Category Dr. M Blatstein’s Blog

Federal Prison Placement Preparation

Incorporate these federal prison placement data points:

Federal prison placement includes Medical and Mental Healthcare needs to be implemented through the BOP CARE LEVELS I-IV Structure

Psychological Treatment

  • I) Brave Program A first-timer young male offender 32 years of age or younger, facing a sentence of 60 months or more
  • II) Challenge Program A male inmate facing a high-security penitentiary with a current diagnosis of either: Mood, Anxiety, Schizophrenia, Delusion and/or a Substance-induced Psychotic Disorders
  • III) Mental Health Step Down A male or female who lacks the skills to function in a general population prison setting and is willing to work with Psychiatry Services.
  • IV) Resolve A male or female with a current diagnosis of a mental illness related to physical, mental and/or intimate domestic violence or traumatic PTSD
  •  V) Skills A significant functional impairment due to intellectual disabilities, neurological and/or remarkable social skills deficits such as Autism Spectrum Disorder, Obsessive Compulsive Disorder, Epilepsy, Alzheimer’s, Parkinson’s or Traumatic Brain Injuries (TBIs) to mention just a few.
  •  VI) Stages  A male inmate with a serious mental illness and a primary diagnostic of Borderline Personality Disorder, along with a history of unfavorable institutional adjustment.
  • VIIa) Sex Offender Non-Residential Single Sex Crime, or first time Internet Sex Offense
  • VIIb) Sex Offender Residential Multiple sex crimes.
  • VIIc) Butner’s Commitment and Treatment Program for Sexually Dangerous Persons, Page 12Is considered for sexually dangerous persons with the possibility of criminal recidivism
  • VIII) Female Integrated Treatment Is a female with substance abuse (RDAP Eligibility Possible), trauma-related disorders, and other mental illnesses. (FIT) Program

Medication availability falls into 3 tiers:

  1. On the BOP Formulary (available).
  2. Non-Formulary; these require a lengthy preauthorization process.
  3. Last: these are just not available. While similar medications are substituted, how is their efficacy verified?

Security Requirements

  1. Offense Level vs Criminal History Calculation
  2. Criminal History Calculation
  • +3 points for each prior sentence > 1 Year + 1 Month.
  • +2 points for each prior sentence > 60 days, not counted above.
  • +1 point for each prior sentence, <= 60 days not counted above; for up to a maximum of 4 points in this category.
  • +2 points for each revocation that has a new charge or occurs under federal supervision.
  • + 1 point for each prior sentence resulting from a conviction of a crime of violence that did not receive any points as noted above because such sentence was treated as a single sentence, up to a total of 3 points for this subsection.

The BOP and Prison Security Level Placement

  1. (Program Statement P5100.08, Chapter 4: Pages 5-13 and Chapter 5: Pages 12-13)

Helpful articles in preparation for the sentencing hearing;

  1. Judges are interested in placement recommendations; By Alan Ellis, • THE FEDERAL LAWYER • September 2017
  2. When recommending a facility placement; BY ALICIA VASQUEZ AND TODD BUSSERT, How Federal Prisoners Are Placed, Published in Criminal Justice, Volume 31, Number 1, Spring 2016. © 2016 by the American Bar Association
The Presentence Report – A Medical, Medication, and Security Requirement Referral

PPRSUS.com

As found in my LinkedIn 2/29/2020 post

A Broad Overview Outline of the Federal Sentencing and Placement Process

1st: Federal Defendants once indicted, >80% likely will be sentenced to federal prison

2nd: The defendant’s 1st appearance in court

  • ~80%, can result in either a plea or verdict of guilty
  • Between the Defendants 1stand, 2nd court appearance; a resume or CV of the defendant’s background is developed: called the Presentence Report (PSR).
  • The PSR is where the Defense Team Can make a Placement Request, while documenting the defendant’s medical, criminal, work & education histories, etc.

