Measuring Level of Function in Mentally Ill Prison Inmates: A Preliminary Study .
V. L. Harris and D. Lovell,
Journal of the American Academy of Psychiatry and the Law
29(1): 68-74, 2001.
The need to portray accurately the level of functioning and severity of psychiatric
symptoms among mentally ill offenders (MIOs) is paramount from several perspectives. The
prison environment may cast aspersions on the reliability and validity of commonly used functional
assessment tools. In addition, these tools do not capture environment-specific areas that may be of
interest to the courts, clinicians, community mental health centers, and other correctional facilities.
Male MIOs (n = 61) who had been treated for at least three months in a (male) Washington state
prison mental health program were evaluated using clinical assessment tools, data abstraction
from medical records, and structured assessments from correctional officers. Clinical assessments
occurred at their current site of incarceration. The semistructured clinical assessments had high
construct validity and correlation for psychiatric symptoms and diagnosis. The ability of
evaluators to determine accurately relative treatment compliance within the prison was low
compared with the reports from correctional staff, particularly with respect to attendance at
programs. In general, the officers did not recognize lack of program participation and reclusive
behavior as potential signs of mental illness. Despite a significant history of psychiatric symptoms
severe enough to warrant inpatient treatment, 70 percent of the MIO individuals were functioning
reasonably well in a general population. A fully informed functional assessment of MIOs likely
requires input from both clinicians and correctional officers.