MIS-ADM-86-3458

156 Pages·2007·1.83 MB·English

DOCUMENT RESUME
ED 284 143
CG 020 076
AUTHOR
Steadman, Henry J.; And Others
TITLE
Developing Jail Mental Health Services: Practice and
Principles.
SPONS AGENCY
National Inst. of M-ltal Health (DHHS), Rockville,
MD.
REPORT NO
MIS-ADM-86-3458
PUB DATE
86
GRANT
R01-MH35241
NOTE
156p.
AVAILABLE FROM
Superintendent of Documents, U.S
Government Printing
Office, Washington, DC 20402.
PUB TYPE
Reports - Research/Technical (143
EDRS PRICE
MF01/PC07 Plus Postage.
DESCRIPTORS
Conflict; *Correctional Institutions, *Correctional
Rehabilitation; Delivery Systems; Institutional
Cooperation; Institutional Personnel; *Mental Hedlth
Programs; *Prisoners; *Program Development; Program
Effectiveness; *Theory Practice Relationship
ABSTRACT
This document presents findings from
a study
conducted to examine the relationships between jails which
were
represented at the 1978 Special National Workshop
on Mental Health
Services in Local Jails and the various components of their
local
mental health systems. Chapter I explains the origins and
scope of
the study, describes the sample of 33 jails located in 26
states and
methods of data collection, and provides
an overview of monograph
goals. Chapter II presents a distillation and review of current
standards for jail mental health services as promulgated by different
professional associations. Chapter III describes mental health
services that were available in study sites at the time of initial
field work. Four distinctive approaches to service delivery
are
identified and capsule profiles of each type
are included. Chapter IV
analyzes responses to survey questions dealing with thP perceived
effectiveness of various organizational arrangements for providing
inmate mental health services on study sites. Chapter
V focuses on
the frequency and scope of staff conflict among mental health and
correctional personnel in study sites. Chapter VI addresses
subsequent developments and changes made at study sites in the 12
to
18 months following initial site visits. Chapter VII
presents a
summary and conclusions concerning study findings and their
implications for mental health program planning for local jails.
Lists of references, cases cited, and participating sites
are
included. (NB)
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*
Reproductions supplied by EDRS are the best that
*
can be made
*
from the original document.
*
***********************************************************************
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Developiq Jail
Mental Health Services:
Practice and Principles
Henry J. Steadman
Dennis W. McCarty
Joseph P. Morrissey
US. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service
Alcohol, Drug Abuse, and Mental Health Adminiesation
National Institute of Mental Health
5600 Fishers Lane
Rockville, Maryland 20857
3
DEVELOPING JAIL MENTAL HEALTH SERVICES:
PRACTICE AND PRINCIPLES
Henry J. Steadman, Dennis W. McCarty,
and Joseph P. Morrissey
Bureau of Evaluation Research
New York State Office of Mental Health
44 Holland Avenue
Albany, New York 12229
For sale by the Superintendent of Documents, U.S. Government Printing Office
ac.
Washington.
20402
This document `was prepared under research
grant
ROI MH35241 from the National Institute of Mental Health.
All material appearing in this volume is in the public domain
and may be reproduced or copied without permission from
the Institute or the authors.
Citation of the source is
appreciated.
Library of Congress catalog card number 86-600577.
OHHS Publication No. (ADM)86-1458
Printed 1986
5
CONTENTS
Page
FOREWORD
vii
PREFACE
ix
THE JAIL IN A POST-DEIN3TITU-
I.
TIONALIZATION ERA
1
Origins and Scope of the Study
5
Study Sample
6
Data Collection
7
Overview of Monograph Goals
8
II.
DEVELOPING SERVICES VERSUS
GENERATING STANDARDS
15
What Is a Jail?
15
The Genesis of Jail Mental Health Standards
17
Correctional Mental Health Care Standards
21
Ad ministration
21
Staffing and Professional Development
24
Identification and Management of
Mentally Ill Inmates
26
The Use of Standards to Develop Jail
Mental Health Services
30
III.
