FOLLOW—UP SERVICE IN A PSYCHIATRIC CLINIC By Benjamin Warner, Jr. I D .3 --._n “*Jt-‘r‘u—W, - s53?- FOLLOW-UP SERVICE IN A PSYCHIATRIC CLINIC 3! Bonjlnin Earner, Jr. A PROJECT REPORT Submitted to the School of Social Wbrk Enchigan State university in Partial Fulfillmant or thu Roquirulcnti f3; the Dtgroo 0 MASTER OF SOCIAL WORK Jun. 1959 ”KENS ACKNOWLEDWTB The writer wishes to express sincere appreciation to all those who have contributed so such in interest, information and cooperation, to this study. Psrticulsr gratitude is expressed to Dr. Herren 3. Ville, Dr. Jsles 0. Min, Hr. Alfred 0. Ball. and all the rest of the prison personnel who have contributed to the completion of this study. The writer desires to sxpross deep grstitude slso to Dr. Gordon Aldridge, projeet sdviser, Dr. Ernest 8. Harper, and Mr. Arnold Gurin, research sdviser. A word of special thsnks to ”Doug” who so ebly fecilitsted the sechsnics of this study. "Self is-the only prison that can ever bind the soul-1 IVsnDyke, Henry Bsrtlet's Quotations, The Prison and the 9.3.0.1.. P- 52- 11 TABLE OF CONTENTS ACKNOWLEDGMENTS . . LIST OF TABLES . . CHAPTER I. INTRODUCTION II. .HBTHODOLOG! III. ANALISIS OF THE DAT! IV. SUMMARY, CONCLUSIONS AND RECOMMENDATIONS “Pmn I O O O O O O O O I O O O O O O O O C C BIBLIOGRAPHY O O O O I O O O O O O O O I O O O O 111 O O O O O O O O O .2525 11 iv 13 17 26 30 32 TABLE '10 2e 3. Lo 5. 6. LIST OF TABLES Length of Stay of sll id-issions to the P"ch1atric Clinic e c e e e e g e e e e e Frequency thst Fcrner Psticnts Returned to the Psychiatric Clinic . . . ._. . . . Disciplinsry Action on Followed-Up (coups snd Non-Followed Groups mcr Relesse tron P'yghiatr1Q Gltnic- e e e e“e I e-c e e n c Assignments on Polluted-Up and lion-Followed Groups mo:- 3.1.... o... the max." on .' ' Clinifi e c e s e e e e e e e e e e s e e 0 Range of Ages in the Follow-Up and. the Non-Followed Group st Psychiatric cum: . Rsnge of Intelligence Quotients in the Follow-Up and the Ion-Followed Group st the Psychiatric Clinic iv 0 O O O O O O O O O PAG§ 18 19 21 22 23 2k CHAPTER I INTRODUCTION Nature and Purpose of the Study This is a study of followdup service in a correctional setting. It is the study of a service currently Indntained by the Psychiatric Clinic of the State Prison of Southern Huchigan, located at Jackson, Michigan. This service is conducted by a team of psychiatrists, psychologists and social workers. The purpose of this study is to determine whether the service is of benefit to the inmates utilising it and, thereby, of benefit to the entire prison population. Followwup service, as:laintained by the Psychiatric Clinic at Jackson Prison (hereafter referred to as SPSH), is best described as a continuation of contact with former ward patients subsequent to their discharge to the general prison pepulation. This is often the case in instances where, although the patients appear to be improved on the ward, they are, nonetheless, not completely well and it is doe-ed advisable to transfer them to less restricted locations in the prison setting in order to make room.in the clinic flor other patients with a greater need for intensive treamtnent. Intensive treatment is offered to the inmates on both inc-patient and out-patient bases. Fre- quently, brief follow-up contacts are made on such occasions as when the Michigan Parole Board requests a progress report on a patient’s adjustment following his release from the ward. In such cases, prompt reports of the worker's findings are required. mo contact is also part of follow-up service. The Clinical Situation ’ The clinic director has expressed acne doubt as to whether this continuing service is proving beneficial to ~ former ward patients. It is felt that, if the therapeutic value of this follow-up service cannot be Justified, Inch time 1- being wasted which could be channeled into other v he areas of treatment. Follow-exp service was initiated at the pychiatric - clinic in September, 1957. At that time, there were four no... social work «moon in training at the clinic, ' ' two from the University of Michigan and two from Michigan State University. ' At the present time. there continue to be four graduate social work students conducting follow-up services at the psychiatric clinic. One of these students is from Wayne State University, two from the University