Thoughts on My Work in the Prison

I’ve been at the prison working for over a month now. As a good friend put it when I said it was interesting work, “Interesting, a word that condemns with subtle praise.”

It is interesting though. I have about 81 guys with varying degrees of mental illness on my caseload. The system has 5 classifications of what they call Mental Health scores. MH-1 are those guys with no history of needing any mental health intervention other than an occasional visit with a therapist due to circumstantial situations. MH-2 means that at some point in the person’s history, he has been on mental health medication or had more involved mental health interventions. MH-3 means that the person is currently involved in the mental health programs, taking psychotropic medications and/or seeing a therapist, but the person is probably pretty stable at this point. MH-4 means the person is actively psychotic, or perhaps in an active episode of depression or a bipolar manic phase, or otherwise engaged in a serious, debilitating mental health episode. MH-5 means the person has completely lost touch with reality to the point where he is a danger to himself or to others

We have only one MH-5 in our prison. Most MH-5 individuals will be found in the state hospital. The one gentleman who is an MH-5 level inmate is in a special “Secure Social Rehabilitation Unit,” or SSRU, which is a separate program than the normal mental health programs we run. The SSRU has a large number of MH-4 level offenders, and the purpose of the SSRU is to teach basic living skills like hygiene and communication techniques to the inmates there. The SSRU is trying to get the inmates functional enough to be able to live within the normal population of the prison. I’m not involved in the SSRU.

Also, within the prison system, there is a special unit called the Enhanced Care Unit (ECU). You can think of it as the nursing home for the prison. These are offenders who have gotten old, whose health is failing, and who need special assistance in activities of daily living, i.e. mobility (confined to wheelchair), or need specialized medical equipment like oxygen tanks. This unit is full of elderly men, most of whom are barely mobile. I’ve been asked to work within this unit with these men, in addition to the 81 guys on my normal caseload. The ECU raises interesting moral questions for me about the nature of our justice system. The men in this unit would probably be confined to a nursing home if they were not in prison, or perhaps be living with a family member because their medical needs would keep them from being active in society. I philosophically believe that the purpose of prison is to protect society against those who would violate the rights of others. The men in the ECU have committed heinous crimes. Some of them committed their crimes at a young age, and have been in prison 30, 40 or maybe even 50 years. Some of them committed their crimes at an older age. I’m currently working with a guy in the ECU who did not go to prison until he was 57 years old. These men pose no threat to society at this time. Why do we keep them incarcerated? There is a fine line between justice and revenge.

The majority of my normal caseload is MH-3 level inmates. There are those on my caseload who have legitimate mental health needs. There are also those on my caseload who have figured out that in prison, drugs are currency. These men claim to have mental health problems, and have spoken loud enough and long enough that they have gotten to see a doctor. They are now being prescribed medications, which they “cheek.” This means when they present to take their medications, they will put the pills in their mouth, but not swallow them. When they leave the medication area, they spit them out and store them to sell to other inmates. The problem is, a fairly intelligent individual with a little time on his hands could study mental illness enough to be able to say the right things to get a diagnosis. In prison, you have a community of some highly intelligent individuals with a lot of time on their hands. They figure out quickly how to work the system. But, as Mad Eye Moody said when discussing the Imperius Curse, “How do you sort out the liars?”

There is a gut feeling I get when I think someone is lying about their mental health condition. The litigious nature of medical care and the litigious nature of inmates in prison (a lot of time on their hands with nothing to do but sue people), however, conspire together to make us at times more interested in covering ourselves from liability than challenging criminal behavior. If someone isn’t lying, but my gut feeling says he is, I can set myself up for an awful lot of trouble.

The other piece of this is a lesson I actually learned from Nathaniel. Nathaniel has a distinct advantage over me when he and I go toe-to-toe on something. He’s not afraid that he’s going to get hurt. This is the same advantage that inmates in the prison have over us. They’re not afraid of hurting or even killing themselves to make a point. If someone claims he is suicidal for secondary gain (claiming to be suicidal, not because he actually is, but because he wants something else), and we know this, we will not call his bluff. The reason is because most inmates are not afraid of hurting themselves to prove us wrong. In other words, if someone claims to be suicidal for secondary gain, and I call his bluff and send him back to his cell, he will break his own arm or fall backwards off his sink causing a possible head injury or tie his sheet around his neck and secure the other end to cut off his oxygen, just to show me that he’s willing to go further to get his perceived need met than I am to address his criminal behavior.

Then you have the guys who legitimately are suicidal. They’ve lost hope. They’ve lost purpose. They don’t care anymore. So we treat all these criminals as if they are telling the truth, because some of them are.

In JCCC, there’s another classification according to housing unit. Houses 1-5 are what are known as the General Population houses (GP). These houses are divided sort of…more or less…according to the level of threat the inmates pose in terms of becoming violent. For example, the ECU that I discussed above is in Housing Unit (HU) 1. These guys aren’t young enough, spry enough, or healthy enough to become violent. It sort of goes up from there. HU 5 is the exception, which contains the Intensive Therapeutic Community (ITC) program. Wow. Different world from the rest of the prison. These guys are intense about challenging each other to become better people. I can tell the difference within the first 5 minutes of talking with an inmate whether he has been through the ITC program or not. I would trust an ITC graduate to babysit my kids. Well, some of them. The drug addicts and murderers I would, but probably not the child molesters.

HU 6, 7 and 8 are what are known as the “adseg” units. That’s Administrative Segregation. These guys are violent. They’ve gotten a bunch of minor conduct violations or have gotten a major violation and are now segregated. This is “the hole.” HU 6 are the guys who are getting ready to get back into GP. They’ve gotten most of their privileges back, and have gone a significant amount of time without further violations. HU 7 are the hard cases in adseg. They have no privileges. They are in their cells 23 and a half hours of the day, most with a cell mate, with no TV, no radio, nothing but a pen and a piece of paper a day to keep themselves occupied. They eat, sleep, exercise, and do everything else in their cell. HU 8 are those guys who are such a danger that they can’t even have a cell mate. They are completely isolated because they will hurt whoever they are around.

Two-thirds of my 81 guys on my caseload are in HU 6, 7 and 8. That’s where I spend the majority of my work week. Good times. Yeah.

What makes it worth it? I go back to what I wrote in a previous blog. The relationship is the key. Being present in the life of someone who has been so wounded that lying and manipulation is first nature to the person can be difficult at days. In that rare moment when someone realizes that there are other ways to go about life, I see the value of my work. I was reminded this week while working with 2 gentlemen who were sentenced to multiple life terms without possibility of parole of how important hope is. These 2 men know they will die within the gray concrete walls of the prison. They have both lost hope. They both asked me the question, “What was the purpose of my life?” Notice they said, “was”, not “is.” They referred to themselves in the past tense. They had lost sight of any bigger hand or greater plan beyond the gray walls of “the camp.” It was sad, sad, sad to be in the room with them. Helping them develop a sense of hope and a sense of purpose is an intimidating thought to me.

I believe, though, that’s the very purpose of this “therapeutic” relationship. That’s where the challenge and the reward come. I believe that’s the mud into which Jesus wants me to wade. I believe in hope. I believe in purpose, even within the gray walls of JCCC. I believe in these men.

Yes, I believe even these men, who have done horrible things, have inherent dignity and purpose. These men have done horrible things, but I believe that God’s image is within them. Faith is the conviction of the reality of that for which we hope, and the belief in the reality of those things we cannot see (Hebrews 11:1).  I guess I have faith in God’s image in these men.

I believe that even these men can become the beautiful creatures God intended all humanity to be.

I believe in God.

So I believe in Man.

So I believe in these in these men.