3rd: The defendants 2nd court appearance is for the Sentencing Hearing

  • The details of sentencing are not taught in most law schools
  • Judges determine the length of time the defendant is imprisoned
  • Judges can also make a placement request to the BOP

4th: The BOP determines placement

  • Some of the factors that affect placement (BOP Policy Statement P5100.08 (Chapter 4 Pages 5-13 and Chapter 5 Pages 12-13):
    • Judges recommendations
    • Public Safety Factor (PSF) Variables
      • Accepting Responsibility
      • Age
      • Criminal History
      • Education Level
      • Legal Release Residence
    • Management Variables; Pre-determined Security levels
      • Disruptive Group-confirmed member
      • Greatest Offense Severity #
      • Greatest Severity Offense
      • Prison Disturbance
      • Serious escape
      • Serious Telephone Abuse
      • Sex Offender
      • The threat to Government Officials
    • Medical CARE LEVELS I-IV Structure
    • Mental Healthcare CARE LEVELS I-IV Structure
    • Psychology Treatment Programs
    • Medication Availability
      • On Formulary, or available
      • Non-Formulary requires a lengthy preapproval process
      • Or Just Not Available, where a similar substitute may be implemented

BOP Psychology Programs and Mental Healthcare

info@PPRSUS.com   240-888-7778

PSR/Sentencing and Placement Preparation: BOP Mental Healthcare Programs

If your client has replied ‘Yes’ to the questions (I- IX) below, one of these 9 BOP Mental Healthcare Programs may provide the best mental illness placement option for your client.

RDAP eligibility and an overview are covered in section VIII.

I) Is your client a first-timer young male offender 32 years of age or younger, facing a sentence of 60 months or more?

  • If yes, would your client be interested in participating in a program that teaches how to create a smoother adjustment to federal Prison?
  • Will they be sentenced to a medium-security facility?
  • If all three answers are yes, this program may help □;
Brave Program- Facility Locations:
    • FCI Victorville, CA-Medium
    • FCI Beckley, WV-Medium

II) Is your client a male inmate in (or facing) a high-security penitentiary setting with a history of substance abuse/dependence or a major mental illness as evidenced by a current diagnosis of a Psychotic Disorder that may include; Mood, Anxiety, Schizophrenia, Delusion and/or a Substance-induced Psychotic Disorder?

  • If the answers are yes, this program may help □;
Challenge Program – Facility Locations:
    • USP Big Sandy, KY-High
    • USP Hazelton, WV-High
    • USP Lee, VA-High
    • USP McCreary, KY-High
    • USP Allenwood,PA-High
    • USP Canaan, PA-High
    • USP Beaumont, TX-High
    • USP Coleman I, FL-High
    • USP Coleman II, FL-High
    • USP Pollock, LA-High
    • USP Tucson, AZ-High
    • USP Atwater, CA-High
    • USP Terre Haute, IN-High
    • USP Coleman I, FL (H)
    • USP Coleman II, FL (H)

III) Is your client a male or female with a serious mental illness, but who does not require inpatient treatment?

  • Do they lack the skills to function in a general population prison setting?
  • Would they be interested in a mental healthcare program that works closely with Psychiatry Services to ensure they receive appropriate medication and have the opportunity to build a positive relationship with the treating psychiatrist?
  • If your answers are yes, this program may help: □;
Mental Health Step Down Program- Facility Locations:
    • FCI Butner, NC-Medium
    • USP Atlanta, GA-High

* Male inmates with a primary diagnosis of Borderline Personality Disorder are referred to the STAGES Program

IV) Is your client a male or female with a history of mental illness related to physical, mental, intimate domestic violence or traumatic PTSD?

  • Would your client be interested in a mental healthcare program that focuses on the development of personal resilience, effective coping skills, emotional self-regulation, and healthy interpersonal relationships?
  • If both answers are yes, this program may help: □;
Resolve Program- Facility Locations:
    • FPC Alderson, WV-Minimum (F)
    • SFF Hazelton, WV -Low (F)
    • SCP Lexington, KY-Minimum (F)
    • SCP Greenville, IL-Minimum (F)
    • FCI Aliceville, AL-Low (F)
    • SCP Coleman, FL-Minimum (F)
    • SCP Marianna, FL-Minimum (F)
    • FCI Tallahassee, FL-Low (F)
    • FCI Dublin, CA-Low (F)
    • SCP Victorville, CA-Minimum (F)
    • ADX Florence, CO-Maximum (M)
    • FCI Waseca, MN-Low (F)
    • FCI Danbury, CT-Low (M)
    • SCP Danbury, CT-Minimum (F)
    • FSL Danbury, CT-Low (F) (Activating)
    • FFPC Bryan, TX-Minimum (F)
    • FMC Carswell, TX-Adm. (F)

V) Does your client have a significant functional impairment due to intellectual disabilities, neurological deficits, and/or remarkable social skills deficits?

