Policy Initiative: Care and Control Mentally Disordered Offenders - Essay Example

POLICY INITIATIVE: CARE AND CONTROL OF MENTALLY DISORDERED OFFENDERS (school) Policy Initiative: Care and Control Mentally Disordered Offenders Problem/Issue The problem of caring and controlling mentally disordered offenders has been a major issue in the management of mental health and in the management of our prison systems. Based on a report from the Ministry of Justice (2008), an increase in the number of mentally disordered offenders has been seen and such increase matched the yearly trend of increase in detained offenders in the last decade. The number of those detained in the hospital in the year 2008 increased by 1 percent from 2007 and the number of admissions to the hospital increased by 3% from 2007 figures. Out of 1255 discharges, 499 were released into the community (Ministry of Justice, 2009). Among those discharged 7% re-offended within two years from discharge. The figures above help lay out the numerical equivalent of the issue involving mentally disordered offenders. In the deeper context, this issue is a major concern because the incarceration process, as well as the care and control of mentally disordered persons is not being adequately addressed by the concerned authorities and by the current policies in place. The reform perspective currently in place for mentally disordered offenders have set forth experimental methods of treatment in areas of psychology, psychiatry, and psychotherapy and these treatments been recognised by the courts (Knight & Stephens, 2009, p. 2). These offenders were then directed to appropriate institutions for care and control. The Mental Health Act of 1959 also laid out important provisions for the care and control of these offenders. Some mentally disordered offenders however did not qualify under the Mental Health Act of 1959 and had to remain in the prison systems (Knight & Stevens, 2009, p. 2). Some form of medical treatment was provided to them however, this was still a limited endeavour towards providing them with medical treatment. The number of incarcerated individuals increased throughout the years because of the increase in the number of decarcerated patients in mental health facilities and the increase in the problems in community care provided to mentally disordered individuals. In other words, this issue stems from the inability of the current prison system to provide adequate mental care for these mentally disordered offenders and from the inadequacy of the current mental health facility incarceration system. Hence, this study now aims to set forth an effective system and policy in the care and control of mentally disordered individuals. Issues involving current policies In 1999, the National Service Framework (NSF) started modernising the mental health service in the prisons. They formed a partnership with the Prison System in order to improve the quality of mental health care and to eventually achieve a quality equal to the care received in the community setting (Towl, et.al., 2002, p. 161). There were several standards conceptualized in the process of improvement and among these standards included the integration between the NHS and the prison health staff to assist the transmission of skills and the exchange of crucial information (Knight & Stevens, 2009, p. 3). Suggestions for the transfer of prisoners having mental health issues to prison health centres to day care and wing-based treatments were also made. With these suggested improvements, the Department of Health and the Prison Service came up with the report called: “Changing the Outlook,” and this report emphasized that mentally disordered individuals should also have access to quality mental health services offered to the general public (Department of Health, 2001, p. 5). A multidisciplinary service on nursing, psychology, psychiatry, social work, and occupational therapy was made available to these offenders. Studies however reveal that no implementation guidance for the mental health teams have been set forth (Sainsbury Centre for Mental Health, 2006). The in-reach teams have sought to focus their efforts towards prisoners who were suffering from the more severe mental illnesses; however the other prison health staff members have not been supportive of this move because they believe that offenders with more moderate illnesses had more complicated needs and needed specialized assistance (Sainsbury Centre for Mental Health, 2006). It is also important to note that the current policies in the care and control of mentally disordered offenders, especially the young people, the ethnic minorities and the women have not been adequately addressed. As a result, poor mental health has been apparent among the young people in prison (Knight & Stevens, 2009, p. 3). As a result of the focus on those who have more severe manifestations of mental disorders, an increase in the mild and moderate illnesses has been seen. Moreover, limited care has been made available to those who had mild to moderate mental affectations. Analysts point out that among young people without any record of severe mental illness, suicide rates among them register at 53% (Leibling & Krarup, 1993, p. 83). This implies that young people suffering from mild mental illnesses and who are not given sufficient mental care are placed at a higher risk of experiencing a declining mental state. Women in prison also later manifest with severe mental problems like schizophrenia and delusional disorders (Wilson, 2005, p. 56). Other studies point out that some of the prison systems over-prescribe psychopharmacologic drugs in order to help them manage their patients. These studies point out that some of the staff members were quick to administer antidepressants and sleeping pills in order to control their patients (Knight & Stevens, 2009, p. 4). This is considered to be a violation of human rights because the administration of drugs should not be used as a substitute for behavioural therapy and other non-pharmacologic interventions. Limited staff to implement the policies of the government is one of the major issues in the current mental health care system. Studies have indicated that about 58% of prison doctors working with