, mental health research is needed to guide decisions about the effective and efficient use of these resources.

ROLE OF MENTAL HEALTH RESEARCH IN CORRECTIONS

Although research has been done on a variety of mental health problems and effective treatment methodologies, it cannot be assumed that the effects of treatment for a given mental health problem in a correctional setting are identical to those outside a correctional setting. This leads to the larger question of how correctional mental health research fits in with mental health research in general.

Mental health researchers in general advocate for increased knowledge about the effectiveness of various treatment methods for different types of mental health problems. This viewpoint is also espoused by correctional researchers. A recent review of the literature on rehabilitation12 indicates that contrary to the "nothing works" position espoused in the 1970s, there is empirically documented evidence of successful rehabilitation. Researchers are now proposing that additional research must identify what works for whom.3'6 More specifically, the question becomes "which methods work best for which types of offenders, and under what conditions or in what types of settings."12

This question again raises issues about treatment needs and effectiveness for the prison mental health population. A natural starting point for exploring this issue comes from research on the classification of offenders. Classification in prison systems is used primarily for management purposes such as designating security level and institutional assignment. Application of classification to treatment and offender matching is sorely lacking: not only is there a lack of adequate means of classification but there is aJso a lack in classifying services.6 Classification to date has been used primarily for placement and not for treatment.

There are many other gaps in mental health correctional research. There is a need to consider the nature of the population to be treated because this could be viewed as having direct implications for mental health services. An example is the absence of basic research in the area of minorities.13 Owens14 discusses problems in using traditional therapy with blacks, most notably in correctional settings; similar problems may exist for the Hispanic inmate population. The effects of cultural differences on treatment needs must be researched in order to provide appropriate services to these groups. Mental health treatment needs must be defined not only by the type of mental health problem but also by the cultural context within which these problems occur. Correctional research also needs to expand into the area of the courts.13

Although some research has examined characteristics of those likely to be found incompetent ?? stand trial or not criminally responsible and who may. receive treatment. very little is known about which offender-treatment matches should occur to produce treatment gain.15 An unpublished study by Poss and Johnson (which empirically classified the federal pretrial forensic population referred for competency and criminal responsibility evaluations) concluded that classification research could have implications for the development of a screening instrument to identify types of forensic inmates requiring minimal evaluation or treatment services. This could increase the efficiency of the use of limited resources. Studies that more directly examine the mutual effects of the psychiatric and legal system upon one another could undoubtedly benefit both groups.

Prediction of career criminal patterns is an emerging interest of criminologists. Although career criminals have not historically been recognized as mentally ill and in need of treatment, mental health professionals can provide a perspective for research on this group that may have management implications, A current project is attempting to identify the thought processes of the career criminal. Such identification could result in the development of more effective treatment interventions with this population.

Although inmates who are violent have often been singled out as requiring special attention and have received some study, Roberg and Webb13 argue that gaps in correctional research still exist in this area. It is noteworthy that violence has also been identified by the National Institute of Mental Health as one of the four major national mental health research issues.10 The prison environment provides an excellent context within which to study the relationship between mental illness and violence. It is also pertinent to understand how this relationship may be affected by the prison environment.

As previously mentioned, correctional research is concerned not only with what type of treatment works best for particular types of offenders, but also with the conditions or types of settings under which the treatment occurs. The treatment setting represents one of the most neglected areas in correctional research. In general, Carney1 suggests it is possible that not every psychotherapeutic strategy is suitable in correctional treatment. This may not be because of the nature of the mental health problems of the inmate population but because of the interaction between the type of individual and the correctional setting. The very experience of incarceration may be counterproductive. Mental health research in corrections could benefit from consideration of when the negative effects of incarceration conflict with treatment goals and should encourage experimentation with methods that may counteract these effects.

In addition to consideration of the general effects of incarceration upon treatment effectiveness, specific aspects of the correctional setting deserve special attention. One aspect is the inherent coercive nature of the correctional environment. Psychologists and psychiatrists have long grappled with the issue of voluntary treatment and patient motivation. This issue is of even greater importance in prisons. Further research is needed to confirm how and when coercive treatment within correctional settings may have beneficial results.1,5 The other side of this issue is the question of the effects of nonintervention and inaction.13

A second specific aspect of the correctional environment requiring attention, that of legal rights to refuse treatment, is also related to coercion. Research in this area may help provide parameters useful in development of policies and procedures concerning management of inmates committed for treatment.

The lack of attention to the nature of the correctional environment is also substantiated by researchers who note the lack of information about the effects of management policies and practices.13,16 Inmates with identified mental health problems have been found to be more likely to violate prison rules than other inmates.17 This subgroup of inmates poses special management problems. Research addressing this issue could be useful in establishing or modifying security and disciplinary practices and policies to increase the safety of staff and inmates.

