Chapter 10 Psychological Interventions in forensic
settings
1. Introduction
Many individuals in the criminal justice system face serious mental health
issues that impact their trial competency and responsibility. Prison staff often
lack understanding of these needs, leading to a focus on punishment instead
of rehabilitation. With about 25% of inmates diagnosed with mental health
conditions and many having experienced trauma, jails and prisons have
effectively become inadequate mental health facilities. Early intervention
and community-based treatment are crucial to prevent the criminalization of
mental illness and reduce recidivism. Additionally, police and emergency
responders struggle to identify and assist those with mental health problems,
highlighting the urgent need for reform in the system to provide appropriate
care rather than punishment.
2. Identifying mental disabilities in inmates
Over the past 20 years, the number of inmates with serious mental
health issues has significantly increased, now estimated to be between
16% and 24%.
More women and marginalized individuals, including those who are
poor and people of color, are being arrested and incarcerated.
The U.S. government Is funding programs to help meet the needs of
mentally ill inmates.
Contributing factors to this rise include tougher crime laws, stricter
insanity defense rules, and a reduction in mental hospitals, leading jails
to become “the new asylums.”
Many inmates struggle with substance abuse, but only about one-third
of correctional facilities offer drug treatment programs.
A significant number of inmates suffer from untreated PTSD symptoms,
indicating a strong need for better mental health services.
Legal protections for inmate treatment are complicated; proving that
prison officials were neglectful is very difficult.
Isolation as punishment can worsen mental health issues, yet it
remains a common practice in prisons.
Advocacy groups are working for improvements in conditions and
treatment for inmates, but many lawsuits result in only minor changes.
Overall, there is an urgent need for reform in how the criminal justice
system addresses mental health issues.
3. Training police and first responders
First responders include police, EMTs, firefighters, and trained volunteers who
are the first to help in emergencies. They are trained to notice signs of
mental health issues and respond in ways that keep the situation calm. This
training helps them connect people to health services instead of sending
them to jail.
In the past, officers without training might accidentally trigger a violent
reaction from a person with mental illness, causing arrests that could have
been avoided. Programs like Mental Health First Aid teach responders how to
spot signs of mental health crises and give basic support.
Communities benefit when responders work together to check if a person is
safe and what help they need before deciding on the best place for them to
go. In some areas, police can use technology to see mental health records,
which helps avoid unnecessary arrests, though this raises some concerns
about privacy.
4. Crisis intervention program
Police and first responders are now being trained to help people who have
gone through serious traumatic events, like violent crimes or natural
disasters. These events can lead to psychological crises, affecting not just
direct victims but also witnesses.
Effective crisis workers share certain qualities, including:
Successfully managing their own life challenges.
Skills in listening, problem-solving, and providing support.
Stability and calmness in stressful situations.
Creativity and flexibility in their approach.
High energy and quick thinking.
Ability to connect with diverse cultural groups.
These traits help responders effectively assist those in crisis.
5. Critical Incident Stress Management (CISM)
is a method used by police and first responders to help people affected by
traumatic events, whether it’s a single incident or a large-scale disaster.
Key points include:
CISM Approach: It involves step-by-step support for victims, encouraging
them to express their feelings. Responders are trained in listening and
providing comfort, like offering a blanket or a warm drink.
Importance of Comfort: During crises like the 9/11 attacks, responders found
that sharing food and drinks often helped more than talking immediately, as
people needed time to process their shock.
Stages of Crisis Resolution:
Identify grief responses.
Assess barriers to life goals.
Recognize and correct distorted thoughts.
Help resolve the crisis.
Check for lingering effects after the crisis.
Six-Step Crisis Model:
Define the problem.
Ensure safety.
Provide support.
Explore alternatives.
Make plans.
Secure commitment.
CISM aims to lessen the psychological impact of critical incidents and
promote recovery through structured support and intervention.
6. Debriefing
is a key part of Critical Incident Stress Management (CISM) that helps first
responders avoid emotional harm after experiencing traumatic events.
Key points include:
Purpose of Debriefing: It allows responders to share their feelings and
experiences, helping them process what they’ve witnessed and preventing
them from developing similar symptoms as the victims.
Group Support: First responders are encouraged to talk with each other
about their experiences, which helps them manage stress and recover.
Goals: The main goals are to stabilize emotions, restore a sense of control,
and build support networks among responders.
