Postcards from the Id

The Issue of Cell Phones in Prisons

Here is an article addressing the issue of cell phones in prison, and what to do about them.  While they are a security risk, there are also laws that prohibit unilaterally blocking phone transmissions.  It seems like there are several common-sense solutions to this porblem, but amazingly, Congress has been unable to address the issue in a timely manner.  Worth a read.

Correctional Psychology - Book Quote on "Correctional Movement"

As noted in an earlier post, one book I like for the purpose of a basic introduction to correctional psychology is the Handbook of Correctional Mental Health.  The chapters focus on various aspects of providing mental health services in correctional settings, and the authors often touch on aspects of working in a correctional environment that may not seem like a big deal to someone who is used to a prison atmosphere, but may be quite informative to a person who has not spent much time in a correctional setting.

One such description is in the second chapter of this book, entitled “Practicing Psychiatry in a Correctional Culture,” by Kenneth Appelbaum, M.D.  He discusses the impact of security on movement within a prison, providing a great overview:

“Containment and security are central to the mission of all correctional facilities, and the environment reflects this priority.  Prisons are fortresses that carefully control who gets in and, more importantly, who gets out.  Without proper clearance and identification, outsiders will not make it past the “front trap.”  Like the entryway of a castle, the front trap is the passage through the razor-wire-topped outer perimeter walls.  A correctional officer in a separate control station regulates entrance to and exit from the trap through the security doors on either end of the passageway.  At least one door is always closed, literally trapping, at least temporarily, all traffic as it transits through the trap.  Another officer assigned to the trap may search visitors and staff when entering or leaving the facility.  Additional inner traps control movement within the facility.  Officers control all movement.  The psychiatrist usually does not have a key.

Although the distance between two points in a prison may be short, transit time can vary considerably.  Many factors affect the ease of movement.  For example, delays can occur when visitors in the trap require more extensive searching and processing.  Sometimes the control officer or the trap officer is temporarily distracted by other tasks.  At other times, a freeze on all movement within the institution occurs because of a medical emergency, a fight, or another disturbance.  These delays cannot be avoided, but even during normal operations, the speed of movement may be directly proportional to the quality of the relationship the psychiatrist has with the officers in charge.  Good rapport with officers can go a long way toward improving a psychiatrist’s efficiency, and as described later in this chapter, rapport can be critical in the efficacy of psychiatric assessments and interventions.”

Monitoring movement within a prison, in addition to into and out of a prison, is an important aspect of the correctional environment.  Obviously, this priority increases proportional to the security level of the facility.  Safety not only for the staff, but also the inmates, is enhanced through the effective monitoring and control of inmate movement; therefore, it is a priority that non-correctional staff should respect.  Regulations are in place for a reason, and often the reason is the result of a past issue or breach.  With respect to the rapport issue described above, I’ve seen a number of non-correctional staff (including mental health professionals) burn bridges through chronic complaining about security-related procedures, passive-aggressive noncompliance with said procedures, and even verbal arguments with correctional staff regarding priorities.  Obviously, there will be times where correctional procedures may come into conflict, to some degree, with optimal mental health practices; in these cases, there is nothing wrong with asserting mental health priorities in the context of a correctional environment.  But, there is a correct way to do this (i.e. seeing oneself as part of the correctional team, and working with custody staff), and a wrong way (i.e. condescension, griping, discounting of correctional concerns).  In the latter case, you may win the battle, but lose the war, which is unfortunate, given the importance correctional staff play in the assessment and monitoring of mentally ill inmates.

Personally, I try to approach custody-related tasks not just from a neutral perspective, but from a positive, pro-custody manner.  I want the correctional staff to not necessarily see me as an officer, but as someone who “gets it.”  In that vein, I will help out whenever possible when correctional disturbances occur (breaking up fights, searching for reported contraband, etc.), volunteer for extra custody posts during time periods when there is a shortage of available correctional staff (for example, during annual training, when all staff attend a week’s worth of training on correctional principles), regular conversations with custody staff (to include “keeping them in the loop,” asking for feedback on individuals, and simple banter), and attending correctional staff events.  I’m generally disappointed with the low participation in staff activities by medical, mental health, and other non-custody staff (i.e. Staff Christmas Party).  Do I always feel like going?  No.  But I do think it’s important to demonstrate through actions that you don’t think you’re better than anyone else, you respect the work of the other staff, and that they can count on you in an emergency.  In return, I generally have a good relationship with many of the officers and other staff at the facility, which not only makes for a better work environment, but also helps out with my job in many little ways.   

