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Mental health: not just a program.

In an age of aphorisms, the observation that America is fatting when it comes to dealing with the mentally ill has become cliche. Nowhere is that truth more obvious than in corrections, where the "order" of the law and the "disorders" of mental illness have their most enduring encounters.

In the February 2005 Corrections Today Commentary article, I concluded that both mentally ill and nonmentally ill offenders need institutions, but they need different kinds of institutions. The mentally impaired and the characterologically impaired (meaning an impairment in a person's character) are populations that are different kind, not just in degree, and as a result, they need institutions that are also different in philosophies, goals, policies and interventions. Six years later, the hens of reform flutter ever more frantically about the coop, kicking up the dust and feathers of expensive lawsuits, more screening devices and new best practices, but the roosting places for change have remained elusive. Perhaps the problem lies within the mental models corrections has been using--models that ignore important differences and underuse the skills of mental health staff.

Despite the good intentions of many administrators; and practitioners, the thinking that corrections has often been using is destined to fail from the sheer weight of differences in a whole host of areas. In fact, it seems even more obvious today that not only is the model of housing severely mentally ill people in correctional facilities rather than treatment facilities wrong, but differences within the models of clinical skills, clinical intervention, management of mental health staff and, indeed, the basic conceptual model of behavioral change underlying the entire process have been too heavy to be supported by the current structure for a long time.

Mental Health Staff Vary in Background and Training

Correctional mental health is typically an unwanted buckle affixed to the correctional and military model boot. The military model is, of necessity, built on the twin pillars of conformity and interchangeability. In this model, as well as in many correctional agencies, roles are carefully defined and staff are expected to rotate through a variety of positions without Joss of safety or efficiency. Interestingly, there is a parallel in medical training where the specificity of the information for medical personnel, based on a consensus of what constitutes the required body of knowledge and the articulation of clear standards of practice, leads to similar essential interchangeability of skills among medical staff that are suitable for most prison requirements.

This is not true with respect to mental health staff. States provide licensing requirements for psychologists, social workers and others in the field, but there are many high-quality paths to those licenses, and they definitely do not lead to the same degree of uniformity in mental health that is found in either medical or correctional staff. Broad variability in theoretical perspectives and clinical training mean that some mental health professionals, while perfectly effective in the community, will not be suitable for employment in correctional settings. Administrators need to keep in mind the important differences in how mental health professionals are trained, the philosophies they harbor and the goals they seek to achieve. Any skills model that expects uniformity and interchangeability among mental health staff will not be able to bear the weight of these differences.

Understanding Crime to Treat Offenders

The flip side of the uniformity model in staff is the uniformity model in offenders. Everyone recognizes that there are more differences behind the inmates' identification numbers than just the shirt size they may be printed on, yet institutional policies are specifically intended to be evenhanded and uniform when it comes to interacting with inmates.

Oddly enough, given the unique social mission of corrections, the crime and criminality of the individual turn out to be largely incidental to their interactions with both custody and medical staff. Consequently, the individual's social history, category of crime (other than sexual-related), personality and many other individual variables (other than gang membership, malingering and drug-seeking) are typically irrelevant in the day-to-day operation of the facility. Even in the clinic, the crime and criminality issues are usually seen as incidental to the practice of medicine.

Again, however, this is emphatically not true in mental health where the kind of crime, the length of sentence and the personality of the offender, as well as his or her family and educational and criminal histories are not just important elements in treatment by mental health staff, but are crucial understandings for staff safety and behavioral change. Sophisticated clinical skills are required to deal with crises such as potential suicide and severe mental illness, but after those conditions are managed or abated, the life situation and personality characteristics of the offender should rapidly replace them as the focus of attention for reasons related to the well-being of the offender, the functioning of the institution and ultimately, the safety of the community to which the offender will return.

One of the biggest failings of the mental health system within corrections is the unwarranted disregard for the crime and criminal-related aspects of the mental health population. It is an unfortunate fact that many mental health professionals are so focused on standard mental health issues that they give too little consideration to the mix of those issues with the uniquely criminal distorted thinking, lack of bonding and absence of conscience often found in offender populations. In addition, some mental health professionals are brought in to work in corrections with little or no training or experience regarding crime, criminality or criminals.

Failure to have a solid grounding in understanding the role of crime and criminality as they relate to the offender's personality, family, peers, school and work will impair the mental health professional's ability to understand and respond to the issues offenders bring with them into the institution and will limit even more those professionals1 ability to create the behavioral change for which citizens and taxpayers are so fervently hoping and praying. There are important differences between criminals and noncriminals, and a clinical model that fails to take these differences into account or does not provide or demand training in crime and criminality will never be able to accomplish its goals.

