BCACC Blog

Prisoners

Supporting Prisoners’ Mental Health: A False Choice between Treatment and Security

By Nicole Kief, Legal Advocate, Prisoners’ Legal Services, a project of the West Coast Prison Justice Society

The West Coast Prison Justice Society will be hosting a conference on June 2, 2017 on mental healthcare in prisons. For more information, please read through to the end of this blog.

 JT suffers from frontal lobe deficits, attention deficit hyperactivity disorder and complex post-traumatic stress disorder. He entered the federal prison system in 1995, where he was held in solitary confinement for extended periods of time. He began to self-harm in the form of head-banging as a coping mechanism.

The Correctional Service of Canada put JT under a Behaviour Management Protocol that required him to be locked in his cell if he engaged in head-banging, and to remain there for 24 hours without banging his head. If he did not stop banging his head, he would be given an order to stop and then force, including chemical agents, would be used against him. He was held in solitary confinement for hundreds of days.

An independent psychiatrist warned that JT was at risk of serious brain damage or death from banging his head. Yet, JT’s solitary confinement continued, where he was locked in a cell for up to 23 hours per day with little or no meaningful human contact, which made his self-harming worse.

After much advocacy by our organization, the Correctional Service of Canada began to provide JT with individual trauma therapy and ended his solitary confinement. JT was able to gain control of his self-harming and was released to the community where he did not engage in head-banging again. He still suffers from flashbacks and nightmares.

The prevalence of mental health issues in federal prisons is estimated to be two to three times higher than in the general community,[i] and up to 90 percent of federal prisoners have a substance abuse problem.[ii] People in prison have also experienced above average rates of trauma and victimization;[iii] indeed, close to 70 percent of federally sentenced women report histories of sexual abuse and 85 percent report having been physically abused.[iv]

Despite the vulnerability of this population, access to meaningful mental health services are very limited in Canada’s prisons. Far too many prisoners with mental disabilities are spending time in solitary confinement – an environment that exacerbates trauma and mental health issues.

The United Nations considers solitary confinement of people with mental disability for any length of time to be torture. Yet 69 percent of people flagged with mental health issues in federal maximum security prisons had recently been in long-term solitary confinement at mid-year 2015-2016, with an average stay of 81 days.[v] A staggering 87 percent of prisoners with a history of self-injury have spent time in segregation.[vi]

Prisoners across BC often complain to Prisoners’ Legal Services about being held in solitary confinement. They report being held in a small and often filthy cell for at least 23 hours per day with very little human interaction, and having their basic human dignity undermined. Prisoners in segregation cells sleep and eat all meals in their cell, in close proximity to the toilet.

Interaction with correctional, medical and psychological staff is very limited and usually happens through the cell door where there is no privacy from guards or other prisoners. Contact with other prisoners is usually limited to yelling through cell doors.

When our clients tell psychological staff that they need more human interaction, they often report feeling that staff are impatient with no time to really talk and that their feelings of isolation are ignored.

Even prisoners on suicide watch are held in cells in administrative segregation units. Ashley Smith, a prisoner who had a long history of self-harm and spent a considerable amount of her sentence in solitary confinement, died of self-strangulation in 2007 while on suicide watch.

The use of solitary confinement in Canada must end. Evidence shows that it makes prisoners with existing mental disabilities worse, and that it can cause severe psychological symptoms, including self-harm and suicide, in prisoners without existing mental disabilities.[vii] As law professor Michael Jackson has noted, solitary confinement is “the most individually destructive, psychologically crippling and socially alienating experience that could conceivably exist within the borders of a country.”[viii]

Prisoners’ Legal Services calls on the governments of Canada and British Columbia to abolish solitary confinement. We call on them to invest in truly meeting the mental health needs of all prisoners. Critical interventions include establishing specialized mental health units to address the specific therapeutic needs of prisoners, and implementing a trauma informed approach, dynamic security and de-escalation practices in all correctional settings. Studies demonstrate that these approaches can reduce incidents of self-harm and violence and foster a prison environment that is more conducive to counselling and rehabilitative programs.[ix]

On June 2, 2017, Prisoners’ Legal Services will bring together prison-based mental health and medical professionals to discuss how they can advocate for their mental health patients and meet their ethical obligations while working in the prison environment. The conference will feature speakers from Correctional Service Canada and BC Corrections, as well as experts in trauma, solitary confinement, self-harm and personality disorders.

We invite you to join us.

And for more information about solitary confinement in Canada and British Columbia, see our report: Solitary: A Case for Abolition.