  • For example, do any of these apply to your client: Autism Spectrum Disorder, Obsessive- Compulsive Disorder, Epilepsy, Alzheimer’s, Parkinson’s or Traumatic brain injuries (TBIs) to mention just a few?
  • Would your client be interested in improving their institutional adjustment and likelihood for successful community reentry?
  • If your answers are yes, this program may help: □;
Skills Program- Facility Locations:
    • FCI Coleman, FL-Medium
    • FCI Danbury, CT-Low

Note:

New Drug Improves Empathy And Social Skills In People With Autism; 2 May 2019, 7:00 am EDT By Rina Doctor Tech Times

Dental care is tough to find for people with autism
Inmate patients (who need specified dental procedures) with autism and other developmental disorders require general anesthesia for non-routine dental work. Most dentists are not equipped to provide it, and insurers will not cover general anesthesia for root canals.

VI) Is your client a male inmate (or facing prison) with serious mental illnesses and a primary diagnosis of Borderline Personality Disorder, along with a history of unfavorable institutional adjustment linked to this disorder?

  • Would they be willing to volunteer for this mental healthcare program?
  • If both answers are yes, this program may help: □;
Stages Program- Facility Locations:
    • FCI Terre Haute, IN-Medium
    • USP Florence, CO-High (Effective 9/ 2014)

VII) Sex Offender Conviction(s)

VIIa) Sex Offender Treatment Program: Nonresidential (SOTP -NR)

  • Is your client considered a low to moderate risk sexual offender?
  • Does your client have a history of a single-sex crime; or are they serving a sentence for first time Internet Sex Offense?
  • If both answers are yes, this program may help: □;
SOTP-NR Program- Facility Locations:
    • FCI Petersburg- Medium
    • FCI Englewood,CO-Low
    • USP Marion, IL-Medium
    • FCI Elkton, OH-Low
    • FMC Carswell, TX-Med. Ctr.(Females)
    • FCI Seagoville, TX-Low
    • FCI Marianna, FL-Medium
    • USP Tucson, AZ-High

VIIb) Sex Offender Treatment Program: Residential (SOTP -R)

  • Is your client considered a high-risk sex offender?
  • Does your client have a history of multiple sex crimes (re-offense sex offender), extensive non- sexual criminal histories, and/or a high level of sexual deviancy or hyper-sexuality?
  • Does their criminal history include; rape, sodomy, incest, carnal knowledge, transportation with coercion, a force for commercial purposes or sexual exploitation of children, unlawful sexual conduct with a minor, and/or internet pornography?
  • If your answers are yes, this mental healthcare program may help: □;
SOTP-Residential Program– Facility Locations:
    • USP Marion, IL-Medium
    • High FMC Devens, MA-Med. Ctr.

VIIc) New: Commitment and Treatment Program for Sexually Dangerous Person’s.

  • Is your client a candidate for psychological treatment, implementation of a behavior management plan, and coordination of a multidisciplinary treatment team?
  • Can your client be considered sexually dangerous with the possibility of criminal recidivism?
  • If both answers are yes, this program may help □;
Butner ‘New’ Commitment and Treatment Program – Facility Location:
    • FCC Butner, NC

VIII) RDAP
To verify RDAP eligibility, in addition to drug and alcohol abuse, prescription medications along with other medications available over the counter are also included.

According to the American Bar Association: there must be a verifiable, documented pattern of substance abuse or dependence within the 12-month period preceding arrest.

IX) NEW: The Female Integrated Treatment (FIT) Program

  • Is your client a candidate for cognitive-behavioral treatment for females with substance use disorders, mental illness, and trauma-related disorders to female inmates?
  • Would your client also qualify for RDAP and those treatment plans which would also address substance use in this residential program may qualify for the early release benefit associated with RDAP?
  • If your answer is yes, this program may help □;
FIT Locations:
    • FSL Danbury, CT-Low – The New (FIT) Program

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A Medical Resource

UpToDate

An evidence-based clinical decision support resource (one of many), that is authored and peer-reviewed exclusively by physicians who are recognized experts in their medical specialties.

Healthcare in the Federal Bureau of Prisons (BOP)

BOP Medical CARE LEVELS I-IV 

Federal PSR / Sentencing Preparation 

info@PPRSUS.COM

240.888.7778

I.              Medical CARE LEVELS I-IV

How and where inmates are placed according to their medical and mental healthcare needs is via the BOP’s CARE LEVEL I-IV structure.