of Michigan. The responsibility for maintaining nuch of this service falls on the four students inasmuch as they are not required to handle large numbers of other cases, as do the regular staff members of the ”clinic. ' There are various levels of follow-up services employed at the psychiatric clinic; for example, contacts are made by the workers on weekly, bi-weekly and monthly bases, as well as by the use of a reminder file. In addition to those instances of follow-up service mentioned, this service may also be construed as a brief contact to assure a patient that he has not been forgotten and to allow him an oppor- tunity for ventilation of his feelings. Follow-up contact is a service offered a former patient as long as he feels the need for it. The practicability of this type of program- ming is imediately apparent when viewed from the vantage that it also helps a therapist evaluate a man's present mental condition. location of the Study The data for this study were gathered at SPSM, located at Jackson, Michigan. This installation is the world's largest walled penal institution. Its fifty-seven acres, enclosed by thirty-four foot 9.11., has fourteen cell blocks. These blocks, plus an almost self-supporting farm system out. side the walls, house some 6, 000 inmates under maximum, medium and minimum security conditions. The psychiatric clinic at SPSM has a relatively short history. In l9h6 the mental Hard, as it was then called, was located in the classification division of the institu- tion under the supervision of the Parole Board psychiatrist. The ward included sixty cells containing beds, with actual supervision of the mental patients conducted by one psychol- ogist assisted only by inmate nurses. The nursing care at that time was of a general nature. In 1951, however, the rotunda portion of the floor which housed the-ental ward was vacated by the institution counseling staff} this adjoin~ ing area was put into use, being remodelled asan open ward for the care of‘mantally disturbed men. From that time until the formal organisation of the psychiatric clinic, there was gradual expansion in the facilities of the ward for the care of disturbed prison inmates. ‘ The psychiatric clinic was formally established on October 1, 1953. Prior to that time, there had been a great need for such a clinic to serve the Michigan Corrections system, however, the need was not sufficiently recognised until after the sensational prison riot at SPSM'in April of 1952. During the investigation of the riot, it was publicly disclosed that there ware many psychotic prisoners housed at the prison without any adequate psychiatric service avail- able. There were also a great many unstable and dangerous psychopaths at large in the general prison population, and - 5 - it was felt that, long since, these should have been appro- priately segregated. Also, there was inadequate screening of newly admitted prisoners as that mentally disturbed inmates among them were not being detected and isolated from the general prison population. These factors in- fluenced the state legislature to allocate funds in 1953 for salaries for professional people to staff the psychiatric clinic at SPSN. Facilities and Personnel under the new’mental health program inaugurated at SPSM, Cell Block No. 6 was converted to meet the needs of’hundreds of clinic out-patients. It was designed to serve as a con- valescent cell block for these empward patients, as well as a.housing unit for a.limdted number of chronic medical patients. The fifth tier of this cell block (including the rotunda area) houses the psychiatric clinic, which is commonly termed "Top-efBSis' within the prises. The remainder of the cell block, which contains a.base-floor upon which rest three tiers of open galleries, is commonly called ”Lower Six." Housed in the cells on these four landings of'Lower Six are expward and other patients of the psychiatric clinic, with a scattering of chronic medical patients such as diabetics, epileptics, cripples, arrested tubercular and senility cases, residing among them. The housing facilities‘on the Top-of-Six include a twentyoseven bed closed ward, a forty-two bed . Open ward, with twenty-nine beds reserved in another closed ward for necessary inmate ward personnel. This results in a capacity census of ninety-eight available beds