Teaching Prisoners to Lead Grief Support Groups

• A Novel Prison Hospice Program
• A Clinician Embraces a New Challenge
• A Surprising Place for Compassion

A Novel Prison Hospice Program

Most people are unaware that many prisons in the United States have hospice programs. What makes them unique is that they utilize select inmate volunteers to serve as caretakers for the dying. The prisoners go through extensive vetting with the hospice staff, current volunteers, and the prison wardens. Once chosen, they become a part of the care team along with the doctors, nurses, and clergy. Most recently, four psychiatry residents from Tulane Medical School were part of a new program that trained 31 caregiver-inmates at four different prisons in Louisiana to facilitate in-house grief groups.

Prior to the grief support project, I had not worked directly with the incarcerated population. Thus, my knowledge of this kind of working was abstract and superficial. It was mostly two extremes, the horrible gruesome details of the crimes that had been committed, or the stories of those who had been wrongfully committed and their civil rights stripped from them for years. I (HC) was intrigued when my therapy supervisor, Dr. Marilyn Mendoza, spoke with me about her experience with Angola’s hospice project and her visits to other facilities. I wasn’t sure what to expect when she connected me with Mr. Jamey Boudreaux, the director of Louisiana Mississippi Hospice and Palliative Care Organization, to talk about the project.

The goal of our grief support project was to teach a select group of incarcerated individuals to lead grief support groups for their peers. In the state of Louisiana, whenever an incarcerated individual meets with a mental health professional, a document is generated which goes into his or her file. These documents are available for the Department of Justice to review. As you can imagine, there is significant stigma that mental health notes will negatively impact the decisions of the Pardon and Parole Board. Thus, by having trained incarcerated individuals provide bereavement support to their community, the dreaded mental health documentation can be bypassed. In addition, having peers with shared experiences lead groups allows participants to feel more comfortable in sharing their stories.

The project involved six participants selected by the corrections facility as individuals that had qualities that made for a good peer support facilitator. Depending on the number of participants, there could be up to 15 weekly meetings. The first three weeks were focused on introductions, outline of the project, and didactics of grief and groups. Weeks four to nine was a six-week adult grief support group led by a facilitator (in our case, psychiatry residents). The weeks contained different topics of introducing their deceased loved ones, sharing a photograph, sharing an item, writing a letter, planning for a special day, and reflecting on the experience. Weeks 10 to 15 repeat the same format but with the participants assigned a week to facilitate.

A Clinician Embraces a New Challenge

Although the outline and the project seemed straightforward, I was worried. I had no prior experience in working with therapeutic groups. Was the setting going to be conducive to groups? Would I be able to establish rapport with the participants? Would I be able to relate to the participants? Would I feel safe where the groups were being conducted? Would the participants be comfortable sharing sensitive information with me?

As I prepared the didactic material, the day for the first visit came. I was grateful that Mr. Boudreaux, who was familiar with the corrections facilities, accompanied me to Elayn Hunt Correctional Center located in St. Gabriel, LA. On the drive, he shared the history and changes that have occurred in Louisiana’s corrections facility. The security process included confirming our identity, searching our vehicle, confirming our identity again, and a complete body scan.

As we walked down a long walkway between chain-link fences, I pondered on all the different possible crimes that people may have committed to bring them to this facility. I had the list of names of the participants that would be joining me. Through public records, I could easily look up the details of their charges, convictions, and sentences. I decided not to as it was unnecessary to know for our work together. In hindsight, I like to think it would not have changed my perspective of the men I worked with, though I will never know for certain. Mr. Boudreaux also mentioned on our drive that it was a faux pas to ask incarcerated individuals why they are behind bars and for how long.

As I prepared, I wondered if I would have difficulty in getting the men to discuss their feelings. I felt that perhaps being in a cold, rigid setting would have made it difficult for them to be vulnerable in sharing their emotions. Would I have any credibility as a “free person” who had no idea what life was like in prison? Being a soft-spoken Asian woman, would I be able to redirect the group if discussion derails into a heated conversation?

As we continued towards the Skilled Nursing building, a few casually dressed men greeted us and I was unsure if they were incarcerated individuals or staff members. The Skilled Nursing building provided the highest level of medical care for the sickest residents. I instantly felt at home as the inside looked, sounded, and even smelled like the regular hospital units I was accustomed to. The eight participants were waiting in a room surrounded by windows facing directly at the nursing station. The men politely shook our hands and introduced themselves.

Mr. Boudreaux had been working with them on improving the education and resources available for the men providing end of life care. As I listened to them reflect on their work, I was struck by how passionately they spoke of their work and their patient advocacy. When I gave them the general outline, multiple participants asked thoughtful questions and seemed very eager to learn. They shared that the experience providing hospice care has been very difficult yet rewarding. I learned that these men are given the option of learning a trade or receiving more education. Hospice was neither and it was completely voluntary. Despite being a thankless job, this core group of volunteers devoted their time to helping others as it gave them a sense of purpose.

