Scenario: You are the Director of Mental Health at Halfway House, which deals with drug addicts who have brain disorders who have found their way into the criminal justice system. The patients in this program were diverted from incarceration into prison because a clear link was established between the drug offenses they committed and their mental illness. Mental illness is often a reason for an individual to turn to substance abuse.

The majority of your inmate/patient population requires medication to maintain a semblance of social function and to be allowed to leave the facility to work and see family members. You must continually evaluate the participants of the program utilizing the Axis criteria and the patient evaluation from the Global Assessment of Functioning (GAF) Scale (DSM-IV, 1994, p. 32). The GAF is broken into 10 groups from 0 to 100. A person in the category from 91–100 would be perfect mentally. This is not normally found with anyone. The person found in the category of 0–10, which is the opposite, would be a persistent danger to everyone around him or her, including him- or herself. This person would be completely dysfunctional socially and unable to work. As the director, you are required to use the GAF to evaluate the ability of your charges to remain in the program on a monthly basis.

The persons in this program must have successfully completed detoxification for the drugs they were abusing.

In addition to your required evaluations, you have a pharmacy on-site. The pharmacy issues medications and requires the participants to take the medication in front of health service professionals so that the medication prescribed is actually being used and not sold or thrown away. The following medications are being given:

• For participants suffering from schizophrenia, the drugs used are classed as antipsychotic drugs.
• For those being treated for depression, antidepressants used are also known as selective serotonin reuptake inhibitors (SSRIs).
• A common illness among inmates is bipolar disorder. This is treated with mood stabilizers that were originally developed to treat convulsions. For bipolar disorder, antipsychotics and antidepressants may also be used.
• Anxiety disorders are also common mental health concerns with inmates/patients. These include many commonly known mental health problems such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), panic disorder, and social phobia. For treatment of such disorders, the most common drugs are antidepressants, anti-anxiety medications, and beta-blockers.

In a 10–12-page position paper, write up the problem you observed in the scenario, and answer the following questions:

• What level of inmate patient are you prepared to take into the program based on the five Axis of the DSM-IV and the associated GAF criteria for identifying function? Justify your reasoning.
• What are the main categories of mental illness that can be treated by pharmaceuticals?
• By category of illness, what corresponding type of drug should or could be prescribed to treat those illnesses?
• What are the side effects of the drugs you indicated in your report?
• How do you plan to convince the participants that they must maintain their drug treatment after they leave the program you are in charge of?
• How will these treatments allow the patient/inmate to reintegrate into family, social setting, work setting, and keep them from re-offending?
• What are the associated dangers of putting a person in a drug therapy program where they had previous chemical addictions?