Download Mental Health Concerns for Educators in Prison - NC-NET

Mental Health Concerns for
Educators in Prison
An Overview Of Mental Health
Services In NC Prisons
Rich Bruner, Staff Psychologist II
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Overview:
Delivery and Structure of MH services
 Major diagnoses
 Typical presentations and medications
 Classroom concerns
 Questions, comments…

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Mental Health Service Delivery

Intake
Initial screening:
- Mental Health Screening Inventory
- IQ testing
-Achievement testing: WRAT-3
-Reading, Spelling, Arithmetic standard scores and grade equivalent

Therapeutic Services:
-
Individual and Group Psychotherapy
Psychiatry
Hospitalization
Special Programs – Day Treatment, SOAR
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Identifying DD/MR



Beta scores < 70 (x2)
WAIS-III score < 70
- with significant social impairment
Adaptive Behavior Checklist
of Substantial Life Functions
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Adaptive Behavior Checklist







Self Care
Receptive and Expressive
Language
Learning
Mobility
Self-Direction
Capacity for Independent
Living
Economic Self-Sufficiency

Three or more
significant life function
deficits to meet
Developmentally
Disabled criteria

150 identified MR
inmates in the system
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Structure of MH Services

Outpatient Services
- Psychological ……………..48/78 prisons
- Psychiatric………………...22 prisons

Residential Treatment……........3 prisons

Inpatient Treatment (Hospital)...2 prisons
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Numbers
Inpatient……………......…28♀+87♂=115
 Residential…………..…………….210
 Outpatient
- Psychologist (or social worker) …....1500
- Psychiatrist….......................1900


TOTAL: 3700+
*approx. 10% of 37,000 inmates
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Prison Population Projections



2006:
2010:
2015:
38,000
40,000+
~45,000
(Job security !?!)
Only 6% are misdemeanor offenders
i.e. (short terms)
* Community Mental Health shortage of services
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Reference:

DSM-IV™
Diagnostic and Statistical Manual of Mental Disorders
– Fourth Edition
© 1994 American Psychiatric Association, Washington, DC
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Classification
of Mental Disorders

Axis I - Clinical Disorders
-and other conditions of clinical attention

Psychosis and Delusional Disorders
 Mood Disorders
 Anxiety Disorders
 Substance Dependence
 Attention Deficit Disorder (ADHD)
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Classification
of Mental Disorders

Axis II - Personality Disorders
- Antisocial Personality Disorder
- Others
-

Mental Retardation
Axis III - General Medical Conditions
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Psychotic Disorders

1/6 of prison caseload ~ 600+ inmates
- many in Inpatient or Residential treatment

Typically 0.2 – 2% of non-prison population
- with differences in rural vs urban, etc.

~ 1.6% prison pop.
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Psychotic Disorders:
What will you see?
Symptoms:
Presentation:

Perception and thought……………


Language and Communication…..

Low productivity of thought,
delusions and hallucinations
Disorganized speech

Behavioral Monitoring……………..

Disorganized behavior, catatonic

Productivity of thought…………….

Excessive or diminished thought

Affect………………………………..

Reduced emotional expression

Volition, drive and attention……….

Avolition, reduced drive
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Medications for Psychotic Disorders
--Limited formulary…

Oral (most choices):
-

Risperdal
Haldol
Geodon
Abilify
Others
Injectable:
- Haldol Decanoate
- Prolixin
- Risperdal Consta - $$$

Good Effects:
-

Less hallucinations!
Sedation
Improved thought
More volition, motivation
Bad Effects:
-
Tremors
Rigid expression
Dystonic reactions (spastic)
Over sedation / restlessness
Weight gain
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Mood Disorders
- Depressive and Bipolar Disorder

Symptoms:
-

Depression
Anhedonia
Disturbances in appetite, sleep, energy
Feelings of worthlessness, guilt
Difficulty thinking/concentrating
Thoughts of death and self-harm
___________
*Ask directly!
Mania: High energy, sleeplessness
elevated mood, pressure of speech
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Medications for Mood Disorders

DEPRESSION:
Limited Formulary – No Tricyclic Antidepressants:
- sedating medications, cheaper, but more side effects and less effectiveness
- SSRI’s: Prozac, Celexa, Paxil, Zoloft
- SNRI:
Effexor
- Atypical: Wellbutrin

MANIA: Mood stabilizers, anti-psychotic meds
-Depakote, Tegretol, Risperdal, Geodon
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Anxiety Disorders

Panic Disorder
- with and without agoraphobia
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
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Phobias
Obsessive-Compulsive Disorder
Posttraumatic Stress Disorder
Generalized Anxiety Disorder
-------------------------------------------------
Range of symptoms: Frequency, Duration, or Intensity
sufficient enough to result in significant social impairment
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Substance Dependence
Several types with mood and scholastic effects…
- Crack cocaine
- Methamphetamine
- Hallucinogens – LSD, Ecstasy
- Alcohol, Opioids, Inhalants
Temporary and permanent brain effects…
- Diminished receptor sites with regrowth
- Alzheimer’s like brain damage
Treatment:
Substance specific groups -AA, NA; and Residential D.A.R.T.
Psychotherapy for presenting secondary disorder
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Attention Deficit –
Hyperactivity Disorder (ADHD)
Child onset, originally thought to disappear in adulthood, now 30 to 50% of ADHD
children thought to carry diagnosis to adulthood.
- Low level of diagnosis in prisons: (40) Underdiagnosed?
DX: Hyperactive-impulsive and Inattentive Behaviors

Causing impairment prior to age 7

In at least two settings – home, school, work, social situations

With clear interference in developmentally appropriate social, academic or
occupational functioning
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Adult ADHD in the Classroom
(Adapted from Wender PH. Attention-deficit hyperactivity disorder in adults. New York:
Oxford University Press, 1995:122-43.)
Childhood history consistent with ADHD
Adult symptoms
I.
II.
Two of the following:


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

Poor concentration (less hyperactivity)
Inability to complete tasks and disorganization
Affective lability
Hot temper
Stress intolerance
Impulsivity
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Treatment for Adult ADHD
Info-therapy
 Skills training – organizational, environmental
 Medication (rarely in prison)

Stimulants: Strattera – but not Ritalin, Dexedrine, etc
SSRI’s: Prozac, Paxil – less efficacy, symptomatic tx.
Other:
Wellbutrin (atypical antidepressant)
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Axis II:
Personality Disorders

Antisocial

Paranoid
Schizotypal
Histrionic
Dependent
Narcissistic
- An enduring pattern of
inner experience and
behavior that deviates
markedly from
expectations of the
individual’s culture, is
pervasive and inflexible,
has an early onset, is
stable over time, and leads
to distress or impairment.
Personality Disorder NOS
and others!
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Antisocial
Personality Disorder
Common in prisons for some reason…
#’s 677 diagnosed, Personality Disorder NOS # 680 (Out of 3700 patients)
Pervasive pattern of disregard for and violation of rights of others since age 15
– with childhood Conduct Disorder
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Failure to conform to social norms and lawful behaviors
Deceitfulness, lying, conning for profit or pleasure
Impulsivity, failure to plan ahead
Irritability and aggressiveness
Reckless disregard for safety of self or others
Consistent irresponsibility – in work or financial obligations
Lack of remorse – indifferent or rationalizing
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Dangerousness

Knowing the risks
- Axis I (Clinical) versus Axis II (Personality) risks

Personal boundaries
- and imposed limitations

Assistance is available

Consult, refer, and excuse!
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Questions and Comments?
Rich Bruner, Staff Psychologist II
Avery-Mitchell Correctional Institution
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