Psychologist Helps Inmate Escape

Ugh.  I hate to see stories like this, especially when it involves a mental health professional.  Well, at least this one occurred in Canada (even though the psychologist in question is Amercian).  In this case, a psychologist aided the escape of an inmate convicted of murder.  Worse, she helped as a result of an inappropriate relationship with the inmate:

Police believe Danto and Wood have a romantic relationship and that she was involved with his escape plans from the beginning, Sun Media's Whig Standard has learned.

“We do understand that a staff member was involved,” said Stephanie Fullerton, a spokeswoman for Corrections Canada at its regional headquarters in Kingston. “Currently this is under investigation by CSC as well as the police so it would be inappropriate for me to comment on specifics.”

In corrections, we go over this stuff again and again - why these relationships are destructive, how it puts others at risk, and what warning signs to look for in terms of relationships becoming inappropriate.  And yet, despite these efforts, this stuff comes up again and again.  I really am amazed at just how often this does occur, especially considering the consequences.  Not sure what the penalty is for this type of conduct in Canada, but it will be interesting to see how it plays out.

Murder Suspect Shot, Killed While Attacking Judge

This article has the details.  Apparently, the suspect was on the stand, and he attacked the judge as she called for a recess.  Initial reports indicate he had a cutting or stabbing instrument on him. and his movement was suggesting he was stabbing the judge on the case.  A couple of random thoughts:

1) Was the guy shackled?  If not, why?  He is a murder suspect, and his comments just prior to his attack (when asked why he killed his girlfriend, he stated, "Because she deserved to die") suggest he was at increased risk for violence.  I'm not sure what the policies are from state to state, but I would think individuals accused of violent crimes would receive extra precautions, regardless of the jurisdiction.

2) How did he get the object into the courtroom? These guys are supposed to be searched prior to entering a room with a judge, attorneys, and family members.  Either he hid this object particularly well, or someone dropped the ball.  Unfortuntately, this occurs more frequently than it should, but searching is one of those mundane, repetitive, not-too-pleasant activities that, after doing hundreds of searchs, becomes rote; until something like this happens.  In the prison, when someone is doing pat searches that are so fast nothing is being accomplished, they are called "drive by searches."  These are never a good idea, obviously...

3) The suspect's own lawyer defended the shooting, which would suggest the story went down pretty much as reported.  Yet another reminder that, whatever you think of defense attorneys, give them credit for meeting with guys like this, day in and day out, and representing their legal interests.  It takes a certain skill set to be able to do that kind of work effectively for any length of time.

4) A family member of the suspect said they tipped off staff that he may have a weapon of some sort.  I winder if this is true, and if so, if anything was done with the information.  Really, all one could expect would be a more thorough search, including with a metal detector, but I suppose more details will need to come out before this part of the story can be comfirmed.

One last thing - this stuff may occur infrequently, but I can attest that there is something to the idea of a security threat in courtrooms.  Yes, people get searched before they are allowed inside, but the fact is trials and hearings are often high stakes, with, in the case of murder, rape, etc., highly sensitive and emotional issues being addressed.  People are taking the stand to make comments that will impact others in many significant ways, including potentially long prison sentences.  Given all of this, it makes sense to be wary in a courtroom, rather than lax.  Just because people pass through a metal detector, and there is an officer in the room, does not mean bad things can't happen.  Hopefully the people in charge of security in courtrooms can use the recent incidents of violence to learn even better safety procedures. 

Correctional Psychology - Types of Correctional Facilities

When considering the concept of corrections, it is important to understand just how complex a correctional system can be. In the United States, for example, you have a federal system, 50 distinct state systems, and thousands of local systems. In addition, there is a separate system for military issues, and there are separate considerations for juveniles. Each state (plus the federal government) determines how it administers its own correctional system, in terms of the various laws, levels of punishment, who is arrested, and how people are incarcerated. Complicated indeed.

Broadly speaking, there are three primary types of correctional facilities: lockups, jails, and prisons. Within each category, there are subtypes (particularly in the prison category), but this breakdown is useful for a basic understanding.

