In 2008 I decided to write a journal of my work as a psychologist with the Federal Bureau of Prisons. My hope was to give doctoral psychology students interested in correctional psychology a real life glimpse into the field. The journal only covers a brief period of time but I think it at least has the potential to open the eyes of upcoming students.
So nothing happened with the OIG, as far as I know. I never was interviewed. Anyway, highlights from this week: Wednesday one of our more infamous inmates, who is housed in SHU and allegedly participated in the recent sexual assault and killing of another inmate (**he is presumed innocent until proven guilty**), began apparently to try to tear down the recreational fence in an attempt to get to another inmate on the SHU recreational yard. (Certain inmates are required to be rec'ed alone and the SHU recreation yard is divided into little sections by cages.) After a use of force team was utilized to gain control of the situation, the inmate was placed in a holding cage (where there is barely room for inmates to sit) where I spoke to him. He was adamant that his actions were simply because he had not received his property. In other words, this inmate was willing to break through a fence and assault or possibly kill another inmate simply because he did not get his books, pictures, letters, etc. when he thought he should get them. The inmate was placed in soft-ambulatory restraints and placed in an observation cell. Later in the day, I was called back to SHU to perform "confrontation avoidance" with the inmate. When a Use of Force team is going to be used to gain control of an inmate it is standard operating procedure to have someone, usually a psychologist, attempt to talk the inmate into complying with the orders of staff before the team goes in on him. This is an effort to insure the safety of both the inmate and the staff. The inmate had successfully come out of his restraints, and I mean completely out of both hand and leg restraints, had smeared feces on the walls, windows, and floor and was swinging the chain on the leg restraints around as a weapon to use against staff when they attempted to come in on him. While we were getting everything set up to go in on him, he busted the window out of the cell door using the restraints. This presented another challenge as I now had to have one of the team members use a Plexiglas shield to cover the window area while I talked to the inmate. Fortunately, I was able to get the inmate to throw the restraints out the window and submit to new restraints without any problems. He was then placed in the adjacent observation cell in 4-point restraints where he attempted to spit and bite a staff member. (As an aside, he has now apologized to several staff members for his behavior.)
Thursday morning, another SHU inmate required an immediate use of force and was placed in restraints. I wasn't involved in this incident, however, whenever someone is placed in restraints a psychologist must evaluate the inmate every 24 hours to assess for psychological deterioration. On Friday we had a meeting with the Associate Warden, medical administrator, unit manager, and lieutenant to determine whether the inmate would remain in restraints. It was decided that he would. This inmate had also smeared feces on the walls, windows, and floor of the observation cell, as well as threatened to assault staff if the restraints were removed.
During the last few weeks, the Correctional Worker's Week Committee has been sponsoring fund raisers for the upcoming Correctional Worker's Week. Thursday I spent the afternoon washing cars and getting sunburned.
It was a fairly ordinary week. Nothing much out of the norm to report. We did get news this week that next week we will be receiving a visit from the Office of the Inspector General (OIG). If you are unfamiliar with this organization, they are like the Internal Affairs of the Department of Justice. While we don't know exactly why they are coming, we have been told that they will be "interviewing" (as opposed to interrogating) psychology staff and specifically interested in our sexual assault behavior prevention and intervention program. We'll see what happens.
One more night on-call. Things were pretty quite yesterday. I did learn upon coming to work that the inmate I recommended for 4-point restraints did eventually go into the 4-points. According to the lieutenant, when the inmate realized he actually was going to be placed in 4-point restraints, he stated, "Alright, game over. Let me go back to my cell." He was taken out of the restraints and returned to his cell several hours later.
