Good for Everyone: Interventions to Maintain Mental Health During COVID

The COVID-19 pandemic has disproportionately affected staff and residents of correctional facilities, and the impact goes beyond physical health. Protecting the community has required increased restrictions, decreased visitation, less programming, and some lockdowns. Though necessary, those mitigation efforts can increase feelings of isolation and uncertainty, undermine emotional well-being, and exacerbate mental health issues among facility staff and residents alike.

A significant percentage of incarcerated individuals – as well as some custody staff – have preexisting mental illnesses. Both populations face tremendous stress, especially now during the pandemic. The following summary of recently published evidence-based interventions offers guidance and strategies for maintaining mental health – your own as well as the mental health of the incarcerated individuals you work with.

For the Incarcerated
Early in the pandemic, The Lancet Psychiatry published several suggestions for minimizing mental health harm related to the pandemic as identified by Hewson et al.

• Offer mindfulness exercises; they can help alleviate anxiety and uncertainty caused by the pandemic.
• Increase access to telephones, video calls, and postage stamps for letters to help reduce feelings of isolation.
• Provide education about COVID. Having access to accurate and up-to-date information can combat some of the uncertainty related to mitigation strategies and helps prepare people for the transition back into society. Education that emphasizes the importance of their role in protecting others can also establish a sense of empowerment and belonging.

Other suggested interventions:

Encourage communication between staff and the incarcerated. A scoping literature review on the subject by Johnson et al. found that clear communication regarding any new COVID-19 information or changes in restrictions or protocol within the facility can help prevent the spread of mistrust, fear, and anxiety and improve the overall climate.

Provide distraction materials. According to a recent article by Kothari et al. in Medicine, Science and the Law, incarcerated individuals appreciate receiving self-help materials such as puzzles, journals, coloring books, and playing cards, as well as instructions for in-cell exercises, to occupy their time and promote physical and mental health.

Increase yard time. Rebecca Vauter, PsyD, CCHP-MH, chief behavioral health officer for Armor Health, suggests providing more time outside and access to sunlight during times of increased isolation. While the logistics can be challenging given COVID-19 restrictions, outdoor yard time offers positive mental health impact with reduced risk of disease transmission – and it’s good for facility staff too.

Look to the NCCHC standards. NCCHC’s Standards for Mental Health Services in Correctional Facilities includes several strategies for maintaining patients’ mental health, which should be emphasized to combat COVID restrictions. The standards suggest the following:

• Engage patients in the development of their mental health treatment plans to establish a sense of ownership and increase the likelihood of compliance to care.
• Provide education regarding mental health, mental illness, coping mechanisms, medications (if applicable), and self-care activities through classes, brochures, pamphlets, videos, and other materials. Self-care subjects include maintaining good personal hygiene, coping with stress, anger management, conflict negotiation, and relapse prevention. Maintaining good personal hygiene can enhance self-esteem and a sense of well-being. (Poor hygiene, on the other hand, can be an indicator of mental illness, including depression, intellectual deficits, and severe psychiatric disorders.)
• Encourage and provide access to exercise and fitness. Exercise is beneficial in managing anxiety, depression, and manic episodes, and improving cardiovascular performance and self-esteem. Although programming may decrease during COVID, offering exercise in a safe setting – in a small group or outdoors, for instance – should be prioritized.

For Facility Staff
As essential personnel, correctional staff serve a critical role in society’s response to the pandemic. The pressure of having direct daily contact with a high-risk population, on top of the well-documented work-related stress and anxiety among those working in jails and prisons, requires interventions to support correctional facility staff.

Create a “buddy” system. Kothari et al. suggest improving bonds between staff members through buddy systems that give them an opportunity to debrief before and after shifts.

Decrease stigma. Managers should encourage custody and health staff to practice self-care and support them in seeking treatment whenever necessary, particularly during the pandemic.

Use the PIES framework. The PIES system of formal support – Proximity, Immediacy, Expectancy, Simplicity – emphasizes the efficacy of treatment and support that is close to the place of work, immediate and efficient, simple, with the expectation of returning to work. Solomon et al. developed this system to support veterans suffering from post-traumatic stress disorder, and it could be extremely helpful in providing services to those who work in high-stress environments like corrections.

Evaluate and update sick leave policies. The Centers for Disease Control and Prevention offers personnel guidance related to COVID-19 and correctional facilities. Recommendations include ensuring that policies are “flexible, nonpunitive, and actively encourage staff not to report to work when sick.” This helps staff to feel supported and also helps prevent symptomatic transmission at work.

COVID-19 has been challenging for everyone in all sorts of environments, but the restrictive and controlled nature of correctional facilities presents unique issues that warrant special attention. Administrators must make efforts to ensure that necessary interventions to address the mental health effects of COVID-19 and associated restrictions are available.

Relevant NCCHC Standards
Standard MH-F-01 Mental Health Education and Self Care: Mental health education and self-care instructions are given to inmates with mental illness.

Standard MH-F-02 Healthy Lifestyle Education and Promotion: All inmates have access to mental health educational materials that promote disease prevention, wellness, and recovery and are encouraged to participate in programs that encourage healthy lifestyle choices.
NCCHC Standards for Mental Health Services in Correctional Facilities, 2015

Talia Parente is an AmeriCorps VISTA intern and Justin Berk, MD, MPH, MBA, is director of medical services at the Rhode Island Department of Corrections.