1. Running head: MENTAL HALFWAY HOUSE 1
A Brief Discussion of a Mental Halfway House Scenario
Tyson G. Campbell, III
American Intercontinental University
Psychopharmacology for Criminal Justice Professionals, CRJS456
August 13, 2016
2. MENTAL HALFWAY HOUSE 2
A Brief Discussion of a Mental Halfway House Scenario
The DSM-IV and GAF
We have been asked to take a given scenario and determine what level of inmate patient
that we would be prepared to admit to a fictional mental health halfway house. This "level" is to
be based on the Five Axis of the DSM-IV and its GAF subdivision. To do that, we must first
give a good and comprehensive overview and understanding of these important assessment
techniques.
The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM
IV) is a tried and true method of classifying mental disorders. It is used throughout the U.S. by
mental health professionals to diagnose and treat their patients as well as creating valuable
statistics on the subject, used for public health records, baseline studies, and future research in
the field (Dive, 2015).
There are five groups of assessment, or axes in this system, designated as I to V. Each
one refers to a separate group of mental disorders. These classifications have proven to be
beneficial to the medical industry as far as insurance and billing purposes are concerned, and the
first is Axis I.
Axis I is a first level diagnosis and involves clinical disorders that focus on the acute and
clear symptoms in need of treatment. This category includes familiar and recognized diagnoses
such as schizophrenia, major depression, somatoform, panic attack, bipolarism, and many others
in several sub-categories (Dive, 2015).
Axis II involves personality disorders and focuses on these and intellectual
disabilities. These issues tend start in one's childhood and follow them for the rest of their
lives. These disorders such as paranoid personality disorder often carry social stigma with them
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because these people do not often function well in society. They are often seen as being
untreatable and may be difficult to correctly diagnose. It is still a matter of dispute as to if this
class of disorder is primarily caused by one's environment, or by genetics (Dive, 2015).
Interestingly, Axis I disorders are often symptomatic of Axis II issues. An example is a
person suffering from serious depression (an Axis I disorder), that can be diagnosed as a result
from a schizoid personality disorder (an Axis II disorder) (Dive, 2015).
Axis III involves general medical conditions and focuses on physical ailments that that
could be relevant to assessing and treating mental conditions. An example is a person who is
diagnosed with multiple sclerosis and later develops depression due to the increasing physical
limitations and pain. The MS would be recorded in the patient's file under Axis IV, as the
depression and increasing pain would be recorded under Axis I. General medical conditions can
be assessed as being directly related to a mental condition, they can be assessed as just part of the
overall diagnostic landscape, or they can be assessed as not having a sufficient relationship at all
(Dive, 2015).
Axis IV involves social and environmental problems and focuses on life stressors such as
family pressures, a radical job change, the death of someone close, and divorce. Such life events
can affect a person's diagnosis of mental health. For example, it's certainly possible for one to
suffer a bout of serious depression during and after a divorce. As above, the depression would
be recorded under Axis I and the divorce under Axis IV. With this diagnosis, the therapist must
be cautious to only include the stressors that actually have relevance to the current mental state.
It is possible that environmental or psychosocial stressors could be so severe that they could be
classified as an Axis I diagnosis, such as sexual abuse (Dive, 2015).
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Axis V involves the Global Assessment of Functioning. This scale is also known as the
GAF mentioned above. It is a 100 point scale, broken into groups of 10, measuring social,
occupational, and psychological functionability in everyday life. This can be a very practical and
effective tool to judge a person's mental health. Ideally, the GAF evaluation is done at the
beginning of treatment and then many times afterward. In this way, the therapist can monitor the
patient's progress with comments attached. The GAF is also important when it comes to
healthcare management. It "provides quantifiable information that is used to measure eligibility
for treatment programs, insurance benefits, disability benefits, etc." (Dive, 2015). The
assessment can take as little as three minutes and therapist normally records the GAF score and
comments as occurring in the "current period." Depending on the situation, this "current period"
may be of the past week, or month, or perhaps half year. The highest and lowest scores during a
period can be recorded (Fritch, n.d.).
