Revolving Prison Door

The study will focus on the disorders predominately found within the prison system: impulse control, mood, anxiety, personality, paraphilia, psychotic, and co-occurring disorders (Birmingham, Gray, Mason, & Grubin, 2000) and target treatments that are shown to be most successful with each syndrome: cognitive behavior therapy, twelve-step program, and psychiatric medications (Soyka, 2000).

This approach will be centered on a revised APIC (Assess Plan Identify & Coordinate) model, which incorporates the above treatments and community follow-up planning. While the original APIC model, developed by Fred Osher, is tailored for persons incarcerated less than seventy-two hours (Osher, Steadman, & Barr, 2003), the revised model will be tailored for those with lengthy prison terms and contain a structured therapeutic model.

Question: If the revised APIC model is implemented will the number of mentally ill inmates returning to prison, be reduced and thus alleviate the "revolving door" epidemic?

Null Hypothesis: The revised APIC model will have no effect on the reoffending of mentally ill inmates and therefore will have no effect on the overall recidivism rates.

Alternative Hypothesis: The revised APIC model will decrease the reoffending of mentally ill inmates and therefore will lessen the overall recidivism rates.

The "revolving prison door" continues to be a debate among states across the U.S (Baillargeon, 2008). In 2006, the Bureau of Justice Statistics reported that approximately fifty-six percent of state prisons, forty-five percent of federal prisoners and sixty-four percent of jail inmates suffered from some type of mental illness (James & Glaze, 2006). Additionally, penitentiaries contain three times as many mentally ill persons than psychiatric hospitals, making them the leading psychiatric providers (Fellner, 2006). While prisons offer mental health care programs, many provide ineffective treatment causing individuals to be undertreated, misdiagnosed, and ultimately at a higher risk for reoffending (Lamb, 2009). For this reason, it is important to examine therapeutic treatments and release programs that will aide in the reduction of mentally ill inmates being rearrested.

The Revised APIC Model will begin upon entry into the unit, where the inmate will be required to enter into the first stage of the model. This portion is known as the Assessment phase. Here the individual will be required to take two tests followed by an unstructured interview. The first test is the Minnesota Multiphasic Personality Inventory -2 (MMPI II). This is a five-hundred-sixty- seven true/false questionnaire designed to identify behaviors and traits that comprise personality. The results reflect an individual's strengths and weaknesses, along with disturbances in personality or mental deficits (Cherry, 2011).

The second test administered will be the Wechsler Adult Intelligence Scale-III (WAIS-III). The test is comprised of Verbal and Performance subtests. The Verbal subsets encompass Verbal Comprehension Index (VCI) (i.e. vocabulary, similarities, information, and comprehension) and Working Memory Index (WMI) (i.e. arithmetic, digit span, and letter-number sequencing). Performance subtests entail Perceptual Organizational Index (POI) (i.e. picture completion, block design, and matrix reasoning) and Processing Speed Index (PSI) (i.e. digit symbol-coding and symbol research) (WAIS, 2004).

After completion of both tests, the inmate will proceed to an unstructured forensic interview. The purpose of this is to elicit information for such things as psychiatric diagnosis and evaluations. The clinician's primary function is to accumulate necessary data (i.e. race, gender, sexual preference, and age), identifying possible psychological symptoms, and formulate an accurate diagnosis, according to the Diagnostic and Statistical Manual of Mental Disorders- IV (DSM-IV) (Kaplan, 2005). It should be noted however that an estimated fifty percent of individuals with serious mental illnesses have a co-occurring substance abuse disorder. For this reason, it is important that clinicians address any dual diagnosis during the Assessment stage (Regier, 1990).

Once the first stage is complete, and if the inmate meets criteria for a mental disorder or dual-diagnosis, he or she will enter the Special Prevention Unit, or SPU. The individual will then move to the Planning stage. This process will entail individual therapy, group therapy, as well as a twelve-step program. In this stage, Cognitive Behavior Therapy will be the primary therapeutic approach used. While there are numerous treatment approaches, this particular approach is seen as most beneficial, in a correctional setting, since it treats wide-ranging mental illnesses such as impulse control, anxiety, personality, paraphilia, psychotic, and co-occurring disorders (Cullen & Gendreau, 2000).

CBT is a therapeutic treatment process that aids individuals in comprehending beliefs and emotions that impact behaviors. Throughout the continuation of therapy, individuals are taught to recognize and alter a negative or alarming thought process, which creates damaging impacts on behavior. The primary notion is that beliefs and emotions are key roles in an individual's behavior (Hanser, Mire, & Braddock, 2010). In forensic settings, CBT additionally places emphasis on improving abilities surrounding re-entry and applying conduct that provide constructive results within the community. The following CBT methods will be used as they are tailored to the individuals specific needs:

1. Aggression Replacement Training (ART) - A method developed to decrease anger and violence amongst youths incriminated in the legal system. Recently, this method has been implemented in adult facilities. ART enables individuals with pro-social skills and devices to control aggressive compulsions, which leads to violent actions. This process entails three main modules (societal abilities, anger control, and ethical perceptions (Cullen & Gendreau, 2000).

2. Criminal Conduct and Substance Abuse Treatment: Strategies for Self-Improvement and Change (SSC) - This process offers a consistent, organized, and precise method to the treatment of individuals with substance abuse and legal issues. It consists of three phases (provoke, pledge, and take possession of change) (Cullen & Gendreau, 2000).

3. Moral Resonation Therapy (MRT) - Designed for individuals with resisting dispositions. Though originally implemented for substance abuse treatment, MRT has been extended to persons found guilty of driving while intoxicated, domestic abuse, and sexual crimes. The process incorporates child-rearing education, employment enhancement, and addresses antisocial reasoning (Cullen