But even beyond those inmates identified as having mental health problems, the knowledge of psychologists and psychiatrists could be valuable in the development and evaluation of a variety of correctional policies and procedures. Pilot programs and new policies are constantly being introduced but are seldom systematically examined. Many of the policies or programs implicitly make assumptions about human behavior, motivation, and attitudes. Mental health professionals could help clarify those underlying assumptions and provide suggestions as to how to substantiate them. For example, the Federal Bureau of Prisons recently established a pilot program to require inmates to have a General Equivalency Diploma (GED) in order to qualify for the highest pay level in prison jobs. Such a program makes assumptions about motivation, but what are the assumptions and does it work as expected in a correctional setting?

Timing of treatment also deserves attention.6 Some literature on imprisonment describes not only coping styles of inmates but stages of adjustment, each associated with different sets of inmate concerns.18 These stages of adjustment may have implications for when some types of offenders are more or less receptive to treatment efforts.

Another dimension of the treatment setting is that of service coordination. General developments in mental health program evaluation indicate an increasing recognition of the importance of service coordination research. With a nationwide system of over 50 prisons in the Federal Bureau of Prisons, some of which have specialized inpatient mental health programs, there is much room to study issues of follow-up care. After inmates are discharged from inpatient beds, what outpatient programs lend themselves to optimal inmate adjustment, and what type of coordination is needed?

CONCLUSION

Mental health resources in prisons are limited and programs are costly. There is a need to develop a knowledge base that enables mental health professionals within the correctional system to allocate these resources efficiently and effectively. Mental health research is particularly crucial since the treatment occurs in a setting that may greatly influence the effects ofthat treatment. Research in corrections can also add to the general knowledge base of mental health for which the question of what works for whom is important.

From the perspective of the role and function of correctional mental health professionals, involvement in research can enhance professional development. It is also an avenue by which they can acquire a more active role in correctional program planning and decision making. Mental health professionals, with their clinical knowledge combined with knowledge about correctional institutional operations and problems, can provide valuable guidance in assessing the efficiency and effectiveness of not only treatment programs but also policies and procedures.

REFERENCES

1 . Carney LP: Corrections: Treatment and Philosophy. Englewood Cliffs. N), Prentice-Hall, Ine, 1980.

2. Lipton D. Martinson R, Wilks J: The Effectiveness of Correctional Treatment: A Survey of Treatment Evaluation Studies. New York. Praeger Press. 1975.

3. BartollasC: Correctional Treatment Theory and Practice. Englewood Cliffs. N|. Prentice-Hall. Ine, 1985.

4. Gendreau P, Ross RR: Revivification of rehabilitation: Evidence from the 1980s. ilatice Quarterly 1987; 4:349-407.

5. Smith AB, Berlin L: Treaiingihe Criminal Offender. Englewood Cliffs, NJ. PrenticeHaU, Inc. 1981.

6. Sechrest L: Classification for treatment, in Gottfredson DM, Tonry M (eds): Crime and fustice: A Review of Research. Chicago, University of Chicago Press. 1987. vol 9.

7. Traub GS. Botin MJ: Note on the reliability of the MMPI with Spanishspeaking inmates in the federal prison system. Psycho! Rep 1985; 56:373-374.

8. National Institute of Corrections: Sourcebook on the Mentally Disordered Prisoner. Washington, DC. Department of luetice, I985.

9. Lamb HR: Commentary: Keeping the mentally ill out of jail. Hasp Community Psychiatry 1984; 35:529.

10. FrazierSH, Parron DL: The federal mental health agenda. Psychiatric Annals 1986; 16:448-458.

11. Lurigio AJ, Lewis DA: The criminal mental patient: A descriptive analysis and suggestions for future research. Criminal iastice & Behavior 1987; 14:268-287.

12. Palmer T: Martinson revisited, iournal of Research in Crime and Delinquency 1975; 12:133-152.

13. Roberg RR, Webb VJ: A research agenda for corrections, in Robert RR, Webb VJ teds): Critical Issues in Corrections. New York. West Publishing Co. 1981.

14. Owens CE: Mental Health and Black Offenders. Lexington. Mass, Heath Lexington Books, 1980.

15. Kass WA: Forensic mental health - More questions than answers, in Proceedings of ihe One Hundred and Ninth Annual Congress of Correction. 1980.

16. Dilulio JJ: Governing Prisons: A Comparative Sludy of Correctional Management. New York. The Free Press, 1987.

17. Adams K: The disciplinary experiences of mentally disordered inmates. Criminal lustice and Behavior 1986; 13:297-316,

18. Miller WB: Adaptation of young men to prison, fottrnal of Applied Behavior Therapy 1973; 19:15-26.

10.3928/0048-5713-19881201-12

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