Challenges in Managing Mental Health Staff

Mental health staff are often different from other corrections staff. People who work in the mental health field are usually high-quality, well-trained individuals who may have dedicated their lives to helping people. They may believe that punishment is the least effective means of achieving behavioral change, which makes many of the interactions in prisons seem wasteful, unnecessary or counterproductive to them,

In addition, as a result of their training, preferences for personal autonomy and trust may vary from other corrections professionals, especially considering their employment in an environment with rigid rules. Despite excellent communication and active listening skills, mental health staff may express implicit disdain or disapproval of "the way things are done around here," which will interfere with overall employee camaraderie. They are often trained to hold ethical commitments that can bring them into conflict with institutional expediency.

The most effective administrators recognize that mental health staff are not vassals to be micromanaged in their daily work, but neither are they monarchs, independent of department and institutional requirements. A solid management model that recognizes the need and desire for acknowledgement of mental health staff's significant achievements and professional autonomy within their scope of practice, while still holding them to

the broader goals of the department's mission, institutional safety and interdisciplinary/work group collaboration will ultimately be the most successful.

A New Mental Health Model

In order for mental health programs to succeed, the corrections field needs a different conceptual model--a new model that will allow corrections professionals to analyze the situation, explore alternatives, make decisions and implement more effective strategies. Fortunately, the seeds of that new model can be found by embracing the differences identified above and using the strengths found in them to solve the old problems that surround mental health in corrections.

Correctional staff are official representatives of society in response to what is right and wrong in the community. As society's representatives, the responsibility corrections has for human life is prodigious, and the power and authority granted to them under the laws is formidable. In light of the responsibility and authority they hold, the people in control at headquarters and in the institutions need to hire the right people to do the work, train those people appropriately, support them in their work, and help them collaborate to accomplish the mission and goals society has set for them. Corrections is increasingly including more strength-based approaches, as well as techniques such as evidence-based practices; the risks, needs and responsively model; stages of change analysis; and motivational interviewing strategies. Corrections has operated too long on the idea of "folk" criminology, or a model that "everyone knows," and the time has come to review and integrate the research for guidance on our mental health strategies. In particular, management of mental health programs and behavioral change initiatives can now benefit by moving away from folk criminology of the past and capitalize instead on the improved evidence-based practices related not just to the mission of the prison, but to the creation of a healthy workplace.

Mental health is not just a program. Among the mental health staff of virtually every correctional department can be found uniquely qualified men and women who could contribute to corrections in many untapped ways. Yet, for the most part, corrections has relegated them to mental health programs rather than use the full range of their capabilities. By constraining mental health professionals to working only with the mentally ill, correctional facilities are wasting the value of their expertise in areas such as organizational understanding, communication skills, the ability to define and encourage relationship-building for behavioral change and institutional efficacy, and problem-solving skills based on evidence-based and best practices.

A Healthier Facility and Workplace

Corrections must recognize that good mental health is not merely a desirable goal for some inmates currently suffering the ravages of severe mental illness. Good mental health is a human quality that should be found most abundantly within the staff and employees of departments of correction nationwide. Turf fights, interdisciplinary hostility and organizational isolation are not signs of good mental health in the workplace.

While it has become commonplace to observe the psychologically challenging circumstances of mentally ill inmates in correctional facilities, corrections has been less attentive to the needs of the correctional workforce itself. While inmates suffer from personality disorders, major mental illnesses, adjustment disorders and a host of other problems, stressed out staff often have undesirably high rates of divorce, substance abuse, eating disorders, anxiety and depression.

Corrections professionals can all benefit from consideration of new ways of looking at mental health in corrections and go beyond the restricted view that only offenders need to improve and manage their mental health. Mental health is not a program, but a process--a process that leads to better outcomes for inmates after release, more job satisfaction for those who are able to discern the value of behavioral change, and higher levels of safety for everyone involved.

If corrections professionals wish to be partisans of mental health, staff well-being and institutional safety, they must also be partisans of the truth--that the stresses of corrections on both sides of the bars result largely from the fact that our mental models too often ignore crucial differences in abilities, philosophies, skills, clinical goals, management and organizational structure. By implementing new models that incorporate scientific principles in each of these categories, including innovations from other models in society such as Covey training; lean; and six sigma; as well as the model above, corrections will find a way out of the continuing dilemma.

Editor's Note: The views expressed in this article are those of the author and not necessarily the American Correctional Assocation.

John L. Gannon, Ph.D., is executive director of the International Association for Correctional and Forensic Psychology.
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Author:Gannon, John L.
Publication:Corrections Today
Article Type:Column
Geographic Code:1USA
Date:Dec 1, 2011
Words:1989
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