I research clinical, social and political challenges to providing both mental health treatment and end of life care for persons who are incarcerated, and those at risk for recidivism. Most recently I have been investigating peer-care models for the delivery of effective and sustainable prison hospice care.
Statement of Interest: Correctional health programs in the US are faced with two convergent problems of epic proportions: 1) The US correctional system (state prisons, community jails and federal institutions) has become our nation’s largest mental health “system”, housing and providing services to more persons with mental illness than any other sector, at any level, in the country; 2) Elderly prisoners are now the fastest growing segment of the US prison population, and a growing number of prisoners have chronic comorbidities and life limiting illness. More prisoners will die while incarcerated, affected by the sequelae of structural violence including chronic illness, poverty, addiction, disparate access to health care and illness prevention, racist sentencing policies and an historical lack of political and economic will to provide adequate health care for those we incarcerate. Corrections administrators and staff see the influx of persons with SMI and the needs of aging prisoners both as significant challenges to their mission correctional institutions are largely ill-suited and ill-equipped to adequately provide care for seriously mentally ill or debilitated prisoners.
Completed Research: My doctoral research (F31 NR07826-01A1) examined how prisoners, staff and administrators in a supermaximum security prison understand mental illness and negotiate interactions and resource use based on this context. My early research as an assistant professor at Utah focused on recidivism rates and risk for persons with SMI. Through a series of studies based on prison and community mental health data spanning 1995-2010, we found the following: 1) A sizable contingent (23%) of the Utah State prison population met criteria for SMI; 2) Recidivism rates (calculated via survival analysis) for this group were significantly higher than all other persons in the same time period-- controlling for demographic, crime-related and condition of release data, this difference is attributable to factors directly related to SMI; 3) An index of severity of illness, constructed from historical and clinical data for the SMI sample, showed variability in illness severity, and higher severity was associated with increased survival risk and shorter community tenure post-release; 4) Latent class analysis confirmed the association of illness severity and survival, and indicates significant and clinically relevant heterogeneity in this sample; 5) Gender-based comparisons within our sample showed that, while women tended to have lower recidivism rates in general and were also more likely to remain connected to children and community, having an SMI had a greater negative effect of the trajectory on women than men; 6) Only 7% of persons with SMI in our sample who were released from prison received mental health services post-release; 7) Logistic regression of factors that predicted service receipt vs. non-receipt showed that women and those with substance abuse histories were less likely to receive services post-release while men with psychotic illness of high severity were most likely to receive services.
Current Research: Through engaging in research with prisons and criminal justice involved groups over the past decade, like a growing number of providers and researchers I have become acutely aware of issues related to the exponential increase in numbers of aging prisoners. Older prisoners are now the fastest growing segment of the US prison population, with higher prevalence of chronic and comorbid illnesses, age-related dysfunction, depression and anxiety than their free-world counterparts. They also face risks amplified by the prison environment such as fear of victimization, loss of social status, and diminished physical and social autonomy. Moreover, more prison inmates than ever before will face life-limiting illness and death while incarcerated. My current program of research focuses on identifying clinical, social and organizational characteristics of sustainable and effective models of prison-based geriatric, EOL, palliative and hospice care. I am particularly interested in prison hospice and EOL programs that use inmate volunteer models to provide 1:1 peer care, including how such approaches affect patient outcomes, the wellbeing of participating volunteers, and institutional culture. Since August 2010 I have led a team of researchers engaged in mixed methods field research, in partnership with the Louisiana State Penitentiary at Angola, to study their long running volunteer-centric prison hospice program. Our goal is to extend research on prison aging, EOL, palliative and hospice care models into multi-state and multi-model comparison studies, to increase our shared knowledge of effective and sustainable EOL care in corrections.