The prison is a unique social institution where offenders are detained with the hope that they will be reformed before they are integrated back into society. Practitioners working within the custodial environment face significant challenges because of the complexities in the settings. Most clients in the correctional facilities have been separated from families, and feel hopeless, and depressed. Notably, research has established that up to 16.1% of violent prisoners have mental disorders such as schizophrenia, and 43.6% have substance use disorder (Völlm et al., 2018). The counselors are exposed to emotional, social, and physical risks partly due to vicarious trauma as they empathically try to help incarcerated clients (Frost and Scott, 2020). Additionally, maladaptive coping can make mental health professionals who work in prisons have a poor quality of life if there is no professional supervision and support. Although it is risky to work with all institutionalized offenders, therapists working with those with suicidal and self-harm experience intense challenges hence the need for a professional and strong social support system.
Prevalence of Suicide and Self-harm and Implication for Therapists
Ending one’s life appears to be a solution to the issues faced by incarcerated individuals; thus, it represents a significant morbidity burden for prisons around the globe. In England and Wales, the rate of self-harm in 2018 was 629 per 1000 prisoners, the equivalence of 52,814 incidents (Ryland et al., 2020). Similarly, Perry and Horton (2020) record that the rate of attempted suicide in UK prisons has been escalating at the rate of 27% in a year such that in 2016 the rate was 405 attempts per 1000 individuals in this population. Young men are 18 times more likely to successfully commit suicide, but their female counterparts have higher incidences of higher self-harming behaviors (Shingler, 2018). The result is that the detainees are always in danger of psychological and physical morbidity. The staffs have an increased level of stress and burn-out when their clients engage in such practices.
Measures such as increasing the time that the incarcerated persons spend outside while engaging in constructive activities are also important in helping them deal with suicidal thoughts. As such, the United Kingdom Prisons have developed the ACCT (Assessment, Care in Custody and Teamwork) to assess and develop a care map plan for prisoners who are at risk of self-harm (Perry et al. 2019b). In addition, Biddle et al. (2018), observed that enhancing interactions between the workers and the detainees had the potential of reducing self-harm. However, there are barriers caused by mistrust between the captives and the staff due to power differences making it had to establish a firm relationship.
The challenge is that the behaviors of the prisoners can negatively impact the therapists more so when the harmful practice is repeated. As stated by Fusco et al. (2020), the professionals working in correctional facilities experience multiple episodes of post-traumatic stress disorder (PTSD). Notably, the incarcerated individuals within the UK prisons receive extreme punishment which makes life hopeless for them (Cowell, 2020). For instance, a therapist can be working with a client and the next day they receive news that they have committed suicide. Such experiences are exhausting and may make the psychologist have unnecessary self-blame.
Contextualizing Forensic Therapy and the Risks
Forensic psychology, within the European context, is more concerned with the treatment or management of offenders with psychological problems. The clients comprise those that have broken the law or are at risk of doing so. Thus, therapists must have some competencies in legal matters since the patients may be having court cases, and reports from the psychologist are required. In addition, due to the offending histories, the counselor has to adjust their office and work with clients within the prison premises, a secure environment. The detention is intended to prevent the detainees from harming others as they undergo rehabilitation.
The role of the therapist includes assessing the client for complex psychological disorders, violence, and sexual defiance. The information garnered helped in directing the objectives of the therapy and interpretation of the reports to judges. If the client poses risks to themself or others the therapist must understand and work with a multidisciplinary team to manage the patient (Perry and Horton, 2020). Offenders with a history of drugs and substance use may be experiencing withdrawal symptoms which further escalates their problem. The therapist must adapt to the prison culture which is characterized by constant social, physical, and psychological risks.
Emotional Risks for Therapists Working in Prisons
Prisons are sites with rich and varied emotional engagement for both staff and incarcerated individuals. As such, working within the detention environment creates a preponderance of negative emotions in the counselors due to their experiences. Most correctional centers have strict regimes and both the captives and the counselors may at different points have feelings of powerlessness and job-related stress (Sygit-Kowalkowska et al., 2017). To adopt and work well in such settings the prison staffs have to develop mechanisms for coping with the chaos and roughness associated with the setting (Einat and Suliman, 2021). The environment is domesticated such that just as is the case in a home setting the inmates and staff spend long hours together and may develop compassion fatigue due to having to support clients that are depressed (Singh et al., 2020). Without sufficient personal and emotional outlets to deal with the workplace events, the therapist can start having psychological issues such as stress and burnout.
Complicated grief is also another form of emotional difficulty that correctional therapists work with suicidal clients. In a research study that was conducted by Barry (2020), findings revealed that mental health specialists experience stress after losing their clients to suicide, and yet they cannot tell anyone. During therapy, the psychologist may form some attachment and develop care towards their patient regardless of the offense that they committed. Their ability to empathize and develop a trustful working relationship makes it possible for them to understand the worldview of their clients (Volker and Galbraith, 2018). When they commit suicide, the therapist is left with the burden of knowing the truth and even feeling grieved. Worse still, they have to remain silent because of the counseling ethics and the fact that other people are judgemental.