Lockups are local, temporary holding facilities that are generally utilized at the very beginning of the criminal justice process. They are very common, and the typical stay is generally very short - maybe 48 hours tops. The location of lockups is usually a local police station, where an individual who only requires a temporary detention can be held. Approximately 30% of police stations have lockups, and they vary in size based on the size of the jurisdiction. Larger communities will generally use a jail if a lockup is not available.

Jails are locally operated detention facilities that will house individuals both before and after adjudication. Generally, if a person is sentenced to a shorter sentence, they may serve the remainder of their sentence at the jail. Jails tend to be a jack-of-all-trades type of facility, with various roles in terms of who is held there: probation/parole violators, individuals convicted of a misdemeanor, people awaiting trial, a temporary holding spot for individuals needing a transfer, etc. Jail staff generally see all types of individuals in terms of the legal process. From a mental health perspective, jails may sometimes be used when the police detain someone with a mental illness, while a determination is made for a more appropriate placement. Jails hold approximately 1/3 of the individuals counted as incarcerated in the U.S. , so they are quite busy, particularly since they are generally not holding individuals who will be there for a very long period of time.

Prisons are correctional facilities that hold individuals who have been convicted of felonies, and are required to serve a significant period of time as a sentence (generally at least one year). They tend to hold a lot of individuals, and they are operated on both the state and federal level. There are a wide variety of prisons, based on gender, security level, medical/mental health needs, etc.

Correctionally speaking, I think it is important to think about corrections as broadly as possible, so I would also like to mention the various step-down facilities, half-way houses, etc. that are used for re-introduction into the community. One may also consider court-ordered outpatient treatment (i.e. court-ordered anger management therapy) within the context of correctional mental health, even if the person may not have any custodial restrictions. Within all of these contexts, mental health assessment, treatment, management, classification, etc. will play a role. For the mental health clinician working in the system, different mental health issues will likely be more or less prevalent, depending on the type of facility. Foe example, individuals working at a lockup facility will see significantly more substance intoxication than at a prison. A jail will see a significant amount of substance withdrawal. A person working in a penitentiary will see a significant amount of Antisocial Personality Disorder, while a prison medical facility will see many older inmates with various medical and mental health issues related to aging. Knowing your population will allow a clinician to be prepared for the more likely clinicial issues that will present themselves.

Correctional Mental Health - Theories of Punishment

As I noted a few weeks back, I am currently teaching a course on correctional psychology, and I am discussing all sorts of interesting topics that I thought would also make for interesting (I hope) blog posts. I thought I’d start with a post for today that addresses a rather simple question - Why do we punish people? And in the context of this thread, how does punishment fit into the nature and purpose of the correctional system?

The simple answer to the question, “Why punish?” is usually something like, “Well, they broke a rule,” or “They did something they weren’t supposed to.” The more in-depth answer, however, is far more complex, and includes the application of theories from a number of disciplines, including psychology. In general, there are four primary reasons for administering punishment to an individual, to include incarceration as one form of punishment:

1) Retribution - this is simply the idea that we punish someone “because they deserve it.” This is an old concept, going way, way, way back; think “an eye for an eye” to see how far back this concept dates. Early legal thinking relied heavily on the idea that someone who causes harm ought to be harmed, though the concept has evolved, over time, to consider “proportionality” when administering punishment for this purpose (i.e. we don’t send someone to the gas chamber because of a parking ticket). Punishment based on retribution has little relationship to any psychological thinking, or any forward thinking in general - the impact is not considered, nor are any benefits.

2) Deterrence - Within this concept, punishment is administered with an eye towards prevention of future harmful/criminal behaviors. There is specific deterrence, in which punishing an individual for an offense is thought to deter that individual from engaging in that offense again. This thinking is grounded in behaviorism - punishing a behavior through negative consequences reduces the likelihood of the behavior being engaged in again. There is also general deterrence, in which it is thought that punishing an individual for an offense will provide a lesson to the public at large; they will be less likely to engage in that same behavior as a result of seeing the perpetrator punished. Does this work? It depends - on the severity of the punishment, the swiftness of the punishment, the type of offense we are talking about, and individual characteristics.

