The Hospital or the Slammer: A look at Correlation and Causation.

Fact: "The largest mental institution in the country is actually a wing of a county jail"(NPR, 2008).  It has 1,400 mental health beds. This is in downtown Los Angeles, and is affectionately known as the Twin Towers. It is two identical hulking structures, one housing psych patients and one housing criminal offenders.

Fact: 11 of our 50 states have 6 or more mental hospitals. This includes Texas, Minnesota, Illinois, Missouri, Florida, Georgia, Virginia, Delaware, New York, Massachussettes, and Rhode Island (SAMHSA.gov).

Fact: 7 of the 11 states mentioned above also report having a shortage of psychiatric beds in that state, meaning there is an unserved mental health population in those states (SAMHSA.gov).

Fact: In 8 states, over half of state hospital expenditures were for forensic and mental health services (FCSMHA, 2007).

     In light of these facts, some questions began to rise for me regarding the state of our mental health and criminal justice systems. Is their union a positive one or a disadvantage to the people they serve? Should we push for mental wards inside of jails, like in LA, or forensic units inside of psych hospitals? And what's the difference?

     According to an article by NPR, the second in a 3 part series on our penal system, this is a tangled web we have woven. Let's begin with a small bit 'o history about mental health.

     Not too many decades ago, around the 1970's, we had a significant institutionalized population in the nation's mental health hospitals. These were mostly state run hospitals, and they weren't four star accommodations. Then, around the same time we were experiencing several other social movements,such as womens' liberation, civil rights, protests, etc., we also had a social movement to free patients from these over crowded mental hospitals and move toward a community treatment approach. This is where our modern day day treatment programs and outpatient treatment were born.

    According to the NPR article, this led to "thousands of mentally ill ended up on the streets, where they became involved in criminal activity". The article also later states that, "Often, the crimes these people commit are the result of their mental illness". This was a quote, but it was simply taken from a mental health worker at the hospital, not a source, and was not later backed up by data in the article. Also, in several places the article, they discuss that some of the inmates in the LA County jail may be feigning mental illness so that they can live on the mental health ward. I felt that this perpetuates the thought process that people who are found mentally incompetent in courts are simply faking and "getting off" by pretending.  I found issue with these insinuations, as it was not cited from a source or supported in any way in the article, so I started to look up information to either support or dispute it. 
     Firstly, I thought, how do we know that the mentally ill were the perpetrators of these crimes? Then several thoughts followed, such as: Is there a prison that rivals the size of the nation's largest mental institution? Are the states where there are more mental hospitals to detain the mentally ill, represented by lower crime rates? Do mentally ill people get their medications when in jail? Do the states with more psych bed shortages have higher crime?

Here's what I found. 
- The state with the highest crime rate is Nevada. Interestingly, this is not one of the 11 states with 6 or more mental hospitals.

- The largest penal institution in the US is in Louisiana. It is the largest maximum security prison. It is larger than the country's largest mental hospital, as it has it's own zip code (chacha.com).

- Of the 15 top US states with the highest crime, 3 of them are also part of the list of 11 states with the most mental hospitals. Therefore 20% of the top crime states are also top states for MH institutions.

- Out of the states with the most mental health hospitals, 6 (54%) have the lowest proportion of mentally ill to the general population. (So why do they have so many hospitals?)

-The state ranked 7 out of 50 for highest crime, Delaware, also saw the biggest increase in crime this year. Rhode Island also became more dangerous, moving nine places in the rankings. Interestingly, both of these states are part of the 11 states with the most psych hospitals.

So, I still found myself with questions. The data is somewhat conflicting. Yet, it could be interpreted in so many ways. Should we increase or decrease our number of state mental hospitals? Should mental hospitals offer more forensic services and beds? Should jails offer more mental health treatment? Should there be stand alone facilities that offer both services- Forensic Psychology Hospitals? Which would be more fiscally beneficial to our state and national budgets? How do we differentiate from the criminals and the disturbed, and how different are they? Please post your thoughts and questions.

Sources:
http://www.npr.org/templates/story/story.php?storyId=93581736
http://www.walletpop.com/2010/04/05/most-dangerous-states-crime-rankings-for-2010/
World Prison Population List, 8th Ed.
Funding and Characteristics of State Mental Health Agencies, 2007.
SAMHSA.gov

Lifetime Learner?

After some research, here are a few more (mostly) FREE CE options. Enjoy, and please add more if you are aware of more!
Also, for the residents of Georgia, here are some job posting for the state. Again, share if you are aware of others.
Sharing is caring!

 

Substance Abuse Counselor

http://www.dbhddjobs.com/jobDesc.aspx?id=815&loc=Savannah

Behavior Analyst

http://www.dbhddjobs.com/jobDesc.aspx?id=344&loc=Savannah

Behavioral Specialist

http://www.dbhddjobs.com/jobDesc.aspx?id=502&loc=Savannah

MCRS Crisis Intervention

http://www.dbhddjobs.com/jobDesc.aspx?id=147&loc=Savannah

Social Service Provider 2

http://www.dbhddjobs.com/jobDesc.aspx?id=813&loc=Savannah

Social Services Chief

http://www.dbhddjobs.com/jobDesc.aspx?id=796&loc=Savannah

Here are a few more resources for Continuing education:

·       If you are interested in the use of meditation as a holistic approach to mental health treatment, here is an introductory CE course online for FREE!

https://www.fastceus-store.com/quizzes/index.php?extension=meditation-intro

·       If you treat the military or are interested in offering services to the military, here are several links to CE that is endorsed by The Department of Deployment. Most are FREE! Some are educational only and offer no CE.

http://deploymentpsych.org/training/online-courses

*  For a certificate program endorsed by Center for Deployment Psychology (not free):

http://postgraduatecenter.org/MVBH%20Certificate.html

*  FREE CE on Healthy Boundaries:

http://ce4less.com/CourseList.aspx?topic=Ethics
You can find it just below the top of the page in a big word bubble that says "FREE"! :) 

CE credits and opportunities to learn

Hello all! Here are some opportunities for CE hours for clinicians. They are FREE! Please comment with more resources if you are aware of other free training offering CE credit. Thanks for reading!

