Treatment of Individuals with Co-Occurring Disorders in County Jails: The Beaver County, Pa., Experience
Bell, Arlene, Jaquette, Nancy, Sanner, David, Steele-Smith, Carol, Wald, Holly, Corrections Today
Authors' Note: This project was funded by the Office of Mental Health and Substance Abuse Services of the Pennsylvania Department of Public Welfare and the Bureau of Drug and Alcohol Programs of the Pennsylvania Department of Health.
Heightened attention has been given to the issues concerning people suffering from co-occurring disorders. This is primarily due to an increase in the number of individuals with dual disorders within the mental health and substance abuse general population. It is also a result of poor outcomes in the attempts to treat this population in the community. (1) Individuals suffering from dual disorders have far fewer success rates, including increased vulnerability to relapse and rehospitalization, (2) more psychotic symptoms, (3) noncompliance with medications and other treatments, (4) homelessness and contact with the criminal justice system. (5)
A co-occurring disorder in the behavioral health field is defined as having both a substance abuse disorder and one or more psychiatric disorders. According to the Office of Mental Health and Substance Abuse Services, it is estimated that anywhere from 20,000 to 30,000 adults in Pennsylvania suffer from this disorder. As indicated in the Substance Abuse and Mental Health Services Administration's 2002 Report to Congress on the Prevention and Treatment of Co-occurring Substance Abuse Disorders and Mental Disorders, there are an estimated 10 million people in the United States suffering from mental illness and substance abuse disorders and dependence. For those involved with the criminal justice system, it is estimated that rates of co-occurring disorders are far more likely to be higher. For example, in Psychiatric Disorders in America: The Epidemiologic Catchment Area Study, authors Lee Robins and Darrel Regier estimate that the rates of mental health disorders are four times higher among inmates than in the general population, and the rates of substance use are four to seven times higher.
Challenges faced by the mental health and addictions field in their attempts to treat this population include a lack of common language/terminology in labeling the disorder; varying skill levels, qualifications and training of staff in identification and understanding of how to treat someone suffering from both disorders; professional differences in treatment approach; lack of follow-up; separate systems and payment regulations; and much too often, a lack of collaboration, resulting in systems operating in "silos."
Several states and countries have implemented model programs in attempts to address this problem with varying degrees of success. In 2001, the Pennsylvania Office of Mental Health and Substance Abuse Services and the Bureau of Drug and Alcohol Programs issued a joint solicitation for Mentally Ill Substance Abuse (MISA) projects and selected five counties for funding. The goal of these projects was to demonstrate the potential of specialized MISA-integrated treatment and support services as a cost-effective alternative to traditional services and to create best practice models of systems and service integration for future policy and program development. Beaver County was awarded funds to develop one of the five pilot programs and was the only county to use a forensic model.
Beaver County is a semirural county in southwestern Pennsylvania, located 30 miles northwest of Pittsburgh. The county occupies 434 square miles and is bordered on the east by Allegheny County (Pittsburgh), on the south by Washington County and on the west by the states of Ohio and West Virginia. The approximate population of Beaver County is 180,000. In the late 1990s, Beaver County replaced its 100-year-old jail with a new 402-bed facility, making it one of the largest county jails in the nation.
The 1999 Bureau of Justice Statistics report titled Mental Health and Treatment of Inmates and Probationers, estimated that at midyear 1998, there were 2,838,000 mentally ill offenders incarcerated in the nation's prisons and jails, which equates to approximately 16 percent of the total prison population nationally. …