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When it comes to providing mental health care to convicts, there has always been a controversy. Some people believe that such mental health therapy is costly and burdensome for the country. Nonetheless, numerous studies indicate that the number of offenders with mental health issues is on the rise (Fagan, 2003). According to Scaggs et al. (2016), there has been a 200% increase in drug and substance usage in US jails. In reality, there was a 38% increase in drug offenders in US prisons between 1980 and 1995. (Scaggs et al., 2016). Some of the reasons for increase in substance abuse among incarcerated individuals is enforcement of laws that prioritize drug arrest and sentencing.
Some programs have, in the past, been initiated to provide mental health treatment to drug abuse offenders, both when they are in prison and upon completion of their sentence. Most of such treatment programs always consume a lot of taxpayers’ money yet the recidivism rate is high Anglin et al., 2013). There is a need to provide a well comprehensive mental health treatment program that will be effective in prevention of drug and substance abuse among prisoners and also be cost-effective in the process. This paper hypothesizes that such a program can be implemented if the treatment program will involve various stakeholders, including the prisoners with history of substance abuse, their friends and families, mental health professionals, the community and related employees in the prison. Also, the program should have long-term follow up. The program will try to implement the suggestion offered by Prendergast & Wexler (2004) in their report that correctional programs for drug abuse should include; continuity of care; treatment process; system integration and evaluation and program development.
It is approximated that 25% of incarcerated offenders have mental health illness (Morgan et al., 2012). Most of the mental health issues that the prisoners have been induced by drug abuse. Peter et al. (2015) point out that most of the mental illness that the inmates suffer from are induced by substance abuse. Incarcerated offenders with substance use disorder are more likely to commit suicide while in prison they also have a high recidivism rate. However, efforts have been, made to rehabilitate the offenders with drug abuse problem. In a research conducted by McCollister et al. (2002), the researchers found that the cost of treating drug abuse among prisoners is using therapeutic community aftercare and vista aftercare was $7,041 for a period of five years for sampled prisoners in southern California. This is so costly for the prison department.
However, when the mental health treatment program is abolished the recidivism rates will rise and the cost of holding the offenders in prison will consequently rise. This creates some sort of dilemma. The solution is to create effective programs that will not just be cost effective but will also help to rehabilitate such offenders and ensure that they are rehabilitated in the community so that they do not commit offenses again (Evans et al., 2012). The program’s major objective is to provide a solution to this challenge by ensuring that the inmates are well rehabilitated in a cost-effective way.
Goals and Objective
This program aims to;
Help incarcerated individuals with substance use disorders to get mental health treatment.
Help the incarcerated individuals to overcome addiction.
Provide a cost-effective way for reducing inmate population.
Enable the inmates enrolled in the program to provide motivation and moral support to each other.
Rehabilitate and integrate prisoners back to the community.
Ensure that prisoners act as responsible citizens after release
In order to achieve the stated objectives, the following goals will have to be achieved.
Provide continuous counseling (including family therapy) to the identified inmates for a period of at least nine months from the first week after the program stars.
Provide the correct medication for the identified inmates with drug abuse psychosis for a duration required by prescription from the first week after program launch.
Ask the family members and friends of the inmates to provide some funds for treatment of their relative especially if they are capable of providing the payment over the duration of treatment within the first month of launching the program.
Form an alcoholic and drug anonymous group specific to prisoners and ex-prisoners one year after launching the program.
Provide follow up program to the released inmates who had been enrolled in the program for five years after their release.
Partner with organizations and help the released inmate to acquire jobs that can be a source of livelihood within one year following the launching of the program.
Continuous counseling and Family Therapy
In order to ensure that the inmates with drug abuse problem get treatment for their disorder, it is important that they get counseling. Drug abuse is often a symptom of an underlying problem. It is very important for the underlying problem to be unveiled for total treatment to occur (Miller, 2010). The family is very significant in the development of a person. Family may also be in a better position to identify some of the problems that the inmate has undergone which precipitates the addiction and drug abuse. Furthermore, the family provides strong social support to the inmate while gaining psychological treatment.
The person who will be responsible for counseling and family therapy must be registered counselor, psychologist or family therapist. The prison department will have to employ counselors and psychologist to help with the psychological treatment. Also, family members will be contacted to attend counseling sessions. The counseling will take place within the premises of the prison. The prison should build counseling rooms within the prison where the inmates can receive psychological counseling. After release of the inmates, they should be referred to counseling centers where they can receive the treatment.