on the ward. Additionally, four cells have been set aside for ward-maint- enance purposes, two for sanitation and two for storage. There are offices for the professional staff, the nurse— supervisors, a civilian secretary to the staff, the inmate clerical staff, inmate nurses and the necessary custodial officers detailed to duty in the clinic. The rotunda, with its offices, dormitory, library, etc., is separated from the closed south ward by a dining room where the patients (who are sufficiently adjusted) are fed. There are daybrooma in both wards of the psychiatric clinic, and these rooms are used by the patients for indoor recreational purposes including radio, television, games and live talent entertainment. On one side of the rotunda is the occupational therapy workshop, while at the extreme and of the south ward is the hydrotherapy room containing facilities for electrow shock therapy treatments, and the clinic laundry. The entrance to the psychiatric clinic is by elevator from the main-floor rotunda to the clinic mm. _ u this point, an iron gate bars the way into the clinic preper ’ where the in-patients carry on their daily activities. Another set of gates, midway of the clinic, per-its access to the Lower 81: area. There are currently forty peeple enrolled in various capacities on the psychiatric clinic staff. Thirteen of these peeple are civilian employees functioning under State Civil Service, with the remaining twenty-seven comprised of carefully selected inmates perforling the various tasks necessitated by the clinic operations. Along the civilian employees are three psychiatrists, one of’whoa is Warren 8. Uille,.M.D., director of the clinic. The third psychiatrist is a full-time resident. There are two psychologists employed by the clinic on full-tine status, both of whoa.possess doctoral degrees. The social work staff at the clinic consists of three full-time social workers, one of when is the director of psychiatric social services. The four graduate students in social work are supervised by the latter. Other non-professional personnel employed in the clinic include an.electroencephalo¢raa technician and two male nurse supervisors. 0f the twenty-seven inmates eaployed on the ward, fifteen are assigned as inmate nurses working three shifts so that there are nurses on duty at all tines. Four inmates comprise the office clerical staff which types and files clinical records. Two other inmates supervise the patients in their occupational therapy activities, and two more inmates supervise the patients' recreational activ- ities. One inmate is in charge of hydrotherapy, and another is the runner who carries nail and supplies to and from the clinic. There is also a.full~tine barber and an inmate receptionist. Hypothesis It is hypothesised that through followaup service an innate will be less likely to return to the psychiatric clinic and will maintain a better prison adjustment. Upon discharge from.the clinic to the general prison population, a patient's card is placed in a.reainder file. This procedure enables the staff to again contact the patient and insures against his being forgotten. Follcwbup service involves considerable time and clerical effort. It also makes great demands on.the professional social workers. It seems of value that the above hypothesis be tested to evaluate whether this service is effective in terms of helping the innate saintain a.good prison adjustmentand, at the same time, reduce the incidence of readmissions to the psychiatric clinic. ' Because of ths_different philosophies concerning custody and treatment, it might be well to look at the tern.'adjust- nest" and how it is measured at SPSM. To determine some criteria, the writer interviewed cheater Powers, inspector of the guard at SPSH. Inspector Powers felt that the inmate's attitude was the most import..- ant factor to consider. This was in reference to an innate's ability to adjust to different work assignments and, more important, to remain on one Job for a sufficient period of tine. It was also opined by the Inspector that the insate'a attitude toward authority played an inportant part, insofar as determining the nusber of tines an innate would become involved with the officials of the prison. When an innate disregards the rules and regulations of the institution, he is subjected to disciplinary punishment. It was with these factors as criteria the: custodial personnel assessed the adjustment of inmates in the prison population. , . 