Confessions Of A Prison Psychiatrist

By Juliet Smith 10 months ago

Prisoners often arrive with no medical history whatsoever

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Prison psychiatrist Dr. Sohom Das spoke of the many years he spent working as a Correctional Psychiatrist in multiple prisons. One of the hardships that psychiatrists faced inside prison was that they had limited or no medical records of the inmates they were seeing as patients, making it hard to make informed diagnoses and treatments.

Inmates often visit the psychiatrist with temporary psychosis

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Dr. Das spoke of how he came across many inmates that suffered from temporary psychosis in prison. One particular account he details is when a woman came to him convinced she was pregnant with the devil's child. She repeatedly threatened to obtain a knife and cut the baby from inside of her.

...and it's contraband drugs that do it to them!

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Dr. Das went on to describe that the above woman's account was heavily induced by some contraband drugs she managed to get her hands on while she was in prison. She'd begun smoking spice, which obviously changed her mental state. It can be hard for psychiatrists to make informed decisions about an inmate's well-being when there are dangerous drugs floating about the facility.

It's hard to keep track of a person's reaction to medicine

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Dr. Das describes how dozens of new inmates can arrive each week in a prison, and can disappear just as quickly, whether through release or transfer to another facility. This can make it extremely hard for a psychiatrist to monitor a patient's reaction to medicine they have been prescribed with.

Prisoners are known to fake their symptoms

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Given the history of mental illness that many of the prisoners have, it comes as no surprise that some of them might go to some extent to fake their symptoms to be taken to the prison psychiatrist. There are a number of reasons they might do this, and one is the safety they feel when being looked after by a medical professional.

The waiting lists to see the psychiatrist are long

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Dr. Das discusses how even in prisons there are a lack of spaces for people in the psychiatry ward and that the waiting lists can be really long. It comes as no surprise considering the state of healthcare in the USA, considering that the waiting lists are just as long outside of prison.

Psychiatry doesn't pay that well in prisons

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Probably unsurprisingly, a prison psychiatrist doesn't get paid a decent salary. According to Comparably, the average Prison Psychiatrist in the USA will take home about $45,310, with the highest-paid psychiatrists being based in San Francisco at a salary of $67,988.

Some patients get moved to high-security hospice areas

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Dr. Das described how there are a shortage of beds in psychiatric units of prisons. Many of the most severely mentally ill inmates are transferred to high-security specialist units where they have seclusion rooms, airlock units, adapted furniture and increased staff.

...and it's super expensive to keep them there!

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To keep an inmate in one of these specialist units where they, and their other inmates, will be safer, the cost is quite high. In the UK, it costs around £200,000 per patient per year, and this is at one of the Medium Secure Units, so not a Maximum Security Prison.

Being stalked by an inmate isn't impossible

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According to the article "The Journal of Family Practice" published in March 2002, prison psychiatrists can become victims of stalking more often than they think. It's possible to deduce this to the level of trust between an inmate and a working professional.

Psychiatrists can't monitor prisoners daily like hospitals can

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Along with no background information on a patient, a prison psychiatrist faces the challenge of not being able to monitor their patients daily, or even weekly. Instead, they are monitored by prison officers, who are usually not trained to the adequate level to deal with inmates suffering with mental illness.

The job is considered much harder than working in the usual psychiatric hospital

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Because of the challenges that prison psychiatrists face compared to hospital psychiatrists, it can be concluded that being a correctional psychiatrist is a harder job than the other. This is due to the lack of medical records, irregular appointments and increased likelihood of mental illness.

Mental illness is rife in prisons

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Psychiatrists around the world have spoken out about how mental illness is an epidemic in prisons, for a number of reasons. This can be down to how inmates struggle with remorse and guilt, they're spending many years of their life locked up there and torment from fellow prisoners and guards.

It can be hard to decide whether prisoners are exaggerating their symptoms or not

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Much like prisoners that fake their symptoms, some inmates can feel the need to exaggerate their symptoms to in order to end up taking the "easy route." This is what they believe a mental hospital is, but that's far from the truth, and the exaggeration can often make it complicated for medical professionals to make informed decisions.

Inmates are described as having multiple crises a day

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Harvard psychiatrist James Gilligan worked in and out of prisons throughout most of his life. He explains how prison psychiatry can be skewed more towards crisis intervention, as these inmates that are struggling can often have multiple crises a day.

Psychiatrists use common sense when meeting a violent offender

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Many people wonder how prison psychiatrists can feel safe around inmates that have committed violent and sickening acts in their past, but ultimately, it comes down to common sense. If a patient is notoriously violent, then there would be an increase in prison officers attending the appointment.

The risk of injury to self is much higher in prisons

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Due to the stigma that prisoners will never get better and always be defined by the crimes they committed in the past, it can increase the likelihood that they would hurt themselves or try to end their lives. It's a terrible circumstance that psychiatrists have to deal with.

Being mentally ill doesn't mean you'll be shipped to a hospital!