  • Medical CARE LEVEL I [under 70, healthy, needing limited to no medical contact].
    • Inmates are generally healthy, but may have limited medical needs that can be easily managed by clinician evaluations every 6 months and are located approximately one hour or more from community medical centers.
    • Inmates are less than 70 years of age.
    • Examples: mild asthma or diet-controlled diabetes not requiring medications.
      • FCI Manchester, Medium [Includes Satellite Camp], KY.
      • FCI Three Rivers, Medium [Includes Satellite], TX.
      • FCI Bennettsville, Medium [Includes: Satellite Camp], SC.
      • FCI Williamsburg, Medium [Includes Satellite Camp], SC.
      • FCI Herlong Medium [Includes Satellite Camp], CA.
      • FPC Yankton, SD.
      • FCI McKean, Medium [Includes Satellite Camp], PA.
      • USP Atwater, [Includes Satellite Camp], CA.
      • FCI Oxford Medium [Includes Satellite], WI.
      • USP Big Sandy, [Includes Satellite Camp], KY.
      • FCI Ray Brook,[Includes Detention Ctr], NY.
      • USP Lee,[Includes Satellite Camp], VA.
      • FCI Safford ‘Low’, AZ.
      • USP Pollock,[Includes Satellite Camp], LA.
      • FCI Sandstone Low, MN.
      • USP Yazoo City , Yazoo City FCC[Low-Med] MS.

 

  • Medical CARE LEVEL II [the majority of BOP facilities, overall healthy with routine medical visits)
    • Inmates are stable outpatients who require at least quarterly clinician evaluations and are located within one hour of major regional medical centers.
    • Can be managed in chronic care clinics, including mental healthcare issues.
    • Examples: medication controlled diabetes, epilepsy and emphysema.

For those inmates with Medical (and Mental Healthcare) Care Levels 3 and 4, the designation decision will be made by The Office of Medical Determinations and Transportation (OMDT).

Example of CARE LEVEL III Requirements

e.g.: Psychiatric Out Patient, Unable to perform their Activities of Daily Living (ADL)

Example of CARE LEVEL IV Requirements

e.g.: Dialysis, or needing inpatient hospital care; 24/7

  • Medical CARE LEVEL III [outpatient care or unable to perform ADL]
    • Inmates are fragile outpatients who require frequent clinical contacts to prevent re-hospitalization, and may be located within Level IV institutions.
    • May require assistance with activities of daily living, but does not need daily nursing care.
    • Examples: cancer in remission less than a year, advanced HIV disease, severe mental illness in remission and on medication, severe congestive heart failure, end-stage liver disease.
    • Designation is done by BOP’s Office of Medical Determinations and Transportation (OMDT).
      • FCC Butner (other than Low, FMC) NC.
      • USP Terre Haute (Minimum, Medium & High) IA.
      • USP Tucson FCC (Female); AZ.
      • FCI Terminal Island (Low) CA.
      • FCI, Med, USP: Allenwood, Pa.
      • FCI Tucson,[Medium w/Detention Ctr] AZ.
  • Medical CARE LEVEL IV [Hospitalization required]
    • Functioning is severely impaired.
    • Requires 24-hour skilled nursing care or assistance.
    • Examples: cancer on active treatment, dialysis, quadriplegia, stroke or head injury patients, major surgical patients, acute psychiatric illness requiring inpatient treatment, high-risk pregnancy.
    • Requesting a CARE LEVEL IV placement should be carefully considered as the inmates there are of all security levels, including both violent and non-violent offenders.
    • There are seven Federal Medical Centers (A brief overview)
      • FMC Butner (North Carolina); the cancer center for the BOP, provides inpatient mental healthcare and houses all security levels.
      • FMC Carswell (Texas); the only facility just for women.
      • FMC Devens (Massachusetts); provides dialysis, one of several facilities that provide a residential sex offender program, along with inpatient mental healthcare.
      • FMC Forth Worth (Texas)
      • FMC Lexington (Kentucky); for lower security inmates.
      • FMC Rochester (Minnesota); contracted with the Mayo Clinic providing all levels of complex medical care along with inpatient mental healthcare.
      • FMC, Springfield (Missouri); higher security, dialysis and inpatient mental healthcare services.

II         Mental Healthcare (MH) – CARE LEVELS I-IV

(Location Levels I-IV are the same as above)

Unfortunately, in general the BOP is not equipped to provide any meaningful treatment for the following underlying disorders, several examples:

□ Post-traumatic stress disorder

□ Major depressive

□ Bipolar

□ (Eye Movement Desensitization and Reprocessing) for treatment of PTSD is not available.

As medical staffing differs from one facility to another, and if the care by chance is available within the BOP; this  may necessitate a transfer to a facility further away from their home.