patients with mental disorders have inadequate training in mental health care (Pearce, 2004, pp. 47-8). In another study, only about 24% of nurses in 13 prisons have had mental health training and none of their doctors have received any training in mental health care (Read & Lyne, 2000, p. 1420-4). Moreover, in assessing the overall attitude of mental health staff towards the mentally disordered offenders, most of them were negative and uncaring and some of them viewed the women to be manipulative and attention seeking (Howard League for Penal Reform 2001, p. 58). Based on the above policies and issues surrounding such policies, it is no wonder that many of the mentally disordered offenders are not responding well to treatment and that their mental issues are not adequately addressed while they are in the prison systems. Research findings and reports Based on some researches, laws which have been passed in order to treat mentally disordered offenders indicate a conflict between the health and the criminal justice systems. Such conflict has caused a hindrance on the service provisions for mentally disordered offenders who have borne the brunt of contradicting treatment policies (Green, 2010, p. 12). Moreover, the commitment of the government in the Care Programme Approach has been compromised by limited funding, making the implementation of its policies difficult and thereby increasing the use of imprisonment for mentally disordered offenders (Green, 2010, p. 12). Another report also revealed that in estimating the mental health needs of mentally disordered offenders, reliable and valid data about the efficacy of interventions must be laid out first. The issue of effective and appropriate interventions for MDOs must also be addressed in order to develop national and service protocols (Cohen & Eastman, 2000, p. 493). A dynamic model should also be applied to MDOs in order to highlight the complexities of important concepts and to point out policy determinants in the measures chosen (Cohen & Eastman, 2000, p. 493). Reports also indicate that some of the models being currently used are purely theoretical and only interpretative. These models rely on synthesising different approaches being applied by various researchers – not proposing new proposals or approaches. In order to move forward, suggestions to overcome deficiencies and limitations must be made. Policy Initiative Aims This project aims to achieve the following: 1. To implement a policy which would address the mental health issues of those who are most vulnerable: the younger offenders, the women, and the ethnic minorities 2. To implement a policy which would address the milder and more moderately manifesting mental health issues. 3. To adequately and efficiently coordinate the mental health care of the mentally disordered offenders between the mental health facilities and the prison system 4. To review the standards which qualify offenders under care in mental health facilities, and prevent their incarceration in the prison system. 5. To recruit highly specialised mental health professionals to implement the different policies. Implementation in the practice My policy would work in practice through the close coordination and communication of the different agencies involved in the prison and the mental health care system. This policy would work in practice with all concerned agencies working with each other and focusing their efforts towards the implementation of the specific goals. The implementation would be highly specialized and specific to each offender and in line with more specific disorders. The policy would be implemented on a case to case basis, regardless of severity of the mental affectation. Those who have milder or moderate manifestations of their mental illness shall be cared for by the appropriate personnel and the same will be true for those who have more severe mental disorders. The practice of placing less priority to those with mild or moderate mental disorders shall be discarded. Women and the ethnic minorities shall not be given any less priority in terms of mental health services. This policy shall be implemented with the constant contact and communication between the authorities in the prison system and those in the mental health facilities in order to ensure that the standards of incarceration and of mental health services are fair and accurate for each offender. This would help ensure that offenders who really need mental help would not be incarcerated, and those who are not mentally disordered would not avoid incarceration by being placed under mental health facilities. This would also help ensure the accurate implementation of justice and the protection of the people from violent offenders. The policy would also be implemented on a wide scale level, first through a thorough review of current legislation on mental health offenders. Appropriate changes and adjustments to these laws shall be set forth where necessary. The implementation of new laws and policies shall then require the different mental health facilities and prison systems to review their policies and to assess how these policies can be amended to comply with the legal provisions. The new policies shall now trickle down to the different detention facilities and mental health facilities for offenders. Mental health personnel with adequate training and expertise in counselling and in treating mentally disordered offenders shall be recruited and fielded to these facilities in order to assist in the implementation of these new policies. Personnel Individuals and personnel who would be involved include legislators, executive officers, managers from the prison centres, detention facilities, and mental health centres (for the mentally disordered), medical personnel with training and expertise in working with mentally disordered offenders. a. Legislators would have to be involved through their legislative acts in Parliament where they would have to study the law and set forth amendments and policy changes to the Mental Health Acts and under related laws in order to lend legitimacy and provide basis to the policies suggested by this paper. b. Executive officers in the government shall conceptualize the implementing policies for the laws set