O nce a year, corrections staff are required to attend refresher training at the Training Academy. The training lasts a week, and it includes units on a variety of subjects pertinent to our jobs. The unit on mental illness, presented on the second day of training, always began with this statement: “The largest locked mental hospital in the country is the Los Angeles County Jail.”
This fact was supposed to startle us, and it did. The presenter had our attention, and we realized that we needed to understand mental illness because many of our inmates suffered from it. In the following hour, we reviewed the mental illnesses present in our inmate population, and we got an overview of the ways our department tried to help them.
This training was a general overview. It did not address some of the difficult questions that nagged at me, so I occasionally voiced them. “Are mentally ill inmates in prison because they are mentally ill or because they are criminals who just happen to be mentally ill?” “Does mental illness cause people to commit crimes?” My questions prompted interesting discussions but not clear answers.
Before coming to corrections, I had worked as a middle school counselor, so mental illness was not a new subject for me. As the years went by at the prison, I encountered mentally ill inmates fairly often, especially after I began working in the Disciplinary Segregation Unit.
As I neared retirement, I had the opportunity to transfer to the Mental Health Unit, and it intrigued me, so I did. While I was there, I worked with mentally ill inmates all day every day.
In Nebraska prisons, we recognized that mentally ill people experience mental illness as something that is happening to them. Mental illness is not their choice. They are afflicted with it, and they often wanted help. We did our best to provide it. One way involved medication.
Mental illnesses have been the subjects of a long tradition of research studies that have produced an entire medicine cabinet of drugs to relieve specific symptoms. A person need not feel constantly anxious. A deep, dark well of depression can be eased, and spirits can be raised. In Nebraska, we make full use of psychiatrists who are knowledgeable of the drugs that are available. They prescribe medications and monitor their side effects and effectiveness.
One of my routine duties in providing care to mentally ill inmates at the prison was to escort a consulting psychiatrist to inmate rooms and stay nearby during routine med checks. Typically, these lasted five to ten minutes. Immediately after an introduction and a greeting, the psychiatrist typically asked the inmate how he was sleeping. His next question would focus on the symptoms that the medicine he had prescribed were supposed to relieve: “So, how’s the level of anxiety been?” He might also check on the side effects a medicine might cause: “Is your mouth dry?” “Any trouble going to the bathroom?”
When the psychiatrist completed his med check, he would sit at a table, dictate notes, and fill out new prescription orders. There was no expectation of a cure. The course of medication the psychiatrist prescribed was not going to cure an inmate, and it wouldn’t provide merely temporary relief until the inmate healed. The need for psych medication was expected to be permanent. It would be just one more feature of who an inmate was.
Med call came four times a day in our Mental Health Unit, and long lines of inmates took their turns receiving their meds and swallowing them in front of us. Sometimes, the number of pills filled an inmate’s palm with brightly colored pills of all shapes and sizes. With a few exceptions, there were rarely complaints or resistance to this medication. Everyone seemed to know the medicine was intended to help them.
When I dispensed medication, I sat at a raised desk in front of a yellow medication box and removed the pills from the slots marked with the inmate’s name. As inmates appeared in front of me to receive their meds, I often interjected humor into this otherwise tedious exercise. I would hold up one of his pills before I opened the package and I’d say “Oh! Here’s a pill that I take, too. It’s my handsome pill. It’s supposed to make me better looking. Don’t you think it’s working well?” Then I’d open the package and drop the pill into his outstretched palm. I’d also identify pills as “smartness pills” and “happy pills.” I always insisted that I was also taking this medication, and that I was delighted with the effect it was having on me. This humor always elicited a smile, and it helped the pills go down.
A second way we helped inmates involved their behavior. For those living in the Mental Health Unit, there was a long list of behaviors we wanted from inmates, and a similar list of behaviors we didn’t want. We wanted inmates to take their medications, eat meals, make their beds, and clean their rooms. We wanted them to complete their job assignments and keep up on personal hygiene. We wanted them to attend therapy groups and community meetings. We wanted them to listen and to participate in their groups. We didn’t want outbursts of temper or abusive comments toward other inmates or staff, and we wanted them to socialize with others and not isolate themselves in their rooms.
We listed all these expectations on a 14-inch long form we called a Baseline, and we visited this Baseline twice a day for every inmate. An “X” next to a listed behavior meant that everything was okay for that time period. A check mark meant there was a problem, which we would explain in a comments section at the bottom of the page. We counted the checks. Once a certain threshold was passed, sanctions followed, or a previously-earned privilege would be withdrawn.
Inmates could view their Baselines whenever they wanted, and most inmates kept close track of their accumulated checks during the week. They did their best not to exceed the threshold where sanctions would be imposed. If they did, the first penalty was to restrict store purchases from the Inmate Canteen, and on “store day,” they would miss receiving the snacks and goodies they enjoyed so much.
For most of the mentally ill inmates in our Mental Health Unit, the combination of medication, group and individual counseling, and behavioral control through watchful notations on their Baselines with rewards for desirable behaviors and penalties for undesirable behaviors worked to keep people stable and to help them live peacefully and cooperatively with each other in our Unit.
When the day arrived that a mentally ill inmate was to be released from our prison, our mental health staff worked with outside agencies in the community where an inmate was expected to live, and they made arrangements for him to move into an appropriate setting and to continue to receive medications and remain under the care of responsible medical staff. Once they were released, we lost track of them, and we hoped that the preparations we had made for them would be sufficient.
One inmate comes immediately to mind when I think of mentally ill inmates we have released. His name was Dan, and you will remember him from Chapter 52. Dan was the only inmate to have punched me two different times, a light tap on my chin when he needed a break from his surroundings and wanted to go to the Control Unit. Dan thrived in a community-based setting after leaving our prison. Speaking was difficult for him, but when I saw him and greeted him and asked how he was doing, his broad grin spoke volumes.
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