Psychiatry can help reduce prison violence

The news has been filled lately with stories of violence within correctional facilities, often involving prisoners or detainees who are alleged to have mental illness. The California prison system recently announced an initiative to reduce the use of force against mentally ill prisoners and to require correctional officers to consider an inmate’s mental health status prior to any use of force.

This is an excellent initiative, and close collaboration between security and mental health services is crucial for effective treatment of some mentally ill offenders.

However, this would be a good time to remember that not all seriously mentally ill prisoners are disruptive and that violence is a behavior rather than a diagnostic criterion. The nonsymptomatic causes of violence are important to consider as well: Is the inmate defending himself from attack by more aggressive peers? Is he taking a stand and making a display of force in order to make the point that he won’t be intimidated? Is he delirious from an unrecognized or treated medical condition? Is he having a seizure, suffering from withdrawal, or medically compromised in some other way? Or is the violence instrumental, a means to an end by a sociopathic inmate who needs to enforce his chain of command or protect his prison drug distribution channels? While for some, violence may be an outward sign of psychosis, for others it’s part of the cost of doing business.

In addition to looking at violence on an individual level, we also need to consider it from an institutional perspective. Violence may be a sign that there are serious problems not only on an individual level but possibly on an institutional one as well. Increased sensitivity to the mental status of the prisoner is only one piece of the puzzle.

Correctional officers are exposed to an environment unlike anything most civilians can imagine. They are exposed daily to threats, actual or implied assault, harassment, and sometimes even flying bodily fluids. When the prison budget doesn’t keep up with the daily institutional census, they may be required to work repeated overtime shifts or to work on tiers in which they are greatly outnumbered by the prisoners they are supposed to supervise and protect. Even when a correctional officer is not directly the subject of violence, the officer is required to respond to traumatic events like inmate-on-inmate assaults or completed suicides.

It’s not surprising, then, that many new officers leave the profession within the first 5 years, and that those who stay longer may be prone to stress-related absenteeism, substance abuse, and depression. Officers (or "guards" as the traditional media repeatedly misidentifies them) who show a change in personality or an unusually low tolerance for inmate misbehavior may be showing early signs of posttraumatic stress disorder or clinical depression. If this is being taken out on an inmate, it may also be a problem at home, leading to relationship problems or domestic violence. Officers who are cruel to a prisoner may not be particularly pleasant to civilian staff, either.

Changing a violent prison environment requires more than additional staff training and another redundant prison directive about the use of force. It requires change in a prison culture that values toughness and bravado. Access to mental health should be rapid and confidential, and not seen as an indication that an officer wants an "easy way out" through medical retirement. Security and psychiatry must work together for the care of the prisoner, but they also need to work on behalf of one another.

Dr. Hanson is a forensic psychiatrist and coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011). The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health & Mental Hygiene or the Maryland State Division of Correction.

The news has been filled lately with stories of violence within correctional facilities, often involving prisoners or detainees who are alleged to have mental illness. The California prison system recently announced an initiative to reduce the use of force against mentally ill prisoners and to require correctional officers to consider an inmate’s mental health status prior to any use of force.

This is an excellent initiative, and close collaboration between security and mental health services is crucial for effective treatment of some mentally ill offenders.

However, this would be a good time to remember that not all seriously mentally ill prisoners are disruptive and that violence is a behavior rather than a diagnostic criterion. The nonsymptomatic causes of violence are important to consider as well: Is the inmate defending himself from attack by more aggressive peers? Is he taking a stand and making a display of force in order to make the point that he won’t be intimidated? Is he delirious from an unrecognized or treated medical condition? Is he having a seizure, suffering from withdrawal, or medically compromised in some other way? Or is the violence instrumental, a means to an end by a sociopathic inmate who needs to enforce his chain of command or protect his prison drug distribution channels? While for some, violence may be an outward sign of psychosis, for others it’s part of the cost of doing business.

In addition to looking at violence on an individual level, we also need to consider it from an institutional perspective. Violence may be a sign that there are serious problems not only on an individual level but possibly on an institutional one as well. Increased sensitivity to the mental status of the prisoner is only one piece of the puzzle.

