Advocating for the Discarded: Challenges in correctional psychology.
Source: Cristian/Pexels, R. Mitchell, used with permission.
In an American Psychological Association (APA) article called “Saying it Again: Psychologists May Never Participate in Torture,” Dr. James H. Bray noted, “APA’s most recent policy statement on interrogation prohibits psychologists from working in detention settings where the US Constitution are violated unless they are working directly for the people being detained or for an independent third party working to protect human rights (APA, 2009).” Dr. Bray says he hopes that the American people and the world will not judge all psychologists by the few involved in this segment of our history but by the many psychologists who spend their professional lives working for the public good.
These excerpts are highlighted to demonstrate the gravity of the charge psychologists have as advocates. I argue that there are subtle commonalities between the military psychologists who failed to uphold APA’s code of ethics and some correctional psychologists who fail to advocate for inmates’ basic needs.
As a psychology professional in a correctional setting, you often feel overwhelmed and helpless regarding your role as a clinician. When you onboard as a staff member, security immediately counsels you on the dangers of being manipulated by inmates, and rightfully so.
However, a “security-first” mentality is established on day one of entering a correctional institution that can feel as though your psychological expertise will not be valued. While some may believe this perspective is necessary to keep staff safe—and I would agree to some extent—it creates challenges for mental health professionals, including treating the chart, not the patient, conforming to security’s expectations of patient care, adhering to audit- driven psychological services, and subscribing to an ineffective rehabilitation process.
Treating the Chart
As a psychology clinician, I believe it is essential to treat the patient using an unbiased therapeutic approach regardless of the disclosed misdeeds unless those disclosures violate ethics and warrant a confidentiality rupture. However, when reminded of the crimes inmate patients have committed by security and staff, remaining unbiased becomes challenging for some.
Over time, clinicians become complacent in overlooking inmates’ basic needs (ie, adequate housing, required caloric intake, supplements with stronger medications, etc.). However, speculatively speaking, due to being institutionalized over time or fear of retribution (eg, labeled as being pro-inmate, discontinued employment, etc.), some clinicians fail to advocate for changes that would effectively aid in the mental health treatment of inmates.
The job of a correctional officer is no small feat. They work long hours and are often underpaid for the amount of responsibility they must endure. They are trained to be on the offense because their safety and the safety of staff members depend on it. They are indeed the glue that holds the correctional system together, and this article is not meant to discredit their sacrifice; it is intended to shed light on the challenges of mental health units in corrections which is a small system within a larger system.
It is my opinion that policing in a mental health unit within a correctional facility should look different in a few ways:
- Officers who work in mental health units should believe in the work of mental health professionals.
- Officers who would like to work in mental health units should receive initial and annual training from licensed mental health professionals.
- Officers with a desire to work in mental health units should be willing to address inmate behavior problems differently than the necessary measures needed to maintain safety and security in the general population (ie, de-escalation versus the use of force).
Audit-Driven Psychological Services
Some correctional institutions have mental health units driven by lawsuits filed by inmates who felt neglected. These units follow guidelines based on court-ordered instructions that pass audits to support the recovery and discharge of mental health patients, at least in theory.
These procedures seem loosely associated with the ethical standards of today’s psychologists, often creating excessive policy-driven paperwork that ensures legal requirements are met while neglecting patient care hours needed to create real change and rehabilitation. The paperwork required to maintain the appearance of a legal fix is no more than a simple “check-the-box,” which leaves mental health workers feeling burnt out and inmate patients feeling neglected.
Patient Rehabilitation Challenges
Based on my experience working in an inpatient mental health unit, inmates enter the unit through an immediate crisis (ie, self-injurious behavior, etc.). While in crisis, they are observed every day until safety is ensured, determined by a psychiatrist.
Inmates are then transitioned to a crisis unit, where they are reviewed every 14 days by a multidisciplinary team until deemed appropriate for a lower level of care in a transitional unit. In the transitional unit, they are reviewed every 30 days until considered suitable for transition to the general population. Throughout the treatment process, a mental health clinician provides therapeutic services.
You probably think this all sounds great from a clinical perspective—and it does, when it works the way it was constructed to perform. But in practice, inmates are often removed too soon from effective treatment, transferred to external institutions without proper termination procedures, and placed back into the general population where trauma occurred, negatively reinforcing self-injurious behaviors that will gain acceptance to another cycle of mental health services.
Treating the Patient
What makes correctional psychologists different from the psychologists who aided in mistreating military prisoners? As an advocate of human rights, I would say they differ regarding the intent, but the ethical component of “do no harm” remains the same. In doing no harm, we must treat the patient, not the chart.
It is not a psychologist’s position to judge patients or create unsafe environments where trust is not at the forefront of the therapeutic relationship in any setting. A psychologist must advocate when policies are not consistent with patient care and advocate for humane treatment for all. I hope this article will inspire and aid in the necessary changes in the psychological services provided to inmates.