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[i] Office of the Correctional Investigator, “Annual Report of the Office of the Correctional Investigator 2014- 15” at 17. Online: http://www.oci-bec.gc.ca/cnt/rpt/pdf/annrpt/annrpt20142015-eng.pdf.

[ii] House of Commons, Standing Committee on Public Safety and National Security, Drugs and Alcohol in Federal Penitentiaries: An Alarming Problem (April 2012) at 19. Online: http://www.parl.gc.ca/content/hoc/committee/411/secu/reports/rp5498869/securp02/securp02-e.pdf/.

[iii] Nancy Wolff, Jing Shi, and Jane A. Siegel, “Patterns of Victimization Among Male and Female Inmates: Evidence of an Enduring Legacy” (2009) Violence Vict. 24(4) at 469-484. Online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3793850/.

[iv] Canadian Association of Elizabeth Fry Societies, “Criminalized and Imprisoned Women”, Fact Sheet, (2015). Online: http://www.caefs.ca/wp-content/uploads/2013/05/FINAL-Fact-Sheet-2015-Criminalizedand-Imprisoned-Women.pdf.

[v] Correctional Service of Canada ATIP response to Prisoners’ Legal Services’ request for information (Fiscal Year 2014-2015). Mental health need was defined as having had at least one mental health treatment-oriented service or stay in a treatment centre during the six months prior to the data extraction.

[vi] Office of the Correctional Investigator, “Administrative Segregation in Federal Corrections 10 Year Trends”, Report, (28 May 2015). Online: http://www.oci-bec.gc.ca/cnt/rpt/oth-aut/othaut20150528-eng.aspx.

[vii] See Stuart Grassian, “Psychiatric effects of solitary confinement” (2007) Journal of Law and Policy 22, pp 325-383; See also Craig Haney, “Mental Health Issues in Long-Term Solitary and “Supermax” Confinement” (January 2003) Crime & Delinquency vol. 49 no. 1 124- 156; and Sharon A. Shalev, A sourcebook on solitary confinement (London: Mannheim Centre for Criminology, London School of Economics and Political Science, 2008). Online: http://solitaryconfinement.org/uploads/sourcebook_web.pdf.

[viii] West Coast Prison Justice Society, “Solitary: A Case for Abolition” (November 2016) at 4. Online: https://prisonjusticedotorg.files.wordpress.com/2016/11/solitary-confinement-report.pdf.

[ix] Penal Reform International, “Balancing security and dignity in prisons: a framework for preventive monitoring”, Report, (London: 2015). Online: https://cdn.penalreform.org/wp-content/uploads/2016/01/security-dignity-2nd-ed-v6.pdf. Sarah Glowa-Kollisch, Fatos Kaba, Anthony Waters, Y. Jude Leung, Elizabeth Ford and Homer Venters, From Punishment to Treatment: The “Clinical Alternative to Punitive Segregation (CAPS) Program in New York City Jails, Int J Environ Res Public Health, February 2016; 13(2): 182. Niki A. Miller & Lisa M. Najavits, “Creating trauma-informed correctional care: A balance of goals and environment” (2012) Eur J Psychotraumatology 3: 10. Lori Whitten, “Trauma-Informed Correctional Care: Promising for Prisoners and Facilities, Corrections and Mental Health”, National Institute of Corrections (2013).

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The Value of Discomfort

by Naomi Adams, M.C.P., R.C.C

 

As young children, our feelings and behaviors are simple and adaptive: we feel something, our emotions tell us what we need and then we take action to get that need met. For example, when a baby is hungry, it is uncomfortable, and it will adaptively cry so that his/her caregiver can come feed it. As adults, social norms and learned ways of thinking often get in the way of this natural process, whereby we skip allowing ourselves to truly feel what we feel, and therefore miss the valuable lesson that our emotions are trying to tell us. We then feel stuck and lost around how to act, because we are out of touch, or in conflict with our emotions and our needs. The proposition I want to make here is something we are all capable of doing with the right support: bravely sit in uncomfortable emotions long enough to understand what they are trying to tell you that you need. This process is not only about getting needs met, but also about reconnecting with your human instincts and wisdom.

