CLINICAL HANDBOOK OF SCHIZOPHRENIA

35. Treatment in Jails and Prisons 357The ACA, the Joint Commission on Accreditation of Healthcare Organizations(JCAHO), and the NCCHC currently provide correctional health services accreditationprograms. In 2003, the ACA and the Commission on Accreditation for Corrections publishedthe fourth edition of Standards for Adult Correctional Institutions, which describesminimal thresholds for mental health services in correctional settings. Recommendationsinclude the following:• Mental health screening provided within 14 days of admission to correctional facilities.• Mental health examination that includes assessment of suicidal risk, violence, historyof mental health and substance abuse treatment, use of psychotropic medication,and sexual abuse.• Outpatient services for detection, diagnosis, and treatment of mental illness.• Crisis intervention and management of acute psychiatric episodes.• Stabilization of mental health symptoms and prevention of psychiatric deterioration.• Referral and admission to licensed mental health facilities for offenders whosepsychiatric needs exceed the treatment capability of the correctional facility.• Development of procedures for obtaining and documenting informed consent.The most recent version of the NCCHC standards (2003) addresses a broad range ofmental health and substance abuse services, and provides more detailed recommendationsfor clinical procedures and approaches. In 2004, the NCCHC developed professionalguidelines in Treatment of Schizophrenia in Correctional Institutions, based in parton the APA’s Practice Guideline for the Treatment of Patients with Schizophrenia (2004),but focusing on correctional treatment issues. Recommendations to guide clinical servicesinclude the following:• Assessment conducted at entry/admission to the correctional system.• Diagnosis completed by a credentialed clinician that addresses subtypes of schizophreniaand considers cultural issues, and the influence of co-occurring substanceuse disorders.• Management overview examines the severity of the disorder, as determined by currentsymptoms, functional impairment, mental health history, and co-occurringconditions.• Treatment goals and a treatment plan that are developed to address biological, interpersonal,social, and cultural factors affecting adjustment, and reflect the phaseof the disorder (i.e., acute, stabilization, and stable phase).• Routine services include a mental status examination and review of side effects ofpsychotropic medication and level of functioning.• Treatment strategies include psychopharmacological services and psychosocial servicesprovided in group settings.• Continuity of care includes discharge planning and active involvement of mentalhealth and case management staff in planning and linkage with community serviceproviders.• Environmental controls to minimize stressors and to encourage use of behavioralprinciples (e.g., positive reinforcement, token economies).• Quality improvement to assist in identification of inmates with schizophrenia andto measure noncompliance and other key treatment outcomes.Additional, more comprehensive guidelines were developed (Hills, Sigfried, &Ickowitz, 2004) by the U.S. Department of Justice, National Institute of Corrections, en-