Addressing the Psychological Needs of Prisoners at the NC Department of Adult Corrections – with Reese Gray

When I was younger, I’d always ask, “Why?” The way I was able to understand things that made me sad or scared was through learning as much as I could about them. I loved learning and would always question things that I could not make sense of. So naturally, when I first started struggling with my mental health, I wanted to know everything I could about what was going on. I was in fourth grade when my mother bought me a book all about different mental disorders, which I read earnestly. I made a “Brain Binder,” where I’d take notes about my own research on mental disorders and phenomena – kind of nerdy, I admit, but I had found my passion.  Ever since then, I knew that I wanted to pursue a career in psychology.

As I progressed through my education, I began to learn more about mental health and its presence in the criminal justice system. I learned of the racial injustices that overwhelm the system, exacerbated by mental illness and disparities in access to mental health resources. Here were people who looked like me who had been failed by the very country that promises liberty and justice for all. Here again, I found myself asking, “Why?” I pursued a study abroad program in London, studying disparities in access to healthcare and the criminal justice system, comparing between US and UK systems. As my final project, I researched severe emotional disturbance (SED). I found that children with SEDs are more likely to be incarcerated, exacerbated by racial factors, including over-punishment of minorities in schools, lack of access to mental health care, and white supremacist culture that presents itself in schools. I began to wonder if there was a way to catch these cases early on, so that maybe the path to prison for these children could be disrupted. In many ways, practices that perpetuate the issue are deeply rooted in our systems and our culture – but there must be some way to intervene. This is what I want to do as a career, and what pushed me to choose the NC Department of Adult Corrections (NC DAC) as my worksite for the Gil Internship.

The Behavioral Health Department of the NC DAC focuses on providing treatment to currently incarcerated individuals, but also on researching ways in which to improve treatment outcomes for them. I am working under Dr. Lewis Peiper (Director of Behavioral Health, NC DAC) at the Randall Building in Raleigh, which is just across the train tracks from Central Prison. I have already learned so much about special psychological needs facing prison populations as well as barriers to successful treatment outcomes. I have also learned a bit about appropriate and effective communication with these populations, as I designed a graphic to be pushed to the tablets used by the people incarcerated in the state prisons with information for Suicide Prevention Month and National Recovery Month.

For my first project, I worked on a Quality Improvement/Program Development project related to creating a unique data point for people with a serious mental illness (SMI) in the prison system. The data point will be used to automatically signal the need for additional services, procedures, and special considerations in the prison system without violating confidentiality. Since the prison system is a large multidisciplinary system, it is important to ensure that the different staff (such as wardens, correctional officers, and disciplinary hearing officers) are aware of the SMI population, but to do it in a way that includes only the minimally necessary amount of information about the person’s diagnosis. My work on the project involved creating a consolidated list of offenders flagged as having a serious mental illness (SMI) and offenders taking antipsychotic medication (such as Olanzapine, Risperidone, and Haloperidol). The purpose of this was to see how predictive a prescribed antipsychotic would be of an SMI flag, with the hopes that catching individuals who should have an SMI flag could be done through their prescription. The results of this project will help to inform the process by which the data point is generated and populated across the prison system statewide.

Next, I worked on building a comprehensive case review of one incarcerated person who has engaged in repetitive self-injurious behavior (SIB). This person has been hospitalized numerous times due to their SIB, but they did not come into prison a self-injurer – so how did they develop this behavior? I started at the beginning of their mental health and disciplinary records to see how the self-injury began and developed and worked my way to the present day. Through this in-depth case review, I found a number of interesting correlations between disciplinary infractions and SIB as well as between movement between/within facilities and SIB. This particular person is diagnosed with antisocial and borderline personality disorders and, by their own admission, engages in SIB in order to achieve something that they want (such as movement off of a cell block or additional medical attention). I will present this case on Friday to my mentor as well as some others in the department that are familiar with this case. I hope to learn more about how to treat this kind of behavior, that occurs for secondary gain and not necessarily as part of a mental illness or psychosis. I am very interested in how cases like this develop and what the available intervention approaches include.

Recently, I worked a bit on a project that the department is working on in collaboration with Kent State University. They are working with the developer of the MMPI-3, Dr. Yossef Ben-Porath, to create a prison-normative comparison group for the test so that results are more relevant to the mental health needs of that population. This is a very important step in the treatment of prison populations, because it is unique treatment setting that contains psychopathologies and personality traits different than those that are seen in the original normative sample of the MMPI-3.

In my remaining time at the DAC, I expect to spend time in the prison and see first-hand what the mental health treatment facilities are like. I will also have the opportunity to speak with current doctoral psychology interns and ask them questions about PhD programs and their career trajectories. I hope to pursue a PhD in clinical psychology, with a focus on child psychology, so this will be extremely helpful for me. Immediately after graduation, I hope to spend time in a Spanish-speaking country in order to hone my language abilities. It is a major goal of mine to be able to provide psychological services in both English and Spanish. Most importantly, however, I will never stop asking, “Why?” I will question the way things are, and what the best psychological, educational, and policy-making practices are, advocating for childhood intervention and diversion so that less children end up in prison. From the time that I first read the book of mental disorders, I have truly come so far, academically, professionally, and personally. I wish the little girl with her Brain Binder could see me now – I hope she would be proud.