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  1. The Culture of Incarceration Working with Justice-Involved Consumers

  2. Presenters • Barbara Glassheim • Steve Gonzalez • James Livingston • Morgan Notestine

  3. 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

  4. Overview • The psychological consequences of incarceration including correctional institution survival strategies and coping behaviors • The elements of prisonization, jail house culture, and the inmate code and their effects on behavior in the community and in clinical settings • Identification of the traumas associated with incarceration, methods to help consumers overcome those traumas, and ways to effectively work with consumers who have experienced incarceration to promote recovery and prevent or mitigate relapse • Strategies that have been found to be effective in promoting cultural competency and reducing barriers to trust and engagement

  5. 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

  6. Prisonization • Coping mechanisms • Social values learned in prison

  7. 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

  8. Hypervigilance, interpersonal distrust and suspicion • Because many prisons are dangerous places prisoners learn quickly to become hypervigilant and ever-alert for signs of threat or personal risk • Interpersonal distrust and suspicion often result • Some prisoners learn to project a tough convict veneer that keeps all others at a distance

  9. 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 • This alienation and social distancing from others is a defense not only against exploitation but also against the lack of interpersonal control in prison that makes emotional investments in relationships risky and unpredictable • Alienation and emotional flatness become chronic and debilitating in social interactions and relationships

  10. 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

  11. Social Withdrawal & Isolation • Some prisoners learn to find safety in social invisibility by becoming as inconspicuous and unobtrusively disconnected from others as possible • Trust virtually no one • Adjust to prison stress by leading isolated lives of quiet desperation • Presents like clinical depression when combined with apathy and loss of capacity to self-initiate behavior

  12. Incorporation of Exploitative Norms of Prison Culture • Obeying the formal rules of the institution • Informal rules and norms that are part of the unwritten institutional and inmate culture and code • Defending against dangerousness and deprivations of the environment by embracing all its informal norms, including some of the most exploitative and extreme values • These are often as much a part of the process of prisonization as adapting to the formal rules that are imposed in the institution, and are as difficult to relinquish upon release

  13. Can create barriers to meaningful interpersonal contact in the community, preclude seeking appropriate help for problems, and a generalized unwillingness to trust others out of fear of exploitation Can also lead to what appears to be impulsive overreaction, striking out at people in response to minimal provocation that occurs particularly with persons who have not been socialized into the norms of inmate culture in which the maintenance of interpersonal respect and personal space are obligatory

  14. The Rules • Rigid, illogical, inconsistent rules lead to the belief “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 • Like other behaviors learned in prison this practice is not necessarily abandoned upon release

  15. Diminished Sense of Self-Worth & Personal Value • Prisoners typically are denied basic privacy rights, and lose control over mundane aspects of their existence that most citizens take for granted • Live in small, sometimes very cramped and deteriorating spaces (a 60 sqftcell = size of king-size bed), have little or no control over the identify of the person must share that space (and the intimate contact it requires), often have no choice over when they must get up or go to bed, when or what they may eat, etc. • Can lead to feeling infantilized • Conditions = a repeated reminder of compromised social status and stigmatized social role

  16. Gangs • Other ways of adapting are induced by the presence of gangs in many prisons • With gangs come a number of related racial tensions, and these conflicts can follow a person into the community • To cope with gangs prisoners are forced to focus on finding a safe niche within the social fabric of prisoners’ relationships • Improving themselves and their prospects for a better life on the outside becomes irrelevant • Parolees may show little commitment to finding a job or otherwise improving themselves

  17. 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 times the number of prisoners for which they were designed) • Displacement, when prisoners are transferred to facilities far away from their communities to serve their sentence

  18. Traumas of Prison Life • Dehumanizing living conditions • Sexual harassment, sexual abuse, and rape (9-20% of prisoners are 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

  19. Recovery Story • James’ Experiences

  20. What it was like 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

  21. 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

  22. Trauma & MI • Morgan

  23. Posttraumatic Stress Reactions to the Pains of Incarceration • For some incarceration is so stark and psychologically painful that it represents a form of traumatic stress severe enough to produce post-traumatic stress reactions after release • A high % have experienced childhood trauma • The harsh, punitive, and uncaring nature of prison life can cause re-traumatization • Exposure to rigid and unyielding discipline, unwanted proximity to violent encounters, and possibility or reality of being victimized by physical and/or sexual assaults, need to negotiate the dominating intentions of others, absence of genuine respect and regard for their well-being in the surrounding environment • Time spent in prison may rekindle not only the memories but the disabling psychological reactions and consequences of earlier harmful experiences

