I’ve previously written about how cell phones are not allowed in correctional settings. In fact, I still use a an old-fashioned PDA in prison settings if I need to access mobile medical applications.
Some people seem perplexed when I tell them that cell phones are considered contraband items in prison. In fact, in addition to illegal drugs and weapons, cell phones are very high on the list of items that prisons and jails want to find and keep out of their institutions.
It all boils down to one simple issue: security.
How much harm can be caused by a cell phone falling into the hands of inmates?
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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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T
he provision of quality health care in any setting is the product of a concerted effort. Correctional settings are no different in this regard. Although practicing psychiatry in a prison or jail setting is challenging in many ways, a well-orchestrated team not only makes it easier but also better.
Detecting mental illness or psychological distress in inmates can be challenging, and the more observers that are involved in their care, the less likely that something significant will be missed. And, determining whether a given intervention is effective is likely to be much clearer and more accurate.
Unfortunately, patients in forensic and correctional settings also exhibit malingering at a much higher rate than do non-forensic mental health patients. Therefore, if a psychiatrist or other mental health professional attempts to do his or her job in isolation, it will be much more challenging to determine whether a given patient may be exaggerating or feigning symptoms. Even if they are, they still may be suffering from psychological distress that could benefit from having several disciplines involved in their care.
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Jen is a woman in her early 30′s who worked for several years as a correctional officer at a facility in the Midwest. She worked in a different state than I do. (I have never worked in her correctional system.) Eventually she left to pursue other interests. I interviewed her because I know her personally.
Please keep in mind that the following is a personal account of her experiences. Other current and former correctional officers’ answers to the following questions might vary considerably. Also keep in mind that I can attest to the character of Jen. She is a strong-willed, conscientious, hard-working, caring person. She is not one to cry foul or complain if nothing seriously wrong occurred. I was surprised by some of the answers she gave to my questions. The interview occurred by phone on 3/21/10.
Photo by cop4cbt
What type of facility did you work in?
A medium security all-male facility.
What did you like about the work? Continue reading »
It was interesting to hear the stories of the offenders. But it was sad to hear their stories, too. Sometimes you can help them because they don’t have anyone to talk to. A lot of them didn’t have any visitors or anyone else in their lives. Not all of them had done horrible things. They weren’t all bad people. They came from different worlds and many had gone through difficult life experiences and had to do whatever possible to survive. It helped me appreciate my life more. The benefits of the job were also very good.
When I first started working in corrections, I was discussing with a seasoned prison psychologist the unique challenges that all helping professions face in a prison environment.
He told me that prisons have always been staffed by “Nazis and Saints.” He was referring to two diverse groups: one wanting to punish people and the other wanting to help people. Of course he did not mean this literally, but it was a useful metaphor for me when I was new to practicing medicine behind bars.
In reality, the literal truth lies somewhere in the middle. Most security staffs are not “Nazis.” I’ve met many dedicated officers who take their jobs seriously and want to see inmates change their ways for the better. These officers accept me and the role I play and realize that when mentally ill inmates are stable, it benefits everyone. Likewise, there are probably health care professionals who are attracted to correctional work because they want to punish people.
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To be effective and enjoy working as a psychiatrist in any setting requires unique personality traits. Likewise, to be effective and enjoy any type of work in corrections requires unique personality traits. But, working as a psychiatrist AND doing so in jails and prisons narrows down the field even further.
For the right candidate it can be a very rewarding career. For others, frustration and ultimately burnout may result.
Here are a few personality traits that I believe are important:
1. Having a Strong Sense of Independence: One needs to be able to organize and prioritize many different tasks without having to ask for advice and reassurance often.
2. Having Patience: Prisons and jails work on their own schedules. The primary priority is always security. Health care is an ancillary service in corrections, not the primary mission. There will be frequent delays and inconveniences that arise. One must be able to shift gears, adapt, and still make the best use of the time available.
3. Having a Sense of Humility: Psychiatrists make more money than most workers in correctional settings and also must work hard to earn the respect of other staff since those providing “help” in corrections are often seen as enablers. Walking in with an attitude will assure a psychiatrist even higher doses of resentment and passive-aggressive behavior from
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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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