CLINICAL HANDBOOK OF SCHIZOPHRENIA

35. Treatment in Jails and Prisons 363In addition, adequate transition planning identifies necessary housing placementsand appropriate linkages to treatment services.Although little research is available to guide transition planning for inmates withschizophrenia, the recently developed APIC model (assess, plan, identify, coordinate)identifies several important elements that are likely to improve outcomes for this groupupon release from custody. These elements include correctional assessment, planning,identification, and coordination of community components required to support integrationof the released inmate. The APIC model provides a reentry checklist for use in recordingtransition needs while an inmate is in custody.Transition planning is of critical importance in supporting the recovery of inmateswith schizophrenia, and implies a partnership between correctional and community providers.Several communities have implemented forensic assertive community treatment(FACT) models, in which evidence-based features of assertive community treatment areblended with approaches to enhance public safety. Early findings suggest that this approachmay reduce hospital admissions and reincarceration.KEY POINTS• Inmates in jails and prisons have rates of schizophrenia that are approximately four timeshigher than in the general population.• Mental health services in correctional facilities have not expanded sufficiently to meet thegrowing needs for these services.• Treatment of schizophrenia in correctional settings is affected by symptom exacerbation relatedto the stress of incarceration, discontinuity in the prescription and administration ofmedications, frequent confinement in disciplinary units, and the presence of co-occurringsubstance abuse and other health disorders.• Professional standards and guidelines are available to assist mental health professionalsand correctional administrators in assessment, treatment, and management of inmates withschizophrenia and other mental illnesses.• Early screening and identification of schizophrenia, other mental health disorders, co-occurringsubstance use disorders, and suicide risk are of critical importance in providing stabilizationand engagement to treatment in jails and prisons.• Several different modalities of treatment in jails and prison are commonly provided for inmateswith schizophrenia, including short-term acute care, long-term residential services,transition or intermediate care services, and outpatient treatment and case managementservices.• Medication algorithms and other specialized guidelines have been developed to assist mentalhealth professionals in treating inmates with schizophrenia.• Specialized treatment approaches have been developed in jails and prisons to address cooccurringmental health and substance use disorders, and these have been found to reducecriminal recidivism upon release.• Transition and reentry services are important in providing continuity of psychotropic medicationsand other treatment services, stable housing, and financial entitlements, and can helpprevent rapid cycling back to the criminal justice system.REFERENCES AND RECOMMENDED READINGSAbram, K. M., & Teplin, L. A. (1991). Co-occurring disorders among mentally ill jail detainees: Implicationsfor public policy. American Psychologist, 46(10), 1036–1045.American Correctional Association. (2003). Standards for adult correctional institutions: Fourth edition.Laurel, MD: Author.