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Challenges in Treating Mentally Ill Offenders

Paulette Fullington
Walden University

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Challenges in Treating Mentally Ill Offenders

Forensic counselors not only handle a wide range of clients and different mental illnesses,
they have to deal with challenges that other counselors may not have to contend with on a daily
basis. One client might have a mild form of depression while the next might be having paranoid
delusions that other inmates are trying to kill him. This paper briefly discusses two challenges to
treating mentally ill offenders as well as possible treatment approaches that might help overcome
those challenges.
Challenge One Environment
Many counselors go to work every day in nice offices in clinics around the country.
Others find their office being a repurposed jail cell in one of the wings of the prison. Walker,
Illingworth, Canning, Garner, Woolley, Taylor and Amos (2014) credited entering the prison
environment for an increase in poorer mental state, some of which might be a result of
overcrowding, isolation and even the sheer size of the prison population. This can be problematic
as Trawver (2008) points out that prison has become a major provider of mental health services.
The environment of the prison is not exactly conducive to building the rapport, or of being a
calming and soothing therapeutic environment which can also make it harder for counselors to
build the rapport needed for the therapeutic alliance between client and counselor.
Prisons are typically built for incarceration rather than rehabilitation so the dcor tends to
be sterile and forbidding (Trawver, 2008). There is little that can be thought of as encouraging
towards the rehabilitation and healing of mentally ill offenders. Rather the environment seems to
add to the stressors that contribute towards the mental illnesses. One of the major challenges is
how to improve the quality of the environment without destroying the necessary function of the
prison setting.

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Challenge Two Self-injury

As some of the media segments watched for this assignment pointed out, self-injury is a
large issue in the prison system. Some injure to feel in control, some self-injure in order to deal
with pain. It can be important to determine why the client is injuring, not just the fact that he or
she is capable of doing so. Trawver (2008) mentions that many offenders counselors will see
tend to have depression, schizophrenia, or a bipolar disorder. A client may have the desire to selfinjure, but not to commit suicide. The challenge becomes not just telling which clients cut for
control, which cut to release some of their pain, and which truly want to commit suicide, but also
how to divert their energy towards something less self-destructive.
Treatment Approach
It is important to not undermine the purpose of the institution but at the same time
provide the necessities for the mental wellbeing of the offenders. Environment is important but
can be hard to achieve when some group sessions may have to take place in a lock-down
situation where each offender is in a separate cell and talking through a door; however that may
be a necessary precaution to ensure not only the safety of the counselor but of the clients. If
there is an office, it is important that it be a safe area, perhaps painted in a therapeutic color,
paintings either directly on the wall or in a safety glass frame. Lighting can also be important and
the use of bulbs other than florescent might help enhance the therapeutic rather than clinical feel.
Ross, and Pffflin (2007) mention the use of attachment theory being used to assist with violent
offenders and implementation of training that encourages prison staff to respond differently to
the offenders (Marzano, Ciclitria, & Adler, 2012) may help reduce the need for self-harm among
inmates. Another interesting approach is called the Cry of Pain Model (Slade, Edelmann,

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Worrall, & Bray, 2014) that might also help to determine who is likely to deliberately self-harm
so that measures can be implemented to protect the inmate.

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References

Marzano, L., Ciclitira, K., & Adler, J. (2012). The impact of prison staff responses on self
harming behaviours: Prisoners perspectives. British Journal Of Clinical Psychology,
51(1), 4-18. doi:10.1111/j.2044-8260.2010.02007.x
Ross, T., & Pffflin, F. (2007). Attachment and interpersonal problems in a prison environment.
Journal Of Forensic Psychiatry & Psychology, 18(1), 90-98.
doi:10.1080/14789940601063345
Slade, K., Edelmann, R., Worrall, M., & Bray, D. (2014). Applying the Cry of Pain Model as a
predictor of deliberate selfharm in an earlystage adult male prison population. Legal
And Criminological Psychology, 19(1), 131-146. doi:10.1111/j.2044-8333.2012.02065.x
Trawver, K.R. (2008). Treating the mentally ill offender: An overview. In Correctional
counseling and treatment (Roberts, A.R. ed.). Upper Saddle River, NJ: Pearson Prentice
Hall.
Walker, J., Illingworth, C., Canning, A., Garner, E., Woolley, J., Taylor, P., & Amos, T. (2014).
Changes in mental state associated with prison environments: A systematic review. Acta
Psychiatrica Scandinavica, 129(6), 427-436. doi:10.1111/acps.12221