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FORENSIC BOARDS > Correctional Psychiatry I - Tx > Flashcards

Correctional Psychiatry I - Tx Flashcards

1
Q

Benjamin Rush

A

American psychiatrist, penologist, founded APA, established hard labor as method of punishing convicted criminals

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2
Q

Walnut Street Jail (2)

A

First correctional institution in US (1790). Introduced “Pennsylvania System” as putting severe offenders in solitary confinement for reflection/repent

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3
Q

Reformatory Model

A

Established late 1800s. Recommended educational/training programs with indeterminate sentencing to help develop self-respect

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4
Q

Progressive Era/Rehabilitative Institution (time, what it was, aim)

A

Begun early 1900s, then dominated 1950-1970. Medical model to understand/treat deviant behavior. Searched for alternatives and reintegration.

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5
Q

Trend For Last 40 years

A

Skepticism about rehabilitation. Harder sentencing/release and more determinate sentencing

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6
Q

Incarceration Trends for Last 10-20 years

A

Rates have generally been decreasing

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7
Q

4 Purposes of Punishment

A

Deterrence
Incapacitation
Rehabilitation
Retribution

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8
Q

Discretionary vs. Mandatory Parole

A

D: When parole board has authority to release prisoners based on statutory/administrative determination of eligibility
M: Determinate sentencing statutes, inmates conditionally released after serving specific portion of sentence

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9
Q

2 Components of MH Diversion

A
  1. Screening/evaluation of defined groups for presence of mental disorder
  2. Negotiation with prosecutors, attorneys, CMH providers, courts to produce MH dispo instead of jail
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10
Q

2 Types of Diversion Programs

A

Prebooking - involves police, then emergency MH responses
Postbooking

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11
Q

3 Types of Postbook Diversion

A
  1. Dismissal of charges w/ agreement to participate in set services
  2. Deferred prosecution w/ reqs for tx participation
  3. Post-sentence relase where probation conditions involve MH/SA tx
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12
Q

4 Types of Confinement Facilities

A

Lockups
Jails
Prisons
Supermax

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13
Q

Lockups

A

Initial site from arrest to arraignment. Most common type, < 48 hours gen

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14
Q

Jails

A

Locally operated, confine before or after adjudication, and/or those sentenced to =< 1 year

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15
Q

Additional 5 Functions of Jails

A
  1. Readmit probation/parole/bailbond violators/absconders
  2. Temporarily detain juveniles before xfer to appropriate juvenile authorities
  3. Hold MI persons pending appropriate xfer to MH facilities
  4. Xfer inmates to Federal, State or other authorities
  5. Hold individuals for military, protective custody, contempt, or for courts as witnesses
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16
Q

Prisons

A

Long-term confineent, run by state or feds, holds for > 1 year

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17
Q

Prison Classification

A

Sorts prisoners into facility security level and inmate custody category

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18
Q

Facility Security Level

A

Nature/number of physical design barriers to prevent escape/ctrl behavior

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19
Q

Inmate Custody Category

A

Degree of staff necessary to ensure adequate control of inmate

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20
Q

Supermax (and aka)

A

Freestanding facility (or distinct unit) that provides secure control of inmates designated as violent or seriously disruptive behavior
AKA Security Housing Unit or SHU

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21
Q

2 Components of MH Problems Reported by Prisoners

A

Serious psychological distress (SPD) within 30 days prior to interview
History of having MH problem

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22
Q

6 SPD Items

A

Within last 30 days, how often felt:
Nervous
Hopeless
Restless/fidgety
So depressed nothing could cheer them up
Everything was an effort
Worthless

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23
Q

Having a MH Problem 7 Possibilities

A

Asked have you ever been told by MH prof that you had:
1. Manic depression/BPAD/mania
2. Depressive d/o
3. Schizophrenia/psychotic d/o
4. PTSD
5. Anxiety d/o such as PD or OCD
6. PD such as BPD/ASPD
7. Any other mental or emotional condition

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24
Q

Estimates of SMI in US Inmates

A

15-25%

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25
Q

Most Common Dx in Both M and F Offenders in Correctional Setting

A

Substance Abuse

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26
Q

Rate of ASPD in Male Offenders

A

Approx 50%

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27
Q

Setting with Most Suicides

A

Lockup

28
Q

Most Common Suicide Method in All Settings

A

Hanging

29
Q

Age Distribution of Jail Suicides

A

Bimodal: < 18 and > 55

30
Q

Jail Suicide Timing 4 Findings

A
  1. Evenly distributed over first few days through several months
  2. Many occurred during waking hours
  3. Most not under influence of ETOH/drugs
  4. Many occurred in close proximity to court hearing
31
Q

Leading Cause of Death in Jails

A

Suicide (almost 30% of all deaths) (2nd leading in prisons, 7%)

32
Q

Jail Suicide Racial Breakdown

A

Whites most common (3x more than Hispanic and 5x than Black)

33
Q

Types of Offenders Most Likely for Suicide

A

Violent offenders (kidnapping highest, then rape, homicide) - 5x more common than drug

34
Q

11 Common Causes for Litigation 2/2 Suicide

A
  1. Inadequate MH/psych eval
  2. Failure to consider obvious/substantial RFs
  3. Failure to place on SPs upon recognizing
  4. Failure to communicate action to providers/staff
  5. Failure to adequately monitor on suicide watch/maintain log
  6. D/c suicide watch despite prior knowledge/cont’d risk
  7. Failure to follow policies/procedures
  8. Failure to provide staff training
  9. Abrupt d/c of meds on pt w/ previous behaviors
  10. Grossly inadequate tx or lack of general procedures/staff/etc creating “grossly inadequate healthcare system”
  11. Repeated delayed/denied medical tx
35
Q