7,. . \ , , . , Treatment personnel, being somewhat divorced from cus- tody in terns of adjustment philosophy, had different criteria for the assessment of adjust-eat. It is felt by the Director of the Psychiatric Clinic, ‘Warren 8. Wills, M.D., that if an execlinic patient does not return to the clinic for further treatment, then the treatment he previously re- ceived was beneficial in, terns of the inmate's adjustment to institutional life. In the event that a foraer patient does return to the clinic, Dr. Ville espressed an interest in learning the length of the patient's stay in the clinic as coapared with the period of tine spent on the ward during -10- the patient's initial admission. Dr. Willa evinced fur- ther interest in learning whether follow-up service helped a former ward patient to reapond more quickly to the general milieu of the prison or whether, in some cases, it helped to eliminate future contacts with the clinic altogether. These are the main factors involved in fellowaup service with which the clinic staff concerns itself at the present time. Review of the Literature Because the writer is considering penal institutions, a psychiatric clinic within such a setting, and casework in the area of follow-up service with schiscphrenics, these subjects were covered in the readings. There was little discoverable information in the literature pertaining to followbup studies in comparable settings. The thinking in regard to therapeutic rehabili- ' tation in penal settings is still somewhat conflicted.and undefined. Certain authors, however, held definitive views. Casework in a penal setting, as the writer sees it, might have been Quentin Reynolds' subject when he wrote, ”Even the run-of-theqaill case fascinates no for the -11.. simple reason that all cases, both big and small, are made up of human beings.” Follow-up service, as carried out by the student work- ers in the Psychiatric Clinic at SPSM, night he an illustration of that which James E. McGinnis has spelled out. He wrote that good planning in correctional institu- tions, with respect to staffing and effective utilisation" of available staff, night bring remlts far in excess or the tiae spent on this planning. Dr. Mcainnisi point is of vital interest to the clinical staff, and to the staff's interest in this study. - Lawson G. Lowery3 and Point of View‘ discuss the nental illness discovered in this study. Both authors agree that schisophrenia does respond to a coordination of psycho- therapy with technical and pharmaceutical aids. . they concur, too, that whether the improve-anti» greater or less, it is not necessarily permanent as evidenced by the high rate of readmissions. I. Quentin Reynolds, Courtroom the Star of Baluel S. » Liebowits, (New York: Straus and Company, I95! pp. £134.19. 3 Jmes I. McGinnis, hid).i I'llel-nnbilitation: A Psychiatriat's view of the Correctional grain,” The Jamal of Social, Therapy, Vol-3, 1957. p. 130. 3 Lawson e. Lowe , 15.3.. s chiat for Social work. (New York: Colulb a UniverEIty mes, 19:5}, p. 35. ‘ Point of View, "P chotherapy and Its Limitations," Th2 gogfll or £31 Thermal, '01s 2. 1956, p. we -12- 1 2 Donald R. Taft and John Vincent Barry have written that the objective of the prison caseworker in to promote the individual'a adjustment within the prison community and, later, for the post—prison community. These authors believe that both the prisoners and society benefit. Some of the readings point up the conflict and un- defined thinking already mentioned. The majority of the authors, however, lend optimistic note to the view that the clinical methods of psychotherapy are helpful and should be developed further. 1 Donald R. Taft, c ninolo (New York: The Machdllan Company, 1956), p. . 