Correctional Psychology in Adult Settings

Posted by permission of Dr. Thomas O’Connor. Copyright by T. O’Connor.

 

“What’s your prisoner number…I said tell me your prisoner number.” Correctional Officer

The field of correctional psychology, as part of forensic psychology, can be (but need not be) distinguished from psychology in corrections. There are many persons working in prisons who provide valuable psychological services, but not all of them are correctional psychologists. AACFP standards (see Internet Resources below) require that at least one (1) employee working in the correctional facility have a Ph.D. or PsyD. before it can be said there is a “correctional psychology” program. However, not all correctional psychologists hold doctorates. 90% of psychologists working in the Federal Bureau of Prisons hold doctorates, but at the state and local levels, the percentage is somewhat less, around 59% (Althouse 2000). A survey by Boothby and Clements (2000) also found that 88% of correctional psychologists work full-time, whereas 12% work part-time. The primary duties of a correctional psychologist are to assess clients, initiate treatment programs, carry out crisis intervention as needed, engage in forensic report writing, and if time permits, carry out research. This is, however, only a limited list of all the appropriate roles that a forensic psychologist might have regarding corrections.

There are many mental health issues involving prisons and jails, far too many to be adequately reviewed here, and the burden of dealing with them can be overwhelming, especially in a system where the psychologist is typically made part of the prison administration and can rarely play any advocacy role for prisoners. Ideally, there would also be sufficient resources so that all mentally disordered inmates could be moved to special forensic facilities, but alas, the reality is that at least 16% of prison inmates and 10% of jail detainees languish under normal confinement conditions without the proper setting or context for treatment (Ditton 1999). Prisons are far more likely than jails to have treatment programs, but there are exceptions. Jails typically have short-term programs, aimed at problems like substance abuse, domestic violence, the prevention of disease, and the need for crisis intervention. Assessments for competency to stand trial (and a variety of other competency assessments) are also frequently done in jails, but the main problems in jails are often “entry shock” (Gibbs 1992) and suicide risk, which is the leading cause of death in jails (Clear & Cole 2000). Hence, the need for crisis intervention services, much of which has to be carried out by nonpsychological staff.

Prisons are likely to have extensive recreation, work programs, educational opportunities, substance abuse treatment, and a variety of rehabilitation programs. However, they are also likely to be places of disproportionate minority confinement, violence, and overcrowding. Such an environment seriously diminishes the chances of rehabilitation success, and other conditions, such as the difficulty of maintaining confidentiality, unexpected transfers of inmates to other prisons, and the undercutting of a psychologist’s work by custodial staff all work to make the tasks of correctional psychology more difficult and challenging. In addition, the war on terrorism has brought with it renewed attention to the issue of federal detention centers, such as Camps which have been set up at Guantanamo Bay in Cuba, or the deportation camps used by immigration authorities. It is unknown what the quality or quantity of psychological services are like at such facilities, but Human Rights groups have been overly critical of the role that correctional psychology might or might not be used for there.

THE MENTAL HEALTH RIGHTS OF INMATES

This section is by no means a primer on this aspect of correctional law. Readers are referred to any standard reference or textbook on the topic (e.g. Cohen 1996; Palmer & Palmer 1999; Cohen 2003). Instead, the purpose here is to only point out certain selected issues of relevance for forensic psychology, and besides, little of what will be discussed are “rights” at all.

The Right to Treatment
Eighth Amendment jurisprudence on this matter allows correctional authorities to minimize an inmate’s right to treatment in the name of maximizing the conditions necessary for human survival. Therefore, since the landmark case of Estelle v. Gamble (1976), the standard has been that only serious mental illnesses have the right to treatment. Serious illnesses presumptively include psychoses, clinical depression, and schizophrenia. The “seriousness” component is far more important than the “deliberate indifference” component, the latter of which was designed to establish when a breach of duty occurs. Whether any non-presumptive illness is “serious enough” is likely to require a battle of expert witnesses in a court of law; hence a role for the forensic psychologist occurs. However, the courts are not in the habit of second-guessing the judgment of correctional officials in this regard, especially if a correctional psychology program is in place.