  24. Trauma • Standard policies and procedures in correctional settings (e.g., searches, restraints, and isolation) can have profound effects on persons with histories of trauma and abuse, and they often act as triggers that re-traumatize those with PTSD • Routine jail/prison procedures such as searches, restraint, and seclusion can be experienced as frightening and threatening, especially to women given their histories

  25. Increased 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 people who experience homelessness have serious mental illnesses, and their homelessness makes them highly visible to law enforcement officers

  26. Mental Illness • A commonly cited estimate for the share of prison and jail inmates with a history of MI is 16% • Up to 1/3 all incarcerated adults have a diagnosable mental disorder; 60-75% have a COD • People with MI often cycle in and out of prison due to inadequate services in correctional facilities and re-entry • Almost 2/3 of people with a mental illness who are released from prison are rearrested within 18 months • People with MI have significantly greater chance of being arrested than those without would for a similar offense

  27. Mental Illness • Average of 4 months longer • More likely to max out sentence and leave unsupervised by parole • Return to prison more frequently and sooner

  28. MH Consumers • MI and DD = largest number of disabilities among prisoners • Incarceration presents very difficult adjustment problems that make prison an especially confusing and sometimes dangerous situation • People in prison or jail who have MI, DD or spend a significant amount of time in solitary confinement are even more prone to developing negative and anti-social behavior patterns while they are incarcerated • Prison diminishes the life management and daily decision-making skills needed for independent living

  29. Mental Illness • Prison is especially traumatic • Preyed upon by other prisoners • Intimidation leads to withdrawal into their cells where isolation worsens symptoms • Others strike out and are 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

  30. Effects of Solitary Confinement • Impaired sense of identity • Hypersensitivity to stimuli • Cognitive dysfunction (confusion, memory loss, ruminations) • Irritability, anger, aggression, and/or rage; other-directed violence (stabbings, attacks on staff, property destruction, and collective violence) • Lethargy, helplessness and hopelessness • Chronic depression • Self-mutilation and/or suicidal ideation, impulses, and behavior • Anxiety and panic attacks • Emotional breakdowns and/or loss of control • Hallucinations, psychosis and/or paranoia • Overall deterioration of mental and physical health

  31. MI • People with a MI can find the prison environment, with its rules and routines, especially difficult to adjust to; often accrue demerits that delay time to release • Those with severe or unmanaged health problems face an increased risk of adverse outcomes, including physical illness, relapse into drug use or, particularly in the case of MI, inappropriate behavior that provokes a police response • People with untreated MI are more likely to commit infractions and to be preyed upon by other inmates • Can cause unrest and tension in the general population and jeopardize safety of corrections officers and other inmates

  32. Consequences – 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.

  33. Role disruptions • Parents who return from periods of incarceration still dependent on institutional structures and routines cannot be expected to effectively organize their own lives & their children’s or exercise the initiative and autonomous decision-making that adult roles require • Those who still suffer the negative effects of a distrusting and hypervigilant adaptation to prison life will find it difficult to trust & promote trust and authenticity within their children • 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

  34. Treatment Implications • The inmate code includes rules and values such as do not snitch, do your own time, and do not appear weak • Manifest in certain behaviors, such as not sharing any information with staff, minding one’s business to an extreme, and demonstrating intimidating shows of strength • These behaviors help the person adapt during incarceration and act as survival skills in a hostile setting, they seriously conflict with the expectations of most therapeutic environments and thus interfere with community adjustment and personal recovery • MH providers are frequently unaware of these patterns and misread signs of adjustment difficulties as resistance, lack of motivation for treatment, evidence of character pathology, or active symptoms of MI • Providers often experience unwarranted concerns about safety and lose opportunities for early and empathic engagement

  35. Implications for Treatment • Behaviors that help with adapting to incarceration and are survival skills in a hostile setting conflict with the 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