Debriefing Process: The debriefing follows a structured approach with several
core elements:
Preparation before crises.
Procedures for managing large-scale incidents.
Immediate counseling for individuals.
Short group discussions for sharing feelings.
Longer discussions, known as Critical Incident Stress Debriefing (CISD), to
prevent further emotional harm.
Family support when needed.
Follow-up care for long-term issues.
7. Hostage negotiation
involves trained police officers working with psychologists and other
responders to handle crises where lives are at stake. Unlike typical law
enforcement strategies that emphasize quick action, negotiation focuses
on using words to calm the situation.Key techniques used in hostage
negotiation include:
Active Listening: This involves techniques such as emotional
labeling, paraphrasing, and reflective mirroring to show understanding
and keep the conversation going.
Effective Pauses: Using silence strategically can help defuse
emotions and encourage the subject to talk.
Open-Ended Questions: These questions invite more detailed
responses, allowing the negotiator to gather information and build
rapport.
The goal is to shift the subject from an emotional state to a rational one,
fostering trust and encouraging peaceful resolution. The FBI offers extensive
training for negotiators, emphasizing these skills as essential for successful
outcomes in crisis situations.
8. Diversion from Jail After Arrest
When individuals with mental illnesses are arrested, many communities work
to divert them from jail as quickly as possible. This can involve training jail
staff to screen for mental health issues upon entry. Some areas have local
mental health centers review arrest lists before court appearances, allowing
for diversion into specialty courts like mental health or drug courts. For
example, in Broward County, psychology interns screen arrested individuals
for mental illness and can recommend diversion to the magistrate. If a
person refuses treatment, they remain in jail and go through regular legal
processes. If they are diverted, they may receive medication or be
transferred to a psychiatric unit for stabilization.
9. Intervention in Jails and Prisons
There has been a significant rise in inmates with serious mental disorders,
necessitating various treatment methods in jails and prisons. These include
medication, crisis intervention, anger management, and specialized
programs for women. Most programs occur in mental health units and can
last from six weeks to ongoing sessions. While medication is often available,
individual therapy is rare due to high turnover in jails. Prisons offer more
stability but often lack sufficient funding and resources for mental health
professionals. Inmates sometimes form self-help groups or participate in
voluntary programs like religious or educational classes to support their
rehabilitation while incarcerated.
10. Medication
In jails and prisons, medication is the most common treatment for serious
mental health issues like hallucinations and extreme agitation. A major
challenge is training correctional staff to recognize mental illness symptoms
without resorting to force, as violence can worsen situations.
Key Points:
Medication Use: Both traditional and newer antipsychotic medications are
used to help manage symptoms. Newer medications like Risperdal and
Abilify have fewer side effects but are expensive. Older medications may be
combined with these for better results.
Bipolar Disorder Treatment: People with bipolar disorder may need mood
stabilizers and antidepressants, like Prozac or Zoloft, which are more
affordable in generic forms.
Legal Rights: Inmates have the right to refuse medication, but a Supreme
Court case (Harper v. Washington) established that if treatment is in the
inmate’s best interest due to a genuine mental disorder, medication can be
given against their wishes. This ruling emphasizes the need for procedural
safeguards.
Challenges in Treatment: Many inmates refuse medication due to concerns
about side effects. Correctional facilities must balance inmates’ rights with
the need for treatment, especially since many inmates have serious mental
health issues that require ongoing care.
11. Crisis intervention program
are crucial in prisons due to the high risk of self-harm and violence among
inmates. Here are the main points:
Suicide Rates: Suicide is the third leading cause of death in prisons, with
rates significantly higher than in the general population. Most suicides occur
within the first month of incarceration, often through hanging or self-harm.
Prevention Efforts: Trained professionals should identify at-risk inmates
during arrest or classification. Close monitoring, special housing, and
effective communication between correctional and mental health staff are
essential.
Implementation Challenges: These procedures are often not followed,
especially in private prisons where medical care may be inadequate. Long
wait times for psychiatric treatment can result in inmates being quickly
returned to general population without proper care.
High-Profile Cases: Incidents like Jeffrey Epstein’s death highlight the need
for better mental health support and monitoring for inmates. Signs of
distress often go unnoticed unless drastic actions are taken.
Environmental Concerns: Modern detention facilities may have advanced
technology but often lack personal attention, increasing anxiety for mentally
ill inmates and leading to suicide attempts.
