The Culture of - Michigan Association of Community Mental Health by malj

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									WORKING WITH JUSTICE-
INVOLVED CONSUMERS
Effective Strategies to Overcome the Culture of
Incarceration in the Community
PRESENTERS
 Barbara Glassheim
 Steve Gonzalez

 James Livingston

 Morgan Notestine
OBJECTIVES
   Promote awareness of:
     Behavioral effects of incarceration on consumers
     Barriers to engagement and treatment of consumers
      with histories of incarceration
     Culturally competent effective strategies to help
      consumers become engaged in and benefit from
      treatment
OVERVIEW OF PRESENTATION
   Psychological consequences of incarceration,
    correctional institution survival strategies, coping
    behaviors
   Elements of prisonization, jailhouse culture, the
    inmate code and effects on behavior in community
    and clinical settings
   Identification of traumas associated with
    incarceration, methods to help consumers overcome
    those traumas, ways to effectively work with
    consumers who have experienced incarceration to
    promote recovery and prevent or mitigate relapse
   Strategies found to be effective in promoting cultural
    competency and reducing barriers to trust and
    engagement
WHAT THE LITERATURE TELLS US
ELEMENTS OF JAILHOUSE CULTURE
 Hierarchy of power among prisoners
 Stronger prisoners prey on weaker ones
     People with disabilities are preyed upon
     Prisoners with mental illnesses are vulnerable
 Jailhouse language
 Jailhouse code of dress
 Camaraderie against a common enemy
 The nature of the person’s criminal offense
  means a lot in the power structure
     Certain crimes are frowned upon
     Some crimes are glorified
   Fear is part of the power structure
PRISONIZATION
 Coping mechanisms
 Social values learned in prison
DEPENDENCE ON INSTITUTIONAL
STRUCTURE & CONTINGENCIES
   Prison requires muting of self-initiative and
    independence resulting in increasing dependence
    on institutional contingencies
       Removal of external structure for those who are
        severely institutionalized may result in no longer
        knowing how to do things on their own, or how to
        refrain from doing those things that are ultimately
        harmful or self-destructive
HYPER-VIGILANCE, INTERPERSONAL
DISTRUST AND SUSPICION

   Many prisons are dangerous; prisoners become
    hyper-vigilant and ever-alert for signs of threat
    or personal risk
       Interpersonal distrust and suspicion
   Project a tough convict veneer to keep others at a
    distance
EMOTIONAL OVER-CONTROL, ALIENATION &
PSYCHOLOGICAL DISTANCING

 Admissions of vulnerability to persons in prison
  environment are potentially dangerous because
  they invite exploitation
 Prisoners develop a prison mask that is
  unrevealing and impenetrable
       Alienation and social distancing = defense against
        exploitation and lack of interpersonal control
           Emotional investments in relationships risky and
            unpredictable
       Alienation and emotional flatness become chronic
        and debilitating in social interactions and
        relationships
THE PRISON FACE
 An expression that comes to be worn by anyone
  in prison for a prolonged period
 The meanest stare one can muster to look “mad
  & bad” to avoid a fight simply by appearing
  willing to fight
 Male prisoners reinforce this image by lifting
  weights and keeping their fears, pain, and other
  emotions hidden
SOCIAL WITHDRAWAL & ISOLATION
   Some find safety in social invisibility
       Become inconspicuous and unobtrusively
        disconnected from others as possible
 Trust virtually no one
 Adjust to prison stress by leading isolated life of
  quiet desperation
 Presents like clinical depression when combined
  with apathy and loss of capacity to self-initiate
  behavior
INCORPORATION OF EXPLOITATIVE
NORMS OF PRISON CULTURE

 Obeying the formal rules of the institution
 Informal rules and norms part of the unwritten
  institutional and inmate culture and code
     Defend against dangerousness and deprivations of
      environment by embracing all informal norms,
      including some of most exploitative and extreme
      values
     Often as much part of process of prisonization as
      adapting to formal rules imposed in the institution
      and as difficult to relinquish upon release
   Can create barriers to meaningful interpersonal
    contact in the community
     Not seeking appropriate help for problems
     Generalized unwillingness to trust others (fear of
      exploitation)
   Can lead to appearance of impulsive overreaction
       Striking out at people in response to minimal
        provocation that occurs with those not socialized into
        norms of inmate culture (obligatory maintenance of
        interpersonal respect and personal space)
THE “RULES”
 Rigid, illogical, inconsistent rules lead to belief of
  “I have got to do what I have got to do to get my
  needs met”
 Ultimately becomes the person’s rule not to
  follow rules
 Can continue after release
DIMINISHED SENSE OF SELF-WORTH &
PERSONAL VALUE

