Doctors, nurses, and other health care professionals often find themselves in situations where they must speak up for their patients. Typically such patients either do not realize what they need, do not know how to ask for what they need, or they lack the authority to obtain what they need.
The circumstances and challenges of advocating for patients vary significantly depending on the practice setting. I’ve previously written about how practicing in correctional settings presents unique challenges. Essentially the main challenge in any jail or prison, regardless of how “treatment-friendly” it may be, is that a correctional facility exists for the primary mission of security, not treatment.
So, if you’re a health care professional in corrections and you have a patient who needs your voice, how can you go about being an effective advocate?
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It’s probably safe to bet that most of the readers of this blog, if they found themselves in the unfortunate position of being incarcerated, would want more than anything to go home.
After many years of treating inmates I can say that most of them want to go home, too. But a sizable minority of them do not.
It’s not that these particular prisoners like being locked up. Most of them despise it. But, for various reasons, many feel that the structure and certainty that comes with prison outweighs the problems they’ll face when they return to the real world.
Although the reasons that inmates give for preferring not to leave vary, I’ll mention some of the more common ones. Some of them overlap. This is an honest look at the reality that many prisoners face, and I’d like to share it with you.
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Many correctional systems classify their inmates as “elderly” beginning at age 55. Some do so as early as age 50.
Why?
In general, inmates age faster than the non-incarcerated. The stress of incarceration, substance abuse, and the lack of access to medical care before incarceration are some of the more significant contributors to the accelerated aging.
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Reducing health care costs is a daily news topic lately. Correctional health care costs are also very high and continue to rise.
While I believe that we should continue to explore ways to reduce correctional health costs, the obvious but politically unpopular issue that needs to be addressed is the fact that these costs would be much lower in the U.S. if we didn’t have by far the world’s highest rate of incarceration.
This exorbitant and increasing incarceration rate combined with an aging inmate population is going to drive costs steeply higher. The percentage of older inmates (over 50) is expected to rise sharply over the next decade. In fact, according to this post from California Budget Bites:
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How many times do we condemn or agree before hearing the other side of a story? How many times do we stand accused of not listening carefully? How many times do we misinterpret or misunderstand a gesture, a word, an intention? Why do we assume that we know so much about other people’s lives even though we clearly do not? And, even if we did, why do we think we know what’s best when it comes to how others should live their lives?
Through our cumulative experiences in life, the figurative spectacles through which we see the world become tainted. We, unlike small children, lose the ability to see all things as they are. Instead, we see things through our tainted lenses and think we know best.
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Imagine that as a child you thought you had been born in the body of the wrong gender. If you were biologically male, in your mind you really thought of yourself as female. Likewise, if you were born in a girl’s body, you thought that you were actually a boy.
Yes, you were probably more interested in children’s role-playing games more often associated with the opposite gender as well, but the issue went much deeper than that. It was your core identity that was at stake. You knew that you were the other sex, at least in all ways except for the reproductive organs of your body.
You felt this way during childhood, but nobody seemed to understand or accept this about you. But you were dressed in the clothing of your biological gender and expected to participate in the activities stereotypically associated with it as well. Imagine that as your body matured in adolescence, you hated your
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Many non-correctional health care providers will also treat inmates from time to time. This may occur in the office or hospital. How can one best approach the challenges of working with the incarcerated in order to deliver the best possible care while simultaneously managing risk?
1. Treat the patient with respect. Not submissive respect, but mutual respect — the way we all want to be treated. I believe that this principle alone goes a long way towards helping one to establish a therapeutic alliance and to minimize interpersonal conflict and hostility. Inmates are people, too. Those who do not agree with this statement should steer clear of treating them.
2. Listen attentively. It may be tempting to get this shackled person (who you may secretly be embarrassed to have in your office) out as expediently as possible. Squelch that temptation, and listen actively as you would to any patient. All patients want their concerns taken seriously. Inmates are no exception. I believe you minimize problems for yourself in the long run (and provide better care) if you ensure that patients’ concerns are heard, especially if they seem to have more challenging personality styles.
3. Be honest. If there is a particular reason why you think something the patient is requesting is inappropriate, then politely tell them so. If you believe they have a particular diagnosis, psychiatric or not, then
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You may be surprised to hear that despite being a physician tech enthusiast who has a blog, Twitter and Facebook accounts, and a MacBook, I do not own a smartphone. I’ll tell you why.
I’ve previously described the challenges and rewards of working as a correctional psychiatrist, but I did not go into any detail about electronics in correctional settings. Since the overriding objective of jails and prisons is to maintain a secure environment, all staff members give up certain conveniences that we’ve all grown accustomed to on the outside.
Today, so many electronic gadgets are capable of making phone calls and connecting to the internet. In the hands of inmates, such devices could allow escapes to be planned, the coordination of gang activity, and the running of illegal businesses from within the prison walls. Because either careless or corrupt actions of staff can result in electronics being possessed by prisoners, staff cannot bring in their own devices.
Cell phones of all types are very high on this list of banned items. In fact, cell phones have become one of the major contraband items in prisons around the world. In “shakedowns” where surprise searches of inmate property are conducted,
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It is a fact that most prison inmates will be released at some point. It therefore would greatly benefit society if those inmates had the opportunity to learn work, coping and life management skills and be physically and mentally healthy upon their release.
While I am in favor of personal responsibility, I also realize from my first-hand experience in corrections that a macho “tough on crime” approach that is purely punitive and does not include such elements is not usually successful in changing bad behavior or in making people more productive citizens. Society, generally speaking, does not appreciate the potential benefit for the greater good that could be realized by investing in treatment programs and clinical research in prisons.
Fortunately there are some researchers who are devoting their careers to solving clinical puzzles in correctional settings. One such person
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It may surprise some people to hear that not all inmates, not even the ones who see psychiatrists, have difficulty coping with incarceration. Certainly some do, but many others are more stressed about family/relationship issues, financial problems, or the prospect of being unemployed felons upon release. Some inmates have found positive approaches to incarceration that make it less stressful and more productive while others struggle and often find themselves in undesirable situations.
Since I regularly see prisoners with a wide variety of effective and ineffective approaches to their incarcerations, I decided to compile a list of suggestions for how one could make prison or jail time more palatable. This list is not all-inclusive and is in no particular order. I offer no guarantees and hope that you will never seriously need a list such as this!
1. Stay busy and healthy: Some inmates do virtually nothing in prison, and I believe this is a mistake. Although freedoms are limited, there are still many things inmates can do to make the time pass more quickly, stay physically and mentally healthy, and better themselves. Go to the prison library regularly and read lots of books. Earn your HSED/GED or take college classes if they are available. Do not pass up the opportunity to go to recreation. As your health permits, work out regularly. You’ll feel better, be less likely to be a target, sleep better, and you’ll likely be healthier.
2. Don’t draw attention to yourself: “Lay low” is good advice. Try not to come up on the radar
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