PSYCHIATRIC STATUS, PROBLEM BEHAVIORS, AND MENTAL HEALTH CARE UTILIZATION IN CANADIAN OFFENDERS David Joubert Kyle Archambault University of Ottawa Greg Brown Nipissing University

Introduction Increasing number of mentally disordered inmates in correctional institutions. Calls for increased funding, resources, training, etc., to provide better mental health care. However, critics charge that the correctional setting itself makes such investments problematic, and possibly counter-productive.

In “Risk Society”, rehabilitative efforts and mental health care more likely to be used for social control and disciplinary purposes. Narrowing of roles and practices that characterize various mental health disciplines.

Objectives Document prevalence of: 1) symptomatology, 2) problem behaviours, 3) mental health care utilization in inmates sampled from provincial correctional institutions. Examine associations between these variables. Investigate the role of gender as a moderator of the link between symptomatology, problem behaviours and treatment use.

Hypotheses “Medical model”: Mental health provision is function of documented or observed symptomatology and diagnosis. “Social control”: Mental health provision is function of problem behaviours in the institution, as well as non-clinical background characteristics in the offender. Female offenders: Symptoms  MH treatment

Method Sample: 519 offenders from 14 institutions in Ontario, Canada. Measure: Items from the RAI-MH covering the following dimensions: 1) Mental health indicators, 2) Problem behaviours, 3) Mental health treatment provided in the last 7 days.

Symptom clusters None/minimal (49%) Anxious/Depressed (19%) Psychotic (8%) Egosyntonic (13%) Situational Distress (11%)

Problem behaviors Low (66%) Aggressive (29%): Physical violence (69%), Intimidation (88%), Violent ideation (75%). Disturbed (5%): Social inappropriate (100%), Physical control interventions (41%), Physical violence (55%).

Mental health: Type professional No treatment (74%) Limited (23%): Psychiatric nurse (40%), social worker (18%). Varied (4%): Psychiatrist (43%), psychiatric nurse (43%), social worker (100%), psychologist (28%), recreational therapist (28%).

Mental health: Type rehab Low involvement (69%) Group-based (28%): Group therapy (93%), alternative interventions (43%), social rehabilitation (18%). Comprehensive (6%): Individual therapy (82%), Vocational counseling (57%), group therapy (39%), alternative interventions (27%), self-help (10%).

Associations between predictors Symptoms-problem behaviours: No link. Gender-symptoms: Women more likely to present as anxious/depressed (35% vs 15%), men more egosyntonic (15% vs 5%). Gender-problem behaviours: No link.

Type of professional “Limited” group: “Disturbed” problem behaviour profile; also male + ”aggressive” profile. “Varied” group: Female; or male + “egosyntonic” symptom cluster. Psychotic inmates: 12.5% in “Varied” group.

Type of rehab interventions Gender only reliable predictor: Female status predicts “Comprehensive” class. Only 1% of anxious/depressed offenders have access to individualized care.

Discussion Best predictor of mental health treatment is gender: female offenders are provided with more varied, comprehensive care. Male offenders may get some limited care if also behaviour problems, particularly involving socially inappropriate behaviours. Access to more varied care if also “egosyntonic” symptom profile.

It appears that mental health care in prison may indeed serve a social control function. However, the form that this control takes may be largely a function of the inmate’s gender (men as “bad”; women as “mad”). Need to further explore the intricate relationships between symptoms, problem behaviours, gender and mental health care.