LIVE: The Psychologist in Correctional Settings
March 7, 2025
9:00 AM - 1:00 PM Pacific
4 Hours | 4 CEs
Live Training via Zoom
Robin Timme, Psy.D., ABPP presents a live virtual professional training program on The Psychologist in Correctional Settings in partnership with the American Academy of Forensic Psychology (AAFP).
The United States incarcerates individuals at alarming rates, cited in 2024 as having “the highest incarceration rate of any independent democracy on earth (Prison Policy Initiative, 2024).” Mass incarceration disparately impacts marginalized communities, specifically Black, Indigenous, and People of Color (BIPOC). As a group, individuals who experience incarceration reflect massive health disparities relative to those who do not, and in recent years the health of incarcerated individuals has become the focus of much attention from a public health perspective. Never have the intersections of public health and public safety been clearer.
In a landmark paper by David Cloud (2014) of the Vera Institute of Justice, a summary of these disparities was laid bare. For example, individuals who experience incarceration are 2-7 times more likely to be diagnosed with HIV/AIDS, and 17% of people living with HIV are estimated to pass through U.S. correctional facilities every year. Rates of Hepatitis C among incarcerated individuals are 8-21 times greater than those who are not incarcerated. The population of incarcerated individuals aged 55+ grew 550% between 1992-2012, reflecting a particularly challenging and clinically complex group of individuals aging behind bars. And with respect to behavioral health, an estimated 68% of all people in jails, and 50% of all individuals incarcerated in prisons, meet the diagnostic criteria for substance use disorders, while just 9% of the general population meets the same criteria. The prevalence of serious mental illnesses in populations of incarcerated individuals are 2-4 times higher than the general population, with 14% of incarcerated men and 31% of incarcerated women estimated to meet that diagnostic threshold (Cloud, 2014).
The psychiatric needs of the population experiencing incarceration are pronounced. Recent decades have shown dramatic increases in the numbers of jail detainees diagnosed with serious mental illnesses (Torrey, et al., 2014). According to the Treatment Advocacy Center (2014), approximately 35,000 people with serious mental illnesses were hospitalized in state psychiatric institutions across the country, while more than 350,000 were incarcerated in jails. This trend can be placed in the context of transinstitutionalization, a systematic process by which individuals with serious mental illness have been transferred from one state-run institution to another. This decades-long sociological process, where the rising rates of serious mental illness in jails and prisons is juxtaposed with the steadily declining numbers of those with serious mental illness in state hospitals, is a powerful representation of the mass movement of this population from hospitals to jails (Harcourt, 2011; Slovenko, 2003).
This perfect storm of clinical complexity, combined with characteristics of the carceral setting, makes delivery of psychological services incredibly challenging, yet critical. The role of psychologists to deliver and supervise screening, assessment, triage, referrals, psychotherapy, and interdisciplinary consultation is unlike any other setting. The work of the mental health professional in a booking area of a jail, for example, is most analogous to a psychiatric emergency room, where it is very common to see individuals on a daily basis who are acutely psychotic, currently intoxicated, and whose medical conditions are unusually complex. Since the late 1970’s, courts have repeatedly ruled that incarcerated individuals have a Constitutional right to evaluation and treatment for serious medical and psychiatric needs, consistent with Eighth Amendment protections against cruel and unusual punishment. Facilities that fail to provide reasonable care that is consistent with community standards risk litigation around these Constitutional protections, the potential ramifications of which have been significant drivers of improvements in care delivery within jails and prisons.
These protections apply throughout an individual’s period of incarceration, including pre-trial detention and during service of a sentence, regardless of whether the sentence is served in local jail or in state or federal prison. Many systems today have evolved to include relatively robust continuums of care inside facilities. These include outpatient, intensive outpatient, residential, and even inpatient psychiatric units within jails and prisons. In many ways, especially in larger facilities or systems, the same roles psychologists play in community settings apply within jails and prisons. While there is certainly tragedy in mass incarceration, the population also lends itself to clinically rich experiences and the opportunity to improve the lives of those who access care within settings of confinement.