I was called to the USP this morning due to the inmate from the previous night continuing to cut on himself. The Captain and Warden were considering placing the inmate in 4-point restraints. This is were the inmate's hands and feet are independently secured to a bed for the purpose of keeping the inmate from harming himself or others. This can only be done after the inmate has been placed in soft-, then hard-restraints, and continues to exhibit destructive behavior. As a CYA-thing, the Warden wanted me to assess the inmate and make a recommendation for how to manage the inmate. By the time I arrived at the institution, the inmate had been placed in a visual holding cell. As he was no longer cutting on himself, I could not recommend immediately placing the inmate in 4-points. As a matter of policy, the least-restrictive measure of restraint must be used to mange inmates. However, I did recommend that if the inmate began to harm himself again, he should be placed in 4-points. Keep in mind, this inmate is not suicidal. Rather he is a strong Antisocial Personality with a life sentence and plenty of time to play games.
Today is the last day for the other psychologist at the USP. We had a cake and people got to come say their goodbyes. The Warden and all the Associate Wardens made an appearance, people made short speeches, and the other psychologist, a female, was given a trip to the SHU to interview a returning inmate (from another institution) with a tendency toward inappropriate behavior toward female staff members as a farewell gift. Later this evening, I was called back to the institution to see an inmate who had superficially cut his wrist. By the time I arrived, the cell mate of the inmate I was called on had been placed in restraints due to cutting on himself. Even after being placed in soft (i.e., padded) restraints, the inmate continued to cut on himself, despite being search for any foreign objects. The inmate was placed in hard (non-padded) restraints. However, he continued to cut on himself. Medical staff confirmed that the superficial lacerations were consistent with a razor blade. I have personally seen inmates hide razor blades (from disposable shaving razors) in what appears to be the back of their throats. I was once talking to an inmate who, to prove that he could kill himself, began to behave as if he were trying to regurgitate something, only to produce one of these razor blades, show it to me, and appear to swallow it again. Inmates have also been known to hide objects under their skin and to create permanent "pouches" in their skin with which they can hide contraband.
Tonight I got called into the USP because an inmate was bored and stated he felt like stabbing someone, breaking something, or hanging himself. There are two things the BOP takes very seriously, threatening one's own life and breaking government property. When I got to the institution, the inmate acknowledged he was bored and stated he felt like hanging himself because he wanted attention. Basically, he just wanted to talk.
Well, I got a "last-minute Psychology play," as I call it. This is when an inmate who has a history of requesting to speak to psychology for questionable reasons waits until just before close of business to request to speak to a psychologist. They do this for various reasons. They may do because 1) they expect that because you want to go home you will more easily give them what they want, 2) if you do not respond to them, they can blame their acting out on the psychologist for not responding to their request for "services," 3) to find out who is the on-call psychologist, and 4) to just piss us off. This 3:50pm request (we get off at 4:00pm) required me to call a "last-minute Psychology audible." Knowing this inmate very well and suspecting explanation number 2 to be the cause of this request, I chose to actually go see the inmate to prevent being called in later in the night. Normally, the inmate would have been notified that he would be seen the following day. Upon meeting with the inmate he demanded that I have him removed from his cell because he was thinking about killing himself. Here is where knowing what you are doing as a psychologist comes in very handy. The inmate refused to discuss his issues at his cell door, citing confidentiality as the reason. He didn't want other inmate's to overhear. I can't blame him for that and as a psychologist I take confidentiality very serious. Still, knowing this inmate as well as I do, I was not going to pull him out for anything other than a legitimate emergency. He has refused to go back in his cell in the past. I was able to conduct an assessment on the inmate without him realizing it and determined that he was not actually suicidal. (I was recently asked by an inmate how psychologists can tell if an inmate is truly suicidal. This is something I can't actually ever see myself discussing with an inmate and I responded that it was a "trade secret." He seemed to appreciate this response.) I won't go into detail here as to how I was able to make this determination, though. I know this may raise some eyebrows or disappoint those who may hope to gain some secret insight, but the truth is, threats of suicide should always be treated seriously and it takes many years of training and/or experience with the subject to even hope to have a clue about what you are doing when you try to determine if someone is actually suicidal. And even if you are 100% sure that the other person is not suicidal, that does not mean the person agrees with you. It's only when you have sufficient training and experience, and use that knowledge in a manner consistent with other practitioners, to make such a determination, that you can even hope to be protected by the law. Back to my story, the inmate was not pulled, although he was offered the opportunity to be put on a wait list to be seen one-on-one. He was not pleased with this offer and continued to demand he be pulled as I walked off the range.