GAF Scoring Assessment of Symptoms
100-91 None. Functions through life's problems with no difficulties.
90-81 Minimal. Mild anxiety, but good functioning and socially effective.
80-71 Transient. Expectable, temporary reactions to psychological stressors.
70-61 Mild. Some minor social difficulties but functioning fairly well.
60-51 Moderate. Growing social or occupational difficulties such as panic attacks.
50-41 Serious. Serious social or occupational impairment.
40-31 Reality Impairment. Major impairment in judgement, family, thinking.
30-21 Serious Impairment. Incoherent, suicidal, delusional, dysfunctional.
20-11 Dangerous. Violent to self and others, manic, uncommunicative.
10-01 Persistently Dangerous. Severely violent, no fear of death, no hygiene.
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0 Inadequate information. (Fritch, n.d.).
Now, getting back to the issue of the level of inmate patient we would admit to the
halfway house, this essay's author believes that we would accept no one higher on the GAF level
than a score of 70. These patients could have difficulties such as mid-level depression, mild
insomnia, occasional truancy, theft within a household, and such. We believe that the halfway
house experience would be beneficial to even these patients, who are at a fairly-well level of
societal functioning (Fritch, n.d.).
Under normal circumstances, we would not admit those with a GAF score above
this. Those in the category above of 80-71 are those with transient mental issues. Though they
might be more severe than the category of 70-61, the symptoms are temporary ones, usually
brought on by environmental stressors, such as a death in the family, losing a job, or a bad family
argument. These mental difficulties normally fade after a short time. If they prove more
permanent, the patient would be re-evaluated, most probably given a lower score and would be
eligible for admission (Fritch, n.d.).
The Main Categories of Mental Illnesses and the Drugs to Treat Them
Most psychologists agree that there are five main categories mental disorders, most of
which have several sub-disorders within them. They are: The Anxiety Disorders, The
Somatoform Disorders, The Dissociative Disorders, Schizophrenia Disorder, and Bipolar
Disorder (Abbott, 2012). Each has their own type of medications that work best for them.
For Anxiety Disorders, there are anti-anxiety medications that can also work to lower
insomnia and agitation. Usually, antidepressants are also effective for anxiety. The most
common ones are: Ativan, BuSpar, Klonopin, Valium, and Xanax ("Mental Illness," 2015).
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Anti-anxiety medications may have serious side effects, the most common being
drowsiness. However, depending on the person, they may also feel nausea, confusion, tiredness,
dizziness, muscle or joint pain, blurred vision, frequent urination, changes in sex-drive,
unsteadiness, coordination problems, and others. Patients should see their doctor if these side
effects become severe or do not cease ("Mental Health," 2016).
For Somatoform Disorders, there are some form of obvious connection between the
mental issues and the body, such as Conversion Disorder or Hypochondriasis (Abbott,
2012). Slightly different antidepressant drugs are often prescribed for these disorders such as:
Vanatrip, Zoloft, Lexapro, Effexor, and Cymbalta ("Mental Illness," 2015).
The side effects of antidepressants are many and varied; some of which can be life-
threatening. The most common ones are: weight gain, sleepiness, nausea, diarrhea, and sexual
problems. Other more serious side effects are: suicidal thoughts, worsening depression, new
anxieties, panic attacks, acting on dangerous impulses, insomnia, and others. Again, patients
should see their doctor if these side effects become severe or do not cease ("Mental Health,"
2016).
Dissociative Disorders leaves a portion of the person's mind walled-off or dissociated
from the rest. These patients may suffer forms of amnesia, identity fugue, or multiple
personalities (Abbott, 2012). Unfortunately, there are no specific drugs to alleviate these
conditions. However, depending on the patient, different medications may help with different
symptoms. So, a doctor may prescribe any one or combination of anti-anxiety, antidepressant, or
antipsychotic medications to ease any number of symptoms the person may exhibit.
("Dissociative Disorders," 2014). The side effects of these varied medications are discussed in
separate paragraphs of this essay.