2 Barry, John Vincent, 'cerreotional Discipline,” The Journal Law rininolo f and ice cienc vol. #7 (JEIy-Ihzust, CHAPTER II METRO 001.06! An interview held Jointly with Dr. Warren S. Uille, director of the psychiatric clinic at SPSM and the writer's immediate supervisor in the clinic, 'Alfredt‘. Ball, director of psychiatric social services, suggested that persons diagnosed schisophrenic, any type, comprise the population under study. The determination of dates to be used in the sampling was arrived at after many interviews with James 0. Martin, Ph. D. , full-tine psychologist employed at the clinic. It appeared that the follow-up group should be made up of cases discharged from the clinic, since there were four graduate students conducting follow-up social services and the students were mainly responsible for these contacts. The dates selected were september, 1957, through June, 1958. The non-followed, or cooperative group, was to be drawn from a tile-period when no students were available for follow- up services. These dates were August, 1956 through June, 1957. Every record within these time-periods was studied. A complete clinical card file, giving names, dates and diagnoses, is maintained in the psychiatric clinic. From this file, the cards pertaining to schisophrenics were drawn. -13.. - 15 - The total number received at the clinic with this disorder, and comprising the follow-up group, was sixty-nine. The clinical records of these cases were then examined to determine the extent of'any fellowbup service conducted by clinical personnel. If there were followbup contacts, the number of tines each was admitted and the length of time he was able to remain out of the clinic were noted. Additional data assumed to be of possible importance were their age and I.Q.'s. Custody maintains a separate record, which is the main record folder. This folder contains all 'of the man's pre- vious crisinal record, fuily history, disciplinary action, education and work record, 3with a listing of every contact lads with the prison authorities. These, too, were studied in relation to cards already pulled from the clinical card file. During the stages of the gathering of this information, a prsblen arose. Many contacts with foraer patients are quite brief, or have never been recorded; therefore, there . would be nothing tangible to assess. This problem was explored with Mr. Ball of the clinic and with Dr. Gordon z Aldridge, study adviser. It was agreed that followuup laterial for thepurpose of this study would include only dictated interview notes and the case-workers' memories of brief contacts. -15.. Of'the specified sixtyonine.patiants seen during 1957-1958, the records revealed that twentybsevcn had never received follow-up service. In an interview with Dr. Ville, he suggested dropping these men from the study. He felt that the reason these men were not contacted again was because! of the pressure of time. Eleven of the remaining fortyb two, although receiving followbup service, were also dropped from the study. These were cases no longer in i the institution due to transfer elsewhere, discharge or parole. The main prison folders on these inmates were not available for use in this study after the men left the institution, because the prison folders had gone to other institutions,to parole officers, or had been placed in the dead files. .There remained, then, thirty-one patients comprising the follow-up group. is mentioned earlier, during 1956-1957 no followwup service was carried out by theclinic. Of the group of schisophrenics drawn from.this period and numbering seventy- fivs, thirty remained in custody at SPSM, nineteen were transferred to Ionia State Hospital, seventeen were paroled, six were discharged and three were transferred to the Branch Prison at.Marquetts. A log of all entries into the clinic from August, 1956 through June, 1957 was eat-lined. From this log, all schiso- phrenics, any reaction, were pulled and a listing compiled. am” This listing was checked against the main prison records. In this way, the current whereabouts of the seventy-five inmates was determined. As previously stated, thirty of the specified seventy- five inmates remained at BPSM, and those comprised the non-followed group to be studied. ‘ CHAPTER III ANALISIB OF THE DATA Initial organisation and study of the findings led to their'formulation into six tables. Within these tables two categories were studied - the followeup patients from.8eptembsr, 1957 to June, 1958 and the non-followed group from August, 1956 to June, 1957. The clinical record in each ease was examined in order to ' determine the number of times a patient was returned to the cum. and the total length of stay involved in such return contacts. From. analysis of the six tables, the following