Clinical Practice in Segregation: The Crucial Role of Psychologists
Magaletta, Philip R., Ax, Robert K., Patry, Marc W., Dietz, Erik F., Corrections Today
Authors' Note: The views expressed in this article are those of the authors only and do not necessarily reflect the policy or opinions of the Federal Bureau of Prisons, Department of Justice or their academic affiliates.
One of the unfortunate paradoxes of correctional mental health care is that the inmates most in need of services are often housed in the type of unit where it is most difficult to provide it. Most correctional institutions contain an area in which selected inmates are isolated from the general prison population, are unable to participate in the general population's daily activities and where they spend most of their time (often 23 hours of the day) locked in their cells. These areas, variously known as segregation, administrative detention, disciplinary segregation, special housing, special management, solitary confinement or control units, are "high volume" in terms of psychology service delivery. Although designed strictly for custodial security purposes, these units must often accommodate inmates with serious and persistent mental illness, impulsivity, ongoing substance abuse, violence and other assorted behavioral problems. Accordingly, the work that psychologists perform in segregation units is crucial to their agency's mission, both in terms of risk management and the fundamentally humanistic goal of saving lives at risk. A consideration of the salient clinical outcomes of such work (e.g., preventing suicide, self-harm, physical assaults and homicide, etc.) reinforces this fact.
The cement and steel austerity of segregation belies the complexity of the problems psychologists confront there. It is not only the inmate living space that segregation consolidates. In segregation mental health work, all elements of effective clinical practice in corrections are condensed. Far beyond the simple application of mental health principles to individuals who are placed or who place themselves in segregation, clinical practice in segregation is a complex enterprise that requires a keen understanding of psychopathology and a broad mastery of the profession's unique body of knowledge as it is applied in the prison. To effectively use such knowledge, it is imperative that psychologists move beyond thinking of segregation as a location. A systems-based ecological perspective of segregation can be particularly helpful in this regard. Understanding segregation as a set of constantly interacting individuals, contexts and processes makes it clear that it is psychologists' work in segregation that distinguishes them as specialists and requires the use of their unique training and knowledge.
Although it might be assumed that the shared experience of "being in segregation" effectively eliminates inmate heterogeneity, nothing could be further from the truth. Several empirical studies show that there is no typical segregation inmate. (1) An individualized approach needs to be taken that involves each segregation inmate's mental health history and the reason the inmate is currently housed in segregation. Some inmates are placed there on protective custody status. For some of these inmates, spending time in segregation is a welcome respite since they no longer have to obsess over their own safety. For others, however, safety concerns, along with anxiety and depression, only increase as claustrophobia and idle time feed their negative thoughts. In these cases, the psychologist must be proactive in assessing suicide, decreasing the inmate's fear and bolstering his or her hope for the future.
Another group of inmates may be brought to segregation for institutional rule violations and stay there for a predetermined amount of time as a consequence. The predictability of their assignment to segregation and the knowledge that they will be returned to the general population afterward may serve to decrease their distress. On the other hand, these rule breakers are likely to represent a high number of notoriously treatment-resistant populations: those with personality disorders, impulsive-aggressive individuals and those whose substance abuse issues remain active despite incarceration. …