Category Dr. M Blatstein’s Blog

BOP BRAVE Program – For Those New To Federal Prison

BOP BRAVE Program is a 6 month program designed to facilitate favorable initial adjustment to incarceration – for young males new to federal prison, serving their first sentence in a medium facility.  Photo Credit: The Marshall Project

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BOP Brave Program – Admission Criteria:

I- Designed for medium security male inmates.

II- The inmate is 32 years old or younger.

III- They will be serving a sentence of 60 months or more, and is their 1st time in the BOP.

IV- The program is assigned at the beginning of their sentence.

The responsibility for your client’s mental and physical health should be safe guarded in order to protect them from themselves (and others), while providing a safe environment for the duration of their incarceration.

This should be the responsibility of legal council, the court and BOP.

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The BRAVE Program is located at the following federal prison facilities:

info@PPRSUS.com * 240.888.7778

  Federal PSR/Sentencing Preparation Software

BOP Challenge Program – Addressing Mental Illness Disorder

Photo Credit: The Marshall Project

  The BOP Challenge Program focuses on mental illness/psychotic disorders and if included in a complete PSR, could affect your client’s prison placement.

Psychotic disorders make up a group of serious mental illness disorders that affect the mind. Psychotic disorders makes it hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately.

When severe,those with mental illness disorders  have trouble staying in touch with reality.

 

BOP Challenge Program Admission Criteria

I) The BOP Challenge Program is for high security inmates in penitentiary settings with substance abuse problems, and/or mental illness disorders.

The inmate must meet one of the following criteria:

  • Has a history of substance abuse/dependence or,
  • Has a major mental illness as evidenced by a current diagnosis of a;
    1. Psychotic disorder
    2. Mood disorder
    3. Anxiety disorder
    4. Personality disorder

The responsibility for your client’s mental and physical health should be safe guarded in order to protect them from themselves (and others), while providing a safe environment for the duration of their incarceration.

This should be the responsibility of legal council, the court and BOP.

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Below is an overview of the BOP Challenge Programs ‘types and symptoms’ of psychotic disorders along with an itemized list of BOP ‘Formulary’ and ‘Non-Formulary’ medications currently available to treat these disorders.

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A)   Types and Symptoms

I- Schizophrenia

Note: Clozapine is the only FDA-approved medication for treating schizophrenia that is resistant to other treatments. It’s also indicated for decreasing suicidal behaviors in those with schizophrenia who are at risk.

II-    Schizophreniform, a Mental Illness Disorder

  • Includes symptoms of schizophrenia.
  • The symptoms last for a shorter time: between 1 and 6 months.
    • Medication* and Psychotherapy —to help the patient manage everyday problems related to the disorder.
      • Clozapine (Clozaril®) – On Formulary
      • Olanzapine (Zyprexa®)– On Formulary
      • Quetiapine (Seroquel®)– Non Formulary
      • Risperidone (Risperdal®)– On Formulary
      • Ziprasidone (Geodon®)– On Formulary

III- Brief Psychotic Disorder

IV- Delusional Disorder

  • The key symptom is having a delusion (a false, fixed belief) involving a real-life situation that could be true, but isn’t; such as being followed, being plotted against, or having a delusion. The delusion lasts for at least 1 month. Symptoms may include;
    • Cold, detached manner with the inability to express emotion.
    • Confused thinking;
      • Disorganized or incoherent speech.
      • Loss of interest in activities.
      • Loss of interest in personal hygiene.
      • Mood swings or other mood symptoms, such as depression or mania.
      • Problems at school or work and with relationships.
      • Slowed or unusual movements.
      • Strange, possibly dangerous behavior.
    • The primary typical medications* used;
    • Atypical antipsychotics* have fewer movement-related side effects;
    • Other medications*:
      • Antidepressants might be used to treat depression, which often happens in people with delusional disorders.
      • Psychotherapy can also be helpful, along with medications, as a way to help people better manage and cope with the stresses related to their delusional beliefs and its impact in their lives.
      • Sedatives and antidepressants might also be used to treat anxiety or mood symptoms, if they happen with a delusional disorder.
      • Tranquilizers might be used if the person has a very high level of anxiety or problems sleeping.

V- Shared Psychotic Disorder (also called folie à deux)

  • Here one person in a relationship has a delusion, and the other person in the relationship adopts that same delusion.
  • Diagnosing is difficult.