  36. MI • 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 patient is a person of color • Misunderstandings and misconceptions reduce likelihood for improvement

  37. Post Incarceration Syndrome (PICS) • A set of symptoms caused by being subjected to prolonged incarceration in environments of punishment with few opportunities for education, job training, or rehabilitation • Most severe in prisoners subjected to prolonged solitary confinement and severe institutional abuse • Severity related to level of coping skills prior to incarceration, length of incarceration, restrictiveness of incarceration environment, number and severity of institutional episodes of abuse, number and duration of episodes of solitary confinement, and degree of involvement in educational, vocational, and rehabilitation programs

  38. Symptoms of PICS • Institutionalized Personality Traits resulting from the common deprivations of incarceration, chronic state of learned helplessness and antisocial defenses in dealing with a predatory milieu • PTSD from both pre-incarceration trauma and trauma experienced within the institution • Antisocial Personality Traits (ASPT) developed as a coping response to institutional abuse and a predatory prisoner milieu • Social-Sensory Deprivation Syndrome caused by prolonged exposure to solitary confinement that restricts social contact and sensory stimulation • SUDs caused by use of alcohol and other drugs to manage or escape PICS symptoms

  39. Institutionalized Personality Traits • Institutionalized Personality Traits caused by living in an oppressive environment that demands • Passive compliance with the demands of authority figures • Passive acceptance of severely restricted daily living, repression of personal lifestyle preferences, elimination of critical thinking and individual decision making, and internalized acceptance of severe restrictions of honest self-expression thoughts and feelings

  40. Post Traumatic Stress Disorder (PTSD) • Post Traumatic Stress Disorder (PTSD) is caused by both traumatic experiences before incarceration and institutional abuse during incarceration that includes • Intrusive memories and flashbacks to episodes of severe institutional abuse • Intense psychological distress and physiological reactivity when exposed to cues triggering memories of the institutional abuse • Episodes of dissociation, emotional numbing, and restricted affect; (4) chronic problems with mental functioning that include irritability, outbursts of anger, difficulty concentrating, sleep disturbances, and an exaggerated startle response. (5) persistent avoidance of anything that would trigger memories of the traumatic events; (6) hypervigilance, generalized paranoia, and reduced capacity to trust caused by constant fear of abuse from both correctional staff and other inmates that can be generalized to others after release

  41. Antisocial Personality Traits • Antisocial Personality Traits are developed from preexisting symptoms and those developed during incarceration as a coping skill and psychological defense mechanism. • Primary traits: tendency to challenge authority, break rules, and victimize others. • Veiled by passive aggressive style that is part of the institutionalized personality. • Duplicitous behavior (acting in a compliant and passive - aggressive manner with therapists and other perceived authority figures while being capable of direct threatening and aggressive behavior when alone with peers outside of the perceived control of those in authority. • A result of internalized coping behavior required to survive in a harshly punitive correctional institution that has two set of survival rules: passive aggression with guards, and aggressive with predatory inmates

  42. Social-Sensory Deprivation Syndrome • The Social-Sensory Deprivation Syndrome caused by effects of prolonged solitary confinement • Symptoms include severe chronic headaches, developmental regression, impaired impulse control, dissociation, inability to concentrate, repressed rage, inability to control primitive drives and instincts, inability to plan beyond the moment, inability to anticipate logical consequences of behavior, out of control obsessive thinking, and borderline personality traits

  43. Reactive Substance Use Disorders • Many inmates who experience PICS suffer from the symptoms of SUDs. • Addictive disorders prior to incarceration, no tx during incarceration, continuation by securing drugs on the prison black market • Development of addiction in prison to cope with PICS symptoms and conditions of incarceration • Relapse or development of SUD to cope with PICS symptoms upon release

  44. Forensic Team Experiences • Steve

  45. 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

  46. 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

  47. 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 • CBT • Moral Reconation Therapy (MRT) • Reasoning & Rehabilitation (R&R)

  48. EBPs • Relapse Prevention Therapy (RPT) • Thinking for a Change (T4C) • Strategies for Self-Improvement & Change (SSC) • Aggression Replacement Therapy (ART)

  49. Question & Comments