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Schizophrenia literally means "split mind," but rather than meaning a splitting of
personality, it refers more to the behavioral/emotional brain functions being split, which are
normally balanced and integrated. This can result in a wide variety of symptoms such as:
hallucinations, disordered thought, attention difficulties, word-salading, delusions, catatonia, and
the like. Some schizophrenic patients have measurable brain deterioration, making standard
treatments quite challenging (Abbott, 2012). One or several antipsychotic medications are
needed for patients with this disorder such as: Clozaril, Haldol, Mellaril, Moban, Risperdal, and
others ("Mental Illness," 2015).
Antipsychotic drugs are quite strong and may have several adverse effects such as:
nausea, blurred vision, dizziness, low blood pressure, seizures, uncontrollable tics and tremors,
restlessness, drowsiness, low white blood cell count, muscle spasms, and others. Patients are
encouraged see their physician if these side effects become severe or do not cease. A particular
side effect that patients who take antipsychotic drugs for long periods of time is a condition
called tardive dyskinesia or (TD). Ranging from mild to severe, it results in unusual and
uncontrollable muscle movements, particularly around the mouth. Sometimes patients with TD
can recover after they stop taking the medication, but sometimes they do not ("Mental Health,"
2016).
With Bipolar Disorder, the patient's mood and attitudes shift between two extreme and
opposing poles with severe depression at one end and unstoppable mania on the other. Very
often a person with this disorder enters these polar cycles over a period of days, or weeks with
times of seeming normality in between. Bipolarism seems to be at least partly caused by the
brain's difficulty in regulating certain neurotransmitters (Abbott, 2012). So, one or more
antimanic medications may be helpful such as: Depakene, Lamictal, Lithium, or Tegretol may
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help to stabilize the mood by getting those neurotransmitters to communicate ("Mental Illness,"
2015).
The side effects of antimanic drugs are as unique as the medications themselves. They
include: excessive thirst, hand tremors, excessive itching, nausea, pounding heartbeat, vision
difficulty, slurred speech, hallucinations, swelling of any or all of the extremities, coordination
loss, blackouts, birth defects, and many others. Again, patients are strongly encouraged see their
physician if these side effects become severe or do not cease. Lithium poses a unique issue in
that the body hastens to eliminate it through the kidneys, but can do damage to the organs. So,
these patients should see their doctor at regular and short intervals to monitor the blood's lithium
levels, to insure the kidneys and thyroid gland are functioning properly ("Mental Health," 2016).
The Importance of Convincing Inmate Patients to Maintain their Drug Therapy
The inmate patients must come to realize and accept all the ins and outs of their mental
issues. They should be educated fully in the matter. And they must come to realize the link
between their mental issues and their deviant behaviour, resulting in crime. It is only by
maintaining their medication and other therapies that this cycle can be avoided, and that is key; it
takes more than just drugs to give these people the proper help they need. It takes ongoing and
attentive therapy giving them the support and self-esteem that it takes for them to even want to
help themselves.
As part of the therapy, it must be impressed upon the patients how important it is to
include the medications into their daily routines. A specific day and time should be picked to
place pills for the whole week into some form of pillbox organizer. It keeps things organized
and helps to prevent an overdose. The organizer should be put in plain sight where using it will
be easy, such as with one's toothbrush. Automated alarms, text messages, emails, calendar
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alerts, all go a long way to helping many patients keep on track with their dosages. Lastly, a
diary of when the medications are taken should be kept. It has been found that this goes a long
way to keeping one honest with their drug-taking activities.
Overwhelmingly, mental patients want to reintegrate back into society. Inmate patients
want the same things we all do: good relationships, health, food, job, and home. And being
added as a productive member of society is a big part of making all that happen. Mental
disorders remove one from society as surely as imprisonment does. So, this patient has double
the hurdles to clear (Carandang, 2015).
Along with the standard vocational and academic rehabilitation that must take place for
an inmate to properly re-enter society, the mental inmate patient also must go through what is
often called psychosocial rehabilitation. The importance of this comes from careful rebuilding of
the self-worth and loss of identity that they often experience. Being subjected to months or years
of probable involuntary treatments and hospitalizations can leave them feeling overwhelmed
with no real control of their life. They must accept that they can and do have control and
responsibility over their own lives. Experience has shown that a therapy involving building
fellowship among mentally ill patients can help break the cycle of social isolation. This can go a
long way to helping when it comes time for the patient to reintegrate, for they will often feel less
disordered and can better self-identify as a person with some control over their own health
(Carandang, 2015).
