Raising Awareness

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By Ashley Gravel

Dr. Roger H. Peters is a professor at the University of South Florida’s Department of Mental Health Law and Policy, serving as Principal Investigator for research projects on co-occurring disorders. He is a member on the editorial boards for the Drug Court Review and the Journal of Dual Diagnosis. Dr. Peters has published his research and was a contributing author to the ‘Co-Occurring Disorders Treatment Manual.’

Ashley Gravel: How did you become involved with treatment for inmates with co-occurring disorders?

Dr. Roger H. Peters: I got into this area through work with the Florida Department of Corrections and the National Gaines Center, a group that works closely with the population of offenders with co-occurring disorders. We’ve been working with the Florida Department of Corrections on different projects, such as screenings, assessments, and treatment services. They called on us to help develop a curricular as a part of a Residential Substance Abuse Treatment [RSAT] grant they received for that particular year. In addition to creating the curriculum, they wanted help training their staff. We also provided technical assistance to help set up several programs across the state, one for men and one for female inmates. We’ve developed a treatment curriculum that’s been used in several other states. That program was in place for 14 years, but budget cuts eliminated both the men’s program here in the Tampa area, and the women’s program in the Fort Lauderdale area. However, the curriculum is still there. It’s been used in other programs related to substance abuse within the Florida Department of Corrections.

AG: In Assessing Dependence, Comorbidity, and Trauma: Importance of Jail Screenings for Mental and Substance Use Disorders, you discussed the importance of early identification of inmates with mental and substance abuse disorders to ensure they receive proper treatment. What is the biggest obstacle to this?

RP: In most settings within the justice system, one of the biggest issues we find is that the institutions don’t use standardized screening instruments for mental health, substance abuse, or trauma. Those are the three primary areas addressed in that essay, and we’ve found that sometimes there isn’t any screening at all. If they do have a screening in that particular area, often times it’s a home grown instrument or a non-standardized instrument. There isn’t much evidence about the psychometric properties of their instrument; how well it identifies disorders, whether or not it over-identifies people, or other potential negative consequences etc.

AG: Is not having enough staff properly trained to do screenings ever an issue?

RP: I think that’s part of it. There’s really a shortage of staff that have the advanced training to provide those types of screenings. For example, let’s say a probation officer administering a screening asks a question such as, ‘have you ever had mental health treatment’ or ‘are there any psychiatric medications that you’ve taken?’ The officer may not know how to follow up on the responses they receive. They also may not provide a comprehensive number of questions to get at the underlying disorders. Individuals suffering from mental disorders tend to worsen when they are released, due the stressful environment of jail or prison. People with mental disorders are victimized and taken advantage of in those settings because they’re perceived to be weaker by predatory inmates. In fact, other inmates in the general population view treatment of any kind as a sign of weakness.

AG: Can you discuss in more depth the struggles that inmates with co-occurring disorders face?

RP: People with both mental and substance abuse disorders are much more likely to have relapses and face additional contact with the criminal justice system once they’re released. If they’re not involved in an intensive treatment program for their co-occurring disorders, it can set these individuals up for failure once they’ve reentered society.

AG: In Co-Occurring Disorders in Specialty Courts you mention that these specialty courts are used to understand what brought the defendant to court in the first place. Can you speak on that subject a little bit? Was it a good solution to the problem?

RP: Specialty courts typically address different areas. There are Drug Courts that focus on substance abuse problems, and Mental Health Courts to address individuals with severe mental illness. There are roughly 30 different specialized sockets or court programs around the United States that focus on co-occurring disorders. In each of these cases, they’re addressing a holistic set of issues linked to the risk of recidivism. In some programs, they’re dealing with not just a single disorder like mental health or substance abuse, but they’re dealing with related adjunctive issues such as employment, education, and housing support.

AG: Would you say that setting up these courts, along with better quality screenings, would be a major step toward reducing recidivism?

RP: Absolutely. Research shows that Drug Courts reduce recidivism by an average of fifteen to twenty-six percent during a one-year follow up period.

AG: Where do you think the agent of change needs to come from for better screening processes?

RP: There are not many advocates for people with these stigmatized problems. The typical stereotypes attached to this population are violent, unruly, and intractable to treatment. That is not the case. We have come to realize that these people are often times warehoused in jails and prisons much longer than other inmates; simply because they have mental disorders and co-occurring substance abuse problems. We have standards that have been developed by national organizations, like the National Commission on Correctional Health Care, for dealing with these issues. NCCHC has developed professional standards for mental health and substance abuse disorders in jails and prisons. Other organizations, such as the American Correctional Association, the American Psychiatric Association, the American Psychological Association, and the American Jail Association have developed professional standards for practitioners in jails and prisons. But, those are essentially voluntary programs. What it comes down to is state agencies dealing with offender populations advocating for improved services. A U.S. congressman or a U.S. senator would have to take it on to develop an initiative focusing on prison reform. One recent example of that is the prison rape initiative. A congressman from Michigan spearheaded a program to investigate prison rape, which is a national epidemic. We have seen some federal agencies take on this issue, such as the Substance Abuse Mental Health Services Administration, The Center for Mental Health Services, and the Center for Substance Abuse Treatment. Each of these organizations has really done some pioneering work. They’ve developed better materials, curricular, briefing papers, trainings and technical assistance for those working in prisons, jails, probation, and specialty courts. The National Gaines Center focused on co-occurring disorders within the justice system and produced a lot of important documents and technical assistance training for individuals working with this population. Much more attention has been given to those suffering from co-occurring disorders within the criminal justice system.

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