As a side note, most inmates hate it when they are told they will be placed on a wait list for a one-on-one session. They are not known for their patience and many are almost pure creatures of impulsiveness. They are concerned with the here and now. However, even for those with legitimate problems (I'm not referring to mental illness here, but rather transient issues such as stressors), research shows that many individuals placed on waiting lists will have their issues resolved or no longer experience distress by the time they are seen. It speaks to the adaptability of human beings.
Today I went on-call for a week. Working at a USP typically makes this an unpleasant responsibility. Working at a complex with 4 institutions doesn't help matters as I am responsible for all four facilities after work hours and on the weekend.
My workday was nothing really out of the ordinary. I am one of two staff psychologists routinely responsible for the USP. This just happens to be the last week at this institution for the other psychologist who is transferring to another BOP institution. I'm expecting a serious bump in work load. Anyway, this evening I was called from the USP just as I was unlocking my front door. An inmate in SHU was stating he was going to start cutting on himself if Psychology did not show up. This particular inmate has a history of threatening to kill himself or engaging in superficial self-harm for secondary gain. In fact, he does this several times a month. He particularly likes to speak to female psychologists and being placed on suicide watch were he has a history of "pleasuring" himself sexually when female staff are present. Tonight I suspect he was attempting to ascertain who the on-call psychologist is so he can plan out his week. He was informed that I was the on-call psychologist. Nothing else was heard out of him for the remainder of the night.
Today was more of a typical day for me. I spent my entire morning in SHU seeing almost every inmate. I got more of the usual, inmates asking to be pulled from their cells, asking for medication, wanting to see a female psychologist, etc. Apparently, several inmates liked the color of my shirt as I got several "compliments." "That's a pretty shirt you got on Dr. Smith. Your a pretty boy. I'd like to kiss you right on the mouth. I'd like to get you in 4-point restraints right up against this fence." Today, I think I got more propositions than the female psychologist I was with.
My afternoon was spent like so many before. This Saturday morning an inmate was placed on suicide watch after making superficial cuts to his neck and hand. While, the inmate has history of feigning mental illness and being suicidal for secondary gain, he remained on watch over the weekend primarily because he refused to speak to any of the psychology staff, preventing a mental health assessment from being conducted. With the help of medical personnel, I was able to get the inmate to speak enough to conduct an assessment. True to form, the inmate was seeking a transfer and a single cell. He was removed from suicide watch. Of course, just because someone is seeking secondary gain does not mean they will not harm themselves. This is an area psychologists in correctional settings have to be weary of. Inmates have been known to go to extraordinary lengths to get something as simple as a phone call or someone to listen to them complain. In fact, removing someone from suicide watch says very little about what they might do to harm themselves. Rather, it is more an indication that the available information suggests that the inmate is not suicidal, that is, not wanting to die. Frequently, inmates will go on to make some suicidal gesture after being removed from watch. In these cases, the inmate's behavior is seen as a correctional issue rather than a psychological issue and "sound correctional techniques" are recommended, although Psychology Services continues to participate in making management recommendations.
Well, it was a very slow week. We finally returned to some resemblance of normal. We have changed the way inmates are allowed to move, trying to minimize their lingering time and access to other inmates. With such a slow week, I must admit that I occasionally longed for lock-down days. Anyway, I was able to read some articles and check out a lot of potential on-line, peer-reviewed journals to potentially submit articles. The federal government is not big on employees searching the internet for personal reasons. Still, I figure what I was doing was not simply personal reasons. After all psychologists are obligated to stay up on current research in the field. Also, any publications by BOP psychologists serves only to boost the bragging rights of the Bureau. So I see any future publications as serving the Bureau as well.