The Dangers of Exposing Drug Addicts to a Drug Therapy Program
Those who are addicted to drugs have created condition in their brains referred to as
chemical dependence. In this, a mood altering substance has sparked a chronic, biogenic,
progressive, condition that is truly a disease. This chemical dependence means that it is the
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taking the drug, rather than the high it produces, that has become the deep, primary compulsion
that will cause one to lie, cheat, or steal to attain more of the substance, regardless of any
negative effects. We see that it is this compulsion pushes one to disregard any moral code they
may have and then slowly reducing their self-esteem and self-worth to little or nothing, looping
back into that disregard of any moral code. This terrible re-wiring of the brain results in the drug
having caused a void beyond the initial need of it, that only the drug itself can fill (Booher,
2016). There is also the reality of the given scenario of this being an inmate patient. This is a
person to which criminal activity is not unknown. To such a person, the mental journey to
disregard those moral codes and embrace deviant behaviour may be a short one, indeed. To such
a person the risk of addiction to pharmaceutical drugs may well be an extreme one.
This is why professional therapy is so very important. Those trained to do so have the
chance to use their knowledge and skills to break this compulsive need the patient's brain is
locked in. While antimanic, antipsychotic, anti-anxiety, and antidepressant drugs can have near
miraculous effects on the mind, extreme care must be used with these in regards to those who are
addicted… because of the aforementioned chemical dependence. Many in medical treatment
will abuse the drugs they are given more than to attain some type of high, but rather to feed the
void of compulsion. To do so, pills that are designed to control dosage are often crushed and
snorted, dissolved or melted and injected, or combined and taken to excess. As carefully listed
in paragraphs above, these dangerous acts can cause quick and permanent harm to the patient and
even death ("Is Abuse," 2014).
Conclusion
The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders is often
referred to as (DSM IV). It is a quick and effective method of classifying mental disorders used
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throughout the U.S. This assessment is broken into five groups called Axis I through V. They
are Clinical Disorders, Personality Disorders, General Medical Conditions, Social and
Environmental Problems, and the Global Assessment of Functioning, also referred to as
(GAF). The GAF is a numerical score that classifies the level of symptoms of the previous
disorders.
This essay's author believes that the GAF level that one should use to admit inmate
patients to a halfway house is that of no higher than 70. While scores in the 80-71 range may be
those with more severe symptoms, those symptoms are classified as temporary.
The five main categories of mental disorders are: The Anxiety Disorders, The
Somatoform Disorders, The Dissociative Disorders, Schizophrenia Disorder, and Bipolar
Disorder. Each has their own type of medications that work best for them. Those medications
would include the major families of: anti-anxiety, antidepressant, antipsychotic,
antimanic. These medications can be strong, have great risk in their use, must only be
administered by a medical professional, under controlled dosages, and monitored carefully, lest
the side-effects, which are many, could quickly grow out of control, causing great damage to the
patient, onto death.
Maintaining drug therapy is very important to the inmate patients, for there is an
inexorable link between their mental issues and their deviant behaviour, resulting in crime. The
therapy and medication in their daily routines must be maintained to break this cycle. This is
vital if their hope is to be reintegrated back into society. It is doubly difficult to do for the
inmate patient, but it can be done.
Those who suffer from drug addiction have a chemical dependency resulting in an
irrepressible compulsion. This compulsion is what pushes one to reprehensible acts they would
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not normally do. For many, no crime, no moral indignity is too great for them. The drugs of
mental treatment can be very dangerous to use for these patients. The risk is even greater for
inmate patients, for their choice to commit deviant behaviour may be easier than a non-
inmate. Extreme care must be taken with this therapy for those with a chemical dependence.
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References
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Carandang, C. (2015, March 19). Reintegration into society for people with schizophrenia.
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schizophrenia-carlo-carandang-md-fapa
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