VARIETIES OF JAIL MENTAL HEALTH
PROGRAMS
37
Criteria for Jail Mental Health Services
37
Distribution of Service Components
41
Major Approaches to Jail Mental Health
Programs
43
Ad Hoc Approach
43
Identification Approach
48
identification and Treatment Approach
52
Comprehensive Approach
58
Summary
63
6
Page
IV.
EFFECTIVENESS OF JAIL MENTAL HEALTH
PROGRAMS: AN INTERORGANIZATIONAL
ASSESSMENT
65
Interorganizational Perspectives
on
Service Delivery
65
Measu rem ent
69
Interagency Conflict
72
Program Effectiveness
73
Safety Goals
73
Service Goals
74
Compatibility of Safety and Service
Goals
75
Discussion
78
V.
SCOPE AND FREQUENCY OF
CONFLICT
BETWEEN MENTAL HEALTH AND
COR-
RECTIONAL STAFF
83
Prior Research
on Custody-Therapy
Conflict
83
Measurement
87
Issues Producing Staff Conflict
90
Discussion
91
VI.
FACTORS CONTRIBUTING TO THE
SURVIVAL AND DEVELOPMENT OF
JAIL MENTAL HEALTH PROGRAMS
97
Changes in Staff and Service Providers
98
Program Development
101
Small Jails
101
Medium-Size Jails
102
Large Jails
104
Changes in Specific Services
105
Litigation and jail Mental Health
Programs
109
Summary
112
VII.
PRINCIPLES FOR PLANNING JAIL
MENTAL HEALTH PROGRAMS
113
Planning Principles
114
A Regional Mental Health Approach?
131
Implications for Practice and Research
133
7 iv
Page
REFERENCES
135
CASES CITED
145
APPENDIX: List of Participating Sites
146
FOREWORD
Many policy changes at the interface of
the legal and
mental health systems have had
an impact on local jails in
the past quarter of a century. The deinstitutionalization
of
State mental hospitals, the
use of more restrictive civil com-
mitment standards, am, the issuance of
court-ordered mini-
mum standards for medical and mental health services
are
illustrative of these far-reaching developments.
Yet little
empirizal research has been carried
out on the short- and
long-term effects of these changes
on local jail operations.
It is unclear, for example, whether these
changes have led
to significant increases in the number of mentally disordered
persons confined in local jails (although this does not
appear
to be the case in many instances)
or whether they have
simply fostered a greater
awareness of what was already a
long-standing problem. Nevertheless, the available
data on
prevelance rates of severe mental disorders
in local jails
clearly suggest that mentally ill inmates constitute
a sig-
nificant population in need of mental health
services.
Even though the provision of mental health services
to jail inmates is a critical need, little research
has been
conducted on the structure and operation of
existing jail and
mental health interfaces in the United States.
As an unfor-
tunate consequence, very little is known about alternative
ways to deliver jail mental health services and their
compar-
ative advantages and disadvantages. This
monograph, which
reports on research undertaken to develop
an information
base on current practices in jail mental health
services, is
an effort to address this glaring need.
Folio wing the first "Special National Workshop
on
Mental Health Services in Local Jails" sponsored by
three
Federal agencies and held in September 1978,
Dr. Henry
Steadman and his colleagues at the New York State Office
of Mental Health examined the relationships
among the jails
represented at the conference and the various
components of
their local mental health systems; this study
was supported
by a research grant from the National Institute of
Mental
Health. By employing an interorganizational framework,
the
study was specifically designed to delineate
the range of ap-
proaches followed by these jails in developing mental
health
services for inmates, the availability and
extent of linkages
with community mental health services, the relative
effec-
tiveness of the identified program approaches, and
the
vii
factors that seemed to influence and sustain program
development.
We are pleased to make this monograph available to
a
wide audience of mental health and correctional adminis-
trators, program planners, and policymakers, and hope that
it will provide useful information as well as aid in the de-
livery of improved mental health services to jail inmates.
I would also like to express sincere appreciation and
thanks to the jail and local mental health facility staffs who
participated in this study.
Saleem A. Shah, Ph.D.
Chief, Antisocial and Violent
Behavior Branch
National Institute of Mental Health
1 0
viii