For clinicians working in or interested in Addiction, here is training offered by NAADAC:

http://links.mkt1408.com/servlet/MailView?ms=MzYyNjQwMTIS1&r=NjY2Nzg5MDMwMQS2&j=OTQxNTM0MTgS1&mt=1&rt=0

For those working with the military or clinicians hoping to move into this area:

http://www.aheconnect.com/citizensoldier/

Reliable Resource: Army OneSource Adds Training Programs with CEs

Army OneSource has launched the next leg of their Behavioral Health Focus, "Treating the Invisible Wounds of War." Counselors are invited to join other professional caregivers in a series of free training opportunities designed to increase awareness and sharpen skills at working with enlisted service members, veterans, and their families.

The Treating the Invisible Wounds of War course topics now include:

Part 1 - Posttraumatic Stress Disorder

Part 2 – Traumatic Brain Injury

Part 3 – Issues of Women Returning from Combat

From your browser, click here and follow these directions:

Step 1: Click on New Users tab at the top of the screen.

Step 2: Create a personal user account following the instructions on the screen. In order to activate the course for an interested individual or group, utilize the course access code denoted below. NOTE: Be sure to enter your Army OneSource referral code of AOSWATRA in the space provided.

Step 3: Login to the system using your new id and password.

Step 4: Click on Courses tab at the top of the screen.

Step 5: Select a course you wish to complete.

Step 6: Click on Register.

Be certain to complete all of the required modules in order to receive full credit. Once you complete a course, your CE credit will be recorded, and you will have access to download and print a Certificate of Completion.

Man's Best Friend Is Amazing

Canine Therapy for the Military

I was once at a workshop and saw that a person that appeared to have no physical impairment was accompanied by a service dog. At the beginning of the workshop, the leader gave a speech about how we should not pet him an so on. She went on to explain that he was a psychological service dog, as opposed to the service dogs for the blind that I was more familiar with. She explained that he was able to sense when his owner was about to have a seizure and would alert her so that she could seat herself, or he would brace her fall. He would then bark for help and stay with her until help arrived. As noted on epilepsy.com, "Seizure-alert dogs, as implied by their name, are dogs that can sense and notify their human companions of an oncoming seizure. This alerting behavior has been reported to occur several seconds to 45 minutes or more before the onset of the seizure. The dog does this by exhibiting marked changes in behavior, including close eye contact, circling, pawing, barking etc."


I was also reading an article recently that discussed the use of service dogs for our returning veterans.

"The dogs, provided by the Psychiatric Service Dog Society, are trained to help jolt a soldier from a flashback, dial 911 on the phone, and even sense a panic attack before it starts." 

I really thought this was amazing.  As most of use know, animals can be used in therapy for a number of symptoms/ diagnoses. However, I was also amazed not just at the variety of symptoms that fido can treat, but also the great results these types of therapy produce. "The dog also provides emotional comfort, and can help a veteran with a sense of responsibility, optimism, and self-awareness."




I thought this was just great food for thought, but was also interested in discussions it might produce.
Allow me to play devil's advocate.
1) Are service dogs and therapy dogs considered to be the same? Not according to http://www.k9web.com/dog-faqs/service.html , which reveals that therapy dogs may not have equal access to public places as service dogs do. What happens when the owner has a flashback in a place that will not allow the dog?

2) Would having the canine companion reduce the motivation to develop coping skills?

3)Also according to http://www.k9web.com/dog-faqs/service.html, it takes $20,000 to train a dog. With managed care the semi-nightmare that it is, would they cover this expense?

4)What about other people that would benefit from a service dog, but cannot afford it? Is this a slippery slope if Medicare/ Medicaid were to fund this therapy?

WHAT DO YOU THINK???


This blog is based on an article discussing therapy for the military that can be found in full at the NAMI website, or
http://psychcentral.com/news/2010/07/09/canine-therapy-for-military-ptsd/15444.html

More information on Seizure Service dogs can be found at
http://www.epilepsy.com/articles/ar_1084289240

Additional facts
http://www.k9web.com/dog-faqs/service.html

All articles cited are the property of listed sites, and do not reflect the opinion of this writer or reflect the intent of this blog.

It's just the beginning.

Day 1 of blogging.

You may want to know why this blog exists. I have felt for a long time that as therapists, counselors and caseworkers, we need more support than the average workplace provides. It is my hope that through blogging and giving feedback to each other, we can create an online support network of clinicians that improves us personally and professionally. So, think of this as a personal soapbox, a safe zone for venting, and a place to share ideas with like minded people.

You can look forward to:
*  Case vignettes for discussion
*  Summaries of therapy articles for you to add your own theoretically oriented opinion to
*  Political news that effects our profession
*  Links to exciting websites, resources, and employment opportunities

So get psyched, because counseling rocks!