3) Rehabilitation - or, as Stanton Samenow would say, “Habilitation.” This is the idea that individuals are incarcerated for the purpose of providing interventions designed to curb criminal lifestyles. The expectation is that the correctional system is designed in order to address the various issues within the prison population that result in criminal behavior. Primarily, we are talking about education, training, and counseling. Does this work? Again, it depends on several factors. However, research has shown that recidivism can be reduced with certain groups, particularly as techniques in assessment, treatment, and monitoring improve.

4) Incapacitation - this is the idea that individuals can’t re-offend if they are incarcerated; it is prevention via incarceration. This can be achieved in various ways, including locking everyone up for the same amount of time, regardless of individual differences; identifying higher risk offenders and choosing to lock those individuals up longer than others; or identifying individuals within certain subgroups of crime that have higher re-offense rates, and giving them longer sentences.

In the 1980s and 90s, this incapacitation approach gained a lot of steam, with the increase of prisons, “three strikes” laws, etc. In addition, the approach is effective, within a narrow view of the issue; crime will drop if more offenders are incarcerated. However, the flip side (or sides) are problematic: 1) false positives - general application of sentences without examination of data leads to the incarceration of individuals who are relatively low risk for recidivism - this helps no one and it is 2) expensive! Correctional systems cost a ton, particularly if you are housing individuals who likely would not re-offend, and could otherwise be offering something positive to society, and 3) is not an efficient use of available resources - there are only so many staff, so many dollars, etc. If we have sound data on which to make rational decisions (i.e. not paroling people because they “found God” or wrote children’s books, but based on scientific knowledge), we could allocate correctional resources far more efficiently - incapacitate the violent, repeat offender high in psychopathy; provide mental health treatment to the mentally ill offender; and provide programming to the individual with a high potential for rehabilitation.

Obviously, this is in fact how the correctional system is run, but trends tend to push the system to emphasize certain areas more than others. Personally, my sense is that the fiscal issues many states are facing, along with the overcrowding, will push correctional departments to swing back towards rehabilitation, along with smarter forms of incapacitation. For example, there will be more liberal use of community corrections and half-way houses as technology continues to improve, facilitating better monitoring via GPS. If a guy is relatively low risk for violence, has job skills, and is likely to cooperate with conditions required of community placement, why not let him serve in a less restrictive environment, contribute to society, attend therapy in the community (if necessary), and save the taxpayers some money to boot?  Hopefully this post will kick off an interesting thread of posts related to the provision of mental health services in correctional facilities.

The Reason Most Inmates Cannot Attend Family Funerals

This story out of Kansas is horrible.  Obviously, many of the specifics regarding the reasons for this assault will be determined in the next few days, as investigators piece together what happened and why.  From a correctional standpoint, this is the primary reason most inmates, even those who are minimum or low security, are not allowed to attend funerals, even those of close relatives.  Many in the public believe it is the cost, but at least in the federal system, the entire cost is paid for by the unmate and his/her family.  No, the real issue is the safety of the staff who must accompany an incarcerated individual to a wake, funeral, etc.  These events are planned and scheduled, and therefore easy targets if someone does intend harm.  One or two correctional staff, even if armed, are not sufficient to ward off an attack like this; in certain cases, they may even make an attack more likely.  There are simply too many variables to account for, so only the least of security risks will be afforded the privilege of attending this type of event. 

Believe me, providing therapy and support to an inmate who has just lost a loved one is one of the most difficult parts of correctional psychology; their not being able to participate in the grieving process makes it even more difficult.  However, correctional staff are simply not in a position to take unnecessary risks in situations like this.  Attacks like this don't happen often, but as this story reminds us, it does happen.

Correctional Mental Health - A New Subject Thread

Hello all.  I hadn't made this announcement yet (in fact, I forgot!), but I have begun teaching a class entitled "Forensic Psychology II (Tagline: "This time, It's Personal.").  The course will have correctional psychology as its primary focus, in that all topics addressed (including crisis intervention, assessment, treatment, release prep, and legal/ethical issues) will be presented with the impact of the correctional system in mind.  For example, when addressing issues related to depression, the imact incarceration has on depression will figure prominently into the discussion.  In addition, corrections will be broadly defined, to include involuntary outpatient treatment (i.e. court-ordered treatment), treatment provided to those on probation and parole, as well as more unique services mental health professionals can provide in various correctional facilities (such as employee assistance, crisis support team membership, etc.).

