Tag schizophrenia

Federal Sentencing: From PSR Preparation To Drafting The BOP Placement Request

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In ALL cases, preparing for the Sentencing Hearing should start as soon as possible.
Why?
a) Depending on whether it’s a state or federal case, there may only be weeks (or months) after the guilty verdict.
b) Getting all medical records via the HIPPA release can take a long time as some physicians and hospitals have been busy, especially in the age of COVID-19. HIPAA-COMPLIANT AUTHORIZATION FOR THE RELEASE OF PATIENT INFORMATION PURSUANT TO 45 CFR 164.508.
c) Coordinating character references, expert witnesses, and documentation for their PSR all takes time.
d) Developing the PSR, along with recommendations for placement, takes time.

 

I- The Presentence Report is used by;
1st) Judges
To establish the length of the sentence, along with they have the option to make a placement request.

2nd) The BOP, For Use It For Facility Placement.

3rd) Probation: Use it during Supervised Release.

4th) It then becomes a permanent part of the defendant’s record.

5th) Lastly, for inmates, it’s referred to as the ‘Inmates Bible.’

 

II) Sentence Length Determined By The Court based on;

2021 (Released), Judiciary Sentencing INformation (JSIN) In real-time, the platform provides quick and easy online access to sentencing data for similarly situated defendants – An Updated USSC Sentencing Table.

USSC Sentencing Table (Point Based), [2018, CHAPTER 5: SENTENCING TABLE]
Offense Level (0-43+): *24+ categories.

Vs
Criminal History (0-13+)
Points for each prior sentence > 1 Year + 1 Month.
Points for each prior sentence > 60 days, not counted above.
Point for each prior sentence, <= 60 days not counted above, for up to a maximum of 4 points in this category.
Points for each revocation with a new charge or under federal supervision.
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.

 

III) BOP Determines Placement Designation
1st) Healthcare: provided based on a CARE LEVEL I-IV Structure
Applies to Medical and Mental Healthcare CARE LEVELs.
Psychology and Life Skills National Programs have now been embedded into the First Step Act, with its limited availability and associated security requirements.
There are approximately 3,500 Medications in the BOP, which fall into 3 tiers. PPRS Prison Match™ has all of these drugs categorized by tier level should this apply to your client.
Is there a special diet request?
Allergies: all need to be documented in the PSR.

2nd) Non-Medical Placement is based on;
Bed Space Availability. 
Aspirational: placement within 500 driving miles of legal residence.
Population Management: some inmates, for specified reasons, need to be monitored or separated from others.

2a) Public Safety Factors (PSF) & Management Variables [P5100.08, CN-I, 9/4/2019, Tables: Chapter 5, pages 12-13]
Could a Public Safety Factor (PSF: Chapter 4, pages 5-13) warrant a reduced security level?
Accepting Responsibility (may get point reductions).
Voluntary Surrender (gets point reductions).
Drug / Alcohol Abuse may allow RDAP.
RDAP; Required usage is within 1 year prior to the date arrested (illegal or legal medications or drugs).
AGE: 55+ (0Pts), 36-54 (2pts), 25-35 (4pts), <25 (8pts), Unknown (8pts).
Education Level: High School (0pts), GED Progress (1pt), No degree (2pts).

Sentence Length
>10 years – Low
>20 yrs – Medium, (Females: High)
>30 yrs – High

Disruptive Group
Male inmates will be housed in a High-security level institution unless the PSF has been waived.

Greatest Severity Offense
Males will be housed in at least a Low-security level institution unless the PSF has been waived.

Threat to Government Official
Male or female will be housed in at least a Low.

Deportable Alien: (male inmate who is not a citizen will be housed in at least a Low).

History Violent Behavior
A female inmate whose current term of confinement or history involves two convictions or findings – Low.

Serious Escape
A female, serious escape with the last 10 yrs. designated to Carswell Adm. Unit unless the PSF has been waived.
A male inmate with or without the threat of violence or escapes housed in at least a Medium.

