Enhancing Effectiveness of the Correctional Response to Serious Mental Illness in Prisons

Background & Purpose

Serious mental illness in prisons is an issue of concern to social workers and corrections professionals across the US. Education is needed to prepare professionals who work in corrections to respond in a trauma-informed, coordinated manner to address mental health issues among incarcerated persons. The goal of the study is to enhance the quality of services provided to justice-involved person with mental illness through identification of the professional development needs of the correctional workforce on inmate mental health.

Methods

We conducted interviews with 49 professionals who worked with incarcerated persons in a single Southeastern state. Interview prompts addressed role at the agency, types of inmate mental health issues encountered, typical responses to mental health issues, common concerns expressed by staff, attitudes and knowledge needed, and strengths and weaknesses of past training on inmate mental health.

Participants included correctional officers (61%), clinical correctional staff (14%), wardens (12%), and professionals from non-corrections settings whose work includes incarcerated persons (e.g., human services, advocacy; 12%). Participants were female (59%, n = 29) and male (41%, n = 20) professionals from facilities across the state. A majority (74%, n = 36) were African American, and the remainder were White (27%, n =13).

Interview transcripts were analyzed using MaxQDA qualitative analytic software, with coding via provisional codes based on interview prompts, followed by more in-depth coding of emergent themes, and finally organization of codes into a series of competencies for professional development.

Findings

Participants described a range of mental health symptoms prevalent among incarcerated persons, including but not limited to self-injury and suicidality, trauma responses, anxiety and depression, aggression, and psychosis.  Malingering and co-occurring disorders were also concerns. Key challenges to effective responding included unavailability of skilled staff, discontinuity of care across shifts and in transitions to/from communities, and institutional focuses on medication and punitive responses. Facilitators of effective responses including staff specialization and screening for serious mental illness.

Important areas for training included challenges of mental illness in the correctional context, identification of mental disorders, de-escalation and crisis intervention, trauma-informed approaches, strategies for coordinating security and mental health staff, and managing workplace stress.

Conclusions & Implications

Participants indicated that serious mental illness among incarcerated persons was a pressing concern within the correctional workplace, with implications for health and wellbeing of incarcerated persons as well as for corrections professionals. Identification of professional development needs has implications for forensic social work as well as for corrections practice and policy. The open-access, online suite of media products resulting from this study may serve as a resource for researchers, practitioners, and policymakers for enhancing systemic responses to justice-involved persons with mental illness.