Correctional Mental Health
Carla Hamand, MSW, LicSW, Forensic Social
Worker
Olmsted County Sheriff’s Office and Behavioral Health Unit
Jail Diversion and Re entry Coordinator
Crisis Intervention Team Coordinator
Crisis Negotiations Unit Mental Health Professional
Megan Vogel, MA, Forensic Social Worker
Olmsted County Sheriff’s Office and Behavioral Health Unit
Operations Behavioral Health Coordinator
Objectives
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What are mental health professionals doing
in the criminal justice system?
What population do we serve?
What mental health issues are most
commonly seen in this population?
Diagnostic assessment
Open Discussion/Questions
Working Within Criminal Justice
System or in a Correctional Facility
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Balance the needs and interests:
◦ Individual in conflict with the law
◦ The mandate and of the various
correctional agencies and organizations
◦ The perspective of victims
◦ Obligations to the community
◦ With an overriding emphasis on both
public and personal safety
A Social Worker’s Scope of
Practice Within Corrections
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Highly dynamic
Intense workloads
Management of sensitive information
Participation on interdisciplinary teams
Building community partnerships
Evidence-based best practices
Olmsted County ADC
Mental Health Team
To provide those programs and services which
are designed to evaluate, prevent, and treat
mental health problems and which contribute to
safe, humane corrections environments.
Interdisciplinary Team:
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Operations Social Worker
Forensic Social Worker
Forensic Psychologist
Psychiatrist
Nursing
Operations Staff
Forensic Social Worker
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Jail Diversion-forensic assessment
Re entry-Assess, Plan, Identify, Coordinate
CIT
CNU
Court Commitments/Civil/Forensic
Educator
Supervise Interns
Research
Operations Social Worker
Morning meeting
 Brief Jail Mental Health Screening
Tool
 Prioritize day
 Assessment
 Treatment planning
 Educator
 Statistics
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Levels of Service
1-2-3
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Mandated Services
◦ Suicide Risk and
Assessment
◦ Screening for Mental
Health Needs
◦ Crisis Intervention
◦ Medication
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Services offered to
Specific Target Groups
◦ Substance
Abuse/Dependence
◦ Anger Management
◦ Voluntary Programs
◦ Voluntary
Psychiatric/Psychological
Services
◦ Case Management
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Level Three
◦ Training for Correctional
Staff
◦ Open Dialogue Between
Correctional Staff and
Correctional Mental
Health Staff
◦ Assisting Administrators
with Policy
Define Mental Illness Most
Commonly Seen in ADC
Most Common Disorders
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Bio Psycho Social Environmental Cultural
Issues
Co-morbidity
Substance Abuse/Dependence
Adjustment Disorder
Personality Disorders
Mood Disorders
Anxiety Disorders
Psychotic Disorders
Sexual Disorders
Examine the Population
Being Served
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2.3 million housed in US prisons and jails
5 million on probation or parole
6% have a serious and persistent mental
illness
20% have a serious mental illness
30-60% have substance abuse problems
*US Census 311,915,120
Bio Psycho Social Environmental
Cultural Factors
◦ Problems related to interaction with the legal
system/crime
◦ Problems with primary support group
◦ Educational problems
◦ Occupational problems
◦ Housing problems
◦ Economic problems
◦ Problems with access to health care services
◦ Problems related to the social environment
◦ Other biopsychosocial and environmental
problems
Diagnosis
Axis I
 Axis II
 Axis III
 Axis IV
 Axis V
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Axis I vs. Axis II
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Complicated Diagnostic Picture
◦ When the psychotic symptoms are
controlled with medication, the underlying
personality disorder becomes primary,
resulting in behaviors that are difficult to
treat and possibly unpleasant to work
with.
◦ Misinterpretation of behavior.
Dual Disorders, Co-morbidity or
Co-occurring
◦ The presence of one or more
disorders (or diseases) in addition to
a primary disease or disorder.
Substance Use Dependence
Polysubstance
Dependence
 Alcohol
Dependence
 Amphetamine
Dependence
 Opioid
Dependence
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Personality Disorders
Cluster A:
• Avoidant
• Dependent
• ObsessiveCompulsive
Cluster B:
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Antisocial*
Borderline*
Histrionic
Narcissistic
Cluster C:
• Paranoid
• Schizoid
• Schizotypal
Personality Disorders
Distinctive set of traits, behavior styles and
patterns that make up our character or
individuality. How we perceive the world, our
attitudes, thoughts, and feelings are all part
of our personality. People with healthy
personalities are able to cope with normal
stresses and have no trouble forming
relationships with family, friends, and coworkers.
