Another week has ended. I am feeling those familiar pangs of disappointment—the kind that make me shake my fists and yell to the sky as I continue to battle decades and layers of systemic challenges outside of my control. I’ve watched my team work tirelessly to find yet another needle in a haystack which itself seems to be on fire. From a systemic standpoint, I work with arguably one of the most difficult-to-place populations—those with a history of incarceration and major mental illness. To be clear, this is not the fault of any of the clients I serve, but clearly a societal issue characterized by a continued and seemingly unrelenting stigmatization of its incarcerated citizens with mental health needs. It’s an ugly truth, but that doesn’t change that it needs to be confronted.
Ned (not his real name) is a man with a complex case history, not unusual to corrections. He is dually-diagnosed and no stranger to the criminal justice system. His supports are extremely limited, and he, not unlike most of his peers, feels that he has a real sense of community and care in the mental health unit at our facility. Ned once said something that profoundly impacted the staff who work with him. It was a typical day of patient care when Ned walked into the room full of clinicians and told the team members how simultaneously sad but wonderful it was that he felt so at home and cared for inside the correctional facility. This was not an easy win with Ned—it took much time and consistency in his relationship with the staff and unit to really feel that he was and is looked after.
Ned is an exceptionally charismatic and humorous individual who deserves the opportunity to have a life outside of the correctional system, no matter how well cared for he feels there. He is someone who responds to redirection and is the epitome of how and why Rogerian therapy can be so impactful, despite its many detractors. Building rapport and a strong therapeutic alliance with Ned has allowed the team members to assist him in moving forward in his life and to spend less time in the justice system than he may have without such extensive support.
The disappointing aspect of all this is that the community mental health system does not know how to respond to Ned. He deserves competent and caring outpatient mental health care, access to substance use treatment, and opportunities for vocational rehabilitation. He has many strengths and is much more likely to stay connected to providers if he feels they are genuinely invested in his well-being. However, despite all of his strengths, he requires a lot of contact with staff members Living in the time of COVID-19 has only made it more challenging for community providers to stay fully staffed and for resources to be obtainable; as a result, the patience that Ned deserves from community caregivers may not be as plentiful. Ned was removed from a community placement twice within the last year, and typically within a very short amount of time. Any time a community setting doesn’t work out, it’s hard to not let the disappointment set in because we are so genuinely invested in the outcomes and well-being of those we serve.
We live in a nation that incarcerates more individuals per capita than any other developed nation, which means that many of us and our clinical colleagues have had professional, or perhaps even personal contact with someone who has been incarcerated. Yet despite this fact, I have found that there is so much fear in the field of human services when it comes to working with previously-incarcerated individuals with mental health needs. Time and time again, the job of finding placements for these individuals has proven to be excruciating. Community providers often want assurance that these individuals aren’t too psychiatrically sick or require resources beyond their capability or willingness to provide. There may even be the implicit fear that previously-incarcerated clients, especially those with a history of mental illness, may be violent and/or physically dangerous. And these are but a few of the barriers for placement and treatment once these individuals are released from prison.
To be fair, we are living in the time of a pandemic, and staffing and resources in the human service world are at an all-time low. Closures are happening left and right, and the competition for resources has intensified. I appreciate the gravity of this, but the fact is that we were struggling with this long before the pandemic began. Deinstitutionalization had a direct impact on the criminal justice system, leading prisons and jails to become the largest providers of mental health in the nation. John F. Kennedy had the right idea with the Community Mental Health Act in 1963—unfortunately, America has never had the infrastructure to support the aftermath of deinstitutionalization in community settings. Pair this with the time of the pandemic, and people with mental health needs are becoming psychiatrically sicker and for longer periods of time, which has immense consequences on their long-term prognosis.
The weight of this has often felt crushing to me and my clinical colleagues in corrections. Agencies need to be equipped to provide treatment to individuals like Ned who have been incarcerated and also live with major mental illness. People reintegrating into society from prison or jail may need more assistance to get on their feet and figure out the fast-moving world that they were removed from and to which they are returning. Yes, individuals with major mental illness may require more staff time and patience. Yes, as those providers, we should step up to the plate and meet this challenge head-on. Furthermore, as clinical providers, we cannot expect marginalized people who often have become very adept at pushing others away or having people ignore them or reject them to instantly acclimate to new surroundings and not need anything from us.
***
So why do I write all this? I write this because I’m betting there are other correctional social workers and clinicians out there who feel the weight of this just like I do. Society has an interesting way of tucking away those it sees as “undesirable” and then looking away, assuming either that these individuals will not reintegrate into society or somehow magically will. These individuals will of course be walking down our streets with us, they may live next door, or they may stand behind us at the pharmacy. If we know people who end up incarcerated will return back into society, why are we not providing them access to services? If services continue to screen for those who are “high-functioning” and “less needy,” then we are truly perpetuating stigma and preventing people like Ned from having the opportunities that they not only deserve, but are fully capable of having. A friend of mine once told me, “We’re all just walking each other home.” I hope community, psychiatric, and correctional providers can work together to make this journey better for our fellow walkers.
