Presentation on theme: "Mental Health Concerns for Educators in Prison"— Presentation transcript:
1Mental Health Concerns for Educators in Prison Correctional Educators ConferenceMay 18, 2006Mental Health Concerns for Educators in PrisonAn Overview Of Mental Health Services In NC PrisonsRich Bruner, Staff Psychologist IIMayland Community College cec.mayland.edu
2Overview: Delivery and Structure of MH services Major diagnoses Typical presentations and medicationsClassroom concernsQuestions, comments…
3Mental Health Service Delivery Intake Initial screening: - Mental Health Screening Inventory - IQ testing -Achievement testing: WRAT-3 -Reading, Spelling, Arithmetic standard scores and grade equivalentTherapeutic Services: - Individual and Group Psychotherapy - Psychiatry - Hospitalization - Special Programs – Day Treatment, SOAR
4Identifying DD/MR Beta scores < 70 (x2) WAIS-III score < with significant social impairmentAdaptive Behavior Checklist of Substantial Life Functions
5Adaptive Behavior Checklist Self CareReceptive and Expressive LanguageLearningMobilitySelf-DirectionCapacity for Independent LivingEconomic Self-SufficiencyThree or more significant life function deficits to meet Developmentally Disabled criteria150 identified MR inmates in the system
10Classification of Mental Disorders Axis I - Clinical Disorders and other conditions of clinical attentionPsychosis and Delusional DisordersMood DisordersAnxiety DisordersSubstance DependenceAttention Deficit Disorder (ADHD)
11Classification of Mental Disorders Axis II - Personality Disorders - Antisocial Personality Disorder - Others Mental RetardationAxis III - General Medical Conditions
12Psychotic Disorders1/6 of prison caseload ~ 600+ inmates - many in Inpatient or Residential treatmentTypically 0.2 – 2% of non-prison population - with differences in rural vs urban, etc.~ 1.6% prison pop.
13Psychotic Disorders: What will you see? Symptoms:Perception and thought……………Language and Communication…..Behavioral Monitoring……………..Productivity of thought…………….Affect………………………………..Volition, drive and attention……….Presentation:Low productivity of thought, delusions and hallucinationsDisorganized speechDisorganized behavior, catatonicExcessive or diminished thoughtReduced emotional expressionAvolition, reduced drive
14Medications for Psychotic Disorders --Limited formulary… Oral (most choices): - Risperdal - Haldol - Geodon - Abilify - OthersInjectable: - Haldol Decanoate - Prolixin - Risperdal Consta - $$$Good Effects: - Less hallucinations! - Sedation - Improved thought - More volition, motivationBad Effects: - Tremors - Rigid expression - Dystonic reactions (spastic) - Over sedation / restlessness - Weight gain
15Mood 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
16Medications 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: WellbutrinMANIA: Mood stabilizers, anti-psychotic meds Depakote, Tegretol, Risperdal, Geodon
17Anxiety Disorders Panic Disorder - with and without agoraphobia PhobiasObsessive-Compulsive DisorderPosttraumatic Stress DisorderGeneralized Anxiety DisorderRange of symptoms: Frequency, Duration, or Intensity sufficient enough to result in significant social impairment
18Substance DependenceSeveral types with mood and scholastic effects… - Crack cocaine - Methamphetamine - Hallucinogens – LSD, Ecstasy - Alcohol, Opioids, InhalantsTemporary and permanent brain effects… - Diminished receptor sites with regrowth - Alzheimer’s like brain damageTreatment: Substance specific groups -AA, NA; and Residential D.A.R.T. Psychotherapy for presenting secondary disorder
19Attention 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 BehaviorsCausing impairment prior to age 7In at least two settings – home, school, work, social situationsWith clear interference in developmentally appropriate social, academic or occupational functioning
20Adult ADHD in the Classroom (Adapted from Wender PH Adult ADHD in the Classroom (Adapted from Wender PH. Attention-deficit hyperactivity disorder in adults. New York: Oxford University Press, 1995: )Childhood history consistent with ADHDAdult symptomsTwo of the following:Poor concentration (less hyperactivity)Inability to complete tasks and disorganizationAffective labilityHot temperStress intoleranceImpulsivity
21Treatment for Adult ADHD Info-therapySkills training – organizational, environmentalMedication (rarely in prison)Stimulants: Strattera – but not Ritalin, Dexedrine, etc SSRI’s: Prozac, Paxil – less efficacy, symptomatic tx. Other: Wellbutrin (atypical antidepressant)
22Axis II: Personality Disorders - 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.AntisocialParanoid Schizotypal Histrionic Dependent Narcissistic Personality Disorder NOS and others!
23Antisocial 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 DisorderFailure to conform to social norms and lawful behaviorsDeceitfulness, lying, conning for profit or pleasureImpulsivity, failure to plan aheadIrritability and aggressivenessReckless disregard for safety of self or othersConsistent irresponsibility – in work or financial obligationsLack of remorse – indifferent or rationalizing
24DangerousnessKnowing the risks - Axis I (Clinical) versus Axis II (Personality) risksPersonal boundaries - and imposed limitationsAssistance is availableConsult, refer, and excuse!
25Questions and Comments? Rich Bruner, Staff Psychologist IIAvery-Mitchell Correctional Institution