Today started off with a mostly quiet morning. I followed-up with a couple inmates on the units. I was called to speak to an inmate who was complaining of hearing voices and starting to hate himself. Turns out he just wanted to speak to a female psychologist and to get a phone call, despite his phone privileges having been taken away for disciplinary reasons. Desiring phone calls is another major contributor to inmates claiming psychological problems.
A little after lunch I was called to SHU due to an inmate telling the warden he wanted to kill himself. I spent a good portion of the afternoon conducting a suicide risk assessment and writing the documentation. If it hasn't become obvious by now, the BOP is hypersensitive about potential suicides. I think this fixation is absolutely justified given the high rates of suicide in correctional settings compared to the general population. However, there is an unfortunate side to this. Inmates are a very resourceful bunch and are quite aware of the Bureau's fears. They often use this to their advantage by threatening suicide if their demands are not met. But, that's why the Bureau employs psychologists.
The BOP has an affinity for giving awards. They give monetary or time-off awards for anything from being names "correctional worker of the month" to "correctional officer of the quarter" (notice the distinction between officer and worker) to doing a good job by finding a shank, for example. The award service pins for every 5-year interval for which a person works for the BOP. It seems quite obvious that sometime way back, some psychologist informed the BOP leadership that staff were like rats or pigeons whose behavior and motivation could be shaped by random and fixed-interval reinforcement. My morning started with an hour-and-a-half-long staff recall in which numerous aforementioned rewards were given out. Of course, I did not receive any award, but hey, at least I was an honor graduate at the Federal Law Enforcement Training Center. That's something that not many other people in the BOP can say. (I was given a $300 bonus for this accomplishment.) After the meeting, I went back to the USP where I had a mostly quiet day. Seems the inmates are settled down for the time being. This may be what is referred to as "rocking staff to sleep."
When you work at this USP, you don't often have the opportunity to visit the other institutions in the complex. Still, today I was called to go to the Medium to assist another psychologist with SHU reviews. Every inmate in SHU is required by policy to have a thorough mental health assessment every 30 days to determine if their "solitary" confinement is causing mental decompensation.
Well, things are slowly returning to "normal." The institution is slowly allowing the inmates more freedom. I was able to serve as a psychologist today, conducting screenings with inmates who have returned from going to state or federal court. Many inmates go through a serious of court visits either due to filing appeals, being tried for other charges, awaiting sentencing, testifying in trials, etc. When an inmate has left the institution to go on what is called a "writ" and then returns, Psychology Services must conduct a screening to make sure that the inmate is not suicidal due to some significant change in their legal status. My day concluded with a SHU inmate threatening to cut on himself if Psychology did not come to see him. Of course, when I arrived he was not interested in speaking to me presumably because I am not a female. He has a history of masturbating in front of female staff. I was thus able to leave work on time. Once again being a male pays off.
Well, the lock-down remains on. I spent my morning escorting medical staff (the complex maintains a contract with a near-by university-related medical system) to different units were the inmates could more easily be seen for their appointments. Compared to other ways to spend my morning, this was not such a bad thing. At least I was able to get out of a single unit and walk around. In the afternoon I returned to a unit to provide back-up support to a unit officer.
Finally! Today I was not assigned to a unit and was therefore able to be a psychologist. The majority of my day was spent reading research articles since the lock-down has lead to a shortage of work to do. Some of the articles I read today were: For women, but not men, religion may aid mental health, Why Are Hispanics at Greater Risk or PTSD?, and The law explored: who is legally responsible for suicide?