File under: The Art of Psychotherapy, Musings and Reflections
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Ned (not his real name) is a man with a complex case history, not unusual to corrections. He is dually-diagnosed and no stranger to the criminal justice system. His supports are extremely limited, and he, not unlike most of his peers, feels that he has a real sense of community and care in the mental health unit at our facility. Ned once said something that profoundly impacted the staff who work with him. It was a typical day of patient care when Ned walked into the room full of clinicians and told the team members how simultaneously sad but wonderful it was that he felt so at home and cared for inside the correctional facility. This was not an easy win with Ned—it took much time and consistency in his relationship with the staff and unit to really feel that he was and is looked after.
Ned is an exceptionally charismatic and humorous individual who deserves the opportunity to have a life outside of the correctional system, no matter how well cared for he feels there. He is someone who responds to redirection and is the epitome of how and why Rogerian therapy can be so impactful, despite its many detractors. Building rapport and a strong therapeutic alliance with Ned has allowed the team members to assist him in moving forward in his life and to spend less time in the justice system than he may have without such extensive support.
The disappointing aspect of all this is that the community mental health system does not know how to respond to Ned. He deserves competent and caring outpatient mental health care, access to substance use treatment, and opportunities for vocational rehabilitation. He has many strengths and is much more likely to stay connected to providers if he feels they are genuinely invested in his well-being. However, despite all of his strengths, he requires a lot of contact with staff members Living in the time of COVID-19 has only made it more challenging for community providers to stay fully staffed and for resources to be obtainable; as a result, the patience that Ned deserves from community caregivers may not be as plentiful. Ned was removed from a community placement twice within the last year, and typically within a very short amount of time. Any time a community setting doesn’t work out, it’s hard to not let the disappointment set in because we are so genuinely invested in the outcomes and well-being of those we serve.
We live in a nation that incarcerates more individuals per capita than any other developed nation, which means that many of us and our clinical colleagues have had professional, or perhaps even personal contact with someone who has been incarcerated. Yet despite this fact, I have found that there is so much fear in the field of human services when it comes to working with previously-incarcerated individuals with mental health needs. Time and time again, the job of finding placements for these individuals has proven to be excruciating. Community providers often want assurance that these individuals aren’t too psychiatrically sick or require resources beyond their capability or willingness to provide. There may even be the implicit fear that previously-incarcerated clients, especially those with a history of mental illness, may be violent and/or physically dangerous. And these are but a few of the barriers for placement and treatment once these individuals are released from prison.
To be fair, we are living in the time of a pandemic, and staffing and resources in the human service world are at an all-time low. Closures are happening left and right, and the competition for resources has intensified. I appreciate the gravity of this, but the fact is that we were struggling with this long before the pandemic began. Deinstitutionalization had a direct impact on the criminal justice system, leading prisons and jails to become the largest providers of mental health in the nation. John F. Kennedy had the right idea with the Community Mental Health Act in 1963—unfortunately, America has never had the infrastructure to support the aftermath of deinstitutionalization in community settings. Pair this with the time of the pandemic, and people with mental health needs are becoming psychiatrically sicker and for longer periods of time, which has immense consequences on their long-term prognosis.
The weight of this has often felt crushing to me and my clinical colleagues in corrections. Agencies need to be equipped to provide treatment to individuals like Ned who have been incarcerated and also live with major mental illness. People reintegrating into society from prison or jail may need more assistance to get on their feet and figure out the fast-moving world that they were removed from and to which they are returning. Yes, individuals with major mental illness may require more staff time and patience. Yes, as those providers, we should step up to the plate and meet this challenge head-on. Furthermore, as clinical providers, we cannot expect marginalized people who often have become very adept at pushing others away or having people ignore them or reject them to instantly acclimate to new surroundings and not need anything from us.
***
So why do I write all this? I write this because I’m betting there are other correctional social workers and clinicians out there who feel the weight of this just like I do. Society has an interesting way of tucking away those it sees as “undesirable” and then looking away, assuming either that these individuals will not reintegrate into society or somehow magically will. These individuals will of course be walking down our streets with us, they may live next door, or they may stand behind us at the pharmacy. If we know people who end up incarcerated will return back into society, why are we not providing them access to services? If services continue to screen for those who are “high-functioning” and “less needy,” then we are truly perpetuating stigma and preventing people like Ned from having the opportunities that they not only deserve, but are fully capable of having. A friend of mine once told me, “We’re all just walking each other home.” I hope community, psychiatric, and correctional providers can work together to make this journey better for our fellow walkers.
File under: The Art of Psychotherapy, Musings and Reflections