Juvenile Violence
A male or female who has any documented:
a) Violent behavior, past or present, which resulted in a conviction, delinquency adjudication, or finding of guilt.
b) Violence: aggressive behavior causing bodily harm, death, or behavior likely to cause serious bodily harm. 

Serious Phone Abuse
a) A male or female who utilizes the telephone to further criminal activities or Promote Illicit Organizations.
b) Conviction is Not Required, housed at least in a Low.
c) The PSF should be entered regarding any one of the following, if applicable.

Criminal acts conducted by telephone
-Leader/Organizer or primary motivator; or
a) communicate threats of bodily injury, death, assaults, or homicides.
b) conducts Fraudulent activity (actual or attempted) in an institution.
-Leader / Organizer who used the telephone to conduct fraudulent activity (actual or attempted)…
a) Smuggled narcotics or alcohol into a prison.
-Federal Law Enforcement notifies the BOP of concern and needs to monitor an inmate’s telephone calls…
a) The inmate has been found guilty of a 100 or 200-level offense code for telephone abuse.
b) A Bureau of Prisons official has reasonable suspicion and/or documented intelligence supporting telephone abuse.

Prison Disturbance
A male or female inmate who was involved in a serious incident of violence, Engaging / Encouraging a Riot:
a) Males will be housed in at least a HIGH-security level institution and
b) Females will be assigned to the Carswell Adm. Unit.

2b) Plus
a) Judicial Recommendations
b) Options For Work Cadre Participation (at secure facilities without satellite camps), where the inmate is allowed to work outside the perimeter of the institution.
c) PSF Waved: An inmate may receive up to three Public Safety Factors (PSFs) wavers.
d) Long Term Detainee transfers for positive or negative behavior may cause placement in a facility different from the scored security or custody level.

 

IV) Making The Placement Request
In recommending a facility placement, it’s helpful to provide a reason, for example:
To facilitate regular family visitation, or
To permit participation in a specific:
a) Medical CARE LEVEL
b) Mental Healthcare CARE LEVEL
c) Psychology has limited in availability and has associated security requirements.
d) Vocational Training Program
e) UNICOR job availability

 

V) Military: Is your client a Veteran?
If possible, connect your client with a facility that caters to veterans.
FCI Morgantown started a Veterans to Veterans Service Dog Training Program in 2016.
The Participants are federally imprisoned military veterans housed in a special wing responsible for training service guide dogs for veterans with mobility impairments, Post Traumatic Stress Disorder (PTSD), or other military service missions.

If you’d like to discuss this, I look forward to speaking with you.

Dr. Blatstein

Physician Presentence Report Service

info@PPRSUS.com, 240.888.7778

BOP Psychology Programs

By inDr. M Blatstein's Blog Tag , , , , , , , , , , ,
FSA - First step act

 

BOP Psychology Programs

If your client has replied ‘Yes’ to the questions (I- IX) below, one of these 9 BOP Psychology Programs may provide the best 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 □;

BOP 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 □;

BOP 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 psychology 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: □;

BOP 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 BOP 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: □;

BOP 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
    • the likelihood of successful community reentry?
  • If your answers are yes, this program may help: □;

BOP Skills Program– Facility Locations:

    • FCI Coleman, FL-Medium
    • FCI Danbury, CT-Low

Note:

New Drug Improves Empathy And Social Skills In People With Autism; 

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 psychology program?
  • If both answers are yes, this program may help: □;

BOP 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 a first-time Internet Sex Offense?
  • If both answers are yes, this program may help: □;

BOP Sex Offender Non-Residential 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,
    • the 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: □;

BOP SOTP-Residential Program– Facility Locations:

    • USP Marion, IL-Medium
    • High FMC Devens, MA-Med. Ctr.

VIIc) New: BOP Commitment and Treatment Program for Sexually Dangerous Persons.

  • 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 BOP 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 □;

BOP FIT Program and Locations:

    • FSL Danbury, CT-Low – The New (FIT) Program

__________________

A Good 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.

