CLINICAL HANDBOOK OF SCHIZOPHRENIA

362 V. SYSTEMS OF CAREior problems. Inmates with significant co-occurring disorders generally do not adjust wellto traditional mental health or substance abuse programs and require specialized services.A small but growing number of specialized treatment programs for co-occurring disordersare available in jails and prisons. These programs typically are located in units isolatedfrom general population inmates, are highly intensive and structured, are longer induration than traditional treatment programs, and feature programming that includes adual focus on mental health and substance abuse issues. These programs are often embeddedwithin larger substance abuse or mental health treatment units, or within “treatmentprisons” that address a wide range of inmate needs. Assessment and treatment servicesare individualized in these programs according to the level of engagement andmotivation, and psychosocial functioning of each inmate.Therapeutic communities (TCs) have recently been adapted for inmates with cooccurringdisorders and include modifications to reduce levels of confrontation; shortengroup treatment sessions; provide more staff coordination and involvement in activities,and specialized groups that address medication issues, managing emotions, and criminalthinking. Research indicates that these modified TCs can significantly reduce criminal recidivismfor inmates with co-occurring disorders. Specialized jail treatment and diversionprograms have also been developed for inmates with co-occurring disorders. Jail diversionprograms are designed to identify new arrestees with mental health disorders, andprovide intensive case management and assertive community treatment to monitor theirinvolvement in treatment.TRANSITION PLANNING AND REENTRY INTO THE COMMUNITYAlthough discharge or transition planning is a key element of professional standards forcorrectional mental health care, it is one of the least frequently provided services. For inmateswith schizophrenia, community reintegration is fraught with complications. Accessto ongoing psychiatric care may be compromised by inadequate insurance, transportationand housing, or profound cognitive impairment associated with their illness. Many inmateswith schizophrenia were receiving Medicaid and other forms of public assistance at thetime of their arrest. Too frequently these benefits are terminated rather than suspendedand are not immediately available upon the inmate’s release from correctional settings. Ittypically takes at least 45 days to reactivate benefits upon release. A consequence of nothaving benefits is that the released inmate does not have any way to pay for medicationand treatment. As a result of abrupt discontinuation of treatment, many inmates experiencerecurrence of acute and harsh psychiatric symptoms, thereby increasing the risk forsuicide, and for arrest and incarceration. Without adequate transition planning and support,successful community reintegration for inmates with schizophrenia is unlikely.The APA lists the following “essential services” for adequate inmate transition planning:1. Appointments should be arranged with mental health agencies for all inmateswith serious mental illnesses, especially those receiving psychotropic medication.2. Arrangements should be made with local mental health agencies to have prescriptionsrenewed or evaluated for renewal.3. Mental health treatment staff should ensure that discharge and referral responsibilitiesare carried out by designated staff.4. Each inmate who receives mental health treatment should be assessed to determinethe appropriateness of community referral.5. Mental health staff should participate in developing service contracts to ensureaccess to community-based case managers to provide continuity of service.