Posts Tagged ‘Mental Health’

Capt. Shawn Welch sprays OC spray into the face of Paul Schlosser who is bound in a restraint chair after the inmate, who has an infectious disease, spit at an officer.  June 10, 2012.

This disturbing photo is from an excellent article on Solitary Watch about the inhumane and brutal treatment of mentally ill people in US prisons. In my ten years teaching minors locked up in a New York adult county prison, I witnessed inmates who were  clearly disturbed and dealing with mental health issues being pepper sprayed and tased by emergency response teams (ERTs) dressed in intimidating riot gear as a way to “calm them down.”

Our prisons are overcrowded with mentally ill people who get little to no treatment, handled by people not trained in these issues, all because Americans refuse to confront the needs of the poor and disenfranchised and to provide the funds necessary for proper community mental health services. Instead we, through our lawmakers, spend billions of dollars on war in its many forms.

 

 

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Many people who work with youth locked up in prisons or in juvenile detention centers aren’t just teachers, nurses, social workers. Something else compels them to stay at a job in what can be some of the most unwelcoming places you can imagine—and are designed to be that way. Something else stirs them, inspires them to put up with harsh working conditions, and with the frustration of having their efforts often garner only poor results. As challenging as the job is, even more challenging is finding answers to the Big Questions: “Why do I do this kind of work?” “Why do I stay here?” “What’s the point of what I do?” Answers don’t come easily, if they come at all, and their comfort rarely stays around long, but it’s a process many of us in the field go through.
What I appreciate about today’s guest contributor is her willingness to share the struggle, the process she has gone through to answer some of those questions with honesty and humility. Shannah is a Family Nurse Practitioner “in one of New England’s highest security long-term juvenile treatment facilities.” Even that short description from her piece gives you pause when you read it. Yet she conveys so well her commitment to these young boys whose lives seem bleak and hopeless. At the same time she doesn’t hesitate to talk about her frustrations, confusion and fears as she searches for meaning in what she does. Her compassion and her understanding of what’s ultimately important in these kids’ lives—and in the end, in all our lives—is deeply moving.

Helping Young Offenders Find Hope in the Everyday

We think our darkness is our rap sheet, but it’s not true. Our darkness is that we don’t see the truth of who we are, we don’t see ourselves as God does…The darkness is we don’t see that we are exactly right…The people who walk through darkness have seen great light. It’s not about moving from the dark terrible past to the light, it’s about recognizing that the light has been there all along. It’s right here. We just have to see it.”
              Father Greg Boyle, Author of “Tattoos on the Heart and Founder and Director of Homeboy Industries”

“The darkness is that we don’t see that we are exactly right.” I think about this a lot in my 4th year as a Family Nurse Practitioner in one of New England’s highest security long-term juvenile treatment facilities. Here, we are not lacking for rap sheets. My patients are 15-20 year old young men who, via a series of unfortunate events and/or choices, are serving long term treatment sentences for crimes that range from carjacking and firearm possession to armed robbery and attempted murder. The facility itself is a 57-year-old concrete building sandwiched between a funeral home and an adult Department of Corrections building. As if to finalize the irony, two cemeteries flank the facility’s front and back. It’s secured with barbed wires, surveillance cameras, obscenely large locks, and an acute sense of vigilance around all things “policy.”

On high-alert, I spent the first month debating whether or not to wear my hairpins with the sharp ends to work, and settled on a ponytail. I worried about unwittingly supplying an underground tattoo ring with my misplaced pens, and I had more than one nightmare in which I “forgot to lock the door” and someone escaped. While it didn’t take long to learn to follow the rules of the building, it’s only in the last three years that I’ve found clarity about the role I play at the center and in the lives of the boys.

My professional job description is straight-forward: “Unit manager and primary healthcare provider responsible for managing all aspects of acute, chronic, and routine healthcare for young men in custody.” But if the description were all-inclusive, it would also say, “Nurse, den-mother, phlebotomist, secretary, boo-boo kisser, nutritionist, custodian, pep squad.” With an average of 15-20 residents at a time, and not a mother in sight, no concern is too small for placement on the daily sick list.

Outsiders are often horrified when I tell them where I work, and there are times I struggle to convey my feelings about the residents and the circumstances that bring us together. How can I capture the complexities of the human spirit or the chronic adversities these boys have endured? How do I relay the feeling in my stomach upon entering the unit after a particularly violent incident, and hearing that abnormal silence beyond the static of the security radio? The boys’ time in custody –weeks, months, and years—is intensely emotional and challenging, and we bear witness together daily. It takes a toll.

At times I’ve felt defeated and heartbroken by obstacles that feel insurmountable: kids picking on each other or becoming obese before my eyes; young men feeling frightened, homesick, or abandoned. Some have lots of visitors; others don’t invite anyone to visit because the pain of family not showing up is far more destructive than being alone.

I wonder what it’s like for them, living out these painfully self-conscious adolescent years being raised by guards, in-between timed phone calls and 30 minute visits with family. Will they ever forget the weight of chains and shackles, the sounds of a physical restraint, or the oppressive atmosphere during a lockdown?