forth by the Parliament. These officers would particularly involve those assigned in the mental health sector and the prisons and corrections sector. c. Managers and supervisors of mental facilities and prison facilities shall also be involved as they have to coordinate with the executive officers in order to ensure that necessary changes are made on the current existing policies of the facilities. If the current policies are incompatible or are inconsistent with the suggested policies, then necessary adjustments shall have to be made by these supervisors and managers. d. Medical personnel with mental health expertise include doctors, nurses, psychologists, psychiatrists, social workers, and other mental health professionals who should have the academic training and the experience to work in the prison systems and the mental health facilities. Their expertise should also be in line with the counselling of mental health offenders based on effective and evidence-based methods. Implications The suggestions set forth in this policy imply that there is a need to lobby the parliament for the passage and amendment of legal provisions which would ensure the implementation of these policies. These policies also imply that there is a need to call on the different individuals and authorities involved in the implementation of mental health and prison policies to cooperate and coordinate with each other and agree on the standards of care and control for mental health offenders. In order to effectively implement these policies, the rights and privileges of mental health offenders should also be considered in order to ensure that they have access to the proper services and proper personnel who can assist them in receiving community-based mental health care. All in all, these new policies imply that there is a need to implement more specific mental health services to mental health offenders regardless of the range and the severity of their disorder. New Tools New tools which have to be developed in order to ensure the successful implementation of these policies would have to include a specific mental health rehabilitation program for women and for ethnic minorities. There are currently no policies or mental health programs in place to address the needs of these women and these minorities. Women mental health offenders have a different biological and mental set-up from men. The program for their rehabilitation and treatment should therefore be different from the programs meant for men as well. These programs must take into consideration the impact of hormonal and biological elements among women which may impact on their behaviour. Ethnic minorities may also have specific qualities which make them different from the general population and such differences can impact on the way they behave and consequently on the way they should be treated by mental health professionals. For one, Muslims can have attitudes, practices, beliefs, and habits which are very much different from the general population. These elements should be considered during treatment in the mental health facilities. Proper adjustments in care must be made in order to accommodate these differences and consequently, to gain their cooperation in the treatment process. New tools also include the development of standards and guidelines in mental health which would help the mental health professionals assess the classification of mental health offenders – whether incarceration or admission into a mental health facility would be beneficial for them. These standards can be developed with the assistance of psychiatrists and those involved in the prison systems in order to ensure the accurate classification of mentally disordered offenders. Training and education As was already mentioned, additional training and education is needed for the current mental health professionals involved in the prison systems and the mental health facilities. Their training must be focused on the application of appropriate processes and interventions for mentally disordered offenders. The application of interventions and therapy for MDOs is very much different from the interventions applied for the general population. There is a need therefore to come up with specialized training programs for health professionals and corrections officers who shall be involved in the implementation of this policy. The current medical professionals involved in these detention facilities and mental health facilities also need to undergo re-training in order to update their knowledge and skills in the treatment of mentally disordered offenders. If they have no adequate knowledge and skills in dealing with mentally disordered offenders, they have to undergo the necessary academic and skills training. Additional workforce Additional workers, especially those with adequate skills and training in counselling and mental health services for the mentally disordered offenders have to be hired. As much as possible, the additional workforce must be composed of a diverse people – from both genders and from different ethnic backgrounds in order to ensure that health services can cope well with a diverse group of patients. Changes to physical environment Changes in the physical environment includes separate cubicles and counselling areas available 24 hours a day and 7 days a week to the different mental health counsellors. These areas can give the mental health professionals privacy and security. These cubicles or counselling areas must however be monitored by security cameras and security personnel must be on hand at all times to ensure the counsellor’s safety. Changes in the physical environment must also include facilities and related elements which can stimulate the imagination and creativity of the offenders. These facilities can also include skills training areas for clients where they can acquire occupational skills which they can possibly use in the community setting. IT, documentation, and information Information technology can now be applied in order to ensure that records and activities are being monitored and are accurately being carried out. IT is the latest in computer technology and it is a system which has made the process of communication, documentation, and transmission of