When things get worse

This is a long post.  It is a recap of a situation that arose with a student and its unexpected resolution.  It is long because some of the nuances are unusual and specific to corrections. In order to convey the importance of the more seemingly mundane details, I have offered more explanation than I normally would.

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One of the worst things about working in a prison is that I see the direct, immediate impact of systemic limitations on real, living people all the time.  I had a student (I’ll call her Martha) who, like most of them, had a terrible history of abuse and trauma. But Martha’s was worse, I think, because it involved child abuse from a family member, multiple court appearances and testifying, all concluding only a short time before her incarceration.  She had another family member pass from a drug overdose around the time she started my class, no mother or father, and two other siblings still using.

When Martha started my class, she had no history of counseling for any of these issues, no treatment or programming, no cognitive or emotional management training, nothing.  She was somehow getting through her days, although I couldn’t say how.  Martha had incredibly high levels of anxiety around academics and testing, as most of my students do, and it took her a while to settle.  About the time she started to relax, I realized she would be eligible for treatment and grew concerned.

Treatment is hard inside the razor wire.  It’s hard outside, but it’s a different type of hard in here.  There is no safety, no privacy, the “peer leadership” model means that the sick are tasked with trying to lead the sick, and there is no option to escape or leave that doesn’t come with significant consequences. There is little therapeutic support, which is highly problematic for people who have such desperate need for therapy.

Add to those fundamental problems that most of these women have suffered trauma and abuse, and that predators and prey are expected to physically co-exist and support each other, and we have a recipe for a toxic, potentially dangerous environment.  The cherry on the sundae is that the women are all expected to behave as if this is a safe, supportive community where they’re all working to help each other, even though the opposite is more often true.  The women compete, sabotage, act out their extensive range of dysfunctional coping mechanisms, and prey on each other mercilessly. That some women are able to learn from the experience and deal with some of their thinking and behavior is miraculous.

Knowing this and knowing a bit of Martha’s history, I contacted two colleagues and expressed my concern.  It was during that conversation that I learned that our therapists are tasked (almost exclusively) with crisis management (using DBT), and almost, but not quite, forbidden from engaging in clinical therapeutic practice.  It may be different in the Medium, but that’s what happens in the Minimum.  The end result of the conversation was that there was little we could do except know that putting Martha in treatment could backfire and that it would be risky for her.  She still wanted to try, so we accepted her decision.

I need to clarify that I believe that this lack of clinical therapeutic practice is a simple function of resources, i.e. money.  Even on the Medium side, they have limited spots in the more intensive mental health treatment programs, and those spots are saved for those with the worst of the worst mental health issues – regardless of whether the treatment could help them be okay outside prison or not.  Taxpayers simply don’t want to fork over more money to deal with people who are incarcerated.  Or maybe the money is there and legislators don’t want to give it to DOC for the same reasons.

Corrections is a giant sinkhole for cash, in part because the population has giant, overwhelming, seemingly endless needs.  DOC is tasked with using not enough money to deal with a bottomless well of need, and clinical therapy is one of the areas that never has enough of anything.  It’s possible there are regulatory or legislative mandates preventing more intensive therapeutic practice, but I don’t know.  In any case, the upshot was that Martha would receive no additional counseling if her past trauma started coming up in treatment – she’d have to figure out how to get through it with peer support and what little staff support we could provide.

Her treatment experience had a rough start.  Her start date wasn’t clarified so we had to juggle for a few weeks so she could continue in my class and, as we found out later, she was shifted from one counselor’s caseload to another.  She and I spoke several times because I could see that she was having a hard time, but she was sort of managing, and there was nothing else I could do.  It’s a delicate issue to even appear to question treatment staff, especially based on the word of an inmate.

Even if I’m trying to clarify something I was told, it can be easily misinterpreted as a critique of staff, allowing an inmate to triangulate staff against each other, or believing an inmate over staff.  Whether real or imagined, those are all serious breaches of etiquette and, if true, can be a problem for any staff person found “guilty.”  So I do the same thing that the counselors do – help students manage crisis and look for ways to navigate a fraught, toxic, confusing, and often frightening environment.

I’m also not a mental health professional and, even though I know them fairly well, I only know them through one aspect of their daily lives.  One of the hardest things about my job is realizing that what they show me – no matter how positive – is only one face and maybe not their primary face.  I try to believe that the people running the treatment programs do have a plan and know what’s best, but it’s rarely easy. I spend so much time with my students, and I have to actively work to stop myself from believing that I know what’s best because I’m the expert on them.

In Martha’s case, it all came to a head over the course of a few days.

