Training for Correctional Staff and Mental Health Staff

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Training for Correctional Staff and Mental Health Staff Working with Male Inmates with Serious Mental Illness who Engage in Self-Injurious Behaviors Kelly Haag MSW Student Dr. Kathy Wehrmann, Faculty Mentor

Transcript of Training for Correctional Staff and Mental Health Staff

Training for Correctional Staff and Mental Health Staff Working with Male Inmates with Serious Mental Illness

who Engage in Self-Injurious Behaviors

Kelly Haag MSW Student

Dr. Kathy Wehrmann, Faculty Mentor

Background into my interest in the topic

Introduction

A growing number of licensed social workers are being employed in correctional institutions. This environment introduces the social worker to clinical issues not explored in the Master’s level training programs. In order to increase competence of practitioners, trainings must be implemented concerning specific clinical behaviors within the prison environment. One such behavior-self injury (also known as SIB)-is prevalent in the male maximum security prison. This research is focused on providing informative and engaging training on SIB for social workers engaged in clinical work within the prison environment. It is hypothesized that such training will increase the social worker’s level of knowledge about SIB in the male maximum security correctional institution.

Training Objectives

• This workshop will introduce Master’s level social work students to information about self-injurious behaviors (SIB) by male inmates in the prison environment.

Issues to be explored are:

• Relevance to social workers.

• Mental Illness in Prison

• Definitions of SIB.

• Explain meanings and functions of SIB.

• Describe factors within the prison environment that contribute to SIB.

• Introduce Evidence Based Practices for SIB among male prison inmates

• Discuss barriers and opportunities for social workers implementing EBP for SIB in the male prison setting

Mental Health Population IDOC as 3/06/2014

• Total: 48,457

• Mental health Caseload: 10,708 (22%)o Males: 9,294 (20%)o Females (49%)

• Total SMI: 4613 (9%)o SMI Males: 3921 (9%)o SMI Females 692 (24%)

Mental Health Professionals in IDOC

• Total MHPs 80

• 32 Master’s level (68% Social Workers)

• 22 of the total # MHPs are Social Workers (28%) (Wexford currently adapting new criteria)

• 29 Psychiatrists

• Remaining are psychologists

Mission Statement of IDOC Office of Mental Health Management

• Is to assist incarcerated individuals affected by serious mental illness and emotional disturbance to decrease needless suffering, better manage their illness, achieve their personal goals and achieve and maintain their highest level of functioning.

• The Department strives to deliver services in a respectful, responsive, and efficient manner and with sensitivity to diversity of culture, language, ethnicity, gender and sexual identity. In collaboration with other departments within our facilities, we seek to maximize the resources available and attend to the concerns for the safety and well being of individuals. Services and supports are designed to provide meaningful assistance to the individual in acquiring and maintaining those mental, emotional and social skills which enable him to function most effectively with the demands of his or her own person or environment.

IDOC Facilities and Info/Handout

IDOC Facilities and Information

Mental Illness in Prison

• Deinstitutionalization• Discovery of Thorazine• The Community Mental Health Act of 1963• “Get Tough on Crime” Policies• The War on Drugs• Losing the “War on Poverty”

Mental Illness Continued

• 3 largest inpatient psychiatric facilities in the country are correctional facilities: LA County Jail, Cook County Jail and Ryker’s Island in NY

• James and Glaze (2006) estimated that 56% of Inmates suffered from mental health problems

• Estimates of 8% to 19% Serious Mental Illness (SMI) in US prison population

Current definition of SMI in IDOC

• Bipolar Disorder

• Major Depressive Disorder

• Schizophrenia

• Schizoaffective Disorder

• Psychotic Disorder NOS

• Notice NO PTSD, or Axis II Personality disorders-which occur frequently in the setting at Pontiac

Self Injurious Behavior (SIB)

• Self mutilation, self harm, Para suicide,

• Fagan et al., (2010) “a direct behavior that causes mild to moderate physical injury, that is undertaken without suicidal intent, and that occurs in the absence of psychosis and/or organic intellectual impairment.”