The Right to Refuse (or Resist) Treatment
The Supreme Court has rather consistently ruled (see Vitek v. Jones 1980; Ford v. Wainwright 1986; Washington v. Harper 1990; and McKune v. Lile 2002) that prison officials can “force” or persuade an inmate to take their medication, take antipsychotic drugs for behavioral control purposes, and participate in certain rehabilitation programs even if they don’t want to. First of all, the “force feeding” of medication only takes place when human life is involved (e.g., hunger strike or treatment for a communicable disease. Likewise, the Ford case allows no inmate resistance toward attempts to make them competent enough to be executed (it should be noted some forensic psychologists balk at this). Vitek and Washington allow the things they do (transfer to a state mental hospital with corresponding loss of good time and “chemical straightjacketing”) only if an administrative hearing is held first, and few inmates take advantage of this hearing right. In essence, prison officials can give inmates psychoactive drugs against their will. The McKune case deals with certain kinds of mandated programs, like those for sex offenders. Such inmates cannot resist their treatment, even if it means the therapy will disclose a history of offending for which further charges may ensure or violate their confidentiality. Prisons generally use loss of privileges as “persuasion” for program participation.

The “Right” to Rehabilitation
There is no “right” to rehabilitation as jailhouse lawyers often think. The Court has consistently rejected pleas by inmates to conduct or direct the course of their own rehabilitation, and it has also rejected claims that prison programs are not sufficient to ward off physical, mental, or social deterioration. Correctional officials are given widespread latitude and discretion to decide who gets assigned to what programs.

The Privilege of Transfer
Inmates have no “right” to be transferred to a facility near their loved ones. In practice, prison officials can transfer an inmate anywhere for any reason, to manage space, to break up gang activity, or in most cases, to reward an inmate for good behavior.

The Practice of Psychiatric Segregation
The segregation (psychiatric seg) of inmates with mental disorders raises many legal questions. Courts have allowed stripped-down observation cells, but generally place limitations on it, such as time limits (anything approaching 100 days is too long) and the outlawing of barbaric practices, such as having to sleep naked on a cold, wet floor.

The Practice of Record Keeping
Correctional facilities are supposed to keep “adequate” records, especially in mental health cases, where the continuity of care is an important consideration. Unfortunately, there is widespread concern about the poor record keeping in many correctional facilities. Rarely are there clinically adequate treatment plans, and follow-up reports or progress notes are sometimes non-existent. Further, there is supposed to be some confidentiality regarding inmate psychological records, but inmate clerks sometimes get access to such records and so do nonpsychological staff who claim a “need to know.” The latter issue points to a role for correctional psychologists to help educate and train staff about inmate mental illnesses.

THE TASKS OF CORRECTIONAL PSYCHOLOGY

Most of a correctional psychologist’s time is taken up with administrative tasks, such as assessment of an inmate’s past, present, or future psychological status. Assessments may or may not involve actually seeing the inmate, as many correctional assessments in the residential prison can be completed on the basis of a records review. All inmates are assessed fairly comprehensively, by the way, at a Reception & Diagnostic center when they are first sent into the correctional system by the courts. Inmates generally stay no longer than 20 days to 3 months in a R&D center. Assessment at the residential prison will generally take place at three points: (1) orientation; (2) pre-release; and (3) during any crisis intervention involving the inmate. Orientation assessment is what takes place for the “fish” or new inmates their first week in the residential prison. They are separated from the general population in a small housing unit called “Orientation” and are not “placed” into general population until screened for problem behaviors and mental states. Normally, this screening is done by a correctional counselor, caseworker, or social worker under supervision of the psychologist. Administratively, correctional psychologists are sometimes supposed to supervise other staff in the prison. Orientation screening usually involves the following:

• risk assessment — whether the inmate is a suicide risk, has indications of substance abuse, has a history of hospitalizations and medication usage, and/or has indicators of violence or other troublemaking, such as gang affiliation

• needs assessment — sometimes this is divided into (a) dynamic or criminogenic needs, such as the inmate’s attitude toward employment or degree of alcohol use; and (b) static or noncriminogenic needs, such as anxieties, depressive tendencies, and level of self-esteem

Even though it is common for prisons to have their own risk/needs assessment instruments, some prisons may use a standardized assessment instrument, like the Level of Service Inventory – Revised (LSI-R) devised by Andrews & Bonta (1995). It is more common for standardized instruments to be used at the pre-release stage or point, when the inmate is about to be released from prison, and authorities want to get an estimate of the likelihood of re-offending. Pre-release assessment instruments include the MMPI, the revised Psychopathy Checklist (PCL-R), the Violence Appraisal Guide (VRAG), and the Historical/Clinical/Management Risk Scale (HCR-20). It is a truism in corrections that many assessments are done for management, not treatment purposes.