On a Monday, Martha decided she wanted to sign out of treatment.  That has a variety of consequences, all of them punitive, regardless of whether the decision is best for her or whether her reasons are valid.  Unless she’s so bad she can rate an administrative removal (i.e. she needs to be put in the mental heath unit in Medium), she’ll lose good time, lose any privileges, won’t be able to get a decent job for months, and have to go back to living in General Population and try to deal with her stress there.  It’s a shitty, shitty system and doesn’t support (at all) people who have valid reasons for not being able to stay healthy in that treatment environment.

Martha couldn’t be in that environment and maintain her stability.  When I was asked to speak with her that Monday night, she was still able to hold herself together, and we came up with a plan to help her get through until Friday.  She agreed she could wait until then to sign out, and that it would be good for her to have more time to make sure she was making the best decision.  She did admit to suicidal thoughts, and that she had a history of physical aggression, but felt confident she didn’t want to act on them.

Tuesday brought a series of update emails, and me asking why she wasn’t being considered for an administrative removal.  The answer I got wasn’t very satisfying as it amounted to “she’s not bad enough yet” but, again, nothing I can do.  There is almost no room for true proactivity in here.  Even the most proactive responses can only happen *after* things have gotten bad.  I’m suspicious that one of the reasons treatment allows so few administrative removals and such harsh punishment for signing out has to do with keeping the beds filled, but I have no proof of that and suspicion means nothing in an atmosphere of mistrust and clouded motives.

Martha degenerated rapidly over Tuesday and Wednesday and we were looking at a possible worst-case scenario:  She’d be booted out of the program and sent to segregation, a move almost guaranteed to cause her to try to hurt herself.  Even though she’d been trying to get out of the program and avoid this very thing, having to stay in that environment was making her much, much worse.  After 15 months of working with her and seeing her thrive and stabilize, this was like a fist in the gut.

I felt helpless.  Although I was being included in the decision-making, I felt much more like part of the problem than the solution.  I knew going to treatment was going to be risky, I’d voiced my concerns early, but no one followed up, and now Martha was being dragged under by her internal demons – unleashed by programming that was supposed to help her.  I felt culpable, somehow, as if I’d failed to protect her, or sound the alarm early enough.  Now, in addition to trying to beat back her personal nightmares, she was also in danger of being subject to undeserved punishment for actions brought about by our inability to offer the support she needed.

Wednesday afternoon was jammed with the usual stuff, on top of a series of meetings to discuss what needed to happen with Martha.  By great good fortune, there were several of us advocating for her – that she’d been stable and cooperative, eager to participate and wanting help, until recently.  Although none of us knew exactly what had set off the recent chain of events, it was obvious that her current state was much much worse and she was acting out of fear and desperation.

After much staff discussion, checking with other inmates (some of whom were accusing Martha of aggressive behavior and statements), and consideration of her history, we settled on an administrative removal.  She may also have gotten a conduct order (based on her reported aggression and, in my mind, unnecessarily punitive) but I’m not sure.  That our normally reactive security staff would come to this decision and take time to understand what was happening was a goddamn miracle.  Even if they did hand out a punishment slip, I didn’t care.

Administrative removal meant she was going to go to Medium for at least a few days, to get help de-escalating and calming down, maybe a bit more support in the process.  Given the alternative, there wasn’t a better solution in sight and I’m quite grateful this was the result.  Once I heard this solution was on the table, I left. Martha was waiting in the common area and I sat down to talk with her a bit before going back to the classroom.

Her fear and panic were palpable.  She was barely able to keep from crying as we sat there, and she had obviously lost whatever composure I’d seen earlier in the week.  She knew she was in a bad place, she felt trapped, and even though she didn’t want to lash out, she couldn’t envision anything else.  I couldn’t relieve any of her fears at that moment, but simply sat with my hand on her back, trying to help her feel better for a few minutes.  Even the best-case solution had its consequences, because that’s how the prison system works.

There is almost no room for complexity or nuance.  What people need can be considered, but the solution almost always has to come from a predefined set of offerings – regardless of how well they fit the person as an individual.  We can almost never create something tailored to an individual person, but have to try and fit them into the same solution as everyone else.  DOC does this because it can’t be seen to be favoring one person over another, accommodating some needs and not others, to do something for X without doing the same for Y.

It’s why this system is a failure, and hurts everyone involved.  We’re forced into using tools that don’t fit the job – over and over and over.  We make our best efforts and the fact that some are helped is a credit to our determination and commitment. That more people are damaged and made worse by their time in prison is an ongoing statement about our desperate need for an alternative.

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3 thoughts on “When things get worse

    • It highlights massive problems in several systems, especially in dealing with women. The percentage of women incarcerated with diagnosed mental health issues is quite a bit higher than men.

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      • That’s disheartening, and not surprising. People who could be vital, contributing citizens are being housed and further traumatized, instead of healed and reintegrated into the community. Grrr.

        Like

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