While the clinical services provided to incarcerated individuals are critically important, there are more advanced topics emerging that focus more broadly on the criminal legal system. For the last 15 years or so, counties have started focusing on the role of law enforcement and the local jail in managing and treating behavioral health crises. Justice reforms across the country have improved their focus on opportunities for deflection (i.e., pre-arrest diversion from detention, no justice footprint) and diversion (i.e., post-arrest redirection from detention into problem-solving courts), along with a concerted effort around reentry for those releasing from local detention or prison back into the community. In this way, those who focus primarily on jail- or prison-based behavioral health services now look upstream for opportunities at early intervention, and downstream at the chance to support reentry in a way that improves health and wellness and reduces risk for recidivism. This way of conceptualizing the individual in the context of a larger system of public health and public safety is the foundation of the Sequential Intercept Model (SIM) (Munetz & Griffin, 2006).
Simultaneously, the backlog of individuals awaiting evaluation for competency to stand trial or who have been found incompetent to proceed but are awaiting bedspace for restoration, is alarming. Setting aside the Constitutional right to a speedy trial, implicating rapid (or at least reasonable) efforts at competency restoration, the impact on jails is overwhelming. Often, the individuals awaiting evaluation or restoration – or who have been returned to the jail after being found competent, and then are able to refuse treatment – represent the highest levels of acuity, present with florid psychosis, extreme psychiatric decompensation, and elevated risk for self-directed and other-directed violence as a result of their serious mental illnesses.
Another area of emerging practice for psychologists and mental health professionals includes appreciation for similar rates of medical and behavioral health conditions found in the population of those who work inside jails and prisons. More than 400,000 people work as correctional officers in the United States, a job with uniquely toxic occupational stressors (U.S. Bureau of Labor Statistics, 2021). Most correctional officers report violent incidents as a regular occurrence in the workplace, with one study reporting that 80% of officers had personally responded to violence in the prior six months (Bierie, 2012). Injuries were noted as common, with nearly three-quarters of respondents in the survey reporting having seen someone seriously hurt or killed in their place of work. Requirements for vigilance, emergency responses, rehabilitative services, and frequency of crises within settings where incarcerated individuals outnumber the employees is believed to create immense pressures that lead to high turnover rates, mandated overtime, and a national staffing crisis among officers (Finn, 2000; Finney, Stergiopoulos, Hensel, et. al., 2013; Sawyer & Wagner, 2020; U.S. Senate Committee on the Judiciary, 2024). As a result, recent studies have consistently shown that correctional officers as a group are far more likely than others to meet criteria for Posttraumatic Stress Disorder (PTSD). Spinaris (2012) found that 27% of officers met full diagnostic criteria for PTSD, while the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition – Text Revision (2022) lists the prevalence rate at just 3.5%. Similarly, serious psychological distress has been fond in 31% of correctional officers, twice the rate found in the general public (Morse, Dussetschleger, Warren & Cherniak, 2010), and the rate of suicide among officers has been consistently found to be elevated, as much as 39% higher than the general public (Stack & Tsoudis, 1997). The clinical implications of these findings for the treatment of correctional officers are staggering, while the impact on workplace dynamics inside jails and prisons cannot be overstated.
These are only a handful of germane topics to the practice of psychology in jails and prisons, and luckily these systems are beginning to receive more attention. The global COVID pandemic revealed jails and prisons to be incubators for disease, filled with vulnerable individuals, and settings of confinement to be completely ill-equipped to appropriately treat infectious disease and the intersections with a medically fragile population. Similarly, the opioid epidemic has led to massive reforms across correctional systems, with the availability of Medication Assisted Treatment (MAT) and Medications for Opioid Use Disorder (MOUD) growing rapidly. The opioid epidemic has also led to waivers emerging for the Medicaid Inmate Exemption Policy (MIEP), the federal government’s preclusion on any federal expenditures on the provision of healthcare to incarcerated populations. Waivers have been granted to several states and large counties to begin treatment for substance use disorders and serious mental illnesses up to 90 days prior to release, reimbursable to Medicaid, creating a much more fulsome opportunity for continuity of care at release and reentry.
In sum, the clinical opportunities to treat individuals in jails and prisons are unique, clinically rich, and so important to providing access to vulnerable and marginalized communities. Additionally, there are significant roles for psychologists to play across the intersecting systems of public health and public safety, from forensic evaluation and risk assessment, to treatment and training of correctional officers. And lastly, the voices of psychologists in policy development are of critical importance, educating the public regarding the health of those who live and work within jails and prisons, and advocating for equitable access to care across the system.
Topics Covered:
- Who is incarcerated today?
- Systemic factors leading to health disparities in jails and prisons
- Clinical opportunities for mental health professionals
- Emerging opportunities across settings of public health and public safety
- Unique ethical considerations working inside jails and prisons