When I was new at this job, I sought out details of their home lives, their charges, their gang involvement, as a way of understanding what they’d been through. I cared deeply about the boys and thought that by understanding their pasts, I’d be able to change something about their futures. Under the weighty ambition of “saving” my patients, I felt constrained by the minutiae of the job itself. Documenting clinic visits and handling administrative duties felt at odds with my desire to make a “real” difference.

Over time, as I watched the majority of boys leave the facility only to return days-to-months later (or worse, landing in adult jail), I became resigned that my impact on their worlds would be minimal. More to the point, I felt like I was failing my patients. Over and over again I asked, “How can we stand by and watch as generation after generation of our babies, our children, our young men steadily march their way to a place where few return unscathed – if they return at all?”

To combat this despair, I created a file on my phone called “Moments,” meant to capture the sweet or poignant interactions with the boys:

Discovering that AH likes to draw, asking to see the pictures he’s drawn and carefully laminated to put on his wall…watching him show off his work and reference a stack of animal books he likes to draw from.

The sheepish smile on SL’s face when he called me upstairs “to see his healing finger” but then shared the REAL reason he called for me…busting at the seams, he shares that he’s gotten into school and “passed” his job interview. So shy and so proud.

DJ during testing—“I know my Mom loves me but she doesn’t show it. I need her to show it. Doesn’t call for three days if I don’t call. Probation officer and court think I am a bad kid – I don’t care what people think.”*He says he likes it here b/c he gets fed and gets to chill and joke around. Going to live with foster family if possible. Likes to fight. Holds anger inside.

JP—the collision of fear, betrayal, anger, pain, embarrassment, adrenalin, pride, sadness, bewilderment, when he was beaten by three other residents. Face swollen and deformed, pacing, hating every tear that falls, vacant eyes.

And moments I struggled to put into words:

KJ—the smile on his face and the twinkle in those deep eyes as he left the building today (after 12+ months). What are you going to do when you get out? “Gonna have a mother’s day. Spend some quality time with my Moms.” Bittersweet—wanting to cry both for all the awesome potential and my own deep concern for his safety. Saying good-by. How proud I am of him. How badly I want him to know his worth. Don’t know how to communicate this to him.

Collecting these moments has kept me in the present over and over again, as well as helped me realize two important truths that I’d failed to see earlier.

First, as their Nurse Practitioner, I’m granted the privilege and responsibility of partnering with my boys in caring for their health, physical well-being, and hearts. I had spent so much time lamenting what I couldn’t change for them that I had missed the tremendous progress we were already making together on these issues. By turning my attention towards a “better” tomorrow, I wasn’t present to the moments already woven into the rich and complex fabric of daily life at the facility—a youth detention center, yes, but for some, the safest, most consistent “home” they’ve known. As I began to change my thinking from “not enough” to the “time is now,” I saw that the most powerful way to make the difference I am committed to making with these boys is to show up and be present, day after day, moment after moment—and I do.

I also saw that my desire to rewrite the past—in an attempt to orient our youth towards a different future—was well-meaning, but it missed the mark. While I still ask the questions—“How do we move forward, and what’s going to make THE difference?”— I now look for the answers in a different place. The answers don’t exist in their past, their stories about themselves, their home lives, or their rap sheets, but in who they are, right here and right now—beautiful, resilient, wise, courageous young men.

As a healthcare provider, I have the opportunity to create a space for my patients in which they get to show up larger than they ever thought they could be. These kids light up my world on a daily basis, and I feel that the least I can do is offer them a place to “arrive,” a place that we create together, moment by moment, where they get to show up as perfect—exactly as they are and as they are not—and so recognize their own light, the one that’s blazing brightly, “the one that’s been there all along.”

 

I recently wrote about the “cruel and unusual” punishment of putting young offenders in solitary confinement, forcing them to live in an environment of complete isolation in some cases for months at a time. The reasons for their isolation are myriad: to maintain what corrections calls “safety and security;” to separate the mentally ill  especially if they appear to be disruptive to general population; to “teach them a lesson” (adolescents especially in prison can be oppositional and rebellious); to separate “troublemakers” who  raise issues that perhaps challenge the prison culture.  Whatever the reason, the effects are negative and far-reaching.

Solitary Watch a wonderful and tenacious watchdog of the murky world of solitary confinement, recently posted an article that shows the devastating damage that solitary isolation has on young minds. What consistently comes to my mind is that the damage we do to the young will only come back to hurt society since a damaged young offender will inevitably grow up to be an even more damaged and potentially dangerous adult.

I urge you to check out the article.

In March 2007, the nonprofit Disability Law Center sued the state of Massachusetts over its treatment of hundreds of mentally ill inmates. Prisoners with emotional problems who are unruly in some way are kept in 23 hour solitary confinement, which, according to a November 10 Boston Globe article, has “led to self-mutilations, swallowing of razor blades, and numerous suicides.”

In response to these grave concerns the Patrick administration, in an out-of-court negotiation, proposed building special treatment units for mentally disturbed inmates. Now, that proposal is off the table; citing the budget crisis, those units will not be built. So it’s back to court in an effort to force the state to give its incarcerated citizens their constitutional protection against “cruel and unusual punishment.”