Toward the end of the day, I made rounds in the Special Housing Unit or SHU. SHU is were we keep the inmates who have gotten in trouble on the compound, are placed in protective custody, are being held for another institution, or are awaiting investigation of some sort before being allowed to the general population. The SHU is supposed to be the most secure place in the institution and extra care is taken when transporting or otherwise engaging these inmates. Psychology Services is required to make rounds in SHU at least once a week. For the most part, everything went as normal with inmates yelling insults at me, asking for medication, asking to be pulled from their cells, etc. One thing that working in a correctional setting is really good for is learning how to identify people with legitimate mental health needs and those who are seeking "secondary gain." Secondary gain is when an inmate feigns or exaggerates mental health symptoms in an attempt to get something unrelated. In SHU my conservative estimate is that 80-90% of inmates reporting psychological symptoms are seeking secondary gain. The number one motive is to get medication. The BOP does not prescribe medication for sleeping difficulties. However, inmates are quite aware that some mental health medications cause drowsiness. Many inmates have a desire to sleep through their incarceration. Other inmates want medications to get "high." To survive as a psychologist in a prison, one must be able to quickly and accurately discern between real and fake mental health issues. This is complicated by the high numbers of Axis II individuals.
I thought my day would end with writing a memo and incident report on an inmate who recently killed another inmate and was currently threatening to kill a staff member over not getting his property. (My attempt at de-escalation did not appear helpful.) I was wrong. As I was just heading through the gate that lead me closer to my own freedom, I was summoned to return due to an inmate in SHU placing a noose around his neck. After conducting a suicide risk assessment, I determined the inmate was attempting to get medication (for sleeping) and a phone call. I left work three hours late.
Today was more of the same with one exception: I met my quota of seeing naked men. It's probably not what you are thinking. The BOP has a procedure called "visual searches." To the lay person, think strip search. Grown men strip down to nothing and proceed through a series of revealing poses that allows the observer to visually check for any hidden objects, if you get what I mean. There is no touching the inmates, but I got to see more than I ever wanted. As of today I am no longer a visual search virgin. And a 400 pound man broke me in. I think I might need some therapy.
We remain on lock-down. Today I got to conduct medical escorts. This is when an inmate has to be placed in restraints and physically escorted to the on-site hospital for an appointment. I got to see a dentist extract a tooth. Escorting took up the first several hours of my day. Sometime after lunch I was free and took the time to meet with my "mentor." The BOP offers a Mentor/Protege program to enhance professional development. My mentor is the Chief Chaplain. We are required to meet for one hour each month. However, we had to make up for last month due to the lock-down requiring me to perform other duties.
Currently, the USP is on lock-down. An institution goes on lock-down at the direction of the warden usually whenever there is a general threat to staff and/or inmates or the threat-level is unknown. Other reasons an institution might go on lock-down include bomb threats, national or local emergencies (natural or man-made), or in response to an assault, riot, or otherwise disruptive activity. When an institution goes on lock-down, all inmates are secured within their (typically) two-manned cell and are not allowed out except for showers, medical escorts, or other activities that cannot reasonably be performed through a food slot in the cell door. The USP has been on lock-down 4-5 times in the last 6 months for various reasons. While I will not go into detail about the rationale for the current lock-down, partly because not all intelligence is shared with all staff (including psychologists) and partly because of security reasons, I will say we have been on lock-down for the last 1 1/2 weeks after being off lock-down for one week following an almost two-month lock-down.
My day started with a meeting with "all staff not assigned to a correctional post." The number of staff meeting this condition varies with the day depending on how many people decide to show up. At this meeting I was assigned to help backup a unit officer as the inmates were allowed out of there cells (but not out of the unit). My role was to play support and to have an increased staff presence in case the inmates decided to engage in some disruptive activity. This was my entire day: watching inmates take showers, talk on the phones, watch TV, and yell with other inmates (the noise-level in one of these units really is unnecessary). I was able to briefly slip into my psychologist role and sneak in a referral for a medical evaluation. We will see what tomorrow brings.
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