points emerged: Table 1 (set forth on the next page) reveals that the followuup group received an average of 17.06 weeks of treatment per man after the date of original discharge to the prison population. The non-followed group averaged 16.5 weeks of treatment per man. This suggests that there is no clear-cut relationship between the men who were followed up and those who were not. That is to say, the length of time required for additional contact after a person has been returned to the general prison population seems to be of little significance. _ 17 _ -18- ' TABLE 1 LENGTH OF‘STAY OF ALL ADMISSIONS TO THE PSYCHIATRIC CLINIC (MW) Followed Non-Followed Returns Nu::er s§:’ Returns‘ Number I 3:3! g hen Weeks Men Weeks# Total ... 31 539 30 #95 O ......... 7 1L8 11 81 1 ......... 10 78, 5 21 2 W. I. 98 1. i3 ‘ 3 ......... b 50 7 267 t ......... 2 62 l 21 5 ......... 2 b2 1 16 6 ......... l 23 0 0 7 ......... 1 38 O 0 s o o 1 t6 Table 2 (set forth on the next page) shows twenty-four men in the followed-upugroup»returned to the clinic, while nineteen non-followed patients were readmitted. This aver- aged to 15.87 weeks of in-patient treatment for the followed group and 21.78 weeks of treatment for the non-followed. This means a savings of approximately twenty-five per cent of the clinical staff time which could be devoted to other -19- persons requiring treatment. Because the social workers are in contact with followbup patients on a regular basis and are quick to note the psychiatric needs of the men, ‘ and because facilities of the clinic are available at all times, it is felt that these men are returned before their illness is too far advanced. TABLE 2 FREQUENCY THAT FORMER PATIENTS RETURNED TO THE PSYCHIATRIC CLINIC (Aumt, 1216..- Jung, 1218) Followed - Ron-Followed Number Length Number Length Returns of of Stay of of Sta Men in Wegks Mg in Wee L Total .. 2b 381 19 Ali 1 ........ 10 7C 5 21 2 ........ I. 98 I. #3 3 ........ h #0 7 267 L ........ 2 62 1 21 5 ........ 2 L2 1 l6 6 ........ 1 23 0 O 7 ........ 1 30 O 56 8 ........ 0 O 1 O As evidenced by Table 2, above, the followaup group may feel more appreciation of the clinic services and are aware ~20- sf the kind of help available. This may be the reason for their frequent returns even though followed in the general 11' icon pepulation. The writer originally thought that, as a result of follow-up service, in-patient treatment might be out in half. This hypothesis was disproved by the findings pre- sented in the preceding tables 1 and 2. There are certain assumptions that the clinical staff believes to be sound in regard to the followed group, as shown in Table 2. One of these is that, in the years studied, too few patients presented themselves to give an adequate picture. Therefore, the total findings may not reveal the true worth of the service. Also, the higher figures of clinic treatment for the followbup group may be misleading, because those receiving followaup2may be better motivated to seek treatment than those who did not receive followQ-up: '1: is recognised, too, that prior to September, 1957. many patients may have been picked up by counselors within the prison, whereas now, the counselors leave this ...-.71.. ”a. ...m workers. For purposes of this study, chronicity was defined in any patient who was seen more than fifty weeks within one year. It was thought that the 'chronics' might slant the findings. This, however, did not prove to be the case. -210 Chronic patients accounted for seventeen per cent of the total weeks of clinic treatment received by the followeduup group. The comparable figure for the non-followed group was sixteen per cent. The writer hypothesised that those men who received followbup service would receive less disciplinary action than those who were not followed after return to the prison population. Table 3 points out that there is no appreciable difference between the two groups in this respect. TABLE 3 DISCIPLINART ACTION on FOLLOWEDJUP GROUPS AND ION-FOLLOWED GROUPS AFTER RELEASE FROM PSTCHIATRIC CLINIC! (Aug st, 12g - Lune, 1218) Action Taken; followed Hon-Followed Tat“ seeeeeeeeee 31 30 no Discipline ...... .21 ' ' 21 1 Discipline ...... 