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Readers learned in the previous post that mentally ill inmates are sinking faster than their incarcerated peers. Correctional clinicians are essential to getting suffering inmates' heads above water, but it's more than throwing them a life raft. Clinicians must get them swimming on their own again, and advocate when correctional staff don’t understand the needs of severely ill clients. In this installment, we look at what a forensic clinician can expect to encounter.
The settings
Forensic mental health clinicians’ work settings range from maximum security complexes to the community, interacting with people released on parole and GPS monitors. The former might take some getting used to; there’s barbed wire, security checks, and doors locking before others open. Some units are open living quarters with inmates in various colored jumpsuits trying to keep occupied. In segregation, clientele will be brought to you cuffed and shackled.
Though most inmates are respectful and appreciate your presence to help them, there may be threats and inappropriate remarks to deal with, boundary-pushing, and intimidation tactics. If you’re interested in personality disorders, there is perhaps no better place to learn to successfully interact with the most challenging representatives of antisocial, narcissistic, and borderline personalities.
On the flip side, jail isn’t entirely a sea of people at their worst. There are inmates caring for their peers, concerned for their illness, and asking clinicians to intervene. Others arrive at their worst, acutely symptomatic and withdrawing from substances. As they stabilize and become productive for the first time in a long time it is rewarding to watch the transformation you played a role in.
The work
Crisis intervention: It’s no surprise that crisis evaluations are a large part of a forensic clinician's work. There are inmates threatening suicide as a bartering tool, to people who just made a serious attempt. Others experience psychotic breaks, receive news a loved one has died, or they're receiving a life sentence. Some may require transfer to a special forensic hospital.
Evaluation: Screening inmates for mental health care services and performing diagnostic assessments for ongoing care is a large part of the role. Many have legitimate mental health concerns while others figure if they say they are mentally-ill they will get special treatment, particularly sedatives, so they can sleep away their time or feed an addiction. Clinicians become skilled at noticing malingering (feigning illness to meet some dishonest need). More than one inmate will profess being highly anxious and in need of Xanax, but have no psychiatric history and appear relaxed while interviewed.
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 a place built for one-session therapy, corrections maybe it.
Group therapy. Some facilities have special groups addressing trauma, grief, substance abuse, and problematic sexual behavior.
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.
Special considerations
Obviously, correctional mental health work has similarities to community service settings. The nature of the environment is what makes the difference. Keeping the following in mind is imperative to success as a correctional clinician:
Safety. Correctional facilities are generally safe places for employees, but being acutely aware of your environment and what you share is of utmost importance. Considering the following 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 someone mentioning they also enjoy a particular vacation destination can easily lead to friendly discussions. This may lead to subtle flirting, and a feeling arises between the two. The flirting leads to working late in order to call the inmate to their office. During employee orientation, you’ll likely hear stories about “downing of the duck," including staff members and inmates quite literally being caught with their pants down. Less scandalous matters also occur, such as a staff member looking up information for the inmate, unknowingly helping them with their case.
- Other times, inmates 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. If they get upset with you, they unleash psychological warfare: "I hope your family enjoyed owning that business. We'll see who screws with who now!" Of course, such incidents get reported and usually are nothing more than angry comments, but you are now in fear for your family's safety.
Assertiveness. This handy skill is essential when dealing with a population adept at pushing boundaries and willing to do anything to get their way. If you’re not very assertive and start working in corrections, don't worry, because chances are you'll be baptized by fire.
Being well-versed in brief therapy interventions. Little time is available for treatment, so 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.
Finding opportunities
Career opportunities in correctional mental health care are usually offered through state and county correctional systems. Networking with local sheriff's departments or related offices can provide leads. Also, some universities, such as the University of Massachusetts Medical School, have a division of Law and Psychiatry, that may provide guidance.
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. It can be an exciting opportunity to participate in the betterment of individuals and society.