Overcoming addiction can be very challenging because of the side effects of stopping to use the drugs, especially when done the cold turkey ways. Some side effects like delirium tremors for the inmates who were alcoholics can be fatal. It is therefore important that professional help is offered as the inmates try to overcome the addiction. Detoxification is especially important to help the body and remove the harmful chemicals in the body.
The psychiatrist and clinical psychologist who are registered and specialized in drug and substance abuse should be responsible for this treatment. The prison department should partner with local healthcare centers in offering such treatments. The detoxification and treatment should be done at the healthcare centers especially when the medications are in form of injections which can only be administered by specialists.
One of the objectives of the program is to ensure that rehabilitation of the prisoners is cost effective especially to the prison department. Cost sharing is one of the effective ways of ensuring that the program is cost-effective. This call for collaboration of the patient the community and the family members of the patient. Families especially should be asked to sponsor their inmates because they will also benefit when the inmates are well. The program will also engage in community fund drive to help the prisoners who have no finances to get enough money for all the activities (Thompson et al., 2013).
The money allocated by the government will also be used to fund the program and pay for the services especially for the inmates who cannot afford the service. The prison department will be involved in contacting family members and asking for their support of the prisoners. Also, the managers of the program should mobilize the people to give donations. This will ensure that the project is cost effective and involves all the members of the society. The fund drive can be done within the prison premises, via the website or in roadshows and other community fundraising.
Inmate to Inmate Support and Motivation
People can be highly motivated by hearing the testimonials from other who have had similar experiences. Alcoholic and drug abuse anonymous groups will be specifically for people who have been incarcerated will be formed. In the alcohol anonymous groups, people who have managed to overcome addiction problem long after they have been released will be asked to continue motivating those who are still in the process of overcoming the addiction. As they work together they will form an identity that will be positive and will enable them to overcome their challenges.
One counselor can facilitate the alcoholic and drug, anonymous groups. The inmates will also be responsible for organizing the days for the groups to meet. This will ensure that they own the group and appreciate it. Also, they can help each other to overcome the addiction and motivate the professionals working at the center. This is important because most people do not like working within the prisons because of the prison environment and also because the prisoners show no interest of forfeiting their problematic behaviors. The location for the alcoholic anonymous groups will be within the prison facilities in one hall. Even the dining hall can be used as a meeting point for the groups.
Coming up with Self-help Group
The self-help groups that are found in the federal prisons are crucial when it comes to undertaking recovery to the inmates. The group also assists in peer’s support. The basis of the self-help groups is the philosophy of self-responsibility where the inmates get to be self-reliant and therefore can easily survive outside the walls of the prison (Center for Substance Abuse Treatment 2005). Some of the specific benefits of self-help groups involve crisis prevention, especially when the prisoners are released, and their personal growth.
Educational and Vocational Training
Training contributes to the psychological and behavioral needs and help the offenders to be responsible members of the community upon their release to the outside world. Some of the skills that they can acquire through the educational program and vocational trainings include basic literacy, GED certificate in addition to life skills that make the inmates adjust when they are released to the outside environment (Center for Substance Abuse Treatment 2005). These services need to be closely monitored during their provision to ensure that they are strictly within the needs of the inmates.
The therapeutic techniques are to promote successful treatment of drug addiction, for instance (Center for Substance Abuse Treatment, 2005). The carrying out of the treatment include the application of such models as motivational interviewing, token economy model, and faith-based initiatives among others. Due to its diverse areas of concern, the therapeutic technique is not applied solely but blended with other approaches for the sake of effectiveness. In this regard, it can be used to address a good number of issues that will assist the inmates to become desirable citizens upon their release.
Conducting gender-specific trainings to the different genders in the prisons will be of great assistance to the inmates as far s their gender roles are concerned. It assists in avoiding the confusion that may result, especially for the inmates who serve long sentences. For example, training the men to be good and caring fathers as well as other roles will help them to establish good relationships with women upon release (Center for Substance Abuse Treatment 2005). The same applies to the female convicts who have been in prison for a considerable amount of time and might have forgotten their female roles in the society.