Social Risks for Therapists working in prisons
The inmates have family members who are outside of the prison and remain optimistic that their relatives will be out of prison and reunite with them. The counselors expect that they can help the incarcerated individual to stop engaging in practices that expose them to physical and emotional injuries. The challenge is that the inmates view the therapists as untrustworthy and powerful (Shingler et al., 2020b). Within such a context, it is difficult to develop a trusting relationship to assess if the client is at risk of suicide. Therefore, as stated by Ryland (2020, p.8), “managing those prisoners who repeatedly self-harm can put particular pressure on the system, including high levels of frustration, the tension between staff groups.” Furthermore, the perceived power differences between the client and therapist make the latter feel a lack of job control. The therapist may clash with colleagues while trying to help the client because they have the pressure to give reports and yet it takes more time for the inmate to be transparent.
In the case of a prisoner dying or committing suicide, the counselor may be blamed for incompetence or inability to prevent the suicide. According to Shingler et al. (2020a), the counselors feel responsible for the lives of the suicidal inmates despite having limited resources and working in an environment that limits therapeutic relationships. Given the emotions involved in such processes, it may be difficult to objectively explain that the therapist failed to understand that the client was at risk of self-harm. Yet, the colleagues have high expectations for the psychologist to offer a solution (Shingler et al., 2020a). In addition, enmity can develop between the family members of the therapist for failing to help their client to stop the self-harm behavior. In some cases, the counselors can even be sued and further derailed by multiple court proceedings.
The other social risk is that the therapist working with suicidal prisoners may experience stress episodes which when not professionally supervised results in displacement behavior. Many staffs working in correctional settings encounter clients with developmental changes and other issues that make it frustrating to deal with (Chester, 2018). Such therapists may be irritable and displace their negative feelings on their children and spouses (Walker et al., 2018). In some cases, the stress may make them not to relate well with friends and colleagues. Thus, the work-home conflicts which are common among the people working in the high-stress environment can result in divorce and even child neglect.
Physical Risks for Therapists Working in Prisons
The working conditions in prison are often not as conducive as in other clinical or office settings. According to Fusco et al. (2020), correctional therapists have a high level of exhaustion.
Counselors working in this setting may have emergency duty calls, especially when they are working with clients who are suicidal. In addition, the therapists are also more at risk of diseases associated with stress such as ulcers, blood pressure, and heart attack (Fusco et al., 2020). The disease significantly lowers the therapist’s quality of life and may shorten their lifespan. Unlike, a psychologist working in other settings such as the office the correctional counselors are also exposed to airborne diseases which spread fast in the prisons due to congestion.
Aggression from unstable prisoners can also pose a risk to the correctional therapist. As indicated by Shingler (2020b) the prison environment is characterized by violence, volatility, and suffering which make it unsafe for both the inmates and the workers. Worse still, people who are suicidal or engage in self-harming behaviors may target the counselors and other workers when they feel that they are not understood (Sweeney et al., 2018). If they succeed the therapist may get temporary or permanent injuries on their bodies.
Conducting a thorough risk assessment can help therapist to understand their clients beforehand and manage them well. According to Shingler et al. (2018), at the initial counseling stage, there must be an emphasis on transparency and clarity, respectful relationships with appropriate boundaries, and purposeful conversation. It is also important to understand the individuality of the client to remain non-judgemental and observe unconditional positive regard. The therapist must continually receive problem-solving training to enhance their competencies in dealing with the patients who are at risk of self-harm (Perry et al., 2019). Particularly, Vossler et al. (2017) recommend that forensic psychologists should focus on preventive interventions rather than reactive measures. Additionally, human experiences should not be medicalized and consideration of the Mental Health Act 1983 needs to be observed to avoid legal implications (Vosseler et al., 2019). The focus should be on promoting positive behaviors and not stopping the negative practices.
Operating prisons as therapeutic settings is important in reducing suicide harm for the inmates as well as minimizing therapists’ exposure to emotional, physical, and social risks. A good example is Grendon’s 1960s experiment whose evidence indicates that it significantly reduced reoffending. The setting allowed prisoners to give their consent to serve their sentence in a therapeutic community staffed with mental health specialists. The inmates had daily group counseling in addition to the regular individual therapies. The intensive regime that was adopted in Grendon challenged the maladaptive behaviors of the inmates leading to comprehensive rehabilitation.
The counselors need to have formal and informal sources of support including debriefing, line management supervision, reflective practice, counseling, and support at home. Cramer et al. (2020) explain that the staff working in secure confinement settings must develop personal coping strategies. For example, after a suicidal event, the staff should receive a debriefing to help them with processing the experience. In addition, the personality of the therapist should not be neurotic so they do not become prone to stress (Lovell and Brown, 2017). The personal, as well as group coping strategies, will help the therapists to deal proactively with issues such as compassion fatigue (Bell, Hopkin, and Forrester, 2019). Therefore, the stressful work environment in the prison demands that forensic psychologists have many ways that they can use to positively cope with their challenges.
The prison environment is characterized by confinement, control, and other uncertainties such as a higher prevalence of suicide and self-harm from the inmates. Therapists working with suicidal people in correctional facilities are, thus, exposed to physical, social, and emotional risks. However, the challenges should not be an excuse for ignoring such patients. The most important thing is to adopt better proactive strategies that help both the therapists and their clients to cope in a positive respectable manner. Having a strong support system and developing coping abilities can further enhance the well-being of forensic psychologists.
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