VI- Substance-Induced Psychotic Disorder

  • This condition is caused by the use of or withdrawal from drugs, such as hallucinogens or crack cocaine that cause hallucinations, delusions, or confused speech.
  • The hallucinations and delusions displayed should be in excess of those that typically accompany simple substance intoxication or withdrawal, although the patient could also be intoxicated and/or going through withdrawal.
  • Some precipitating substances:
  • Treatments
    • A calm environment.
    • Often a benzodiazepine or antipsychotics in most substance-induced psychoses, stopping the substance and giving an anxiolytic (eg., a benzodiazepine [Not Available]) or an antipsychotic drug can be effective.
    • Psychosis due to:
      • dopamine-stimulating drugs such as amphetamine; an antipsychotic drug could be used here.
      • For drugs such as LSD, quiet observation may be all that is needed.
    • For substances with actions that do not involve dopamine, observation may be all that is needed, or possibly an anxiolytic may help.

VII- Psychotic Disorders due to other medical conditions;

  • Hallucinations, delusions, or other symptoms may happen because of another illness that affects brain function, such as a head injury or brain tumor.

VIII- Paraphrenia: (Symptoms similar to schizophrenia).

  • It starts late in life in the elderly.
    • Generally has a much better prognosis than other psychotic disorders.
    • Antispsychotic medication can be helpful.
    • Paraphrenia sometimes co-occurs with depression and anxiety.

IX- Mood Disorder

  • Depression [Slide Show] ; can be emotionally crippling.
  • Bipolar disorder also known as manic depression.
    • Can cause risky behavior, even suicidal.
    • Can cause periods ranging from overly happy and energized, to other periods feeling very sad, hopeless, and sluggish.
    • Symptoms of mania (“the highs”):
      • Angry, and hostile.
      • Becoming more impulsive.
      • Drug and alcohol abuse.
      • Excessive happiness, hopefulness, and excitement.
      • Increased energy and less need for sleep.
      • Making grand and unrealistic plans.
      • Rapid speech and poor concentration.
      • Restlessness.
      • Showing poor judgment.
      • Sudden changes from being joyful to being irritable.
      • Unusually high sex drive.
    • Symptoms of (“the lows”):
      • Appetite changes that make them lose or gain weight.
      • Attempting suicide.
      • Feelings of hopelessness or worthlessness.
      • Insomnia.
      • Irritability.
      • Loss of energy.
      • Needing more sleep.
      • Sadness.
      • Thoughts of death or suicide.
      • Trouble concentrating.
      • Trouble making decisions.
      • Uncontrollable crying.
B) Other possible treatment medications*
C- Note: Psychotherapy, or “talk therapy,” is recommended.

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BOP  Challenge Facility Penitentiary (USP) Locations:

Allenwood, PA-High

Atwater, CA-High

Beaumont, TX-High

Big Sandy KY-High

Cannan, PA-High

Coleman I, FL-High

Coleman II, FL-High

Hazelton, WV-High

Lee, VA-High

McCreary, KY-High

Pollock, LA-High

Terre Haute, IN-High

Tucson, AZ-High

 

* Medication availability:
  • On Formulary – These are available.
  • Non-Formulary – These medications require a lengthy review process.  It is prudent to document these at the sentencing hearing, and through their PSR.

PSR / Sentencing Preparation Software

240.888.7778 * info@PPRSUS.com

https://www.pprsus.com/

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-UpToDate-

Just one of many medical resources that consist of practicing physicians, editors and researchers.

Prison Design and’ Mental Health Outcomes.

Can Prison Design Affect Inmates’ Mental Health Outcomes?

by Joyce Frieden, News Editor, MedPage Today

As written in the article:

The researchers listed two theories of prison design:

  • Deprivation Theory: This is the idea that when an inmate is subjected to a restrictive environment, certain basic needs may go unsatisfied and an inmate may adapt to the situation by satisfying needs via maladaptive behaviors.
  • Situational Theory: This is the idea that architectural and social determinants can impact one’s perception of his/her experience (safety, available resources, relationships) and the likelihood of engaging in violence.

Reading the article in full should be considered in future building contracts.

Getting the PSR right – before the sentencing hearing.

Getting the PSR right – before the sentencing hearing.

Abstract

Imprisonment is a frightening experience for both your client and their family. Counsel and family can assuage some of these fears by addressing federal prison healthcare both before the sentence begins, and while the inmate is in Federal Bureau of Prisons (“BOP”) custody.