Assessment done during crisis intervention can be tricky, as a variety of instruments may be used, particularly those that try to get at suicidal ideation, suicidal acting-out, and suicidal risk. Typical crises that destabilize a normal functioning inmate include: victimization by other inmates, news of the death of a loved one, and denial of parole. Experts such as Young (1989) have long pointed out the importance of tailoring crisis intervention services to the multicultural issues prevalent in a prison since age and ethnic differences affect how different kinds of distress are handled.

Rarely is a correctional psychologist involved in the assessment of employees or correctional personnel, and further, such assessment is hardly ever done, unless perhaps in the context of a critical incident stress debriefing. This runs contrary to the tasks typically performed by police psychologists. Psychological screening of correctional officers has been strongly resisted by correctional officer unions and been the subject of numerous court cases. It seems ironic, since many prisons rely upon the mentally healthy interaction or interpersonal patterns between staff and inmates, but correctional facilities have their own way of dealing fairly privately with problem employees, and if the candidates for correctional jobs are screened, it’s usually just for criminal record and aptitude. There may be good reasons for why correctional psychologists are NOT involved with psychological services for employees. For example, if the psychologist is called as a witness at a legal proceeding for, say, when a correctional officer is accused of an illegal or wrong action, there are some unusual laws on confidentiality (see Jaffe v. Redmond 1996). The content of any therapist-patient communication is privileged, but the fact that such communication took place is not.

TREATMENT AND REHABILITATION PROGRAMS

Second to assessment in terms of how a correctional psychologist spends their time is the implementation, monitoring, and evaluation of inmate treatment programs. It probably goes without saying that the literature on the effectiveness of prison treatment programs is generally not promising, but correctional psychologists as a whole tend to be rather optimistic and never give up hope. Bartol & Bartol (2004) provide a good classification and overview of the most common psychological treatments in prison, as follows:

• behavioral models — these are behavior modification programs that reward inmates for good behavior and punish them for bad behavior; sometimes a token economy is used, but more often the privilege system around the prison is used to tailor reinforcement strategies

• cognitive-behavioral models — these are behavior modification programs that not only use tokens and privileges, but require the inmates to develop their own contract for what they will commit to doing; the examination of one’s own beliefs that goes into making the contract is the cognitive part

• rational-emotive models — this is group or individual therapy where inmates are challenged to confront their own irrational beliefs, such as “If I fail, I must be a bad person” by catching how they self-talk and handle emotion; inmates are also encourage to keep journals, worksheets, and do “homework” assignments

A prison may also have special programs for special offenders. Again, Bartol & Bartol (2004) provide a good overview of the most common special programs, as follows:

• violent offender programs — a variety of approaches are typically used, and differential treatment is usually the norm since violent inmates are not a homogenous group. At minimum, those who use violence for instrumental means are treated separately from those who use it for expressive means. Programs range from relaxation training (called “stress inoculation”) to pharmacological treatment.

• criminal psychopath programs — psychopaths often volunteer for treatment, show remarkable progress, and present themselves as “cured” but some prisons have programs attempting to deal with this by creating emotion-laden encounter groups, which is order to have any hope of being successful, must be done intensively, at least one or two nights a week.

• sex offender programs — although this group shows some promise with cognitive-behavioral approaches, the more common approach is relapse prevention, similar to treatments for alcoholism, smoking, or overeating, where the offender is made responsible for their own solution to the problem

TREATMENT IN COMMUNITY CORRECTIONS

It can safely be said that most correctional psychologists are strong advocates of community corrections, or anything that keeps a person in need of psychological services out of the prison environment. However, in many ways, the role of a correctional psychologist is often more complicated (and busy) in the community corrections environment. For example, most community correctional departments or divisions require frequent (often weekly) reports, participation in mandated therapy or counseling is more closely monitored, and frequent assessments are ordered, ranging from step-down assessment of more privileges to competency to be released. Besides the increased paperwork burden, psychological and clinical staff in community corrections are frequently asked by inmates to advocate on their behalf for things like whether they can get permission to attend an out-of-state wedding, and such things are normally outside of the psychologist’s responsibilities.

