Based on my personal experiences, I believe one of the most difficult tasks for a mental health counselor is to work with inmates that are in solitary confinement. I am a licensed mental health counselor and I have been in the field of mental health for over twelve years. During my career I have worked for different populations such as a dual diagnosis program, individual therapy, group therapy, and family therapy. But one of the most interesting and challenging populations that I have worked with as a mental health counselor is at a correctional institution with male inmates that were housed in confinement.
Inmates who are housed in confinement have been placed there because they have broken prison rules. I usually tend to say that inmates that are sent to confinement are going to a jail within a prison because they have lost their institutional privileges, their personal properties have been stripped from them, and their family visits are taken away. Plus, they are being confined to a small cell for thirty to ninety days, or even longer. This makes it very stressful for them and in such cases some inmates become suicidal.
Self-harm is a prevalent and dangerous occurrence within correctional settings, specially when inmates are sent to confinement. Usually, inmates who are sent to confinement often have a history of self-harm. Most inmates that I have attended to in confinement attempted to harm themselves by cutting, hanging, overdosing, and many other ways. There are many reasons why inmates try to harm themselves. Some of these suicidal attempts can be influenced by environmental stressors within correctional settings or preexisting mental illness. Also, sometimes inmates malinger feeling suicidal or fake a mental illness to avoid certain situations or any type of punishment. So the motivation of the inmate can be complex and difficult to discern for a mental health counselor.
The effects of confinement are significant with inmates that have severe mental illness such as major depressive disorder, bipolar disorder, schizophrenia, etc. The lack of social contact and being in solitude with unstructured days can exacerbate symptoms of illness. They tend to display bizarre behaviors and even become dangerous to others or themselves. In my opinion, many of these inmates with mental illness should not be placed in confinement because their mental condition will not improve but rather deteriorate. I will always refer them to an in-patient unit were they will be provided with the proper treatment.
Furthermore, in the correctional institution that I worked, an average of three to six inmates were sent to confinement on a daily basis and these inmates needed to be seen as soon as possible - no later than five days - to avoid any suicidal attempts and to insure their emotional and mental state. These daily evaluations and crisis interventions tended to consume the workday and this can be challenging for any mental health counselor.
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