Role of the Presentence Report (PSR), at the Sentencing Hearing

The Presentence Investigation Report (“PSR” or “PSI” or “PSIR”) plays a critical role in Sentencing Guidelines departures and statutory sentencing considerations. From the judge at sentencing to the Probation Office’s use during Supervised Release, the PSR is considered gospel fact about the defendant. Photo Credit: The Marshall Report.

Once in BOP custody, the PSR becomes a bible about the inmate. The BOP’s interpretation of the PSR drives its decisions about security level and prison placement, programming, pre-release, and even medical care. The inmate’s federal prison life depends on that PSR.

One cannot overstate the PSR’s importance, or the need for it to be accurate the first time. Asking to change the PSR later asks a court to change positions that it has already adopted as accurate. Even if this can be done – a big if – the amendment process can take years and many billable hours to complete.

Should there be a medical or mental healthcare issue, the PSR drafting process is the time to get it right. An inaccurate PSR can mean a lack of consideration at sentencing and inappropriate or absent care after imprisonment.

For example, if kidney dialysis is necessary, submit related physician notes to the Probation Officer through their PSR. If the defendant is undergoing liver dialysis while waiting for a liver transplant (Mars, for their transition period until they receive a liver transplant), make sure all events are documented.

  • Everything is important, from osteoarthritis and degenerative joint diseases to food allergies and medically necessary diets. 
  • Everything needs to be documented, including how any maladies would limit “activities of daily living” (“ADL”).  Patient-inmates are considered ‘independent’ if they can accomplish their Activities of Daily Living (ADL) – things like dressing, bathing, and eating – on their own.
  • Medications must also be identified to estimate which prescription drugs the BOP will make available. It is critical to identify whether given medications are available on formulary, or if they require a request for non-formulary medications.
  • Understand that the BOP will discourage the use of non-formulary medications by requiring that they need special approval. More likely, BOP physicians will just switch the inmate’s treatment medications to those are similar equivalents. Do you know which medications are either available and on formulary, or non-formulary.

These issues should be addressed with the court before incarceration, because after incarceration the court has no real oversight. Letters from the client’s personal physicians should provide documentation about their prescription selection, and reasons why “similar” medicines are not appropriate for individual inmates.

Today the BOP uses a complicated method to convert a person’s medical diagnoses and treatments into a CARE LEVEL Classification. Classifications range from CARE LEVEL I for the healthiest inmate-patient, to CARE LEVEL IV for gravely ailing inmate-patients who need ‘in-patient’ care. Each facility then is identified by both a Security Level and this CARE LEVEL structure, and inmates are placed accordingly.

Photo Credit: https://pixabay.com

Reducing Recidivism – A Personal Holistic Approach

…supporting those who wish to create positive futures for themselves and their families.’

One example is the Last Mile

The Last Mile (TLM) was created to provide programs that result in successful reentry and reduce recidivism. We believe that jobs are the key to breaking the cycle of incarceration. Our mission is to provide marketable skills that lead to employment. Our in an out program provides career training in prison with mentorship and job placement upon release.

‘Felony’ currently is forever on one’s record:

We can all agree that leaving prison with a “Felony” on one’s record disqualifies them from most jobs in our current workforce. While discouraging, this existing ‘disclosure requirement’ that appears on most employment applications. It inhibits those affected from moving forward with their lives by not even then to make it into the interview phase, thus contributing to this recidivism paradigm.

The issue of a “Felony” on one’s record is a political issue, and one that politicians all across the country need to address. Our society’s reality is that released inmates are facing this challenge every day; this is their albatross. Even so, if the effort is made early before prison placement, we can begin to start changing some of their future ‘paradigm’ challenges.

92% of defendants with public counsel and 91% with private counsel either pleaded guilty or were found guilty at trial. DOJ Cases, November 2000

While this is a difficult and fearful time, it is worthwhile to discuss with your client what job, educational or lifetime goals they (and their families) may have, and then including this in their PSR.

A personalized Presentence Report (PSR) submitted before sentencing that matches your client with a facility that provides for their individual healthcare needs, security level, encourages and supports their interests in: Education (College) as well as interests they may have in a specific occupational trades training (i.e.: Accounting – Welder), is all a great start.

Who Benefits:

Society’s benefit: Individuals released with a new futures for themselves, now becoming contributing members to their communities.

Your Client’s benefit is that they are now released with enhanced life skills and future positive goals.

The Last Mile’s is a successful example of what can be done in changing our existing recidivism paradigm.

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