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Corrections leaders: It is on with the impossible - treating mentally ill in a correctional setting - Part 2
By Dr. Susan Jones
Published: 06/22/2020

Inmateclass The following article is continued from last week.

The third necessary component to prepare the corrections work environment for a real plan to move forward is getting the rest of the employees on board with the notion that working with mentally ill inmates is a very important part of their job. The barriers that can be erected between mental health treatment staff and the rest of the workforce can be very difficult to navigate past for many people. These barriers are often based upon the notion that the work of these providers is somehow in conflict with the goals of everyone else. This type of belief can be heard when talking to corrections officers as they describe the individual providers. Terms such as inmate lover, coddler, touchy-feely, and do-gooder have been used to communicate the distance between the mental health providers and the rest of the staff. None of these terms communicate an understanding about the need for mental health treatment or an understanding of the “big picture.”

Strategies must be put in place to retain mental health clinicians and help them to become a part of the corrections team. While some mental health providers choose to leave the corrections environment early in their career, there is another piece of this retention issue that needs to be addressed. An often-ignored phenomenon occurs at the other end of this spectrum, when the mental health providers become too much a part of the team. In an effort to “fit in” sometimes clinicians become an extension of the security force and are no longer fulfilling their clinician duties. In essence, they become disciplinarians and no longer are therapists (Jones, 2016). This transition is difficult to prevent because as it occurs, the corrections staff rally around the clinicians to protect them from any scrutiny, because they are now one of “us.” This transitioning away from therapeutic duties to more security duties is a gradual process that is sometimes difficult to stop. After all, we want these mental health clinicians to be accepted in the team and to become invested in what is needed from the security personnel. It is critical that mental health supervisors are constantly on guard to ensure that this transition does not become toxic to the delivery of mental health services. The goal is to become an accepted part of the team, while maintaining a very clear sense of their objective: to provide care for mentally ill inmates.

The corrections staff are key to any success of any program because they are the people who have the most interaction with inmates(Applebaum, Hickey, & Packer, 2001; Dvoskin & Spiers, 2004; Jacobs & Retsky, 1975). The custody officers, food service employees, teachers, and programs staff are with inmates daily and most of these individuals spend their entire shifts working with inmates. Therefore, these individuals can be the force that successfully implements a new program or shift in culture. These individuals can also be the force that derails any plan to ensure that a program or a shift in culture does not occur. Attention must be given to bringing these line staff personnel into the vision for change (Antonio, Young, & Wingeard, 2009). Representatives from line staff must be involved in policy and program development at the front end of the process. Our line staff employees are in the best position to tell the leaders about the challenges and needs of the mentally ill inmates. Remember, when leaders were still fighting about whose job it was to deal with the mentally ill, line staff were dealing with the mentally ill.

Line staff may be in the best position to describe specific challenges, even though they may not have the training to identify strategies that can help reduce the challenges. When line staff are part of the treatment and management decisions for mentally ill inmates, there is a higher likelihood that these strategies will be used. After all, it is usually the custody staff who have to get the inmates to the therapy areas or the programs areas and there are many things in a prison that can prevent that from happening.

Closely tracking the actual delivery of services is a key cornerstone to effective implementation of treatment. Remember, the old adage, “people don’t do what you expect, but what you inspect.” Line staff know what managers and leaders are checking on, which logs they are reading, and which attendance rosters are being pulled for review. This type of follow up is necessary for two reasons: 1) things come up, frequently, in corrections that can result in cancelation of programs, and 2) treatment providers can always find something more urgent to do than providing direct services to their clients. When these two forces work together, with no monitoring, the result can be that many of the scheduled treatment interventions are cancelled.

The other well-known fact in corrections is that corrections employees know which programs or scheduled activities cannot be messed with. In other words, if the expectation is clearly given, in more than one way, that treatment programs will occur and that any deviation of the schedule requires a high-level approval, the message is received and will be adhered to in all but the most extreme cases. It is this type of message that is necessary for a sustained, effective, treatment program for the mentally ill in prisons.

One could argue that if all staff understand the significance and results of consistent treatment for these very vulnerable inmates, they would be on board to ensure that all services are provided. In theory, that should be accurate, but when you have staff doing the work of 2-3 people due to staff vacancies, or working shifts that extend well beyond 8 hours a day, these staff are just trying to survive the latest crisis and get through (Denhof, Caterina G. Spinaris, & Gregory R. Morton, 2014). It is hard to have your eye on the “end game” when you are sleep deprived, severely stressed, or stretched beyond your capabilities.