Massachusetts isn’t alone in facing the problem of caring for mentally ill inmates. Every state has had to confront this growing trend which started in the 1960s and accelerated in the 1980s, when the system of large state psychiatric hospitals was shut down even though, as Oliver Sacks states in his bittersweet eulogy to these former mental hospitals (“The Lost Virtues of the AsylumNew York Review of Books, 9-24-2009), it was obvious that these closings created “as many problems as they solved.” Communities weren’t prepared, and still aren’t prepared, to absorb and meet the needs of what he calls “sidewalk psychotics.”

With these closings, along with the current “tough on crime” policies, it shouldn’t surprise anyone, then, that these same people– alone, unsupported, often self-medicated with drugs and alcohol– increasingly end up behind bars, despite the fact that jails aren’t set up to help people deal with emotional problems, problems that confuse their judgments and impel them to destructive actions

No doubt these are hard choices in hard economic times for any state. Yet, once again, as municipalities struggle to come up with innovative ways to deal with the money crunch, the one formula that never gets recalibrated is that the people with the greatest need and the least resources take the biggest hit.

Being locked up is hard enough. Being “crazy” in an already crazy system is the worst. In jail you get “props” from the other inmates for being a “badass” but not for being disturbed. They have names for you– 730, forensic, Gucci gown (at least in the county penitentiary where I taught; if you’re put on the forensic unit, you spend your days in a paper gown that the inmates have branded “Gucci”); along with bugged, psycho, mental.

Attitudes aren’t much better among most of the correctional staff. They treat you as though your mental illness is a part of your crime. You might have had a choice not to carry that gun, or get into that stolen car. But you don’t have a choice about your mood swings, or the voices you hear, or your paranoia, conditions that, when you have your medication, are usually under control. It doesn’t help that when you get locked up those medications stop. The medical information might be taken when you’re booked, but too often it gets “lost.”

I worked with a seventeen-year-old boy in my jail classroom who found himself in that situation. Lamont was a friendly, polite, quiet student. He sat in the back of the room, away from everybody else. He had pretty good judgment, in my opinion: he was eager to learn and wasn’t interested in hanging out with the knuckleheads. But, as the weeks went by, I noticed that he sat further and further back in the room, his back to the door and the rest of the group. The darker the corner he sought out, the darker the expression on his face became. I knew something wasn’t right.

Most days Lamont stayed behind after class. I got the feeling that he didn’t want to give up the safety and security of the classroom for the chaos of the block. He always had a question or a comment about what we had done that day. He never talked about himself, his charge, or what kind of time he was looking at. He had that hooded look that I remembered so well from my years working in a psych hospital– as though he was a denizen of two worlds. Yet he stuck around. He clearly needed to talk. Since I knew education was important to him, I suggested he meet with our school social worker and discuss what he’d like to do with his life– anything to get him into her office.

That afternoon Kay, the social worker, thanked me for recommending Lamont to her. Then she told me a story I’d heard a number of times during my ten years in jail.

Lamont was bipolar. Usually it was well controlled with medication. But since he had been sent to the county lockup he hadn’t gotten them. He had requested them, but got nowhere. His mother had done the same, and got nowhere.

Kay didn’t have to say what I knew already. All kinds of treatments don’t get done, are delayed, or forgotten. “You didn’t do the paperwork right.” “You’re on the list.” Or “The doctor’s only here every other Tuesday.” All tactics to save money. (At least, I’ve always hoped that that was the reason and not the more disturbing one: pure neglect because someone just didn’t give a damn about the people in their charge.)

“It’s amazing that Lamont talked to me. He’s real paranoid by now,” Kay said. “But he can feel himself getting crazier and crazier everyday without his meds, and he’s terrified of what he’ll do. I’m going to see about getting them for him.”

Luckily Lamont was in touch with reality enough to know that he was slipping; and luckily Kay had enough jailhouse capital to get him what he needed.

But it doesn’t always happen that way. Things escalate quickly on the overcrowded, noisy, smelly blocks. Anything can push a kid like Lamont into the ring. Words, looks, or nothing at all can suddenly lead to a fight. Then some guy loses control or his tentative grip on reality breaks, and the emergency response team gets called. They come storming in, shouting, dressed in black with combat boots, the reflective visors on their helmets mirroring back to the inmate the confusion and fear that got him into this mess in the first place, pushing at him with their plastic shields, crowding him, shoving him to the floor, screaming in his face. A paranoid’s dream– and nightmare. Finally, cuffed, dazed and more than likely bruised, the inmate is led away, his head shoved down in submission, and he’s put in isolation where everybody hopes he’ll just calm down, shut up, go to sleep; where, once again, he’s left alone with a life, and mind, out of control.

Of course, not every inmate who has a fight is mentally ill, although the level of instability is high with a prison population used to living the high voltage life of the street combatant in and out of jail. However, there are enough volatile situations that could be avoided if these locked up men and women struggling to maintain their emotional balance were given what they needed– decent living conditions, medications when needed, compassion, and viable therapy, or any therapy at all. It would, if nothing else, save municipalities money in the long run.