Schizophrenia in Federal Prison

By inDr. M Blatstein's Blog Tag , , , , , , , , , , , , ,
Schizophrenia in Federal Prison

 

In federal prison, Schizophrenia is a mix of symptoms that varies from person to person and affects the mind. When severe, people have trouble staying in touch with reality. It’s hard for someone to think clearly, make good judgments, respond emotionally, communicate effectively, understand reality, and behave appropriately. There is no cure, and treatment requires a psychiatrist-guided team approach, which includes a psychologist, social worker, psychiatric nurse, and possibly a case manager to coordinate care.

Anxiety may present as a component, along with Posttraumatic stress disorder, as a symptom of a co-occurring disorder. While Schizophrenia is a serious brain illness, there is no test for it. Diagnosis requires eliminating what it’s not occurring, in order to identify the symptoms that are present.

There are three types of symptoms:

  1. Psychotic symptoms may distort thinking, including hallucinations, delusions (beliefs that are not true), and organizing thoughts.
  2. Negative symptoms: where you’re not able to show emotions – leaving you to present yourself as depressed and withdrawn.
  3. Cognitive symptoms: Trouble making decisions and paying attention.

There is no cure. Different medications may have to be tried to see which are effective because medications affect each person individually. Once you find the medication(s) that work, stay on them daily, keep your doctor’s appointments and follow their recommendations.

Schizophrenia

Changes in behavior;

Includes delusions and hallucinations – which may last a lifetime.

Delusions; False beliefs, not based on reality, such as another person is in love with you, or a major catastrophe is about to occur.

Hallucinations involve seeing or hearing things that don’t exist. They can be in any of the senses, hearing voices is the most common hallucination.

Disorganized thinking and speech may include putting together meaningless words that can’t be understood, sometimes known as word salad. Extremely disorganized or abnormal motor behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement. All of these behaviors can result in less than optimal interactions between other inmates or with correction staff. The result may be a trip to the hospital or the SHU (isolation), neither is acceptable, and both are preventable.

Negative symptoms can be expressed as, neglecting personal hygiene, appearing to lack emotion, (not; making eye contact, changing facial expressions, or speaking in a monotone), and losing interest in everyday activities, including socially withdrawing.

Treatment is accomplished under the psychiatrist-guided treatment team approach with a case manager coordinating care. The full-team approach may be available in clinics with expertise in schizophrenia treatment. These delusions and hallucinations — may last your lifetime.

First-generation older antipsychotics, introduced in the 1950s – As a class, these provided treatment for acute agitation, bipolar mania, and other psychiatric conditions.

On- Formulary Medications: Haloperidol (Haldol), Perphenazine (Trilafon), Loxapine, Trifluoperazine(Stelazine), and Fluphenazine

Not Available: Flupentixol, Zuclopentixol, Sulpiride, Pimozide, Molindone, Prochlorperazine, Thioridazine, and Thiothixene

Second-generation or atypical antipsychotics,

Some associated side effects; “Schizophrenia in adults, “Bipolar mania and hypomania in adults“,  “Unipolar major depression with psychotic features“,  “Delusional disorder”,   “Brief psychotic disorder”, and  “Treatment of postpartum psychosis”

On Formulary: Clozapine (Clozaril) “Clozapine remains the only antipsychotic that has been FDA-approved for treatment-resistant schizophrenia,” “and it provides effective treatment even when patients do not respond to other second-generation antipsychotics. No existing first- or second-generation antipsychotic is as effective as clozapine monotherapy in treatment-resistant patients. Deanna Kelly, Pharm.D., of the Maryland Psychiatric Research Center (MPRC)” Other Medications: Olanzapine (Zyprexa), and Risperidone (Risperdal).

Medications Non-Formulary: Quetiapine (Seroquel)

Some of the more recent atypical antipsychotics:

Medications Not Available: Asenapine (Saphris), Iloperidone (Fanapt), and Lurasidone (Latuda).

Schizophreniform

Symptoms of schizophreniform

Schizophreniform is a similar disorder that affects how you act, think, relate to others, express emotions, and perceive reality.

Unlike schizophrenia, it lasts one to six months.

A mental condition that can distort the way you:

  • Think.
  • Act.
  • Expresses emotions.
  • Perceive reality.
  • Relate to others.