Rehabilitation and Integration of the Inmates to the Community
The transition between the prisons to the community is often challenging for the inmates and also for the members of the society (Leukefeld et al., 2009). This is because of mistrust towards incarcerated individuals. The current program will ensure that the integration and rehabilitation program is smooth not only to the released inmate but also to the community members. To start with, the program will partner with other counseling centers to ensure that upon release the prisoners who were not yet through with psychological counseling continue to receive counseling when they are out of prison (Weinman, 2011). The prisoners will also continue attending the anonymous groups after release for accountability.
Follow-up of the ex-prisoners who had been enrolled in the program will also continue for at least five years after release. The program manager will be responsible for seeking potential partners and partnering with them. Concerning the follow-up. Social workers will be employed by the program management to help with the follow-up during the five-year period. It is expected that after five years the inmates would be well integrated into the society.
Upon release, most prisoners experience a lot of challenge getting decent job that can allow them to earn some honest income. Some of the reasons as to why it is difficult for the ex-inmates to get a job is because employers don’t trust them. Also, most prisoners may have very little qualifications and skills to enable them to get employment. The current program will engage in activities that help the inmates to gain skills that are necessary for employment. In order to ensure that the skills gained are relevant, the program will liaise with companies and enterprises which can offer employment. Skill training will then be offered based on the skills and knowledge required in the company. This will help keep the ex-inmates engaged and responsible. The managers of the program will have to offer this service after identifying potential companies and asking on behalf of the prisoners to have them incorporated in the organization.
Current Status of Inmates with Mental Health Issues
According to Morgan et al. (2012), there has been an increase in prisoners with mental health problems over the last decade as a result of the cases being given too little attention by the authorities as well as the immediate associates to the prisoners. This increasing trend has been of worry to the people concerned because it compromises the need for the correctional facilities that should assist the inmates to integrate well in the society upon serving their sentences and not come out mentally ill.
There has been statistics regarding the cases of mental problems to confirm the worry as reported by Fagan (2003). According to the records and trends of the cases, if there are about 16% of prisoners, then 7% of those prisoners have a diagnosis of mental illness. Fagan (2003) further states that if the figure of the drug addicted inmates is included in the statistics, then the rate of mentally ill patients in the prison will be 14%. Often these prisoners do not get enough mental health treatment while in the prisons. The reason is that such treatment can be very costly and without the intervention of the government or well-wishers, it becomes a big challenge to meet the goals of treating the medically ill individuals.
Besides, even when the funds are available, most mental health professionals do not like to work in prisons (Fagan, 2003). The reason is that sometimes it is challenging to deal with inmates especially those who do not consider changing to the better; hence they become aggressive and arrogant, posing physical and psychological danger to the people taking care of them. The fact that few mental professionals agree to serve the inmates with a bid to help them with their conditions has led to high mortality rate among the inmates who have been released from the prisons in comparison to people who have not been in prison (Chang et al. 2015).
According to Kinlock et al. (2010), 12 – 15% of the inmates – out of the 2.4 million people in U.S prisons in 2008 – were addicted to heroin. Only a few percentage of the inmates with drug-abuse-related issues were treated either when they were in prison after living the prison. The majority did not receive any mental health treatment even after they were released. Such individuals had a high chance of going back to their usual routine and were jailed even before two years after release.
Scaggs et al. (2016) provides statistics revolving around the inmates and their post release behaviors that lead to some consequences. For example, according to the report, 67% of the inmates get rearrested for new offenses; 47% of them will be reconvicted, more than 50% will go back to prison within three years after being released. This is further supported by Balyakina et al. (2014) stating that the inmates who are frequent users of drugs risk to be re-arrested due to the high potential of re-engaging in crime.
According to the American Psychiatric Association (2015), some of the serious mental illnesses that are common with inmates include psychiatric disorder that has psychotic symptoms and schizophrenia. The reason for this lies in the fact that the inmates lack professionals like psychiatrists to help them cope with mental issues they always encounter while serving their sentences. All these factors lead to the need for prison model that will contribute towards assisting the inmates during and after they have served their sentences in the correctional facilities.