   Prisoners typically denied basic privacy rights,
    lose control over mundane aspects of existence
    most citizens take for granted
       Live in small, sometimes very cramped and
        deteriorating spaces (a 60 sq. ft. cell = size of king-
        size bed)
           Little/no control over who must share the space (and
            intimate contact it requires)
           No choice over when must get up or go to bed, when or what
            may eat, etc.
 Can lead to feeling infantilized
 Conditions = a repeated reminder of
  compromised social status and stigmatized social
  role
GANGS
 Other ways of adapting are induced by the
  presence of gangs in many prisons
 Create racial tensions; conflicts can follow a
  person into the community
 To cope with gangs focus on finding safe niche
  within social fabric of relationships
       Self improvement and prospects for a better life on
        the outside becomes irrelevant
           Parolees may show little commitment to finding a job, etc.
TRAUMAS OF PRISON LIFE
   Isolation units (prisoners with MI are more likely
    than anyone else to end up in these units, which can
    produce trauma and psychosis even in healthy
    prisoners)
   Use of force and restraint
   Arbitrary harassment
   Withholding information
   Denying privileges and requests
   Racist behavior from guards and fellow prisoners
   Overcrowding (prisons now hold many X # designed
    for)
   Displacement (transfers to facilities far away from
    home communities)
TRAUMAS OF PRISON LIFE
 Dehumanizing living conditions
 Sexual harassment, sexual abuse, and rape (9-
  20% of prisoners victims of sexual assault in
  prison)
       PTSD, failure to participate in support services, and
        high incidence of social failure and re-arrest)
 Language barriers
 Loss of identity

 Suicide attempts
MENTAL ILLNESS & INCARCERATION
THE FACTS
 Increased risk for CJ involvement
 People with MI may behave publicly in ways that
  are symptomatic of an untreated MI or SUD
       Many arrests of persons with MI are for
        misdemeanors associated with crimes of survival and
        nuisance offenses (public intoxication, panhandling
        or urinating in public)
 People with MI are at an increased risk of
  developing an SUD; arrests for drug offenses
  have skyrocketed since 1980
 Nearly a 1/3 of homeless have SMIs and
  homelessness = high visibility to law enforcement
MORE FACTS
 16% prison/jail pop has hx of MI
 Up to 1/3 incarcerated adults have a diagnosable
  mental disorder; 60-75% have COD
 People with MI often cycle in and out of prison
  due to inadequate services in correctional
  facilities and re-entry
 People with MI have significantly greater chance
  of being arrested than those without would for a
  similar offense
MORE FACTS
 Average of 4 months longer LOS
 More likely to max out sentence and leave
  unsupervised by parole
 Return to prison more frequently and sooner
       Almost 2/3 of MI released rearrested within 18
        months
MH CONSUMERS
 MI and DD = largest number of disabilities in
  prison pop
 Incarceration = very difficult adjustment
  problems that make prison an especially
  confusing and sometimes dangerous situation
 Prisoners with MI, DD spend significant amount
  of time in solitary confinement and more prone to
  developing negative and anti-social behavior
  patterns while incarcerated
 Prison diminishes the life management and daily
  decision-making skills needed for independent
  living
MH CONSUMERS
 Prison is especially traumatic
 Preyed upon by other prisoners

 Intimidation leads to withdrawal into their cells
  where isolation worsens symptoms
 Others strike out and sent to isolation units (the
  hole) where they are less likely to receive
  psychiatric care
       Prisoners with MI go to the hole much more often
        than others and experience sensory and social
        deprivation that exacerbates symptoms
EFFECTS OF SOLITARY CONFINEMENT
   Impaired sense of identity
   Hypersensitivity to stimuli
   Cognitive dysfunction (confusion, memory loss,
    ruminations)
   Irritability, anger, aggression, rage; other-directed violence
    (stabbings, attacks on staff, property destruction, collective
    violence)
   Lethargy, helplessness and hopelessness
   Chronic depression
   Self-mutilation and/or suicidal ideation, impulses, behavior
   Anxiety and panic attacks
   Emotional loss of control
   Hallucinations, psychosis and/or paranoia
   Overall deterioration of mental and physical health
MH CONSUMERS
 People with a MI can find prison rules and
  routines especially difficult to adjust to; often
  accrue demerits that delay time to release
 Those with severe or unmanaged health
  problems have increased risk of adverse
  outcomes (physical illness, SA relapse,
  inappropriate behavior that provokes a police
  response)
 Untreated MI more likely to commit infractions
  and preyed on by other inmates
    •   Can cause unrest and tension in the general
        population, jeopardize safety of corrections officers
        and other inmates
TRAUMA
 Standard policies and procedures in correctional
  settings (e.g., searches, restraints, and isolation)
  can have profound effects on people with hx of
  trauma/abuse and often = triggers that re-
  traumatize those with PTSD
 Routine jail/prison procedures (searches,
  restraint, seclusion) can be experienced as
  frightening and threatening, especially to women
POSTTRAUMATIC STRESS REACTIONS
TO INCARCERATION
   Post-release PTSD symptoms
   High % have experienced childhood trauma
       Harsh, punitive, uncaring nature of prison life can cause re-
        traumatization
   Rigid unyielding discipline, unwanted proximity to violent
    encounters, possibility/reality of being victimized by
    physical/sexual assaults, need to negotiate dominating
    intentions of others, absence of genuine respect and regard
    for well-being in the surrounding environment
   Time spent in prison may rekindle not only memories but
    disabling psychological reactions and consequences of
    earlier harmful experiences
IMPEDIMENTS TO POST-RELEASE
ADJUSTMENT

