Phyllis M. Connolly, PhD, APRN, BC, CNS Professor, San Jose State University

1. CA Forensic Nurses’ Practices & Views With Inmates with Serious Mental Illness: Medication Compliance Phyllis M. Connolly, PhD, APRN, BC, CNS Professor, San Jose State University Chia-Chen Lee, MS, RN, FNP Santa Clara County Custody Facilities & NP Crestwood

2. The Problem • Estimated 283, 800 mentally ill inmates is US (Sniffen, 1999) • 547,800 mentally ill offenders on probation every year (Sniffen, 1999) • Non compliance with psychiatric medications most significant predictor of arrest (McFarland, 1989) • 1/3 discharged from psychiatric hospitals lose contact with services within a year (Barr, 2000) • Costs California, $40,000,000 annually (MIOCRG, 2002)

3. Solutions • Increasing compliance with psychotropic medications • Improving compliance ￬relapse, ￬ hospital readmission and ￬ criminal transgression (Dubyna & Quinn,1996)

4. Research Questions • What do forensic nurses believe about medication compliance? • What information do forensic nurses collect during their assessment of inmates’ medication compliance? • What barriers do forensic nurses identify related to medication compliance after inmates are released? • What are the self care behaviors? • Do they have concerns for their safety?

5. Methodology • Exploratory mail survey • Questionnaire developed based on literature review and Scope and Standards of Forensic Nursing Practice (IAFN & ANA, 1997) • Experts utilized to develop and pilot tool • Human Subjects Protected by meeting IRB requirements, SJSU • 31 jails or prisons with population over 500 in CA were targeted

6. Final Instrument • Survey design expert formatted the final 60 questions in a 4 page questionnaire • Piloted by 10 forensic nurses not part of the final study

7. Procedure • Phone call made to medical directors/or directors of nursing stratified nonrandom sample of 31 CA jails or prisons with populations over 500 • 3 facilities could not obtain administrative approval • Surveys were mailed to 28 sites in CA • Forensic nurses: RNs, NPs, & CNSs • Each nurse was supplied pre-stamped, pre-addressed envelope • A follow up phone call was made 1 week after mailing

8. Response & Data Analysis • 14 facilities participated (50%) • 55 Forensic nurses returned questionnaires • Question #50 asked for the exact number of forensic nurses & based on self-report there were 86 potential participants • 64% response (55/86) • SPSS was used to compute frequencies and percentages

9. Institutional Characteristics N = 14

10. Demographic Characteristics: Gender, Age, Education N = 55

11. Ethnicity N = 55

12. Nursing Experience N = 55

13. Nursing Experience as Forensic Nurse N = 55

14. Experience With Inmates With Mental Illness N = 55

15. Medication Compliance Views (N = 55)Very important to Important

16. Assessment of Medication Compliance

17. Medication Compliance Nurse Behaviors N = 55

18. Perceived Barriers Referrals to Outside Agencies N = 55

19. Barriers Providing Discharge Summaries to Outside Psychiatrist and/or Medical Clinic

20. Barriers When Providing Medications at Discharge

21. Barriers When Providing Prescription Prior to Release

22. Self Care Practices N = 55

23. Personal Safety N = 55

24. Limitations • Nonrandom sample • Survey tool lacked established reliability & validity • Study population in California only • Participants well educated & experienced and may not be representative of all forensic nurses • Self-report and may not match actual practice or behaviors

25. Conclusions • 55 well educated, experienced, caucasian forensic nurses in 14 jails & prisons in CA believe that medication compliance is very important in reducing recidivism & crime • Believed that forensic nurses had the most influence over inmate’s medication compliance • Believed that the therapeutic relationship was very important to medication compliance • Identified many barriers to medication compliance after release • 58% were concerned about their personal safety • Self care behaviors are not engaged in frequently • 94% believed that debriefing services were important

26. Recommendations • Repeat study with larger random sample in multiple states • Maintain high percentage of baccalaureate and advanced practice nurses employed in jails and prisons • Increase self care practices • Increase ethnic diversity of nurses • CA specific recommendations: • Add regulation to Title 15 California Code of Regulations to include discharge plans, follow up care, medications or prescriptions upon release, visits by forensic nurses after release

27. A Vision Mandating discharge medications and ensuring follow up treatment, along with well-educated, experienced, compassionate, and dedicated forensic nurses practicing in CA jails and prisons may lower rates of crime, recidivism and reduce costs. Furthermore, ex-inmates with serious mental illness may have an opportunity for improved quality of life and increased tenure in the community