Correctional officers are exposed to an environment unlike anything most civilians can imagine. They are exposed daily to threats, actual or implied assault, harassment, and sometimes even flying bodily fluids. When the prison budget doesn’t keep up with the daily institutional census, they may be required to work repeated overtime shifts or to work on tiers in which they are greatly outnumbered by the prisoners they are supposed to supervise and protect. Even when a correctional officer is not directly the subject of violence, the officer is required to respond to traumatic events like inmate-on-inmate assaults or completed suicides.

It’s not surprising, then, that many new officers leave the profession within the first 5 years, and that those who stay longer may be prone to stress-related absenteeism, substance abuse, and depression. Officers (or "guards" as the traditional media repeatedly misidentifies them) who show a change in personality or an unusually low tolerance for inmate misbehavior may be showing early signs of posttraumatic stress disorder or clinical depression. If this is being taken out on an inmate, it may also be a problem at home, leading to relationship problems or domestic violence. Officers who are cruel to a prisoner may not be particularly pleasant to civilian staff, either.

Changing a violent prison environment requires more than additional staff training and another redundant prison directive about the use of force. It requires change in a prison culture that values toughness and bravado. Access to mental health should be rapid and confidential, and not seen as an indication that an officer wants an "easy way out" through medical retirement. Security and psychiatry must work together for the care of the prisoner, but they also need to work on behalf of one another.

Dr. Hanson is a forensic psychiatrist and coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011). The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health & Mental Hygiene or the Maryland State Division of Correction.

The news has been filled lately with stories of violence within correctional facilities, often involving prisoners or detainees who are alleged to have mental illness. The California prison system recently announced an initiative to reduce the use of force against mentally ill prisoners and to require correctional officers to consider an inmate’s mental health status prior to any use of force.

This is an excellent initiative, and close collaboration between security and mental health services is crucial for effective treatment of some mentally ill offenders.

However, this would be a good time to remember that not all seriously mentally ill prisoners are disruptive and that violence is a behavior rather than a diagnostic criterion. The nonsymptomatic causes of violence are important to consider as well: Is the inmate defending himself from attack by more aggressive peers? Is he taking a stand and making a display of force in order to make the point that he won’t be intimidated? Is he delirious from an unrecognized or treated medical condition? Is he having a seizure, suffering from withdrawal, or medically compromised in some other way? Or is the violence instrumental, a means to an end by a sociopathic inmate who needs to enforce his chain of command or protect his prison drug distribution channels? While for some, violence may be an outward sign of psychosis, for others it’s part of the cost of doing business.

In addition to looking at violence on an individual level, we also need to consider it from an institutional perspective. Violence may be a sign that there are serious problems not only on an individual level but possibly on an institutional one as well. Increased sensitivity to the mental status of the prisoner is only one piece of the puzzle.

Correctional officers are exposed to an environment unlike anything most civilians can imagine. They are exposed daily to threats, actual or implied assault, harassment, and sometimes even flying bodily fluids. When the prison budget doesn’t keep up with the daily institutional census, they may be required to work repeated overtime shifts or to work on tiers in which they are greatly outnumbered by the prisoners they are supposed to supervise and protect. Even when a correctional officer is not directly the subject of violence, the officer is required to respond to traumatic events like inmate-on-inmate assaults or completed suicides.

It’s not surprising, then, that many new officers leave the profession within the first 5 years, and that those who stay longer may be prone to stress-related absenteeism, substance abuse, and depression. Officers (or "guards" as the traditional media repeatedly misidentifies them) who show a change in personality or an unusually low tolerance for inmate misbehavior may be showing early signs of posttraumatic stress disorder or clinical depression. If this is being taken out on an inmate, it may also be a problem at home, leading to relationship problems or domestic violence. Officers who are cruel to a prisoner may not be particularly pleasant to civilian staff, either.

Changing a violent prison environment requires more than additional staff training and another redundant prison directive about the use of force. It requires change in a prison culture that values toughness and bravado. Access to mental health should be rapid and confidential, and not seen as an indication that an officer wants an "easy way out" through medical retirement. Security and psychiatry must work together for the care of the prisoner, but they also need to work on behalf of one another.

Dr. Hanson is a forensic psychiatrist and coauthor of "Shrink Rap: Three Psychiatrists Explain Their Work" (Baltimore: The Johns Hopkins University Press, 2011). The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health & Mental Hygiene or the Maryland State Division of Correction.