Archive 11/21/2018

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.

Photo Credit:


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.

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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.