Mental Illness Treatment in a Correctional Setting - Term Paper Example

Mental Illness Treatment in a Correctional Setting Term Paper of Introduction One of the most widespread personality disorders among prisoners is borderline personality disorder (BPS). Borderline personality disorder, as defined by DSM-IV, is characterized by “patterns of instability in interpersonal relationships, self-image and affects, and marked impulsivity that begins in early adulthood” (Dobbert, 2007, 65). Individuals with BPS usually have severe and unstable emotions, are vulnerable to depression, and can be manipulative and demanding. Many inflict harm on themselves. Borderline personality disorder can also involve incidents of psychosis. Studies show that traumatic experiences during childhood, especially physical and sexual violence, are one of the causes of BPS (Dobbert, 2007, 65). Perhaps as troublesome to the systematic functioning of a correctional institution is the self-destructive behavior of a person with BPS. Inmates with BPS display insecurity, unpredictability, frenzied or anxious attempts to avoid rejection, problems coping with anger and depression, and persistent self-destructive behavior or suicidal tendencies. Even though these characteristics can aggravate disorder in a correctional setting, it is the least among mental health illnesses that demands substantial resources (Hollin, 2005). This paper discusses the treatment of borderline personality disorder in the correctional setting. When prisoners hurt themselves by means of self-mutilation or suicide attempts, all correctional personnel are likely to be drawn in. When prisoners continuously attempt to commit suicide, the likelihood of staff exhaustion or depression is elevated. Even though mental health treatment in correctional settings must constantly include interdisciplinary collaboration, it is particularly essential in handling and treating prisoners who are vulnerable to BPS (Harvey & Smedley, 2010). Appropriate management and treatment are usually problematic because of time constraints and the need for rigorous participation of personnel, which are demanded by the occurrence, severity, and volatility of some of the self-mutilating actions of these prisoners. The accountability and ethical concerns are complicated and require full staff involvement. Besides self-harm other behaviors of prisoners with BPS may also aggravate stress, trauma, and management difficulties (Schoenly & Knox, 2012). For instance, inmates with BPS may burden personnel resources through their continuous need to be freed from anxiety and fear of rejection. This may be noticeable in ‘staff splitting’, where in inmates with BPS manipulate staff members. This kind of manipulation is usually deeply rooted among individuals with BPS that they may not be aware of taking part in certain actions (Fagan & Ax, 2002, 113). It usually leads to tensions and conflicts among personnel, specifically between custody and mental health staff. Other signs involve simulating crises to assess personnel responses and taking part in spontaneous careless behaviors to determine whether personnel will save them. Overview In the New York state penitentiary, a research on borderline patients found out that at least one-third suffer from a personality disorder. Related discoveries were disclosed from a research of prisoners under mental health treatment in correctional facilities. In a research on the commonness of mental disorder among individuals imprisoned in Connecticut, 23 percent of females and 12 percent of males fell under the classification of borderline personality disorder (Schoenly & Knox, 2012, 230). Of all the mental disorders identified in correctional facilities, it is BPS that most necessitates the application of an integrated multidisciplinary treatment process to alleviate a prisoner’s miseries and symptoms as well as to lessen the troublesome effect on the correctional setting. After thoroughly and correctly diagnosing the illness, an accurately documented treatment plan that explains the obligations of all individuals and/or groups involved, including the prisoner and specific personnel, is the subsequent component for an effective treatment outcome with individuals with BPS. It is important that mental health and custody personnel have the same opinion about the procedure that should be used in particular situations and that all involved individuals and/or groups monitor what they have decided to carry out in the treatment plan (Willmot & Gordon, 2010). At times, in spite of the utmost attempts of staff, the innately punitive attributes of correctional settings, the insufficiency of mental health resources, and rates of staff turnover hamper the treatment of inmates with BPS. They may also transfer from facility to facility as personnel become exhausted or disgruntled with these prisoners’ demanding and unremitting