Programs for Dealing with the Problem
In the U.S, the correction drug treatment strategy has been the largest since the 1980s (Prendergast & Wexler, 2004). They offer treatment and counseling programs to inmate with substance use disorder. Some of the programs that are currently being used in south California and other parts of the nation include the Amity Vista Aftercare. This program targets offenders who have already been released and integrated into the society. It helps offenders to cope with life after prison and to manage their drug-related issues. The program offers residential rehabilitation for the convicted felons and parolees of either gender. This project helps to reduce recidivism,
The other common program that is offered for inmates with substance abuse disorder or addiction is the Amity In-Prison Therapeutic Community (McCollister et al., 2004). This program only focuses on male people who have been incarcerated. The program usually takes 9 to 12 months for completion (Chan et al., 2007). The inmates are enrolled when they are left with about one year to be released. The inmates are required to voluntarily agree to participate in the project. Also, once the inmate is enrolled in the project they are required to reside in the program housing where they receive pharmacological treatment and psychological counseling.
Cost Incurred in Treatment Programs
The cost of treating mental illness may seem to be high in the short –term but in the long-term the benefits are many. For instance, Anglin et al. (2013) point out that treating inmates with mental health issues help to save on the cost of hospitalization because early treatment prevents progress of the illness. Also, substance use and abuse treatment help the individual inmates to save their money since they do not waste the money to buy drugs. As the individual is empowered to have better investment and better savings the economy of the nation is also empowered. The treatment also prevents ex-inmates from reoffending. This is because some people engage in criminal activities under drug influence while others engage in such activities to satisfy their craving for drugs. Once liberated from the drugs they will not have to continue taking the drugs. Consequently, there will be less incarceration and less money required for maintaining the inmate population.
The research conducted by McCollister et al. (2016) on long-term cost effectiveness of VISTA and therapeutic community found that using the programs was cost effective since $65 was daily compared to the average cost of incarceration which is $72. In yet another study by Angelin et al. (2013) found that the government would gain more savings $2317 per offender by implementing the Substance Abuse and Crime Prevention Act (SACPA). Though treatment programs may vary in terms of cost, most of the programs are cost-effective in the long-term because recidivism is reduced hence lowering the government cost of incarceration.
After each year following the launching of the program, there will be quantitative study in which the rate of incarceration and recidivism will be determined. It is expected that the rate will reduce. This will be a clear indication that the ex-inmates have been rehabilitated and integrated back to the community. Statistical measures of the number of patients employed will also be determined and then compared. Having increased number of ex-inmates being employed will be an indication of the Success of the program.
Interviews will be conducted among inmates, family members of offenders, professionals working in prisons to determine if they notice any positive changes in the inmates. Some characteristics such as being responsible, sober, honest among others will be an indication of a successful program.
By simply observing the inmates it will be possible to notice changes after implementation of the program. In mates should be able to take initiative in organizing the alcoholic anonymous groups, they should observe personal hygiene and be enthusiastic about learning new skills and gaining knowledge. When observation of such elements is positive then it is a clear indication of progress.
Evaluating the project
The process of evaluation to this project can be done by independent individuals or agencies that will countercheck the set objectives of the project and actual achievements in the correction facilities. There can also be interviewing of the inmates as well as those who have been released from the prisons to find out how they are coping up with the processes of the implementation of the change model in the prison. This will help in uncovering the areas that are not well addressed; hence there can be new recommendations for better adjustments.
Mental illness among incarcerated individuals is on the rise; most of this mental illness are drug induced. This is costly to the government due to high prison population and recidivism. There is a need to curb the problem through development of mental health program that will curb such trends. The current program has been developed to offer a holistic and effective program for incarcerated individuals with drug and substance abuse issues.The program’s major objective is to provide a solution to this challenge by ensuring that the inmates are well rehabilitated in a cost-effective way. This paper hypothesizes that such a program can be implemented if the treatment program will involve various stakeholders, including the prisoners with history of substance abuse, their friends and families, mental health professionals, the community and related employees in the prison. Also, the program should have long-term follow up.
American Psychiatric Association. (2015). Psychiatric Services in Correctional Facilities. American Psychiatric Pub.
Anglin, M. D., Nosyk, B., Jaffe, A., Urada, D., & Evans, E. (2013). Offender diversion into substance use disorder treatment: the economic impact of California’s Proposition 36. American journal of public health, 103(6), 1096-1102.
Balyakina, E., Mann, C., Ellison, M., Sivernell, R., Fulda, K. G., Sarai, S. K., & Cardarelli, R. (2014). Risk of future offense among probationers with co-occurring substance use and mental health disorders. Community mental health journal, 50(3), 288-295.
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