Recommendations for Implementation

There are some staff in some prisons or jails who, despite being in regular contact with inmates with mental illness, have received little or no meaningful training regarding mental health issues.  These personnel may be uniformed security staff who received academy training but are not prepared for in-service refresher training on mental illness.  This audience may also be program staff, such as case managers, teachers, or vocational counselors, who did not attend an academy and may have received minimal pre-service training.  Whatever their background, any corrections personnel who have regular interaction with inmates with mental illness should receive basic training on how to better serve those inmates.

Basic training for corrections personnel should be geared toward the following goals:

• improve staff's ability to identify inmates with possible mental health issues
• enable staff to understand when to refer an inmate for a mental health screening and/or assessment
• teach staff to recognize symptoms of an adverse reaction to psychotropic medication
• provide basic information on issues related to co-occurring substance abuse and mental illness
• reduce stigmatization of inmates with mental illness by sensitizing corrections staff to the unique needs of these individuals
• assist correctional staff in recognizing cultural factors that may influence their awareness of signs and symptoms of mental illness
• improve the ability of corrections officers to communicate facility procedures/rules to inmates with mental illness

Many states have established policies that require basic mental health services training.

Example:  Virginia Department of Corrections

The Virginia DOC has established a comprehensive training program to train both institutional (security and nonsecurity) staff and clinical staff.  The Department has engaged a full-time mental health training coordinator who is stationed at the DOC's Academy for Staff Development.

Training of correctional mental health staff should include experiential, in-service activities in addition to didactic, classroom instruction. For example, the Oregon Department of Corrections trains mental health staff on the housing units directly alongside the correctional officers.  In developing training programs regarding mental illness for corrections staff it can be especially helpful to collaborate with personnel from state mental health agencies, community-based mental health providers, or other professionals with mental health expertise.

Example:  Training Video, New York State Department of Corrections, New York State Office of Mental Health

In New York State, the commissioner of the Department of Corrections reached out to the commissioner of the Office of Mental Health to request collaboration and expert assistance in producing a training video on managing inmates with mental illness.  The video is designed for use in the corrections pre-service training academy as well as for in-service training purposes for those already through the academy.

Training academies and pre-service training programs offer an opportunity to begin sensitizing corrections staff to issues regarding mental illness.  This training should focus on the development of competencies.  Though a number of hours may be designated for academy training on mental health issues, it is critical that the measure of training success be improvements in the trainees' knowledge and abilities.  Suggested topics for academy training include the following:

• signs and symptoms of mental illness
• attitudes about mental illness (e.g., stigma)
• understanding and assessing mental illnesses
• the relationship between violence and mental illness
• dual diagnoses: substance abuse and mental illness
• developmental disorders
• homelessness and mental illnesses

• de-escalation techniques
• officer safety
• calming approach methods
• interviewing techniques
• medications: noncompliance; side effects
• internal services and referral procedures
• suicide prevention

• civil rights, including privacy rights
• confidentiality
• victims with mental illness
• available community resources
• cultural diversity/gender difference
• consumer and family perspectives

Example:  Pre-service and In-service training, Connecticut Department of Corrections

The Connecticut Department of Corrections (DOC) offers pre-service and in-service training to corrections officers on how to work with inmates with special needs, including those with mental illness.  This training addresses a number of issues, including legal requirements regarding confidentiality, symptoms of different mental illnesses, collaboration with correctional mental health staff, and suicide prevention, among other topics.  Correctional mental health staff, who are employed by Correctional Managed Health Care, receive training facilitated by both psychiatric professionals and corrections officers.

Example:  Correction Officer Training, New York State Department of Corrections

The New York State Department of Corrections (DOCS) Training Academy has teamed with the Capital District Psychiatric Center (CDPC) Mental Health Players to develop an enhanced pre-service training curriculum concerning mental health issues.  The full-day training emphasizes hands-on experience in dealing with inmates with mental illness.  The morning session provides background information on types of mental health issues encountered most often in correctional facilities, including suicide prevention.  The afternoon module is unique in that volunteers from the CDPC Mental Health Players role play inmates experiencing mental health problems, providing correction officer candidates a chance to practice communication skills in a "real-world" setting.  Feedback from training academy staff and candidates has been overwhelmingly positive.

Corrections staff who are assigned to work specifically on units with inmates at high risk of mental illness (e.g., special housing units, administrative segregation) and/or already diagnosed with mental illness (e.g., psychiatric intensive care units) should receive intensive training in mental health issues and management of inmates with mental illness.  In Florida, state law requires that corrections officers employed by a mental health treatment facility receive specialized training beyond that required for basic certification.  It is important to tap the expertise of professional mental health crisis workers when offering specialized training, especially in dealing with de-escalation techniques, restraints, and lethal force.

