In the US, jails and prisons qualify as the country’s largest mental health providers. Surprising at surface level, the statement—like so many facets of the mental health-criminal justice relationship—is even heavier in context, the product of many intertwined social and governmental developments. An increased incidence of mental illness on the outside, for instance, means as many as 73 percent of prisoners in a given facility may exhibit signs of mental illness [PDF Link]. Shrinking budgets and fewer earmarked dollars for the problem, meanwhile, mean as few as 17 percent of inmates may receive post-intake care.
For correctional facilities themselves, the soundbite is not nearly as important as the issues surrounding it. Factors like the above-mentioned community mental illness rate show just how these issues can have a deep impact on the individual facility while still occurring entirely outside of its control. As noted in Psychology Today, correctional facilities are “the one institution that can’t say no to admitting someone,” and hospitals with mental health services may be authorized to transfer mentally ill patients who have not committed a crime as a space-saving measure. Instead of the safety net role dedicated health facilities took on in previous years, these situations show how jails, have become closer to a safety valve, making open beds and free space a potential liability.
While no organization within public health and safety is immune from the effects of community mental illness, correctional facilities carry far lengthier periods of interaction than most others do. An inmate who struggles with mental illness may find their condition worsening when incarcerated in a facility with substandard access to care or subjected to practices known to amplify certain disorders. On the inverse, an arrestee who pushes officers to the absolute brink of their patience over a five-hour mental health call may be a negative influence on morale and productivity in a facility for the length of his sentence. Then there are the potential impacts to administrative and institutional performance indicators: at the institutional level, mentally ill prisoners who do not receive adequate treatment pose an extremely high recidivism risk.
With many important front-end considerations handled upstream and nothing to indicate relief in the future, the facility with the best chance to thrive is one that draws out its ability to plan, adapt, and prevent. Along with the non-negotiable legal and ethical imperatives to provide every inmate a level of care appropriate to their ailment, equipping correctional officers with relevant mental healthcare training suits all three needs: a capability that can defuse misunderstandings, reduce liability, and even save lives. This is particularly true when used in conjunction with tools that remove common recordkeeping bottlenecks.
With all the potential costs and challenges listed above, it is important to note that every person introduced to a correctional environment when a better option is available ultimately comprises another cost and more effort the facility could have avoided. Similar to recidivism’s cost measurements, a mentally ill inmate could book into a jail for the first time under the right circumstances and “cost” the system 100 percent more than a newly arrived cellmate serving the same sentence for the same category of crime. The same long view that allows institutions to enact plans and monitor various trends over years also makes various financial inefficiencies sting that much longer.
On a more direct level, every prisoner added to the roster means an expanded workload for staff, with overwork strongly tied to burnout, job dissatisfaction, and avoidable errors. By these points, President Ronald Reagan’s 1981 Omnibus Budget Reconciliation Act (OBRA) holds more day-to-day influence over facilities and their employees than most other legislation in memory. The act’s combination of spending cuts, block grants, and repeals—most notably President Jimmy Carter’s Mental Health Systems Act (MSHA)—effectively sounded a death knell for federal spending on mental health facilities. Instead, the act sent countless qualified suspects through the criminal justice system by default. Yet, reduced funding for preventative services [PDF Link] inadvertently amplified illness in individuals who could no longer access the services or systems they previously relied on, resulting in a cycle common to mentally ill offenders. An illness left unchecked makes them more likely to engage in behaviors that result in criminal justice interaction, while a justice system with fewer mental healthcare options has little choice but to send them to jail, which may yet worsen their condition.
Keeping this information in mind, consider the following hypothetical situations, adapted from real-life news pieces:
The optimal choice is clear here. While it is impossible to know precisely how often situations like the second unfold in jails and prisons across the country, the post-OBRA world is increasingly full of outcomes like the first—and the biggest differences between the two come down to training and documentation, areas over which jails and prisons still have direct control.
Returning to the examples in the previous section, readers may notice the differences in officer behavior from one outcome to the next are not extreme. The first example shows commonly standard demands for compliance coupled with negative reinforcement in the observation-based patients, while the second offers minor flexibility. At a high level, this change is consistent with the industry’s larger push towards de-escalation and other forms of non-physical intervention. Drilling down, the behaviors also show the small adjustments an officer can make for the sake of maintaining order. This requires a relatively small level of training, compared to the potential benefits provided.
In other words, a corrections officer does not need to earn a minor in psychiatry to pick up skills useful and applicable to working with an inmate population that typically includes a mentally ill subset of the overall population. The Crisis Intervention Team (CIT) model, among the most complex and time-intensive mental health-focused courses available today, consists of roughly 40 hours of coursework. Numerous other courses found online, many of them geared specifically towards corrections, come in four- to eight-hour blocks.
In this regard, short, focused coursework allows institutions to select a combination of lessons that best suit their inmate roster. Upgraded management systems can further help by aiding record management and associated tasks (more on that below). Although specific content differs from course to course and provider to provider, the content providers offer tends to focus on three general skillsets:
Depending on the size of employee rolls, inmate roster makeup, budget, and other factors, facilities may wish to grant some level of training to their entire staff or only a small selection of officers. A prison with a large roster may elect a “crisis team” from a pool of patient, calm officers, and send these employees to specialized training. For another, a jail with a smaller number of officers and influx of mentally ill inmates may opt for an all-in afternoon course.
In any event, the way an institution chooses to document its training activity can be every bit as important as the training itself. In the courtroom, failure to provide explicit proof of the training an officer receives is often tantamount to not providing the training at all. As an administrative task, knowing exactly what training an employee received and when—a significant effort when using “siloed” electronic or paper-based manual systems—can help with scheduling, team roster decisions, promotions, and countless other tasks. This point will continue to stick to the industry as the number of inmates with mental issues increases, and especially as prisoners with specialized needs appear on the intake form.
Putting it all together, if training is one of the remaining areas prisons and jails have control over in the current mental health crisis, so too is management of that training. With incidence of mental illness on the rise and correctional facilities struggling keep pace, the only institutions that “can’t say no to an admission” will continually have to train for optimum preparedness and the tools and training they receive will be essential to their success.
Posted on Jun 18, 2019