The most effective treatment programs for mentally ill inmates are accomplished in facilities that have adequate staff working in environments in which they have been adequately trained for the duties of their position. It does little good to draft programs, revise schedules and hire specialty staff when the custody staff are working so short that the mere act of moving inmates within the facility is not something that can be done consistently. No amount of culture shifting, program delivery and development, recruitment and retention of clinicians, or leadership training can overcome the staff shortage issues.

The team approach is critical if real change and treatment is going to be provided for mentally ill inmates. Corrections leaders, line staff, and mental health clinicians must commit to being a part of the answer to this incredibly complex issue. Corrections leaders must focus on these key components in order to ensure that mentally ill inmates are being provided the best treatment options within the confines of a correctional facility.
  1. Promote training programs for clinicians that provide experiences of corrections based clinical work.
  2. Train all corrections staff how to work with mentally ill inmates and with mental health clinicians, focusing on the team approach to success.
  3. Monitor the environment closely to ensure that treatment is actually being implemented as directed and that all staff are fulfilling their particular roles appropriately.
  4. Make every effort to retain staff, both corrections staff and clinicians. Retention must focus on maintaining a workforce that has enough staff on duty (and reduce the number of staff working beyond a normally scheduled shift) to actually do the tasks necessary.
Remember, the goal of providing treatment for mentally ill inmates is inextricably linked to safety of staff and inmates within facilities and the safety of the public upon their release. This is what matters.

Aufderheide, D., & Culbreath, T. (November/December 2019). Florida Department of Corrections: First in the nation to achieve APA accreditation of psychology residency. Corrections Today.
Antonio, M. E., Young, J. L., & Wingeard, L. M. (2009). When actions and attitude count most: Assessing perceived level of responsibility and support for inmate treatment and rehabilitation programs among correctional employees. The Prison Journal, 89(4), 363-382. doi: 10.1177/0032885509349554
Applebaum, K. L., Hickey, J. M., & Packer, I. (2001). The role of correctional officers in multidisciplinary mental health care in prisons. Psychiatric Services, 52(10), 1343-1347.
Aufderheide, D., & Culbreath, T. (November/December 2019). Florida Department of Corrections: First in the nation to achieve APA accreditation of psychology residency. Corrections Today.
Canales, C. (2012). Prisons: The new mental health system. Connecticut Law Review, 44(5), 1725.
Denhof, M. D., Caterina G. Spinaris, & Gregory R. Morton. (2014). Occupational stressors in corrections organizations: Types, effects, and solutions. . Washington D.C.: National Institiute of Corrections. NIC Accession Number: 028299.
Dvoskin, J., & Spiers, E. M. (2004). On the role of correctional officers in prison mental health. Psychiatric Quarterly, 75(1), 41-59.
Fagan, T. J., & Ax, R. K. (Eds.). (2003). Correctional mental health handbook. Thousand Oaks, CA: Sage.
Fraser, A., Gatherer, A., & Hayton, P. (2009). Mental health in prisons: Great difficulties but are there opportunities? Public Health, 123(6), 410-414.
Jacobs, J. B., & Retsky, H. G. (1975). Prison guard. Journal of Contemporary Ethnography, 4(1), 5-29. doi: 10.1177/089124167500400102
Jones, S. (2016). The rise and fall of Colorado's supermax prisons, The IACFP Newsletter.
Jones, S., Slate, R. N., & Johnson, W. W. (2018). Corrections and Mental Illness. In Griffin, III, O Hayden & V. H. Woodward (Eds.), Routledge handbook of corrections in the United States. New York, NY: Taylor and Frances.
Slate, R. N., Jacqueline K. Buffington-Vollum, W. Wesley Johnson. (2013). The criminalization of mental illness. Durham, North Carolina: Carolina Academic Press.
Stelovich, S. (1979). From the hospital to the prison: A step forward in deinstitutionalization? Psychiatric Services, 30(9), 618-620.
Stringer, H. (2019). Improving mental health for inmates. Monitor on Psychology, 50(3), 46-.

Dr. Susan Jones retired from a warden’s position within the Colorado Department of Corrections. She worked in a variety of corrections positions in Colorado for 31 years, including: community corrections, correctional officer, sergeant, lieutenant, manager, associate warden and warden. Dr. Jones research interests have focused on the issues that correctional employees face on a daily basis. Visit Dr. Jones's Facebook page "A Glimpse Behind the Fence".


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