information faster, more efficient, and more dynamic. Computers therefore have to be made available in all the facilities. Moreover, records and other documents have to be computerized and systematized. Process changes Changes in the different processes have to be made in order to accommodate the new policies to be implemented. The processes in place have to accommodate equal counselling sessions not just for those with severe mental health issues, but for other patients with less severe mental disorders. The sessions and allocations for time have to be made for those who have mild and moderate manifestations of mental disorders, for the women, and for the ethnic minorities. Access to services Access to services now has to be facilitated for all mentally disordered offenders. The access must not be selective for those who are severely disordered alone, but also for those with less severe manifestations of their disorders. All offenders must also be given equal time and equal opportunity to access the services through the allocation of schedules for each offender. Key Recommendations 1. Focus in interventions for the mentally disordered offenders must be on helping them cope with stress and other issues. 2. Skills training for offenders must be included in the program in order to equip them with the tools to be valuable members of society 3. Counselling and behavioural therapy must be prioritized as interventions. 4. Psychopharmacologic drugs must be used sparingly on patients and must not be used as tools to control unmanageable offenders. Expected Impacts 1. Equal access to mental health services for mentally disordered offenders 2. Less discrimination against women and ethnic minorities in the mental health facilities and in the prison systems 3. Skilled and expert mental health workers in place in the different facilities Issues in the policy and its implementation Costs The cost of implementing this policy is expected to be high. Costs in the training of the mental health workers, hiring mental health workers, equipping the facilities, physically changing the facilities, lobbying, and upgrading the IT system in these facilities would amount to major funding costs from the government. Ethics/human rights/legislation The counselling sessions with patients still need the consent and cooperation of offenders. The program would not be effective without their cooperation. Some of these patients however would not be receptive to the counselling process. This would make the implementation of the policy difficult and complicated. Risk There is always a risk that emphasizing on the mental health counselling of these offenders instead of their incarceration can expose mental health workers to harm from violent offenders. In instances when they would be reintroduced in the society, they may still pose the risk of relapsing to their condition and therefore pose a threat to society. Public/political acceptability This program may not be accepted by the general public because they may see it as a waste of taxpayer’s money. They may not be receptive to the fact that their money is being spent to counsel and provide mental health services to criminals. Some politicians may have the same view as the general public and would not support any legislation for the policy being suggested here. Justification The justification of this policy is on rehabilitation. Incarcerating or imprisoning mental health offenders would not resolve their issues and our issues in society as well. At the end of their sentence, they are still mentally ill and might re-offend and harm other people again. Rehabilitating and counselling helps solve the mental issue at its very core – giving the offender a chance to identify his problems and solve these issues logically. In effect, it would give him the chance to cope well with his problems and later be a productive member of society. Benefits 1. Lesser incidents of re-offenders among those admitted to mental health facilities. 2. Higher chance of gaining more productive members of society 3. Lesser incidents of suicide among young offenders in the prison systems 4. No discrimination in the access of mental health services 5. Increased funding for mental health services, especially, for mentally disordered offenders. 6. Highly-skilled mental health workers available to mentally disordered offenders Works Cited Cohen, A. & Eastman, N. (2000) Needs assessment for mentally disordered offenders: measurement of ‘ability to benefit’ and outcome, The British Journal of Psychiatry, volume 177: pp. 493-498 Department of Health & HM Prison Service (2001) Changing The Outlook: A Strategy for Developing and Modernising Mental Health Services in Prisons. London: Department of Health. Green, R. (2010) The Treatment of Mentally disordered offenders within the criminal justice system, Internet Journal of Criminology, viewed 08 December 2010 from http://www.internetjournalofcriminology.com/Green_Treatment_of_Mentally_Disordered_Offenders_Within_the_Criminal_Justice_System_October_2010.pdf Howard League for Penal Reform (2001) Suicide and Self-Harm Prevention: Reptitive Self-Harm Amoung Women and Girl in Prison. London: Howard League for Penal Reform. Knight, L. & Stephens, M. (2009) Mentally disordered offenders in prison: A Tale of Neglect? Internet Journal of Criminology, viewed 08 December 2010 from http://www.internetjournalofcriminology.com/Knight_Stephens_Mentally_Disordered_Offenders.pdf Leibling A. & Krarup, H. (1993) Suicide Attempts and Self-Injury inside Prisons. London: Home Office. Ministry of Justice (2010) Statistics Bulletin (2010) viewed 08 December 2010 from http://www.justice.gov.uk/publications/docs/mentally-disordered-offenders-2008.pdf Pearce, S. (2004) Training Needs Analysis to Identify Primary Care Skills and Primary Specific Competencies for Doctors. London: Department for Health. Read, J.L. and Lyne, M. (2000) ‘In-patient Care of Mentally Ill Prisoners: Results of a Year’s Programme of Semi-Structured Inspections’, The British Medical Journal, 7241, 320, pp. 1031-34. Towl, G., Snow, L. and McHugh, M. (2002) Suicide in Prisons. Oxford: Blackwell Publishing. Wilson, D. (2005) Death at the Hands of the State. London: The Howard League for Penal Reform. Read More