CorrectCare

A Framework for Correctional/Mental Health Partnership

By Erik N. Schlosser, PhD

Providing mental health services in corrections has many challenges. One of the biggest is working in a setting that puts the highest priority on security. Correctional and mental health staffs view situations differently, and may minimize the point of view the other holds. This article will discuss the different worldviews of correctional and mental health staffs, and review how common ideas, language and practices can help each to accomplish their respective missions.

Understanding the worldview of the other is important for creating effective communication. Correctional staff see their mission as maintaining order through the use of reward and punishment. Inmates are viewed as people not to be trusted, who have done wrong and are likely to repeat past behaviors. Correctional staff are exposed routinely to the dirtier parts of correctional work, such as violence and abuse and the games inmates engage in, which can jaundice their view of inmates.

Mental health staff see inmates as potential clients. Clients receive mental health services to become more stable and change problematic behaviors. While mental health staff are aware of the games and behaviors of inmates, the focus is on their potential for change. Along with years of empathic listening and, usually, a lack of formal training in evaluating psychopathy and malingering, this can result in an incomplete view of inmates.

It is possible to build a framework for communication within these different worldviews. Such communication rests on building common ideas, language and practices.

Common Ideas
There are three ideas that correctional staff can understand and appreciate about their role in mental health care. First, we are all in the mental health business. I often tell correctional staff in training that I may be the only one in the room who came to prison to work with the mentally ill, but all of us in corrections work with the mentally ill.

This point is illustrated by providing information on the percentage of inmates in the institution who are mentally ill, and the nationwide number of mentally ill people who are incarcerated compared to the number residing in state hospitals. Seeing this reality can help correctional staff expand their mission from maintaining order to providing help to the most vulnerable in society.

The second idea, while less noble, can be a catalyst for correctional staff to expand their worldview: We are obligated to provide mental health services in corrections. While we in mental health see our work as vital and necessary, correctional staff may not. Furthermore, they may have no understanding of our work. In the same way that mental health staff may not know or appreciate the types of nonlethal and lethal force, correctional staff may not understand what mental illness is, how therapy works or who gets medications.

A basic review of legal precedent instituting mental health services as necessary (Bowering v. Godwin, 1977) and the concepts of negligence and deliberate indifference (Estelle v. Gamble, 1976; Farmer v. Brennan, 1994) can establish the importance of maintaining adequate mental health care in corrections. Reviewing case law particular to one’s own state also can be helpful.

Once the general concepts of negligence and deliberate indifference are covered, correctional staff can learn of specific treatment progams and approaches, number of inmates on medication, and types of medication used in their institution. This can help counter the belief held by some correctional staff that prisoners get any medication by merely asking. Be sure to discuss the criteria for treatment and the number of inmates on medication when doing this type of training.

The third idea is that correctional staff see inmates more than mental health staff do. Correctional staff are in a unique position to observe inmate behaviors in various settings, while mental health staff tend to be limited to obervations in clinic settings. Information on an inmate’s sleep pattern, appetite, energy level, social interaction and significant changes in behavior can help mental health staff to assess an inmate more accurately. Tell correctional staff that they are your eyes and ears out there; this can help them to view their work in a new light.

Finally, the idea that “good therapy makes for good security and good security makes for good therapy” is one that can help both correctional and mental health staffs appreciate each other’s role. When inmates do the work of therapy, their behavior often improves, which helps correctional staff maintain order. Similarly, when inmates feel that the facility is safe and under the control of correctional staff, they report less anxiety and are more willing to consider making prosocial behavioral changes. Less secure facilities encourage antisocial behaviors, and inmates are less willing to attempt prosocial behaviors in strongly antisocial settings.

Common Language
If common ideas are helpful in building alliances, using a common language is essential. For mental health staff, describing psychiatric diagnoses and symptoms in plain English, becoming familiar with custody terminology and addressing custody issues are critical in communicating effectively between the two groups.

Think of how frustrating it is when an auto mechanic drones on about your car in language that you don’t understand. Correctional staff might feel similarly when listening to mental health staff talk about personality disorders or flat affect. If we want correctional staff to provide information on inmates’ functioning, we must give them a list of things to look for that makes sense to them.

When training correctional staff on the signs and symptoms of mental illness (NCCHC Standards for Health Services in Prisons 2003, p. 38), use examples and words that make sense to the audience. A personality disorder (PD) can be described as a personality that creates more problems than it solves. Antisocial PDs have problems with authority and lack remorse. People with borderline PD have a mood that “changes on a dime” (reactive mood) and feel things very intensely. People with psychosis see or hear things that aren’t there; they have a brain disease, which is different from PDs.

Use examples from movies and television to flesh out clinical examples: “Fatal Attraction” for borderline PD; “Jerry Maquire” (Cuba Gooding Jr.) for narcissistic PD; the movie “Cobb” and the television show “NYPD Blue” (Dr. Jennifer Devlin character) for bipolar disorder.

Custody terminology involves terms that correctional staff use to answer inmate placement questions. Suitability for general population, classification systems and safety concerns are key elements in determining where and with whom an inmate is to be housed. Make sure to address these issues during mental health evaluations in order to provide correctional staff with information relating to their job.

For example, if an inmate appears anxious, ask about safety concerns, and let housing staff know what you learn. Sometimes an inmate is not appropriate for general population due to a severe mental illness or similar problem. Sharing this information with correctional staff also role models how you would like them to work with you.

Custody issues that mental health staff can address include whether an inmate is a risk to self or others, will be a management problem, and whether this is the best place for this inmate given the resources of this particular unit. Considering these questions and providing timely information enables mental health staff to assist correctional staff in their mission, and helps correctional staff see mental health staff as partners.

Common Practices
Building common practices is a final step in creating effective communication. Offender management reviews or similar meetings occur on each housing unit, usually on a weekly basis. Mental health staff can attend these meetings during a specific time allotted to address issues pertaining to inmates having mental health problems. This can be done without revealing confidential information, and can enable both mental health and correctional staffs to develop specific responses to an inmate’s behavior.

Other practices that provide an opportunity for interaction include debriefing after referrals, tapping into the grapevine at work, showing care for correctional issues and providing training to correctional staff.

A recent survey by the Utah Department of Corrections revealed that about 50% of correctional staff work a second job, and two-thirds have to work overtime or another job to make ends meet. Developing an awareness of such issues allows mental health staff to understand better what correctional staff go through.

Mutual understanding using common ideas, language and practices can result in an improved ability to accomplish our diverse missions in corrections.

[This article first appeared in the Winter 2006 issue of CorrectCare.]