• Applebaum et al., (2011) include following behaviors• Cutting• Burning • Hitting• Head banging• Inserting or ingesting of foreign objects• Biting• Self amputation• Enucleation

SIB

• Definition that makes most sense in Prison setting• Loehner and Conrad (2006, pg. 373)

• “implicitly defines it as a deliberate act inflicting damage to the body of the perpetrator or affecting its integrity”.

SIB

• http://www.youtube.com/watch?v=WHnx1WSH1dQ

Research on SIB in Prison

• Paucity of research on male inmates. Fulweiler et al., (1997) the

Majority of research on self-injurious behavior conducted on female inmates

• According to Applebaum, et al., (2011) 30% of inmates engage in self-injurious behavior during their incarceration, 75% of self-injuries in prison consist of cutting and 50% of incidents occur in restrictive housing placements (p. 285).

• Doty, et al. (2012) found that among the prisons surveyed, 85% had incurred incidents of self-injurious behavior by an inmate at least once a week.

Precursors to SIB

• Handout

Function of SIB

• Suicidal intent, manipulation of the environment, emotion regulation and response to psychotic delusions (Jedlik, Vanderhoff and Donovick, 2005).

• Self-injurious behavior is practiced by some inmates as a coping mechanism (Doty, et al., 2012; Lanes, 2009).

• Inmates that use such behavior as a coping mechanism are often suffering from dissociation or feelings of deadness, many times as the result of childhood traumas (Loehner and Conrad, 2006).

Function of SIB Cont.

• Strong self-hatred and extreme anger without opportunity to vent have also been identified as precursors to self-harm (Doty, et al., 2012).

• The correctional environment may subject inmates to “stimulus deprivation” (Loehner and Conrad, 2006, p. 379).

• Boredom and rebellion have also been identified as motivation for SIB (Doty, et al., 2012).

• It has also been noted that the “corporal body may be the only part of one’s life in which one is able to assert control” (Doty, et al., 2012, p. 33).

Function of SIB : Rebelliousness?

• SIB allows the offender some sense of control over an otherwise oppressive and disenfranchising environment.

• When SIB is considered from the perspective of rebelliousness, many are inclined to believe that the behavior is an attempt to manipulate personnel (Jeglic, et al., 2005; Loehner & Konrad, 2006).

• In the research, manipulative acts of self-harm are defined as “any act of SIB that serves primarily to get attention, to manipulate the environment or achieve another form of secondary gain” (Jeglic, et al., 2005, p. 134).

Rebelliousness cont.

• It is difficult, however, to determine motivation for the self-harm and dangerous to discount the possible lethality of any such act (Loehner and Conrad, 2006; Jeglic, et al., 2005). The implicit belief that all self-injurious behavior is an attempt for the inmate to manipulate staff and receive secondary gain tends to also increase the perception that such behavior requires disciplinary action rather than treatment interventions.

SEGREGATION PLACEMENT

• Segregation placement has been identified as a risk factor in self-injurious behavior among male prison inmates (Doty, et al., 2012; Fagan, et al., 2010; Lanes, 2009; Lohner and Conrad, 2006). Lanes (2009) found that segregation negatively correlated with the SIB free time of male prisoners. Applebaum, et al., (2011) state “The high rate of occurrence of self-injurious behavior in segregation and other lockdown units is noteworthy” (p. 289). Due to the fact that research shows that inmates with SMI are overrepresented in Segregation units and that inmates living in segregation units are more likely to engage in SIB, we must question whether alternative housing arrangements should be made for inmates with SMI engaged in problematic behavior that would otherwise render them segregation time.

Current Interventions

• Crisis Watch

Diagnoses

• Bipolar Disorder

• Psychotic Disorders

• PTSD/Developmental Trauma

• Depression

• Borderline Personality D/O

• Other Axis II do

Evidence Based Practices

• DBT: Linehan, Pederson • Multidisciplinary team approach• Teaching skills-individual/group• Accepting, non-judgmental and validating approach to clients• Uses CBT, psychodynamic, and client centered interventions• Eastern concepts of mindfulness and philosophical underpinnings of

dialectics

DBT cont

• Dialectics

• Problem-solving

• Building a satisfying life

• Boundaries

• Shifting Thoughts

What else?

• EMDR?

Role of social workers

• Introduce social work values to correctional environment

• Implement evidence based practices

• Advocate for clients

• Advocate for correctional reforms