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There is a scale of mental illness, according to Dr. Das. If a patient is extremely mentally unwell, hearing voices, committing violent acts, etc., then the likelihood of them being transferred to a mental facility is much higher than that of an inmate who is experiencing mild depression.

Referrals to specialist teams don't come easy in prison

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According to Dr. Das, referrals in prisons can take ages, for a number of reasons. Not only are inmates put to the bottom of the pile, but also the referrals are often bounced back to the prison because they've been sent to the wrong department, dependent on place of birth, current residence, family doctor and place of arrest.

Student psychiatrists are terrified of correctional psychotherapy

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Dr. Gilligan describes how their was a subconscious stigma in the students at Harvard. While they would be happy to attend psychiatric facilities like Maclean Hospital, they absolutely feared any kind of prison mental health hospital and would actively avoid going their at any cost.

Psychiatrists have been known to be sued by inmates

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According to the 2011 "New England Journal of Medicine", while psychiatrists have decreased rates of reported lawsuits, there's still a 2.6% likelihood of a professional being sued on an annual basis. This can be due to a number of reasons such as medical negligence or wrongful diagnosis.

Violence against psychiatrists can happen

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Dr. Gilligan described how in his 25 years of the profession, he was violently attacked three times, one of them he was punched in the face. Luckily, there was no serious injury (e.g. broken nose or jaw) but he admits that there may well could have been.

...and psychiatrists can learn from the experience!

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Instead of taking his anger out on the inmates, Dr. Gilligan used these instances as criticism to learn about the patients at hand. He described how, upon reflection, his behavior could have been misinterpreted as distracted or impatient with the inmate.

Psychiatrists must overlook the heinous crimes of the past

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When asked about how Dr. Gilligan looks past the heinous crimes that the inmate has committed, he speaks about how just because he is there to treat the inmate doesn't mean that he accepts or respects the patient's crime. However, he does have a duty of care to the inmates.

The past crimes can make psychiatrists sick to their stomach

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Dr. Gilligan admits that he did once meet an inmate that had disturbingly killed a young girl and buried her in his basement. On this particular occasion, he felt sick to his stomach (a normal bodily response) but instead of focusing on the sick crimes, he approached it how he would approach dissecting a carcass.

It's a misconception that inmates are un-treatable

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Dr. Gilligan admits that he doesn't think any inmate is un-treatable, a stigma that is quite often circulated through the incarceration system in the US. He wouldn't give up on anybody, he says, and that he believed that everyone could be brought to a point where they stop being violent towards other people.

Not all the criminals show remorse for their actions

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While psychiatrists do often come across people that feel remorse for their actions, they don't always. Sometimes, those who don't feel remorse, look at themselves as the victim until they start to open up about what they did and face reality, questioning what they had done.

...and those showing remorse might be put on suicide prevention!

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While those who did show remorse were deemed less likely to commit the same act again, it could also put them in a position of vulnerability because suddenly they weren't able to comprehend the violent and repulsive crimes they may have committed, landing them on a suicide prevention list.

It's no lie that mental health services in prisons are underfunded

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Obviously, as we would've thought, mental health services are consistently underfunded in the US, especially access to these services in prisons. Many believe that inmates and prisoners don't deserve to be treated because of the crimes they've committed; but in reality, problems don't go away without being treated first. Everyone has a right to healthcare.

Ultimately, psychiatry is crucial in prisons

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In order to break the cycle of re-offending, psychiatry is one of the most important services in prisons. It can help inmates come to terms with the crimes they have committed, the reasons for these and also coping strategies for the future in case they are ever triggered again.

Confessions from a women's prison guard: it's nothing like Orange Is The New Black

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When most people think of a women's prison, they're going to base it on something they've seen in the media - and that's of course going to be Orange is the New Black for a lot of people! You might be shocked to learn a TV show isn't the most authentic, but nope, a women's prison job isn't anything as 'exciting' as the show would have you believe - and not much drama goes down.

In one prison there could be every crime imaginable

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Working as a women's prison guard can see you working in a prison that has every kind of inmate. Sometimes prisons only house certain prisoners in terms of crimes (like prisons only for the worst offenders) but some female prison guards are faced with inmates from all crimes off life, from petty crimes, shoplifting, minor crimes to extremely serious assault or murder.

There might not be enough staff to give personalized attention to the inmates

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We know there are always going to be more inmates than prison guards, of course, but the sheer outnumbering means that a lot of the time, female guards can feel helpless at not being able to give dedicated attention. One female guard might have over 200 prisoners all asking her things at once, or needing something from her. And sometimes that guard is the only one with the authority to answer or sort things - so it can be difficult!

It's tough to get staff because of violence - but in women's prisons, there's little violence

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One of the most difficult things about getting the staff at female prisons (and hiring female prison guards) is that a lot of women don't apply because they're worried about the reputation for violence in prisons - when actually, the reality is there is very little violence in women's prisons compared to male prisons. The gaps are filled with male prison officers applying and being hired in women's prisons instead.