 Those who struggle with a personality
disorder have great difficulty dealing with
other people.
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Personality Disorder
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Tend to be inflexible, rigid, and unable to respond to the
changes and demands of life.
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Although they feel that their behavior patterns are “normal”
or “right,” people with personality disorders tend to have a
narrow view of the world and find it difficult to participate
in social activities.
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A deeply ingrained, inflexible pattern of relating,
perceiving, and thinking serious enough to cause distress
or impaired functioning.
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Usually recognizable by adolescence or earlier, continue
throughout adulthood, and become less obvious
throughout middle age.
Antisocial Personality Disorder
Most commonly found in males.
 Very high percentage of prison/jail
population.
 Characterized by:
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A pattern of disregard for others
Involvement with law enforcement
Fail to abide by social norms
Aggressiveness
Irritability
Lack of concern for safety of self/others
Actual Character, Ted Bundy
Fictional Character,
Hannibal Lector
Random Character
Borderline Personality Disorder
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Affects 2% of population
Women tend to be most commonly diagnosed
with BPD.
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Characterized by:
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Instability in relationships
◦ Impulsivity
◦ Low self-image
◦ Onset in early adulthood
Social Chameleon
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Someone who changes the way they
interact with people depending on who
they're with.
Anxiety Disorders
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PTSD: Common in veterans of war,
victims/witnesses of violent crime, refugees,
survivors of traumatic events.
10-20% incidence in law enforcement.
Can occur at any age or time in life.
Symptoms usually begin within 3 months of
trauma but there may be a delay of months
or years before symptoms appear.
Symptoms may wax and wane throughout
the disorder.
Mood Disorders
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Depression
◦ 15% lifetime
occurrence.
◦ Symptoms that interfere
severely with the ability
to work, sleep, eat, and
the ability to enjoy
pleasurable activities.
◦ Symptoms last longer
than two
weeks.
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Bipolar Disorder
◦ Also known as manicdepression
◦ Characterized by a wide
swing in moods from high
to low-each episode last
about two weeks in a
year-long period
◦ Others (10-30%) will
develop rapid-cycling with
four or more episodes in
one year
◦ Type I and II
◦ “Low” and “high”
symptoms
◦ “Low” symptoms the same
as depression
Psychotic/Thought Disorders
Schizophrenia
 Schizophrenia Paranoid Type
 Schizoaffective Disorder
 Delusional Disorder
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Schizophrenia
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Schizophrenia is not “Split Personality”
There is a common notion that
schizophrenia is the same as "split
personality” – a Dr. Jekyll-Mr. Hyde switch
in character
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Affects 1% of the world’s population
2.7 million is the United States
Treatment can result in 85% remission rates
Onset is between 17-30 for women
Onset is 20-40 for men
Irrational thought processes
Assessment
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Client Interview
Collateral:
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Bio Psycho Social Environmental
Cultural
Psychometric Testing
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◦ Gathering information from other sources can
often help in the assessment.
 Family
 Friends
 Witnesses
 Providers
 Other resources (social services, detox)
Assessment
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What brings them in?
What is currently the matter?
List all the symptoms that the client has experienced in
their lifetime.
List the current symptoms that the client is reporting.
Inquire about additional symptoms.
Have a discussion about the severity of symptoms.
What level of impairment do the symptoms bring to their
daily functioning?
What substances have been used?
Is there abuse or dependence?
What are the symptoms?
How do the symptoms interfere/affect symptoms of
mental illness?
Criminogenic Factors—Determining Risk
WHY?
Genetics
 Environment
 Bio Psycho Social
 Medical
 Brain Injury
 Drug Induced
 Other?
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In the diathesis–stress model, a biological or genetic vulnerability or
predisposition (diathesis) interacts with the environment and life
events (stressors) to trigger behaviors or psychological disorders. The
greater the underlying vulnerability, the less stress is needed to trigger
the behavior or disorder. Conversely, where there is a smaller genetic
contribution greater life stress is required to produce the particular
result. Even so, someone with a diathesis towards a disorder does not
necessarily mean they will ever develop the disorder. Both the
diathesis and the stress are required for this to happen.
Websites
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http://www.co.olmsted.mn.us/sheriff/division
s/lec/Pages/cit.aspx
http://psychservices.psychiatryonline.org/cgi/
content/full/57/4/544/F1
http://gainscenter.samhsa.gov/pdfs/reentry/ap
ic.pdf
http://www.pbs.org/wgbh/pages/frontline/sho
ws/asylums/
http://www.pbs.org/wgbh/pages/frontline/rele
ased/view/
http://longgonefilm.net/