Research project DR/26 (Research action DR)
1. Problem definition
International research indicates the elevated prevalence of co-morbidity among drug abusers (a combination of a major psychiatric disorder and substance abuse). Especially within correctional or other secure contexts, many persons seem to fulfill the criteria of having a ‘dual diagnosis’. Besides negative effects for individual dually diagnosed persons, particularly because there is no well-developed comprehensive system of prison-based treatment services up until now, co-morbidity also negatively influences the atmosphere in prisons or secure settings for mentally ill offenders. However, according to recently published studies the reported (high) prevalence rates heavily depend on the used assessment methods. This finding underscores the importance of more systematic, comprehensive, accurate and adapted procedures for assessment and diagnosis of co-morbidity in special target groups. Particularly within secure settings, including correctional establishments and institutions for mentally ill offenders, the implementation of assessment procedures is affected by specific conditions. Existing instruments are often not validated for prison populations, there is a high risk of socially desirable answers or other forms of respondent bias and the administration of complex assessment protocols is hampered by practical and financial difficulties. Therefore, currently used screening and assessment methods are often limited to pencil-and-paper self-report instruments.
2. Objectives
The major objective of this research project focuses on the development of an adapted assessment method for screening psychiatric and substance abuse disorders in detainees and incarcerated mentally ill offenders in (psychiatric wards of) Belgian correctional establishments and other secure settings.
A first goal consists of mapping the currrent state of practice, focusing on currently available methods. Moreover, we will make an inventory of the available instruments.
A second important objective is the exploration of the current state of scientific knowledge concerning the assessment of psychopathology and substance abuse ('dual diagnosis') in Belgium and abroad. This includes the description of examples of national and international 'good practices'. Besides a broad, general review of the literature, specific attention will be given to studies within prison settings and to the accompanied special features. The necessity of specific forensic approaches will be investigated as well (for instance with regard to differences between high risk and medium risk residents).
Consequently, the third objective contains the mapping and further exploring of the ‘setting specific conditions' (professional secrecy, judicial and security issues, etc.) and the financial and practical implications of the proposed assessment method.
The fourth and last goal focuses on the actual development, evaluation and potential adaptation of the assessment method and script.
3. Methodology
The study is divided in two, partly synchronized parts. The first section primarily focuses on the development of an adapted assessment method and script, in order to gain more insight in treatment and support needs (concerning psychiatric disorders, substance abuse and co-morbidity) of detainees and incarcerated mentally ill offenders in Belgian secure settings. The second part of the study aims at clarifying facilitating and inhibiting factors with regard to the proposed method. Meanwhile, an estimation of the financial implications of the procedure will be part of this second section as well.
In the first phase of the first part a telephone survey will be conducted to inventory the currently available assessment protocols for substance abuse, psychiatric disorders and co-morbidity in Belgian prisons (n=34).
The second phase consists of an exploration of the literature and the consultation of several (inter)national experts in order to assemble expertise regarding screening in correctional settings. This phase will result in a survey and an inventory of instruments for screening psychiatric and substance abuse disorders (and co-morbidity). A description of 'good practices' is the main objective of this research part. If possible, one or more settings will be visited by the researchers.
The third phase concerns the development of an adapted assessment method and related script, based on the acquired information from phase 1 and 2. Hereby, the implementation of setting specific (criminal justice, security, etc.) conditions (cf. part two) will be emphasized. Alongside identifying necessary instruments to assess prevalence and nature of dual diagnosis in prison, the feasibility of the proposed instruments will be stressed. These instruments do not only result in a diagnosis and an overview of related treatment and support needs, but they also provide (further) insight in the prevalence of co-morbid psychiatric disorders within Belgian secure settings.
In a fourth phase the proposed method and the related script will be tested in a limited sample. Therefore, a pilot study will be carried out in four correctional facilities (two in Wallonia and two in Flanders, i.e. per region one establishment for 'regular' detainees and one for incarcerated mentally ill offenders). This research aims at:
a. testing of the validity of the proposed assessment instrument(s);
b. exploring the feasibility of the script in correctional establishments, focusing on the outlined setting specific conditions;
c. investigating whether or not the instrument could be used for epidemiological purposes regarding the prevalence and nature of dual diagnosis in correctional settings.
The proposed assessment script will be administered to a randomly selected sample of newly admitted detainees and mentally ill offenders (n=60; 15 per secure setting). The script will be rigorously followed, evaluated and - if necessary - adapted. Next to fine-tuning the assessment method, this pilot study will result in a preliminary indication of the number of dually diagnosed persons in Belgian correctional establishments. The development of an effective system to manage the obtained prevalence data will be one of the research topics in this phase as well.
Chronologically, the second part overlaps with the four phases of the first research section (cf. supra). The most important objective focuses on mapping the setting specific conditions with regard to the development and implementation of the proposed assessment method. The following components are essential:
a. identification of the various parties involved in the assessment and treatment process;
b. study of the judicial framework, including the legal components of (coerced) drug testing in Belgian prisons, with special attention to human health rights (cf. basic law on the judicial position of detainees, 2005);
c. inventory of the organisational conditions concerning diagnosis, assessment and treatment services;
d. estimation of the financial implications with regard to the implementation of the suggested research script, including personnel and operational costs (e.g. estimated duration of assessment moment, time and resources needed to analyze the data, role of several parties within the diagnostic process, etc.).
Likewise, parallels to foreign situations will be drawn.
In conclusion, the intended purpose of this research project is the development and testing of an adapted assessment method for screening psychiatric and substance abuse disorders in detainees and incarcerated mentally ill offenders in (psychiatric wards of) Belgian correctional establishments and other secure settings, based on the inventory of the Belgian state of practice, the results of the literature review and the description of the good practices.
Druggebruik en psychopathologie in gevangenissen : een exploratieve studie tot methodiekontwikkeling = Usage de drogue et psychopathologie dans les prisons : une étude exploratoire pour le développement d'une méthodologie
De Wilde, Joke - Soyez, Veerle - Vandevelde, Stijn ... et al Gent : Academia Press, 2007 (PB6186)
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Druggebruik en psychopathologie in gevangenissen: Een exploratieve studie tot methodiekontwikkeling : samenvatting
Brussel : Federaal Wetenschapsbeleid, 2007 (SP1738)
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Usage de drogue et psychopathologie dans les prisons: Une étude exploratoire pour le développement d’une méthodologie : résumé
Bruxelles : Politique scientifique fédérale, 2007 (SP1793)
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Substance abuse and psychopathology in correctional establishments: an exploratory study on the development of a method : summary
Brussels : Federal Science Policy, 2007 (SP1794)
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Inventarisatie van screening en assessment instrumenten voor middelenmisbruik en/of psychopathologie
Brussel : Federaal Wetenschapsbeleid, 2007 (SP1795)
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