Security Threat Group (STG)

A

2+ inmates acting together who prose threat to security of staff/inmates and/or disruptive to programs/facility system
I.e., gangs

36
Q

Homicide Rate in State Prisons

A

5 per 100,000 (2% of all deaths)

37
Q

Prison Litigation Reform Act (what it is)

A

Permits prison/jail to alleviate constitutional violation caused by overcrowding, can release prisoners

38
Q

Prison Litigation Reform Act 3 Reqs

A

-District court must determine overcrowding is “primary cause” of constitutional violations
-No other relief would be sufficient
-3-judge panel must review and consider impact on public safety/operation of CJS

39
Q

Brown v. Plata (SCOTUS 2011) FOTC

A

2 class action lawsuits saying CA prison system violated 8th A due to deprivation of adequate healthcare
(CA system eventually placed into receivership bc state unable to fix system)

40
Q

Brown v. Plata (SCOTUS 2011) Initial Panel Ruling

A

3-Judge Panel (Prison Litigation Reform Act) said overcrowding primary cause, set cap at 137.5% design capacity, ordered state to reduce by 40,000 over 2 years. Ruling appealed to SCOTUS.

41
Q

Brown v. Plata (SCOTUS 2011) SCOTUS Ruling

A

Court-mandated pop limit necessary to remedy violation of prisoner’s const rights (primary cause and no other relief would remedy)

42
Q

Brown v. Plata (SCOTUS 2011) Scalia 2 Dissent Points

A

Called it “most radical injunction” by SCOTUS in hx
1. Individual claims of unconst tx did not extend to all inmates
2. Most inmates that would benefit from this decision not part of Coleman or Plata (2 class-action suit groups) class

43
Q

% Inmate UDS Positive

A

10%

44
Q

Ganser Syndrome (what it is/etiology and 4 components)

A

Constellation of sx in prisoners that appear to be attempt to exhibit own generic concept of MI, unclear if malingering/fictitious d/o/dissociative d/o
1. Approximate answers (eg 2+2 = 5, elephant has 5 legs)
2. Clouding of consciousness
3. Somatic conversion (particularly sensory sx)
4. Hallx

45
Q

Ganser Syndrome Pathognomonic Sx

A

Approximate answers (but also seen in malingering)

46
Q

Inmates Malingering % of Suspected

A

66%

47
Q

2 Triggers of Litigation re: Isolation/Segregation

A
  1. Wanton infliction of pain
  2. Denying basic human needs
48
Q

Self-Harm in Isolation

A

Massive increase. (NY only 7.3% inmates experienced, but 53.3% acts of self-harm in this group)

49
Q

Sexual Victimization by Inmates v. Staff

A

58% inmates 42% staff

50
Q

Prison Rape Elimination Act of 2003

A

Calls of gathering national stats of problem of prison rape and developing guidelines for states about how to address

51
Q

HIV/AIDS rate in Prisons

A

Approx 1%

52
Q

Most Common Infectious Ds Reported in Prisoners

A

HCV (10%)

53
Q

Privilege/Confidentiality in Correctional Settings

A

Still apply, however countervailing demands of security

54
Q

7 Correctional Situations Where Might Suspend Confidentiality

A
  1. Suicidal
  2. Homicidal
  3. Presenting reasonably clear danger to self/others, either by conduct or statements
  4. Reasonably clear risk of escape/creating internal d/o or riot
  5. Receiving psych meds or is noncompliant
  6. Requiring xfer to special unit for acute episodes
  7. Requiring xfer to tx facility outside jail/prison
55
Q

Dual Agency (Dual Loyalty)

A

Situations where psychiatrist subject to > 1 authority or potentially >1 moral principle

56
Q

3 Disclosures MHP Should Make to Prisoners Due to Possible Dual Agency

A
  1. His/her agency
  2. Purposes of encounter
  3. Uses to which information will be put
57
Q

National Commission on Correctional Health (NCCHC) Guidelines on Health Personnel and Forensics

A

Prohibit health personnel from collecting certain info for forensic purposes

58
Q

Parole Boards and Confidentiality

A

In many states, parole boards (by statute) have access to health records, including MH evals/notes

59
Q

Percentages of Psych Tx/Meds in Prisons

A

12% of state prison inmates receive psych tx, 15% psych meds

60
Q

Constitutional Right to SUD Tx (2)

A
  • When viewed as a status condition, no right to SUD “rehabilitation”
  • In situations of “disease,” such as active w/d, then right to tx
61
Q

Constitutional Right to ID Rehabilitation

A

None

62
Q

APA Task Force (2016) Fundamental Policy Goal for Correctional MH Care

A

“provide same level of MH services that should be available in the community”

63
Q

APA Task Force (2016) 3 Basic Services That Should Be Provided

A
  1. Screening/referral/evaluation
  2. Treatment
  3. Community tx
64
Q

Most Important Service Element in Correctional MH Health (& possible case)

A

Screening
(Ruiz v. Estelle (1990)?)

65
Q

3 Recidivism Rates (& more likely offenders)

A

3y: 68%
6y: 79%
9y: 83%
Property offenders more likely to be arrested for a new crime compared to drug and violent offenders

66
Q

Mentally Disordered Offender (MDO)

A

Individually who has been formally judged by judicial system as both G of a crime and emotionally disturbed. NOT include those whose MI hasn’t been reocgnized by court.

FORENSIC BOARDS (34 decks)

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