*Alan Ellis and J. Michael Henderson (July 19, 2018); How To Do Time- Part IV.

  • MH CARE LEVEL I[under 70, healthy with limited medical visits]
    • No Remarkable Issues, no significant level of functional impairment.
    • No history of regular Mental Illness Interventions, seeking help should there be a returning episode.
  • MH CARE LEVEL II [the majority of BOP facilities, overall healthy with routine medical visits)
    • ‘Routine and/or Infrequent Crisis Oriented Outpatient’ Care.
    • Treatments Controlled with medication.
    • May require suicide watch or brief observation.

For those inmates with Medical (and Mental Healthcare) Care Levels 3 and 4, the designation decision will be made by The Office of Medical Determinations and Transportation (OMDT).

  • MH CARE LEVEL III [outpatient care, not able to perform ADL]
    • ‘More Severe Outpatient’ or Residential Mental Healthcare.
    • May require weekly mental healthcare visits or Residential Psychology Treatments.
  • MH CARE LEVEL IV [Hospitalization required]
    • ‘Inpatient’ Psychiatrist Monitored, includes those who are:
      • Gravely disabled and cannot function in general population as in MH Care Level III.
      • Has a current or recent historical need for inpatient psychiatric care.
      • Requires psychotropic medication control may require MH Care Level IV.
      • Requesting a CARE LEVEL IV placement should be carefully considered as the inmates there are of all security levels that includes both violent and non-violent offenders.

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UpToDate – A Medical Resource

An evidence-based clinical decision support resource that is authored and peer-reviewed exclusively by physicians who are recognized experts in their medical specialties.

Probation Officers: their impact on the PSR and final prison placement

Probation officers representing the court will:

  • Receive and evaluate pre-sentence investigation requests.
  • Identify and pursue leads to obtain evidence.
  • Gather and document evidence by interviewing involved parties, obtaining statements, reviewing and analyzing records and files, etc.
  • Gather criminal history, police reports, victim impact statements, criminal complaints and information and review prior to interview with offender.
  • Inform crime victims of their rights.
  • Assist the victim advocates in coordinating victim requests for offender information; victim issues such as recovery from injury, financial losses, or victim mediation; preparation of victim impact statements and reports; communicate offender progress and victim assistance to various local, state, and federal officials, and to treatment staff.
  • Conduct offender criminal history checks, warrant inquiries, and driver’s license abstract checks.
  • Compile and maintain history and case records.
  • Inform offenders of their rights, responsibilities, and purposes of the pre-sentence investigation process.
  • Interview offenders required by the courts to have a pre-sentence investigation completed.
  • Utilize PSI interview guide and the Criminogenic Domains of Criminal History, Education/Employment, Financial, Family/Marital, Accommodation, Leisure/Recreation, Companions, Alcohol/Drug, Emotional/Personal, and Attitude/Orientation.
  • Complete various extensive assessment tools to gauge offender risk and needs.
  • Collect PSI fees.
  • Coordinate investigations with other law enforcement agencies, regulatory agencies, and other relevant entities.
  • Confirm information gathered during interview.
  • Communicate with the appropriate Department of Corrections and Rehabilitation staff, other state agencies, related organizations, other entities, volunteers, and the public to provide information, referral services, technical advice and consultation regarding PSI.
  • Communicate with Courts, attorneys, law enforcement, and other agencies involved in a court-ordered pre-sentence investigation.
  • Document interview and investigation.
  • Prepare investigative reports and recommend administrative, legal, and/or sentencing action.
  • Present evidence to prosecutors, legal staff, or courts.
  • Prepare and present testimony as required for legal proceedings or administrative hearings.
  • Report offender compliance with the presentence investigation to courts.
  • Summarize information gathered during investigation and interview into the pre-sentence format.
  • Make sentencing recommendations based on sentencing guidelines and a thorough analysis of criminal history, medical and mental healthcare history allowing for continuity of care, medication availability, offender risks, resources, and evidence-based practices.
  • Ensure the report is distributed according to Applicable Code standards.
  • Monitor programs for compliance with state and federal laws compliance.
  • Gather, compile, and maintain statistics for required and requested reports.
  • Investigate and confirm the information on offender release plans or interstate compact investigations. Maintain working knowledge of the Department of Correction and Rehabilitation (DOCR) programs and community bases programs that are available for offenders.

Note: The duties of probation officers listed above are not intended to be all-inclusive.

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.

_______________________

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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