We live in a society that has constructed the idea of “good” emotions and “bad” emotions. We constantly want to feel the “good”- happiness, confidence, love, strength… and avoid the “bad”- sadness, fear, uncertainty, pain etc. While there is nothing wrong with wanting comfort, like a crying baby seeking relief, problems begin when we reject negative emotions from our lived experience all-together. There is a big difference between a baby being scared and crying out for help, and a baby convincing itself that it is not scared. The latter sounds quite silly, and yet adults do this all the time. “I don’t get scared” or “I’m not sad, that’s weak” when in reality, so many of us have become so frightened of having “bad” feelings that we begin to completely reject them from our conscious awareness. However, when we lose touch with scary or painful emotions, or stuff them down in dark corners of our bodies where we cannot access them, we disown valid parts of ourselves that are in fact natural and healthy. This can cause a number of compounding issues both internally and relationally that can be far worse than acknowledging the negative emotion to begin with.

Why do we do this?

Not only does society project the idea that we “should” always be happy, but the fear of experiencing “negative” emotion could have also developed for very valid reasons. For example, for self-protection in childhood, or during key events in adulthood that taught you that having/expressing certain emotions was not safe. Even when we can intellectually admit that something was scary or sad, letting yourself actually feel “bad” emotions can feel extremely threatening and vulnerable. So threatening in fact, that the body can respond in flight or fight: move away from it and distract, or become angry and defensive. Letting yourself risk accessing those dark corners can be terrifying, but what if you were to resist the impulse to move away from emotional discomfort? What would that look like? Could you sit in a negative emotion like fear or sadness? What do you think might happen? Having a supportive other there to ask these questions or to be with us as we ask ourselves these questions can make all the difference to help us turn toward, rather than away from, our hurts and challenges.

Although it may sound like a big request to you or your clients to sit in the muck of discomfort for a little while, when the rational mind typically wants to run in the other direction, it is important to remind ourselves and our clients of the value of it: when we let ourselves fully feel an emotion, it tends to lose its charge after a short while. It’s a paradox – and thus can take clients some time to trust.  However, when we know and trust that resisting feeling the emotion is part of what makes it get stronger, and feel worse, we can start to find the courage and seek the right support to allow us to go there. When we let our emotions have a little airtime, even though it may feel “bad,” we may be surprised at how much strength can come with being able to access our vulnerability, our humanity. The baby allows itself to feel whatever it feels, without judgment or resistance, and it is its most effective survival strategy. Trust that you can do the same.

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Naomi Adams, MCP, RCC is an RCC, working at Honey + Garlic Health Studio on Fraser St and 16^th Ave. She sees couples and individuals, and is skilled in and passionate about Emotions Focused Therapy. She helps clients move through painful emotions by staying present and empathic with them, validating their courage to come into contact with their suffering long enough to access their drive for wellness. This enables clients to have a corrective experience. “You don’t have to be sick to get better” and “the only way out is through” are two quotes that speak her values and therapeutic approach. Learn more about Naomi and book appointments directly here:

Book appointments

www.honeyandgarlic.ca

 

Interested in being a guest blogger? Email your suggestions and feedback to: [email protected]

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These Troubling Times: Self-Disclosure in Clinical Practice

by Lisa Mortimore, PhD, RCC and Stacy Jensen, M. Ed., RCC

 

In the changing landscape of our global world, some authors (see Gibson, 2013; Tosone et al., 2011) have suggested that shared traumas or shared traumatic reality may continue to shift the edges of what is considered appropriate in terms of self-disclosure in the therapeutic relationship. We would go beyond appropriate and suggest therapeutic – when clients bring their shock, anguish and despair at the world gone wrong to the clinical space, an authentic yet regulated response is at times being asked for and needed.

Over the past several years an upsurge of news events have made their way into our practices – not in a passing way but with a need to be met, witnessed and processed. Over the past year or so therapeutic conversations about: the rampant rape culture in our nation and across borders; mass shootings; the death of icons; and of course the fear and threat felt with the election of Donald Trump in the USA have been potent. The common thread of these events is that they are part of our social reality and have shaken the bedrock of our security.

Karen Maroda’s (2009) wisdom that the “therapist’s expression of emotion toward the client served to complete the cycle of affective communication that was insufficiently developed in childhood. In expressing emotion at the appropriate times, the therapist provides an emotional reeducation and remediates a developmental void” (p. 20). Client led co-grieving in the session can be an extension of that re-education, and perhaps more significantly, a source of much needed human connection and comfort in times of heightened societal insecurity, social isolation and social dislocation (researchers indicate that social isolation is a leading issue for people in Greater Vancouver, The Vancouver Foundation, 2012).

As therapists, the question becomes how do we meet people in their shock, fear, and anguish while we are swimming in similar waters?