Example:  Special Housing Unit Training Program, New York State Department of Corrections

The New York State Department of Corrections (DOC) has developed a standardized annual mental health training for corrections officers assigned to Special Housing Units (SHUs) designed for inmates with mental illness.  The training is provided by Office of Mental Health staff, who are responsible for the mental health services in the SHUs.  The training emphasizes the special problems and concerns of the SHU population along with an overview of the types of mental illness and disorders likely to be encountered in the SHU.  Much of the training is dedicated to the issue of suicide, including the warning signs, intervention techniques, legal responsibilities, and reporting procedures.  In addition, the training addresses communication skills and stress management techniques.

Parole board members come from a variety of backgrounds and areas of expertise.  Some may have experience that helps them understand people with mental illness, but most do not.  The stigma of mental illness, especially the common association between mental illness and violence, may cause parole board members to be wary of offering parole to offenders with mental illness. (see Policy Statement 20: Release Decision) Training can enhance parole board members' understanding of the complex issues presented by this offender group, and enable them to make informed decisions regarding parole candidates.

Example:  New Board Member Training, National Parole Board, Canada

The National Parole Board in Canada offers extensive training about mental illness to new board members.  Of the 15 days of total training required of new board members, two of the days are devoted to mental health issues.  The board relies on two general reference documents - the Diagnostic Manual for Mental Disorders and the Historical, Clinical and Risk Guide for Violent Offenders with Mental Illness - and one internal  risk-assessment manual, which has a chapter on mental illness.  The parole board is also developing an even more in-depth guide for board members on dealing with offenders with mental illness.

Training curricula should be developed and, depending on the jurisdiction, tailored for individuals appointed to serve as parole board members, both for new appointees as well as on an annual or ongoing basis.  Parole board members should have a fundamental understanding about the nature and types of mental illness and how mental illness is diagnosed and treated.  They should also be provided with training about the risks and needs associated with mental illness and the types of treatment, resources, and support services that can mitigate that risk.

There is also opportunity in this context to provide cross-training, which would include training for mental health personnel about a jurisdiction's criminal justice system as well as its public safety issues, needs, and processes.  In many jurisdictions, these two systems, while having a significant shared population, have operated substantially apart from each other.  Only in recent years have these barriers begun to break down.  Cross-training is one opportunity to develop shared understanding about the potentially competing criminal justice and treatment needs of the offender who has a mental illness.

Example:  Cross Training, Massachusetts Parole Board, Massachusetts Department of Mental Health

In 1998, the Massachusetts Department of Mental Health (DMH), The Massachusetts Parole Board, and the Department of Corrections developed a broad agreement to strengthen the delivery of mental health services to individuals with mental illness incarcerated in state correctional institutions or eligible for parole.  Cross-training between the DMH and the parole board provided background on new policies and procedures developed as part of the agreement and helped staff from the different agencies better understand the roles of their colleagues.  Regional groups engaged in roundtable discussions to develop specific goals and strategies for realizing the objective of improved service to inmates with mental illness.  DMH staff has also offered training to senior parole officers in support of the collaborative agreement.

Parole officers have a varying degree of exposure to people with mental illness.  Parole officers with typical caseloads will undoubtedly encounter some clients with mental illness.  These parole officers need basic training on how to best serve these clients.  This training should cover topics similar to those dealt with in the basic training offered to corrections personnel discussed above.  In addition, parole officers need training on the availability of community mental health resources, intervention services, alternatives to revocation, sensitivity to victims, and updates on the changes in mental health treatment law.  Parole officers should be able to recognize when a person with mental illness is decompensating and when a person with mental illness is not complying with conditions of release because of an inability to obtain access to effective treatment.

 It is especially important to reconcile the different missions of community corrections agencies and mental health service providers.  Most mental health and substance abuse treatment providers view relapse and setbacks in treatment as part of the recovery process.  Parole requires offenders to follow certain release conditions or risk violation and reincarceration.  These two outlooks can conflict when mental health (or substance abuse) treatment is part of a parolee's release conditions.  Cross-training between parole officers and mental health providers, consumers, and family members can be effective in synthesizing the goals of parole and mental health treatment.

  Some parole officers have caseloads dedicated to parolees with mental illness.  Because the primary focus of these parole officers is to supervise parolees with mental illness, it is appropriate to provide more in-depth training on mental health issues.  Parolees who work with a dedicated mental health caseload will likely be collaborating frequently with mental health service providers.  It is crucial that these providers work together to understand each other's roles in supporting an offender's reintegration into the community.