Modified Therapeutic Community Program for Inmates with Mental Illness and Chemical Abuse Disorders

Article excerpt

Six years ago, the Colorado Department of Corrections developed a therapeutic community (TC) program for offenders with mental illness and chemical abuse (MICA) disorders. (1) With the assistance of staff from the National Development and Research Institutes, a nonprofit social research organization, as part of a research project funded by the National Institute on Drug Abuse, these efforts resulted in the creation of a model modified TC treatment program for MICA inmates. (2) Further refinement and elaboration of the model extended its application in both the prison and community as part of a post-release aftercare strategy.


Prevalence of MICA Disorders

The body of research amassed during the past 20 years has substantially increased the knowledge of both the nature and prevalence of MICA disorders. Reports from the mental health field have identified the incidence of substance abuse among patients with a diagnosed mental disorder to be in the range of 20 percent to 50 percent. Likewise, substance abuse treatment programs have typically reported that 50 percent to 75 percent of clients have a mental disorder. (3) Clients with severe mental and substance use disorders often have poorer outcomes, expressed as higher rates of HIV infection, relapse, hospitalization, depression and suicide risk. (4)

Administrative and treatment professionals working in criminal justice settings throughout the country have observed that the number of MICA offenders in the jail and prison population has increased. In fact, several studies indicate an incidence of between 3 percent and 16 percent. (5) A recent Justice Department report estimated that 283,800 offenders with mental illnesses were incarcerated nationwide, with 16 percent of state, 7 percent of federal and 16 percent of local jail inmates reporting that they either had a mental condition or had stayed overnight in a mental hospital at least once during their lifetime. Likewise, about 16 percent of probationers, or an estimated 547,800 people, responded that they had a mental condition or had stayed overnight in a mental hospital at least once during their lifetime. (6) The prevalence of serious mental illnesses among offenders in Colorado has more than tripled during the past 10 years, from 3.9 percent in 1991 to 14 percent in 2001 (or 1 percent per year). Approximately three-quarters of these inmates have a substance use disorder. (7)

Although more MICA inmates are entering prison facilities throughout the country, for a variety of reasons few states have, until recently, developed treatment programs that respond to their additional needs. (8) Those providing treatment in criminal justice settings face unique constraints, such as limited space and treatment resources, as well as having to consider mandated time offenders must devote to work, head counts and meals; institutional dynamics, including accelerated paroles and discharges in response to crowding; and the corrosive effect of criminal thinking within the peer culture. (9) Real system barriers to program development are often created at the outset by the conflicting values of the criminal justice and treatment systems, which obscure the potential synergy of the goals of security and treatment. Because treatment for MICA offenders must integrate substance abuse and mental health services--typically segregated both by delivery and funding source--further barriers emerge. Still, more obstacles result as separate disciplines guard the confidentiality of client records, and as corrections officials make decisions to move, parole or discharge offenders for legal and operational reasons often at odds with the preferred clinical course. All of these factors make keeping an offender in treatment extremely difficult. (10)

Despite the barriers and challenges, treatment programs for clients with MICA disorders are being developed as a direct result of the rapid growth in this segment of the U. …