3,Disciplines'..... .3 Disciplines ..... .i Disciplines ..... UNUN HNN” ‘1: :111 be noted from.the findings contained in Table 3, above, that ten out ef’thirty-one patients in the followed -22- group received some type of discipline while nine out of thirty in the non-followed group also were disciplined. Ventilation of feelings through followaup service is deemed of value to a man's total adjustment, but it is also recognised that even hourly ventilation might not suffice in some cases. The possibility of inappropriate 'vsntilation' toward custody’must be considered. This might account for the high rate of disciplinary action among the followuup group. The writer has speculated whether a greater differ- ence might not be revealed between the two groups if the service were more intensive and systematic. Concerning Job and school assignments, Table 5 reveals little difference in either group's ability to obtain and maintain these. TABLE¢A ASSIGNMENTS ON FOLLOWEDAUP AND NON-FOLLOWED GROUPS AFTER RELEASE FROMIRSICHIATRIC CLINIC W) Assignments Followed Non-followed Tom eeseeeeeese 31 30 Job er School ........ 2t 23 ”on. ssseeseseeeeeeeee 7 7 - 23 - securing assignments is a function of the classification -committee, which is completely separate from the clinic. Dischargedpatients are picked up routinely by their counsel- ors and screened for employment-or school attendance. Secial work follow-up service has no relationship with this screen- .ing process, and wouldunot necessarily enhance assignment Opportunities. This may explain why there is not a signifi-- cant difference on the question of assignments following discharge from the clinic. In the followed group there were twenty-threemen under thirty years of'age, as illustrated in Table 5, below; TABLE 5 RANGB.OF AGES IN THE FOLLOWEDAUP AND THE NON-FOLLOWED ,GROUP AT PSYCHIATRIC CLINIC 1§2Rlllhsti_1219_=_131;+_1215l Ages Followed lonoFellowed total ........ 31 30 18 4 20 ........... 5 O 21 ~‘25 ..w........ 7 l 26 "’ 30 we'e'e-eo'o'oe'oe 11 8 '31 # 35 ..........t' 3 7 36 -'t0 ...........“ 2 h u {1.5 2 s 56 “.50 1129€°‘¥{{?.. ° 5 51 - 55 ........... .1 0 56-60 .-........ o l -21.... In the non-followed group (contained in the preceding Table 5), there were only nine men under thirty years of age. This, it seems, is due to better screening in the' 1958-1959 group in the Reception-Diagnostic Center of SPSM, and more readiness on the part of this staff to admit younger psychotics fer psychiatric treatment. Because of the fact that this is a disease characteristic of youth, and because there is an apparent attempt to treat these patients earlier, the findings may well be influenced in the fellowed group. The range of I.Q.'s in the followed and non-followed groups indicated wide variations, as might be expected. (See Table 6, belowz) new 6 RANGE OF INTELLIGENCE QUOTIENTS IN THE FOLLOW¢UP AND THE . NON-FOLLOWED GROUP AT THE PSYCHIATRIC CLINIC (September. 1256 - July, 12:8) I.Q. ' ‘ "Followed Non-Followed L AA;+A¥LL Total .......... 31 50 - 59_ .......... so . 69 ........... 70 " 79 sseeeeeeee 80 - 89' .......... 90 - 99 .......... 100 'I' 109 '...'.'.'....'. 110 - 119 .......... 120 - Up--.......... H O caou‘r-¢>\n'o~u~ra PU-NO‘WOUN -25- Table 6, preceding, reveals that the mean I.Q. in the followed group was 8b; the mean 1.0. of the non-followed group was 95. This disparity in the two groups suggests that the followed group was a retarded group, and that the non-followed group was of normal intelligence. Apparently this difference in 1.0. rating is not reflected in such mat- ters as following through with assignments, return to clinic, and disciplinary action. CHAPTER IV SUMMARY, CONCLUSIONS AND RECOMMENDATIONS Summary and Conclusions Two groups of former patients of the psychiatric clinic at SPSM were studied to determine the effectiveness of fellowwup service. One group comprised patients followed-up after discharge from.the clinic; the other group comprised patients not followeddup. It was hypothesised that, through follow-up service, an inmate would be less likely to return to the psychiatric clinic and would maintain a better prison adjustment. The major factors considered were: age, 1.0., length of prison stay after discharge from the clinic, incidence of readmissions to the clinic, disciplinary infractions, work and school assignments. The findings suggested no appreciable difference between the groups' prison adjust- ments, and the hypothesis was not supported. The groups were