The first three meetings were lectures based with PowerPoint slides printed on physical paper. Each person came prepared with writing utensils and jotted down notes as I talked. They were engaged and asked insightful questions. They were interested in topics from the neuroscience behind grief to the spiritual aspects of grief and loss. They even made a point of asking if I could bring the articles or books I listed on the reference page at the end of the packet. There was a genuine curiosity to learn as much as they could.

A Surprising Place for Compassion

Week four was our first official session using the peer-support model. Having never led groups prior to that time, I was a bit anxious. We started the session by discussing ground rules of respectful listening and confidentiality. They shared how important confidentiality was in a setting where at times what you say can be used against you. Each person shared how he slept at night (“like a baby” can mean two totally different things), how he felt, and introduced the person whom they were grieving. They were all immediate family members, some that had passed years ago and some only months ago. As the sessions progressed, I became more comfortable.

Something the men have told me multiple times was that the course gave them the opportunity to learn skills that were not only helpful in facilitating grief groups, but also supporting their own family in the free world. I was inspired by their motivation and passion for helping others and often found myself lost in thought on the long drive home. I reflected on what it was that made this experience something I looked forward to weekly. Working in outpatient psychiatry, I sometimes feel drained by patients coming to me for a quick solution. It was refreshing that these men were looking within themselves for the answer. I was grateful that they felt comfortable in being vulnerable. There were lots of laughs and some tears shed.

When the second half of the lessons started, where the participants were each assigned to facilitate group, it did not feel repetitive as the men created new topics to focus on. Though each participant had their own style in facilitating, they all possessed great leadership skills. Many of them were trusted mentors and already possessed counseling skills. They created a therapeutic environment for sharing. I felt that in comparison to the sessions that I led, which might have been separated by a sense of power differential, they were building onto the conversation.

They chose interesting topics such as reflecting on their favorite memories, sharing where they keep photos and why, and what items from their loved ones they would like to have. There were times when the men disagreed with each other and respectfully brought up their own perspectives. They also provided comfort for each other. We frequently discussed how their loved ones continue to live through them and how spirituality and their culture affects the way they grieve. At the end of every session, they expressed gratitude for having a space to share.

Although our primary focus was on grief, it was only natural that we also discussed other sensitive topics. There was a lot of discussion about trauma and “the hand you were delt.” They described past life decisions as choosing between a series of what consisted of only bad options. Psychosocial factors made it very easy to choose a life of crime and drug use. It also made it difficult to trust others. It was after incarceration that some were compelled to take the arduous, personal journey of searching for purpose. Religion and spirituality were often sources of comfort and guidance.

During our discussions about grief, I reflected on how although it was such a personal journey for everyone, the universal stages of grief were ever-present. Some men spoke of their loss in superficially lighthearted manner as to not disrupt the complex, darker emotions lying underneath the surface. Some shared their experiences of shifting between the various stages of grief. Some shared how they grew from the experience. In some ways, being isolated from the outside world made it easier to stay in denial for longer. It was difficult to have a sense of closure, there was limited opportunity in attending funerals or, especially during the pandemic, to share the grief in-person with another family member.

As hospice volunteers, they have all experienced grief from losing patients. They each took shifts keeping vigil at the bedside of their fellow dying inmate, ensuring that their last moments would not be alone. After a patient died, they felt that it was only appropriate to push the emotions to the side to attend to the many other duties. They described a sense of relief in then having a gathering dedicated to sharing complex emotions. We felt less alone. I say we because the men included me into their groups. This was a foreign experience to me as I have mostly limited self-disclosure in my practice. Each person was a successful facilitator, I felt heard and supported.

Our last session was bittersweet. I felt proud of all the work the participants did and was confident that they would be able to lead grief groups successfully. Echoing my initial concerns, some of the men wondered if others would be able to share their feelings and personal details of their lives. Throughout the weeks, I gave them supplemental material regarding compassion, reflective listening, exploring feelings, and managing strong emotions. I could see that they studied the additional resources, sometimes quoting them or utilizing specific skills. The last session, I gave them a handout on termination. They quickly read the title and declared that they didn’t like that word termination because it sounded too definite. I like to think that the things we have learned from each other will continue to positively impact our lives.

***

The award ceremony was a bustling event with some unfamiliar faces of important people at the facility. I brought some snacks that were required to be repackaged in clear containers. One of the men made two different homemade cakes that tasted professionally done. Compared to our usual intimate group, it felt a bit foreign as I called each participant by his legal name to obtain his certificate. I have come to know them each by their nicknames, their unique personalities, and the stories they have shared with me. The car ride home felt a lot like being let out for summer break after graduation from college. There’s a sense of uncertainty about whether I will be able to reconnect with these wonderful, caring people I have met or if this was truly the last time I will see them.

This has been one of the most meaningful experiences that I have had in my career. During times I feel exhausted and drained from clinic, I think of my time at Elayn Hunt. The men reminded me of the fulfillment and joy that comes with being able to help others. Their passion for learning is truly infectious.  

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