Mental Health: Not Just a Program

Article excerpt

In an age of aphorisms, the observation that America is fatting when it comes to dealing with the mentally ill has become cliche. Nowhere is that truth more obvious than in corrections, where the "order" of the law and the "disorders" of mental illness have their most enduring encounters.

In the February 2005 Corrections Today Commentary article, I concluded that both mentally ill and nonmentally ill offenders need institutions, but they need different kinds of institutions. The mentally impaired and the characterologically impaired (meaning an impairment in a person's character) are populations that are different kind, not just in degree, and as a result, they need institutions that are also different in philosophies, goals, policies and interventions. Six years later, the hens of reform flutter ever more frantically about the coop, kicking up the dust and feathers of expensive lawsuits, more screening devices and new best practices, but the roosting places for change have remained elusive. Perhaps the problem lies within the mental models corrections has been using--models that ignore important differences and underuse the skills of mental health staff.

Despite the good intentions of many administrators; and practitioners, the thinking that corrections has often been using is destined to fail from the sheer weight of differences in a whole host of areas. In fact, it seems even more obvious today that not only is the model of housing severely mentally ill people in correctional facilities rather than treatment facilities wrong, but differences within the models of clinical skills, clinical intervention, management of mental health staff and, indeed, the basic conceptual model of behavioral change underlying the entire process have been too heavy to be supported by the current structure for a long time.

Mental Health Staff Vary in Background and Training

Correctional mental health is typically an unwanted buckle affixed to the correctional and military model boot. The military model is, of necessity, built on the twin pillars of conformity and interchangeability. In this model, as well as in many correctional agencies, roles are carefully defined and staff are expected to rotate through a variety of positions without Joss of safety or efficiency. Interestingly, there is a parallel in medical training where the specificity of the information for medical personnel, based on a consensus of what constitutes the required body of knowledge and the articulation of clear standards of practice, leads to similar essential interchangeability of skills among medical staff that are suitable for most prison requirements.

This is not true with respect to mental health staff. States provide licensing requirements for psychologists, social workers and others in the field, but there are many high-quality paths to those licenses, and they definitely do not lead to the same degree of uniformity in mental health that is found in either medical or correctional staff. Broad variability in theoretical perspectives and clinical training mean that some mental health professionals, while perfectly effective in the community, will not be suitable for employment in correctional settings. Administrators need to keep in mind the important differences in how mental health professionals are trained, the philosophies they harbor and the goals they seek to achieve. Any skills model that expects uniformity and interchangeability among mental health staff will not be able to bear the weight of these differences.

Understanding Crime to Treat Offenders

The flip side of the uniformity model in staff is the uniformity model in offenders. Everyone recognizes that there are more differences behind the inmates' identification numbers than just the shirt size they may be printed on, yet institutional policies are specifically intended to be evenhanded and uniform when it comes to interacting with inmates. …