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Mental Health Concerns for Educators in Prison

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1 Mental Health Concerns for Educators in Prison
Correctional Educators Conference May 18, 2006 Mental Health Concerns for Educators in Prison An Overview Of Mental Health Services In NC Prisons Rich Bruner, Staff Psychologist II Mayland Community College

2 Overview: Delivery and Structure of MH services Major diagnoses
Typical presentations and medications Classroom concerns Questions, comments…

3 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

4 Identifying DD/MR Beta scores < 70 (x2)
WAIS-III score < with significant social impairment Adaptive Behavior Checklist of Substantial Life Functions

5 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

6 Structure of MH Services
Outpatient Services - Psychological ……………..48/78 prisons - Psychiatric………………...22 prisons Residential Treatment…… prisons Inpatient Treatment (Hospital)...2 prisons

7 Numbers Inpatient……………......…28♀+87♂=115 Residential…………..…………….210
Outpatient - Psychologist (or social worker) … Psychiatrist… TOTAL: *approx. 10% of 37,000 inmates

8 Prison Population Projections
2006: 38,000 2010: 40,000+ 2015: ~45,000 (Job security !?!) Only 6% are misdemeanor offenders i.e. (short terms) * Community Mental Health shortage of services

9 Reference: DSM-IV™ Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition © 1994 American Psychiatric Association, Washington, DC

10 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)

11 Classification of Mental Disorders
Axis II - Personality Disorders - Antisocial Personality Disorder - Others Mental Retardation Axis III - General Medical Conditions

12 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.

13 Psychotic 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 hallucinations Disorganized speech Disorganized behavior, catatonic Excessive or diminished thought Reduced emotional expression Avolition, reduced drive

14 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

15 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

16 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

17 Anxiety Disorders Panic Disorder - with and without agoraphobia
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

18 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

19 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

20 Adult 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 ADHD Adult symptoms Two of the following: Poor concentration (less hyperactivity) Inability to complete tasks and disorganization Affective lability Hot temper Stress intolerance Impulsivity

21 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)

22 Axis 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. Antisocial Paranoid Schizotypal Histrionic Dependent Narcissistic Personality Disorder NOS and others!

23 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 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

24 Dangerousness Knowing the risks - Axis I (Clinical) versus Axis II (Personality) risks Personal boundaries - and imposed limitations Assistance is available Consult, refer, and excuse!

25 Questions and Comments?
Rich Bruner, Staff Psychologist II Avery-Mitchell Correctional Institution

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