different, however, in two respects. The followed group was retarded and much younger, while the non-followed group was of normal intelligence and, of course, older. Although the data do not support the hypothesis, possible reasons for this were advanced. -25.. .27- It appears that the benefits derived from this type of follow-up service did not lend themselves readily to measure- sent. This may be particularly true in terms of the inmate's comfort. This has been a study of’men, not only facing a prison sentence but, also, their own illness. The overt interest shown toward a man through followaup service may be seen by him as personalised, giving himxcomfort, support and direction. The study failed to reveal these important factors. It measured the obvious factors - yet was not able to measure the not-so-obvious, which may be more important. Attitudes cannot be measured precisely, yet the possi— bility is always present that the clinic worker's contact and individual interest could be changing the man's concept, . not only toward his illness but toward the prison sentence as well. With these factors in mind, and the response of the men followed, it is believed that followaup service is helpful - even though not proven by the methods selected. Recommendations In order to improve the clinic's followwup service, it would seem worthwhile to consider the addition of a social worker to the staff, whose sole responsibility would be in this area.‘ This would permit more systematic followwup, with regularly scheduled interviews. ‘ The importance of'more intensive orientation of custody to the approach and goals of the clinic, particularly with respect to early referral, is suggested. Similar interpret- ation to the civilian foremen in charge of work assignments might be useful. Productive working relations with the prison counseling staff have permitted earlier recognition of problem situations requiring clinic concern. The continuing development of this counselor-clinic relationship can contribute to increasingly effective help for patients during and after their treatment at the clinic. Consideration of an outlet, in addition to Ionia State Hospital, for seriously disturbed inmates would.mekerit pos- sible for the clinic to offer better focused service to less seriously disturbed patients. ’ A future study concerned with followwup of former clinic patients after their parole or discharge from.prison would be 'informative. This would be difficult in certain instances, but would be of interest in relation to the former inmate's adjustment outside the ”walls." Within the psychiatric clinic a study dealing with psychotic and/or severe neurotic disorders treated, and their preportion within the total prison population, would be of interest. Are these proportions larger in a penal setting -29- than in the total society and, if so, why? The State Prison of Southern.Michigan, the largest walled prison in the world, offers an unusual laboratory for the investigation of such questions. Studies carried out in such a setting could contribute to specific knowledge of deviant behavior, and to the general knowledge of man in society.‘ APPENDIX FLOOR PLAN Psychiatric Clini c State Prison of Southern Michigan, Jackson, Michigan (Inserted, Next Page) BIBLIOGRAPHY Books 3.11. Marjorie (editor). . _ nds in c me 1‘ atmen ea __. . National Probatisn Assoc at on '32 ew or x e ‘at one 'ro.et on Assoc at on, ' ‘). . Lindner, Robert 14., EM). and Seli'ger, Robert V.. M.D. a ok of re tiona P be (New York: 0.0? “1". e Lewrey, Lawson O. M.D. Ps chiat fo 3 a W (New York: Colubia Univers ty ress, . Reynolds, Quentin. nggtrogg, m. Stgz of Bengal 14.29 g:- (liew York: Farrar, traus an ompany, ‘ . Sutherland, Edwin H. and Cressey, Donald R. P le gaminolgn (New York: J.B. Lippincott ompany, ). Taft Donald R. 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Williams Christoiher, "Penal Practice in a Changing Society,” The égiminal w Review'(Marth, 1959). Monograph Louis J. Lehrman, Hilda Sirluck, Bertram 43 Black Selma J. Click and others of the staff of the Jowish Board of Guard ans. "Success and Failure of'Treatment of Children in the Child Guidance Clinic of the Jewish Board of Guardians ' Analysis and Followbup of Cases Closed Between April 1. ism and March 31, ion. (a... York: Research monograph No. l, l9k9).