I have chosen Handbook of Correctional Mental Health as my textbook for this class. I believe it covers the essentials of providing mental health services, including basic overviews of the legal origins of current treatment standards (where applicable), and a wealth of statistics to demonstrate certain points.  I also like its inclusion of chapters related to such issues as assessment of malingering (or feigning mental health symptoms) as well as medication, which are prescribed by psychiatrists, but often only after an initial assessment and referral by a psychologist or other mental health professional.  Overall, a very solid text for the subject at hand, and one I'd recommend to anyone embarking on a career in correctional mental health.

What I'd like to do is present some brief summaries of useful and/or interesting issues that I present in class on this blog.  Like blogging in general, which helps me stay sharp in my field, this will sharpen my knowledge in a more specific direction, towards my class material.  I've also found that peeople just can't seem to hear enough about what goes on inside prisons (well, except for those who've either been to prison, or have worked inside one - they tend to want to voice complaints, rather than ask questions!).  So, look for at least a few posts centered around mental health in the correctional field over the next couple of months...  

Female Sex Offenders Often Have Mental Health Difficulties

According to research discussed in this article, female sex offenders tend to have mental health issues equal to that of women who have committed other violent crimes (the sex offenses used in this study included rape, non-consensual sex, sexual assault, and sexual molestation). In addition, the rates of mental health problems as compared to a control group were significantly higher. From the article:

“However, the figures differ widely from the control group. Incidences of psychosis were 16 times higher amongst the sex offenders than the control group, drug abuse 23 times higher. According to the research team, the results indicate that women suspected or convicted of sexual offences should undergo routine psychiatric examination, something which, at present, is not done.”

The article notes that previous research has not shown higher levels of mental health problems for male sex offenders. Having worked with both male and female offenders, I am not surprised by this finding. Without making any comment on whether the mental health issues present are mitigating in terms of the offending behavior, in my experience female offenders by and large do have a significantly higher number of mental health issues, as compared with male offenders. It seems reasonable that this general trend would also apply to this specific class of offender. Female offenders not only tend to have more mental health difficulties, they also utilize mental health services far more than their male counterparts. Part of this may be the types of mental health issues typically present in the female offender population, part of this may be that mental health services are less stigmatizing in the female offender population, and part of this difference is likely due to other factors as well. In general, the differences in the prison culture at female prisons versus male prisons are fascinating. In addition to the differences in the usage of mental health services (as well as the need for crisis services due to self-injurious behavior, or “crises” that turn out to be not-quite crisis level), there are a number of other dynamics that are really interesting. Sounds like a great future blog post topic!

Faking Problems for Personal Gain - Who Would Have Guessed?

This article reports on what I would have figured to have been common knowledge - people with head injuries (as well as other problems) often fake or exaggerate symptoms when there is an external reason (such as financial gain, court proceedings, etc.) to do so.  The researchers seem to indicate that there are "new tools" in the assessment of feigning regarding neuropsychological symptoms (i.e. memory problems), but in fact there have been a number of tools designed for this purpose for some time.  I suppose it is possible that since this study was conducted in pain, they may not have had tolls available for use with Spanish speakers...

While I will never go into any details regarding the assessment of malingering on this blog (malingering is the term used in psychology to describe the intentional faking or exaggerating of symptoms for personal gain), I can say this - successfully mimicking psychological symptoms is much, much harder than people think, and offenders, at least, often present so inaccurately that, at least informally, it is easy to spot.  In conducting court-ordered evaluations of individuals who have a lot at stake (sometimes 15-20+ years of prison), it makes sense that an individual will do whatever they can to avoid incarceration.  Since this is this case, I see efforts to malinger on a regular basis, and not only have to determine this informally, I have to document it formally.  There are tools and statistics to do so, and again, trying to pretend you have a psychological problem that you have never actually experienced is a difficult thing to do, at least with a clinician who's looking for it.  That is another impediment to truly successful malingering, at least for offenders - they have likely faked something before in a non-correctional context, and been successful.  However, if someone presents for outpatient treatment, or substance abuse treatment, or is hospitalized at a state hospital, clinicians at those settings aren't less adept, it is just that malingering is not on their radar.  This gives the offender a false sense of confidence, so that when they try the same presentation in a forensic setting, they are usually discovered. 

The important point of the article, cynical as it may be, is that is is important to be at least somewhat skeptical of reports of psychological difficulties in settings where there is an obvious potential gain to the individual, especially if there is no history of said symptoms in the past.