We’re suggesting that when clients bring forth their anguish or horror at what has happened, what is happening, or what they fear will happen in our world, that the required therapeutic response may go beyond holding space, witnessing and processing and move into a moment of shared grief and conscious disclosure of our authentic response. We know that right brain to right brain communication between client and therapist reveal our genuine response and our felt sense, words and actions need to be congruent otherwise confusion ensues: if incongruent, our “posture, facial expressions, gestures, and voice level convey reactions dissonant with their verbal communication” (Greene, 2005, p. 197).

For Lisa, the Orlando nightclub shooting brought a moment of client disclosure which aroused her own deep sadness – they sat for many moments, both with water on their faces and deeply connected, and Lisa regulated (meaning present, attuned, embodied and internally organised) which in this way was an antidote to the senseless violence and disconnection of this crime. This illustration of self-disclosure was non-verbal but potent: self-disclosure “can provide a deepened sense of connection between patient and therapist….increasing the transformational power of positive affect for self-regulation and reconfiguring of the internal world” (Quillman, 2012, p. 2).

The election of Donald Trump has brought similar energies and calls into our practices. We have both offered genuine responses to his words and actions, alleged or otherwise, both verbally and nonverbally, depending on the therapeutic value in the moment. Again we heed the words of Maroda (2010), “The overriding principle that guides my choice of interventions is emotional honesty” (p. 3-4). Responding in this way is complicated and not without hazard, and needs to be timely, specific, developmentally appropriate and used with restraint, reflection and meta processing. Further, we need to be cognisant that our unresolved or partially processed material is being consciously invited into the therapeutic relationship (as opposed to our unconscious material entering in through enactments).

A further question remains, how do we stay regulated and offer an authentic connection while maintaining our role as ‘regulated anchor’?

As somatic therapists and educators we think a lot about embodiment and regulation of the autonomic nervous system (ANS) and how our reliance on a regulated nervous system allows for travel into unknown terrain with others while remaining in the here and now so that they can touch into the terror of what was previously unbearable – in this way, we provide the anchor to the present where healing can occur. Staying embodied and regulated is easy to suggest but the road to a deeply regulated ANS can be a long and arduous one as dysregulated traumatic material from early relational experience and challenges throughout the lifespan needs to be processed and reorganised internally – neurobiologically.

The capacity to regulate these shared traumatic realities requires therapists to have regulated autonomic nervous systems and strong social connections to keep their ventral vagal systems deeply engaged and be connected to a world beyond themselves including: the web of life, the sentient world, spiritual or faith based understandings and practices, and nature to suggest a few. It is through these connections that therapists can feel steadied and supported and can reliably access the regulating influence beyond the world of social turmoil we face. As therapists, this expanded orientation offers added stability in the often rough seas of dysregulated affective material inherent in the therapeutic process and living in these troubled times.

 

REFERENCES

Gibson, M. F. (2012). Opening up: Therapist self-disclosure in theory, research, and practice. Clinical Social Work Journal, 40 (3), p. 287 – 296.

Greene, A. (2005). Listening to the body for the sake of the soul. Spring 72, p. 189 – 204.

Maroda, K. J. (2010). Psychodynamic techniques: Working with emotion in the therapeutic relationship. New York: Guildford Press.

Maroda, K. (2009). Less is more: An argument for the judicious use of self-disclosure. In Bloomgarden, A. and Mennuti, R. B., (Eds.) Psychotherapist Revealed: Therapists Speak About Self-Disclosure in Psychotherapy. New York: Routledge, p. 17 – 30.

Quillman, T. (2012). Neuroscience and therapist self-disclosure: Deepening right brain to right brain communication between therapist and patient. Clinical Social Work Journal. 40, p. 1 – 9.

Tosone, C., McTight, J. P., Bauwens, J. & Naturale, A. (2011). Shared traumatic stress and the long-term impact of 9/11 on Manhattan clinicians. Journal of Traumatic Stress, 24(5). p. 546 – 552.

Vancouver Foundation. (2012). Connections and engagement: A survey of metro Vancouver. Retrieved http://vancouverfoundation.ca/documents/VanFdn-SurveyResults-Report.pdf March 17, 2013.

 

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Lisa Mortimore, PhD is a psychotherapist and educator on Coast Salish land in Victoria, BC. In her Bringing the Body into Practice trainings and workshops, Lisa weaves somatic psychotherapy, embodied relational and attachment oriented practice, and connection to the sentient, archetypal world. www.lisamortimore.com

Stacy Adam Jensen, M.Ed. works from an affect regulation, somatic and attachment orientation in his clinical and teaching practice. He lives, works and plays on Coast Salish land in Victoria, BC. www.stacyadamjensen.com