needs. These repeated transfers aggravate the fear of inmates with BPS of being neglected, hence strengthening the cycle and resulting in relapse or reappearance of symptoms (Willmot & Gordon, 2010). Nevertheless, several institutions are testing a number of innovative substitutes to transfers with this group. Law enforcers will at times run into individuals with BPS, because people with this disorder comprise 1-2 percent of the U.S. population. Women are more vulnerable to BPS than men (Schoenly & Knox, 2012, 230). These impulsive people usually have chaotic lives. Because their thoughts and emotions are disorganized, these individuals have difficulties controlling their feelings. Individuals with BPS usually have miserable lives because they feel extremely worthless sometimes and have severe problems building and maintaining strong relationships. When they feel neglected or rejected by others, individuals with BPS are at their weakest. While they could have an actual desire to commit suicide, they at times exploit their suicidal tendency as a means to manipulate and pressure other people into saving them (Freeman, Stone, & Martin, 2006). Suicidal behaviors are the survival and coping mechanism of individuals with BPS. Sadly, the prognosis of BPS is somewhat weak and treatments are quite inadequate for borderline patients. Personalities do not change radically over time, even though several findings indicate that as they become adults, individuals with BPS can learn to handle their emotions more successfully and be less reckless. These people usually have eating disorders, severe depression, and comorbid substance abuse (Soothill & Dolan, 2008). If these overlapping disorders are treated, the prognosis could get better. Individuals with BPS at times take part in illegal activities, normally minor crimes, although they may perpetrate more severe crimes like murder. However, they usually express guilt and regret for their actions and they often see their own behaviors unsympathetically (Harvey & Smedley, 2010). A number of treatments are available for borderline patients. Even though medications seldom alleviates their emotional insecurity and extreme frustration, studies report that people with BPS are more emotionally secure when they receive medications like mood stabilizers, antipsychotics, or antidepressants (Hollin, 2005). Psychotherapy is extremely useful as well. Borderline patients can acquire appropriate coping abilities, like being capable of controlling their impulses. Borderline patients have lower hospitalization and suicide rates when they are in continuous, appropriate treatment (Fagan & Ax, 2002). If, in giving details of violence, a summary of the person’s psychological and biological behavior may be reported to a legal entity, then the characteristic and level of disorder must guide the outcome, whether punishment, rehabilitation, treatment, or a mixture of the three. In reality, however, judgment is made partially in connection with existing services and treatments. Individuals with psychosis receive assistance from mental health providers eager to accept obligation for their treatment, offer community management plans, supply hospital beds, and administer an array of management, psychosocial, and pharmacological interventions (Halleck, 1987). Thus, it is quite simple for a jury to put a psychotic individual into treatment. Treating Borderline Patients in Correctional Facilities Individuals with borderline personality disorders, until in recent times, have had a smaller number of mental health practitioners eager to accept obligation for their treatment and a lack of services accessible to them. The mandate enclosed in the title of the report of the National Institute for Mental Health in England, Personality disorder: No longer a diagnosis of exclusion, has encouraged a reform in service availability and delivery (Soothill & Dolan, 2008, 375). Over the recent years, there has been advocacy for the creation and expansion of professional community-based treatment programs. These enhance access and delivery in the forensic mental health arena and the combined Department of Health and Prison Service in Wales and England (Soothill & Dolan, 2008). To succeed, these provisions have to develop useful treatments. Meta-analyses of results of psychological treatments for borderline patients reveal a clear positive treatment outcome, with both psychodynamic and cognitive-behavioral procedures demonstrating positive outcomes (Freeman et al., 2006). Nevertheless, reliable studies are few and this group of treatment studies is excessively focused on borderline personality disorder. Duggan and colleagues (2007 as cited in Willmot & Gordon, 2010, 25), in their methodological assessment of psychological treatments for borderline patients, discovered two treatment procedures for borderline personality disorder. These placed emphasis on mitigating