What works in community corrections somewhat well are substance abuse programs and contract-based therapies like the cognitive-behavioral approach. Educational and faith-based programs also tend to show promise, but it is generally NOT the case that those inmates who qualify for community corrections need nonintensive treatment to help with daily living skills (which are often a component of community corrections). It may be time to try intensive treatments in community corrections.

REFERENCES
Althouse, R. (2000). AACP Standards: A Historical Overview. Criminal Justice and Behavior 27: 430-436.

Andrews, D. & Bonta, J. (1995). The Level of Service Inventory-Revised. Toronto: Multi-Health Systems.

Arrigo, B. (2000). Introduction to Forensic Psychology: Issues and Controversies in Crime and Justice. NY: Academic Press.

Bartol, C. & Bartol, A. (2004). Introduction to Forensic Psychology. Thousand Oaks, CA: Sage.

Boothby, J. & Clements, C. (2000). “A National Survey of Correctional Psychologists.” Criminal Justice and Behavior 27: 716-732.

Clear, T. & Cole, G. (2000). American Corrections. Belmont, CA: Wadsworth.

Clements, C. (2000). “Prisons and Correctional Institutions.” In A. Kazdin (ed.). Encyclopedia of Psychology. NY: Oxford Univ. Press.

Cohen, F. (1996). “Offenders with Mental Disorders in the Criminal Justice Correctional Process.” Pp. 397-413 in B. Sales & D. Shuman (eds.) Law, Mental Health, and Mental Disorder. Pacific Grove, CA: Brooks/Cole.

Cohen, F. (2003). The Mentally Disordered Inmate and the Law. Kingston, NJ: Civic Research Institute.

Correia, K. (2001). A Handbook for Correctional Psychologists. Springfield, IL: Charles C. Thomas.

Ditton, P. (1999). Mental Health and Treatment of Inmates and Probationers. Washington DC: BJS.

Federal Bureau of Prisons. (1986). Psychology Manual. Washington, DC: U.S. DOJ.

Gibbs, J. (1992). “Jailing and Stress.” In H. Toch (ed.) Mosaic of Despair: Human Breakdown in Prison. Washington DC: APA.

Hawk, K. (1997). “Personal Reflections on a Career in Correctional Psychology.”Professional Psychology 28(4): 335-337.

Levinson, R. (1985). “The Psychologist as Change Agent in Corrections.” Pp. 129-144 in C. Ewing (ed.) Psychology, Psychiatry, and the Law. Sarasota, FL: Professional Resources Exchange.

O’Connor, T. & Scott, R. (2004). “Treatment in Transition: The Role of Psychiatric Corrections.” Pp. 514-26 in P. Kratcoski (ed.) Correctional Counseling and Treatment, 5e. Long Grove, IL: Waveland Press.

Palmer, J. & Palmer, S. (1999). Constitutional Rights of Prisoners. Cincinnati: Anderson.

Roth, L. (1986). “Correctional Psychiatry.” Pp. 429-468 in W. Curran, A. McGary & S. Shah (eds.). Forensic Psychiatry and Psychology. Philadelphia: Davis

Schwartz, B. (Ed.) (2003). Correctional Psychology. Kingston, NJ: Civic Research Institute.

Towl, G. & D. Crighton. (1996). The Handbook of Psychology for Forensic Practitioners. NY: Routledge.

Walker, L. & Shapiro, D. (2004). Introduction to Forensic Psychology: Clinical and Social Psychological Perspectives. NY: Kluwer Academic/Plenum.

Weinberger, L. & Sreenivasan, S. (1994). “Ethical and Professional Conflicts in Correctional Psychology.” Professional Psychology 25(2), 161-167.

Wrightsman, L., M. Taflinger & M. Linsenman. (2000). Forensic Psychology. Belmont, CA: Wadsworth.

Young, T. (1989). “Treatment of Multicultural Counseling in Correctional Psychology Textbooks.” Psychological Reports 65: 521-522.

Online Resources