Mentally-ill inmates are sinking faster than their incarcerated peers. Forensic mental health professionals are essential to getting these inmates’ heads above water, but it’s more than throwing them a life raft. We must get them swimming on their own again.
Forensic clinicians must be acutely aware of their environment and be ready to jump. This has less to do with your own safety than on-the-job flexibility. Like a lifeguard, they are always vigilant for those in need and be ready to intervene. They are watching for people who need services and are sinking, to come running when the emergency whistle blows, and to advocate when correctional staff do not understand the needs of severely ill clients.
A Day in the Life of a Correctional Clinician:
Forensic mental health clinicians may work in maximum security facilities to community-based corrections such as with individuals on parole and monitors. Working within a prison or jail may take some getting used to. The walk into work will include barbed wire, security checks, and doors locking before others open. You’ll roam from living area to living area, a sea of people in various colored jumpsuits milling about. In other areas, like segregation, inmates will be brought to you in cuffs and shackles. There may be threats and inappropriate remarks to deal with; there may be boundary-pushing and intimidation tactics. You’re likely to become well-versed in managing personality-disordered individuals. Overall, though, working in a correctional facility is safer than walking down a city street. Most inmates are not there to give you problems, and security is high.
The majority of inmates know you’re there to help them, are respectful and appreciate your presence. While jail is usually thought of as people at their worst, we also see people at their best. We see inmates caring for their peers, concerned for their illness and asking clinicians to intervene. Others arrive at their worst, acutely psychotic or manic and withdrawing from substances, and you’ll watch them stabilize and become productive for the first time in a long time.
- Crisis intervention: Jail is a societal microcosm; a microcosm with a disproportionate amount of stress and illness. Therefore, it is no surprise that crisis evaluations are a large part of a forensic clinician’s work. Situations range from evaluating inmates threatening suicide just to be difficult, to people who have just made a serious attempt; to those experiencing a psychotic break or becoming acutely manic; to others receiving news a loved one has died, or they’re receiving a 50-years-to-life sentence. Given many facilities don’t have inpatient psychiatric units, inmates at risk are often managed in special cells in segregation. If particularly ill or acutely suicidal, they may be sent to community hospitals with forensic beds or state hospitals associated with the correctional system. A tough stomach is sometimes required. Evaluating someone after a serious suicide attempt or witnessing someone hitting their head, hard as can be against a cement wall, is not unheard of.
- Evaluation: Much of the time is taken by screening inmates for mental health care services and performing diagnostic assessments for ongoing care. Many have legitimate mental health concerns and must be quickly triaged into services. Others enter the facility and figure if they say they are mentally-ill they will get special treatment, particularly sedating medications, so they can sleep away their time. Clinicians become skilled at noticing malingering, or the practice of feigning illness to meet some dishonest need. I’ve met more than one inmate who denied any history of mental health care and sat there telling me how anxious he was, looking cool as a cucumber as he asked for Xanax!
- Individual Therapy: Caseloads are often high and meetings are a mere once or twice per month. Inmates frequently move around, and we don’t have the luxury of establishing foundational relationships like we can in a private office. If ever there was place built for one-session therapy, corrections maybe it. Other times, if inmates have long sentences or pretrial dates far into the future we do get to know them well and establish a more traditional long-term therapeutic relationship.
- Group Therapy: Some facilities have special groups addressing items like trauma, grief, substance abuse, and problematic sexual behavior. Sometimes specialized staff are hired, such as for the latter two. Other topics are often within the purview of the forensic clinicians.
- Miscellaneous tasks: These include case management, being the liaison with psychiatrists and other medical personnel, advocating for the mentally-ill inmates’ needs to correctional personnel, and aftercare planning.
As you can see, working in corrections has some of the same components of working in the community. There is crisis, therapy, evaluations and advocacy. The nature of the environment, however, requires a particular tool kit if you are to be successful and inmates are to benefit.
- Being well-versed in brief, effective therapy approaches: Given the minimal time available for treatment, clinicians with well-honed active-empathic listening skills and a razor-sharp solution-oriented psychotherapy approach, à la Bill O’Hanlon, Steve Deshazier, and Insoo Kim Berg, will do well.
- Assertiveness: Assertiveness is a handy skill anywhere, but is essential when dealing with a population adept at pushing boundaries and trying anything in the book to get what they want from you. If you aren’t very assertive, don’t worry, chances are you’ll be baptized by fire as you learn to ropes. Some facilities offer assertiveness training, keeping staff sharp and safe.
- Safety: While correctional facilities are generally safe places for employees, especially those in the helping professions, being acutely aware of your environment and what you share is of utmost importance. A couple of examples:
- Staff ideally sit by the door of the office with a desk between you and the inmate for a quick escape if need be; just because someone is mentally-ill does not mean they can’t also be nefarious.
- Self-disclosure is out of the question. Savvy, charming inmates can use it against you and you don’t even know it. Something as simple as saying you also enjoy a particular vacation destination can lead to friendly discussions. This may lead to subtle flirting, and a feeling arises between the two. Soon, you’re working late in order to call the inmate to your office. Incident abound, such as a female staff member who succumbed to this “downing of the duck.” She was caught, quite literally, with her pants down with the inmate.
- Other times, they may wheedle out seemingly minor information like if you have kids or if your family owns a business and hold it in their back pocket for a later date. Perhaps they were in crisis and you deemed them at risk so had them placed in segregation. Upset with you, they start psychological warfare: “I hope your family has enjoyed owning that business. We’ll see who screws with who now!” Of course, such incidents get reported and usually are now more than angry comments from the inmate, but you are now in fer for your family’s safety.
Opportunities to work in correctional mental health care will usually be offered through the state and county correctional system. Networking with people in local sheriff’s departments or related offices can provide leads. Some universities, such as the University of Massachusetts Medical School, have a division of Law and Psychiatry, that may provide leads to positions within your location.
Though it is within a paramilitary environment sprinkled with unsavory characters, if you are interested in this niche and have good boundaries and sharp clinical skills, it needn’t be nerve wracking. Rather, it can be an exciting opportunity to participate in the betterment of individuals and society.