substance use, comparing mixtures of cognitive-behavioral therapy, methadone treatment, and contingency management. Although positive outcomes were identified for contingency management, this is a considerably limited treatment for BPS. Apparently, treatment for BPS is an issue calling for a larger number of additional studies (Willmot & Gordon, 2010). It is important to examine the outcome of treatments so that courses of action can be created based on empirical findings, hence endowing mental health practitioners the willingness and strength to work with individuals with BPS, the judges the certainty to place borderline patients into treatment, and the patient the eagerness to work toward his/her treatment and recovery. With empirical support and infrastructure, mental health providers may start to realize that, even though individuals with BPS have to be held liable for their actions, they may also gain from regular treatment. Prisoners with BPS can be legally obliged to take part in treatment only if they are confirmed to be treatable (Schoenly & Knox, 2012). Diagnosis of treatability are derived from several aspects, such as the accessibility of a useful treatment for BPS, existing resources, observations of the prisoner’s determination to get well based on earlier involvement in and outcome of treatment, and the prisoner’s existing eagerness to take part in the available treatment (Dobbert, 2007). When treatment of BPS is involved, there is a basic concern of what should be treated. As regards inmates with personality disorder, Blackburn (1993) states (as cited in Hollin, 2005, 245): Since it is mental disorder rather than offending which justifies the diversion of mentally disordered offenders to the mental health system, alleviation of the disorder is a necessary outcome criterion, but reduced recidivism will be one indication of successful outcome in the case of personality disorder. Reduced recidivism is therefore a necessary but not sufficient outcome criterion. The primary need is to identify and target the mediators of antisocial behavior, and to establish which treatments influence those mediators. As regards offenders with BPS, one could reshape the explanation of Blackburn and claim that because it is felony instead of BPS that is the reason that criminals are in prison, decreased recidivism will be the marker of effective result, but that this is more attainable through determining and focusing on the mediators of personality disorder (Hollin, 2005, 245). Harris and Rice (1997 as cited in Hollin, 2005, 245) propose that correct desired results could be a decrease in recidivism, alleviations of the severity of symptoms, and enhancements in community functioning, overall satisfaction, and quality of life. According to Willmot and Gordon (2010), the contribution of pharmacological treatments for BPS is questionably narrower than that of psychosocial treatments, but is still essential to take into consideration. Pharmacological treatments must focus on particular symptoms of personality disorder which are diagnosed to be intervened by neurotransmitter pathologies. Dialectical behavior therapy (DBT) is a comprehensive, cognitive-behavioral method created purposely to train those with BPS to control their emotions. This treatment is rooted in the principle that BPS is characterized by inability to control emotions, which has arose as an outcome of a biologically-rooted emotional weaknesses alongside a negative environment, where in the personal experiences of a child are ignored, negated, or reprimanded by members of the family or other significant others (Harvey & Smedley, 2010, 8). A course on group skills training focusing on maladaptive thoughts, interpersonal abilities, and problem-solving skills is carried out in combination with individual treatment. Outcome research reveals decreased parasuicidal tendencies and negative emotions, enhanced social adjustment, and inpatient psychiatric therapy (Harvey & Smedley, 2010, 8). According to Freeman and colleagues (2006), initial outcomes of DBT among inmates with BPS in a safe psychiatric treatment setting reveal decreased dissociation, depression, suicidal tendency, and self-mutilation, alongside enhanced coping and survival mechanisms. On the other hand, Beck and Freeman (1990 as cited in Freeman et al., 2006, 101) derive their cognitive treatment from the idea that cognitive representations, or prevailing perceptions, are the screen through which all inward information or data is processed and hence influence actions and thoughts. They view these representations as the basic components of personality. The objective of treatment is to instigate change in these representations and thus affect actions and thoughts. Evidence for the positive outcomes of this method is insufficient, but case studies of borderline patients showed enhancements on targets specific to every person, for