Women inmates like to talk

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Sure, the fact that women like to talk might be an unfair - or maybe too close for comfort - cliché, but in women's prisons with just female inmates, it's definitely the case. Women like to talk more than anything else in these prisons (not that there's much else to do) and compared to male prisoners, who usually get more violent than they do talkative, women use their words more than physical violence.

Everyone gets annoyed at each other

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Of course, being more talkative than you are violent doesn't mean that a few choice words aren't used! Female inmates can talk amongst themselves, ask too many questions, annoy each other and even get annoyed at the female prison guards. When everyone is talking so much in such a restricted space, it's inevitable some people are going to be pointed out as the most annoying!

Inmates don't like to hear the word 'no'

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One thing female prison guards can struggle the most with is saying no to a female prisoner - but that inmate refusing to take no as an answer. This often results in back and forth arguments when the result isn't going to change, which can waste a lot of time and energy for a female prison guard. If they have to say no to something, it's for a reason, and the prisoner arguing isn't going to change that - but that's not often something they understand!

Female inmates versus male inmates

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One of the biggest differences between inmates in a female prison and a male prison, as we mentioned, is that the women like to talk while the men can be more violent. But this difference in conversation level also makes for a hugely different experience for the guard. A female guard working at a female prison is used to chit chat in the morning and small talk, and if they're then transferred to a male prison to work, it can be shocking how the men don't like to be told good morning or engage in any small talk at all.

They're happy to see prisoners get out on parole

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Sometimes there's an idea that prison guards don't get along with the prisoners, or are there just to do a job instead of seeing them as people - but for the most part, female prison guards are wholly supportive of their inmates, and love to see them get out on parole if they've been working hard to better themselves! Sometimes prison guards can be their biggest cheerleaders.

You need to be tough

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It goes without saying that to be a prison guard you have to have a certain personality, and while that's true of any gender prison guard, for females it can be more demanding if they're stationed in a male prison and subjected to wolf whistling for starters! According to the women who have been there and done that themselves, you need to be a strong person who isn't easily intimidated.

Being a prison guard is a great work-life balance for some people

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Being a prison guard can see some people working long hours, but it all depends on where you work and the job role you have. Some female prison guards have actually said their job has been one of the best for a work life balance, because they have had their prison employer happy to fit their working hours around their childcare needs in their personal life.

It's a stable job

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What most people are looking for these days in terms of employment is something they can depend on not only for a monthly pay check, for a future. Even those jobs these days that you think could be safe prove that anything can change. With a prison guard job, however, you know there are always going to be criminals and inmates behind bars, making it a secure position!

They can be responsible for female empowerment

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Being a female prison guard in a women's-only prison is a lot more than just acting as security and doing the rounds every day. You also have the power to make a positive difference on these women's life even for after they have left the prison and are finding their way in the outside world again. Female prison guards often feel responsible for the empowerment of their female charges.

Female guards might be in charge of other guards, too

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In a women's prison there's a hierarchy with the staff just like any other job, so if you're a female prison guard of a high management position, not only do you have to manage the day to day dealings of the inmates themselves, but also of the other guards working with you. This can mean a heavy workload and a lot of responsibility making sure everyone is where they should be.

If mistakes are made, the inmates let you know about it

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One thing the female prisoners don't like - and they'll be sure to tell you about that fact if you're a prison guard - is when mistakes are made for things they're entitled to, like their everyday meals. This means that even the smallest mistake in the kitchen can create a huge drama with the female inmates who like to get vocal about the issue, even if they know it was an honest mistake.

Female guards can see a lot of upsetting things

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There's no doubt that some inmates in certain prisons aren't evil people, and there can be a bond formed between a guard and certain prisoners who get along. That means it's very easy for guards to see some really upsetting things when they just want the best for their prisoners. This can include prisoners having dangerous thoughts or anything that makes a guard feel like they've failed in duty of care.

Male prisoners can treat female guards better than male guards

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Sure, there are bound to be the wolf whistlers and the men who say inappropriate things - which a female guard is trained to deal with - but for the most part, female guards have said that a lot of male prisoners can actually be more respectful to female guards than they are with male prison guards. If a female guard is working in a male prison instead of female, this can often be the case.

Some prisoners stay in touch

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With those success stories of female prison guards helping prisoners to rehabilitate and get back out successfully into society also comes the gratitude from the prisoners themselves. You might think once they've served their time they don't want to think about the guards they were in there with, but a lot of the time, prisoners will keep in touch with the guards and write them thank you letters.

Some guards help set up educational courses

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A lot of female prison guards also like to do what they can to help get the prisoners back on track, get them some qualifications and keep them busy. Some guards might set up courses within the prison that the inmates can study with and gain relevant qualifications that will still be applicable in the outside world once they're out on parole or have served their time.

It's important to have empathy

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One of the key things you'll need as a female prison card is that toughness and strength, and the ability to not be intimidated, but that doesn't mean you should be as cold as ice! While it's important to have strength, it's also important to be able to empathise with the prisoners under your care, so you can better understand them and work with them during the job.