12. Special Programs for Abuse Survivors
Many inmates, especially women, have histories of abuse and trauma. To
address this, trauma-specific treatment programs like the “Survivor Therapy
Empowerment” (STEP) program have been developed. These programs focus
on healing from trauma and its effects on mental health. While some shelters
provide such programs, they are often lacking in correctional facilities.
The STEP program consists of 12 units that include:
Identifying and discussing the abuse.
Teaching relaxation techniques to reduce anxiety.
Raising awareness of negative thoughts that hinder healing.
Building assertiveness and reducing compliance with abusers.
Understanding personal cycles of abuse.
Reducing PTSD symptoms and triggers.
Eliminating harmful coping methods like substance use.
Reflecting on childhood experiences and parenting.
Improving emotional control and mindfulness.
Learning about legal rights for abuse survivors.
Letting go of unhealthy relationships and building new ones.
Developing resilience for future well-being.
13. Special Programs for Women Prisoners
Jean Harris, a notable inmate, highlighted the lack of consistent programs for
women in prisons, noting that many incarcerated women are pregnant and
often separated from their babies shortly after birth. Most women are single
mothers, making it difficult to maintain connections with their children while
in prison.
Conditions vary by state, with better programs available where staff are
trained in psychology. However, funding for mental health support is often
limited due to concerns about appearing lenient on crime.
Women in prison frequently experience PTSD from past abuse, which can be
triggered by their environment. They need supportive programs to help them
rebuild social skills and self-esteem, which are often lacking due to their
traumatic backgrounds.
14. Sex Offender Relapse Prevention Programs
Programs for convicted sex offenders in correctional facilities often use a
“relapse prevention model.” These programs typically involve group sessions
where inmates complete homework to help them recognize and avoid
situations that could lead to re-offending. The key steps in this model
include:
Abstinence: Committing to not think about or plan any offenses.
Seemingly Unimportant Decisions (SUDs): Identifying everyday choices that
could lead to risky situations.
Dangerous Situations: Recognizing environments where they might re-
offend.
Lapse: Identifying behaviors or thoughts that bring them close to offending.
Giving Up: Realizing that they believe they have failed, leading them to
commit an offense.
Offense: Actually committing the crime.
Inmates learn cognitive exercises to change their behavior at each stage,
using both hypothetical scenarios and their own past actions.
15. Anger Management Programs
Anger management programs are also used in correctional settings. These
programs typically start with educating inmates about anger—its causes and
effects—and then focus on building skills to manage anger more effectively.
Key components include:
Understanding what triggers anger (e.g., stress, frustration).
Learning techniques to control anger, such as relaxation methods and
keeping anger logs.
Developing communication skills, including assertiveness training and
problem-solving through role-playing.
16. Other Treatment Approaches in Prisons
Cognitive Skills Development: Programs help inmates learn to solve problems
instead of acting impulsively. They identify issues early and create better
ways to handle them.
Dialectical Behavior Therapy (DBT): This therapy teaches inmates to balance
their emotions and improve their relationships. It includes:
Mindfulness: Balancing thoughts and feelings.
Interpersonal Skills: Respecting others and reducing entitlement.
Emotional Regulation: Understanding and managing emotions.
Distress Tolerance: Accepting that distress is a part of life.
Inmates use these skills to analyze their crimes and make plans to avoid re-
offending.
Therapeutic Communities: These supportive environments encourage
inmates to help each other daily, but they are now rare due to a focus on
punishment.
Crisis Mental Health Treatment: Some facilities offer short-term care for
inmates who become mentally ill, but these units are often overcrowded.
Psychopathy Research: Studies show that psychopathic individuals feel pain
differently, making regular punishment less effective. New treatments focus
on correcting their thinking patterns.
Public Health Models: These models suggest using prisons for education and
prevention of mental health issues, but funding for such programs is often
difficult to get.
17. Limitations to Traditional Treatment in Prisons
Prison treatment programs face several challenges. One major issue is
confidentiality. Therapists cannot promise inmates privacy because prison
staff can access their records. This raises concerns about what information
should be documented. For example, if an inmate has angry thoughts about
another person, writing it down could lead to punishment and damage the
therapeutic relationship.
Additionally, there is concern that punishment, like solitary confinement, can
worsen mental health issues for inmates. This is troubling because parole
boards often consider an inmate’s participation in treatment when deciding
on parole, which may discourage inmates from being open during therapy.