instance self-control, irritability, and anger (Freeman et al., 2006, 101). The treatment of inmates with borderline personality disorder is a controversial issue. There are ethical oppositions to treating offenders, but it is obvious that offenders, and especially those with severe psychopathology, may be liable for a larger number of offences, particular major crimes, than non-personality disordered or mentally ill prisoners (Schoenly & Knox, 2012). Ethical admittance of offenders with BPS into health provisions for treatment obliges mental health providers to diagnose the individual’s disorder, what the objectives of therapy are, what therapies are useful, what kind of individual may gain from the treatment, and the duration of the treatment. Without accurate knowledge of what treatments are available, their objectives, and possible effectiveness, the offender with borderline personality disorder is only kept in custody for the appropriate treatment and, while this could be justifiable, the condition should at least be understandable for everyone who is involved (Hollin, 2005). Mental health professionals and researchers engaged in the arena of personality disorder within correctional settings are looking for solutions to the most basic problems. Most of the everyday dealings that correctional staff, especially nurses, have is with prisoners who manifest social withdrawal, selfishness, aggression, and suspiciousness; behavior falling under the borderline personality disorder. People with disruptive, severe personality disorders, like BPS, involve a large percentage of prisoners who are regarded by nurses to be problematic and difficult to handle, with their continuous need for reassurance and attention (Schoenly & Knox, 2012). Correctional nurses regard borderline patients as difficult one because of their tendency to inflict harm on themselves and others and inability to build positive relationships with mental health professionals. These prisoners are commonly regarded as challenging and manipulative, thus bringing about severe anger, disappointment, and depression. Staying professional and handing the emotional reaction of personnel when working with individuals with BPS necessitates teamwork. Nurses must seek assistance from mental health personnel when working with borderline patients. Information about the nature of the offender’s personality disorder must be made available so that the correctional nurse can adopt practical expectations, methods of handling unhelpful internal cognitions, and sustain a therapeutic relationship with patients (Fagan & Ax, 2002). Correctional nurses who do extremely well in managing offenders with BPS are those who use their knowledge and experience while embracing constructive outlook of the patient; they have an ethical obligation to the treatment of borderline patients, have interpersonal skills, and possess the ability to stay composed and lucid amid tension, pressure, and conflict. Conclusions Psychotherapy is the major type of treatment for borderline personality disorders in the correctional setting. The most popular psychotherapy is cognitive behavioral therapy (CBT), which merges cognitive and behavior treatments to assist correctional nurses in identifying damaging, unhelpful behaviors and thoughts and supplanting them with positive, helpful ones. Dialectical behavior therapy (DBT) has proven to be successful in treating inmates with BPS. DBT facilitates behavioral capabilities to help cope with anxiety and pressure, enhance interpersonal relationships, and control emotions. Researchers report that inmates with BPS are highly vulnerable to behavior problems. DBT in correctional facilities can be helpful in handling and mitigating violent, destructive, aggressive behaviors. Medications are usually recommended to help patients cope with the emotional difficulties caused by BPS. References Dobbert, D. (2007). Understanding Personality Disorders: An Introduction. Westport, CT: Greenwood Publishing Group. Fagan, T. & Ax, R. (2002). Correctional Mental Health Handbook. London: Sage. Freeman, A., Stone, M., & Martin, D. (2006). Borderline Personality Disorder: A Practitioner’s Guide to Comparative Treatments. New York: Springer Publishing Company. Halleck, S.L. (1987). The Mentally Disordered Offender. New York: American Psychiatric Publisher. Harvey, J. & Smedley, K. (2010). Psychological Therapy in Prisons and Other Secure Settings. London: Routledge. Hollin, C. (2005). The Essential Handbook of Offender Assessment and Treatment. UK: John Wiley & Sons. Schoenly, L. & Knox, C. (2012). Essentials of Correctional Nursing. New York: Springer Publishing Company. Soothill, K. & Dolan, M. (2008). Handbook of Forensic Mental Health. London: Routledge. Willmot, P. & Gordon, N. (2010). Working Positively with Personality Disorder in Secure Settings: A Practitioner’s Perspective. UK: John Wiley & Sons. Read More