 Interference with successful re-integration into a
  social network and employment setting
 Compromise ability to resume roles with
  family/children, employee, etc.
     Parents still dependent on institutional structures/
      routines cannot effectively organize their own lives &
      their children’s or exercise initiative and autonomous
      decision-making that adult roles require
     Those who still suffer the negative effects of a
      distrusting and hyper-vigilant adaptation to prison
      life find it difficult to trust & promote trust and
      authenticity within their children
IMPEDIMENTS TO POST-RELEASE
ADJUSTMENT

  Those who remain emotionally over-controlled and
   alienated from others will experience problems being
   psychologically available and nurturing
  Tendencies to socially withdraw, remain aloof, or
   seek social invisibility dysfunctional in interpersonal
   & family settings where closeness and
   interdependency is needed
TREATMENT IMPLICATIONS
   The inmate code (rules and values: do not snitch, do
    your own time, do not appear weak) manifest in not
    sharing any information with staff, minding one’s
    business to an extreme, demonstrating intimidating
    shows of strength
     Behaviors = adapt during incarceration (survival skills in
      hostile setting) but
     Seriously conflict with expectations of therapeutic
      environments and interfere with community adjustment,
      personal recovery
   MH providers frequently unaware of these patterns
    ●   Misread signs of adjustment difficulties as resistance, lack
        of motivation for treatment, evidence of character
        pathology, active symptoms of MI
   Providers often experience unwarranted concerns
    about safety and lose opportunities for early and
    empathic engagement
TREATMENT IMPLICATIONS
 Behaviors that help adapt to incarceration
  (survival skills in a hostile setting) conflict with
  expectations of most therapeutic environments
  and interfere with community adjustment and
  recovery
 Providers are frequently unaware of these
  patterns
     Misread signs of difficult adjustment as resistance,
      lack of motivation for treatment, evidence of
      character pathology, or active symptoms of mental
      illness
     Unwarranted concerns about safety and lose
      opportunities for early and empathic engagement
TREATMENT IMPLICATIONS
 Stresses and traumas of prison life worsen
  psychiatric disorders and reverse tx progress
 MH services in prison have problematic racial
  dynamics
       Usually the clinician is white, and consumer is a
        person of color
           Misunderstandings and misconceptions reduce likelihood
            for improvement
JAMES: A STORY OF RECOVERY
LIVING IN THE PRISON SYSTEM

 Find good friends
 Work (12hours/day)
     Extra time out of cell
     6 hours in yard (3times/day 2hours each)

 Loss of hope
 Acting a certain way/looking a certain way  got
  preyed upon
     Looking weak or vulnerable
     Learn new ways from prison to prison
     Rules to live by
   Sexual predators in prison system
     All ages at risk for sexual prey
     People making out in the gallery
     Blankets on cell doors

   Not just sexual predators but predators in
    general
     Mistaken kindness for weakness
     For store bags
     Anything & everything

   Fights
INTERVENTION: SCCMHA FORENSIC
TREATMENT TEAM
STRATEGIES
   Establish Trust
       Create a very welcoming atmosphere and tell the person
        how glad you are to meet/see them
       Take care to avoid the look of an institution in every detail
        of your setting; furnish and decorate entryways to
        buildings to be homelike
       Demonstrate almost formal, respect; acknowledge that the
        person has been through a lot
       Demonstrate a sense of attachment to “their side” and of
        detachment from correctional institutions
       Pay formal attention to explaining the person’s rights and
        protections; explain parameters of confidentiality
       Be prompt with every appointment and reliable with every
        commitment (distinguishes you from treatment by prison
        guards).
       Be consistent in how rules are enforced
STRATEGIES
    Explain why you do things the way you do
    In interviews, sit across from the person in chairs
     instead of behind desks or tables
    Hire returning citizens as staff/peer mentors
    Be highly flexible about the time and place where you
     will meet
    Meet in the community/person’s residence rather
     than office all the time
    Step out of traditional clinical boundaries; forgo rules
     about disclosing anything personal; returning
     citizens can be offended by this
EBPS
 Motivational Interviewing
 Supportive Inquiry

 Trauma-Focused Interventions
       Seeking Safety
       Trauma Recovery & Empowerment (TREM)
       Traumatic Incident Reduction Therapy (TIR)
       Prolonged Exposure Therapy (PE)
       Helping Women Recovery
       Beyond Trauma
EBPS
   CBT
       Moral Reconation Therapy (MRT)
       Reasoning & Rehabilitation (R&R)
       Relapse Prevention Therapy (RPT)
       Thinking for a Change (T4C)
       Strategies for Self-Improvement & Change (SSC)
       Aggression Replacement Therapy (ART)
FOR MORE INFORMATION
   A Guide to Evidence-Based Prisoner Reentry
    Practices

   http://sccmha.org/quality.html
QUESTION & COMMENTS

								
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