Medication and Psychotherapy —to help the patient manage everyday problems related to the disorder.

Medications On Formulary: Click here for the article…

Brief psychotic disorder

Involves a sudden, short period of psychotic behavior, often in response to a very stressful event, such as a death in the family. Recovery is often quick — usually less than a month.

The first line of treatment may include atypical antipsychotics.

Medications On Formulary: Click here for the article…

Medications Non-Formulary:   Click here for the article…

For those that have an increased risk of having depression, medications that address this symptom can be an important part of their treatment.

Delusion 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 disease. The delusion lasts for at least 1 month.

The exact cause is not yet known, but researchers are looking at genetic, biological, environmental, or psychological factors.

A cold, detached manner with the inability to express emotion

  • …has an over-inflated sense of worth, power, knowledge, or identity.
  • Jealous
  • …that someone is spying on them or planning to harm them.
  • …believes that he or she has a physical defect or medical problem.
  • …have two or more of the types of delusions listed above.

Symptoms that are ‘non-bizarre’:

  • An irritable, angry, or low mood
  • Hallucinations

Diagnosis: There are no laboratory tests to yield positive results, they are only good to rule out what it is not.

Treatment:

  • Psychotherapy is primary
  • Conventional antipsychotics

First-generation older antipsychotics, introduced in the 1950s – 

1st Generation, Medications On- Formulary for available medications: Click here for the article…

2nd Generation, Medications On- Formulary for available medications: Click here for the article…

Medications Non-Formulary medications require pre-authorization; click here for the article…

Other types of medications:

  1. Antidepressants might be used to treat depression, which often happens in people with delusional disorder
  2. 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 their impact on their lives.
  3. Sedatives and antidepressants might also be used to treat anxiety or mood symptoms if they happen with delusional disorder.
  4. Tranquilizers might be used if the person has a very high level of anxiety or problems sleeping.

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, possibly with an MRI.

Treatment: Psychotherapy aims to ease emotional distress, with medication to ease the symptoms of anxiety.

It cannot be prevented, and the key is to diagnose and treat them as soon as possible.

Substance-induced psychotic disorder

Substance-related disorders involve drugs that directly activate the brain’s reward system which typically causes feelings of pleasure.

The classes of drugs include

·       Alcohol

·       Caffeine

·       Cannabis and synthetic cannabinoids

·       Hallucinogens (eg, LSD, phencyclidine, psilocybin)

·       Inhalants (volatile hydrocarbons [eg, paint thinner, certain glues])

·       Opioids (eg, fentanyl, morphine, oxycodone)

·       Sedatives, hypnotics, and anxiolytics (eg, lorazepam, secobarbital)

·       Stimulants (eg, amphetamines, cocaine)

·       Tobacco

·       Other (eg, anabolic steroids)

Treatment/Management

Clinical judgment, with a proper history, creates a safe environment during the withdrawal period. Due to the relative safety of most antidepressants in the setting of depressive symptomatology, and manic episode guidelines, second-generation antipsychotics, such as Quetiapine (Non-Formulary) or Olanzapine (On Formulary), may also be beneficial as they are faster-acting than mood stabilizers.

Psychotic disorder; 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.

Paraphrenia: symptoms similar to schizophrenia.

It starts late in life in the elderly,

  • Generally has a much better prognosis than other psychotic disorders.
  • Antipsychotic medication can be helpful,
  • Paraphrenia sometimes co-occurs with depression and anxiety

I) BOP Placement Based On Security Level Alone – Without Multiple Medication Needs

The Challenge Program – an EBBR FSA Evidence-based Recidivism Reduction Program for male inmates in Penitentiary (High Security) facilities. Treats those with substance abuse and/or mental illness disorders (psychotic, mood, anxiety, or personality).

II) BOP Placement- With Multiple Medication Needs v Prior Hospitalizations

Here, it depends;

  • the number of types of psychiatric hospitalizations, not related to substance abuse, and
  • the number of multiple diagnoses treated with antipsychotic and/or different psychotropic medications

Influences Mental Healthcare (MH) CARE LEVEL I-IV facility placement.