Lecture

Welcome to the Care and Counseling in Corrections course. The lectures have been developed by several contributors who are chaplains or experts in their field.

This course will include principles and counseling techniques that can be applied to all people as well as addressing the challenges of working in a correctional environment and common issues faced by the incarcerated. Throughout the following eight weeks, you will hear lectures on mental health in corrections and the church, psychological and spiritual health, counseling and motivational interviewing skills, and types of therapy and specific areas encountered by chaplains as they provide care and counseling with the incarcerated. Your beliefs about mental health, psychology, theology, and spirituality may be challenged and hopefully stretched.

Providing care and counseling involves developing helping skills. You will have an opportunity to practice these skills and reflect on your experience.

As we go through this class, you may discover that the pastoral care dimension of chaplaincy is not your strongest area or most passionate part of ministry. Like the other dimensions of chaplaincy, surround yourself with those who complement your skills and strengths. Lesson 24 will discuss creating a lay helping ministry to help meet the vast amount of inmate and staff spiritual and emotional needs.

Let’s begin with prayer: Dear Lord, we humbly come to You as we desperately need Your help in providing compassion and Your wisdom as we guide those You have placed in our care. Thank You for the example Jesus is for us in caring for those with physical, emotional, and spiritual needs. Help us to be more like Jesus. In His name we pray, amen.

One of the dimensions of chaplaincy identified by Beckner is pastoral care. Beckner points out that most chaplains enter correctional chaplaincy because they are drawn to provide pastoral care for the incarcerated and feel that one of their most valuable institutional roles is that of agent of change.

In a survey of correctional chaplains in California, chaplains identified inmate/resident counseling as the most frequent task they performed. This was especially true in the Youth and Adult Correctional Agency, where 94 percent of the responding chaplains and spiritual advisors regularly counsel more than ten inmates a week. Forty-two percent regularly counsel between ten and 25 inmates a week, 24 percent regularly counsel between 25 and 50 inmates a week, and 19 percent regularly counsel over 50 inmates per week.

The study found that Protestant chaplains generally set aside part of each workday, or one day of the workweek, to individually counsel inmates. On average, counseling sessions last about 30 minutes per inmate, with an average of ten to 15 inmates per designated counseling day, a total of five to eight hours of counseling per week. While spiritual matters are the major focus of inmate counseling, personal and family issues and matters of grief are often discussed. Several Protestant chaplains mentioned that it is not unusual for them to counsel an inmate who is also receiving psychiatric counseling.

Chaplains in women’s institutions reported spending more time counseling inmates. For example, one Protestant chaplain said that he devotes as much as one-third of his daily activities to “crisis counseling” with women inmates who are “depressed and sullen” about news of problems with their families and children. Keeping their families together is a major worry for women inmates and is something they have little control over. “Helping women inmates cope with this situation is much different than with men,” said one chaplain.

For correctional chaplains, providing pastoral care goes beyond the incarcerated and includes corrections staff and at times volunteers. As chaplains build trust with staff, they are sought out for prayer and counseling help. At times, volunteers may need care and counseling as they face family, work, and life issues.

Pastoral care is one of the primary dimensions of chaplaincy, with endless needs from inmates, staff, and volunteers. Chaplains must manage pastoral care in the midst of competing demands placed on them by the other critical dimensions of personal, administrative, and community development.

So what is counseling? For clients, it is a relationship where they come to a trained and caring counselor for help solving problems and reaching goals they are having trouble attaining. From a counselor’s perspective, according to Clinton,

It is a multidimensional process that targets and works to change thoughts, feelings, behaviors, relationships, and environments by applying knowledge and skill to serve a client’s best interest in personal growth and maturation.

Christian counseling is more than having a Christian counselor. According to Clinton,

The competent Christian counselor is a person who knows Jesus Christ intimately and is able to make him known to others. In Christ and by his power and wisdom, all of the best ideas, methods, and principles of helping converge.

In the development of Evangelical Christian counseling, there are three primary approaches. These approaches will be identified but not described in detail. The goal is to make you aware of the different approaches. First is the integrationist, created by Gary Collins, where biblical theology and the psychological sciences are integrated into a workable counseling model. Second is nouthetic counseling, founded by Jay Adams, which is primarily anchored in Reformed theology and where counselors use the Bible almost always, if not exclusively, as their source. A third approach is the community model developed by Larry Crabb, who believes that helping should be centered in the church and, specifically, that counseling should be connected to the body of believers in Christ.

The essential attributes of Christian counseling have been defined by Bufford as pursuing excellence, working from a Christian worldview, incorporating Christian values, assuring the personal faith of the counselor, being confident of the personal calling of the counselor, recognizing and inviting into counseling the person and work of God, and becoming skilled with spiritual interventions and resources.

In the midst of many perspectives of Christian counseling is an old saying, “The most important counseling tool is you.” Self-awareness and applying the use of self is a crucial counseling variable. The excellence of the counselor’s life and the quality and intensity of the counselor-client relationship empower change in counseling. This statement emphasizes the need of the counselor to have psychological and spiritual health, to be growing in their spiritual formation, to have accountability, and to constantly pursue humility. Throughout the lectures, you will be reminded of the key role you play in the life of the client and the counseling experience.

One of the challenges expressed by a chaplain is the constant struggle to maintain humility and resist the pull toward a “savior” mentality. Chaplains are often put on a pedestal by inmates. The words of a respected chaplain carry great value and weight in the lives of inmates. I highly recommend watching the video Journey: Session 4 Growing in Humility, which provides theological and practical tips for pursuing humility.

As we move into the topic of mental health and corrections, I want to describe mental illness and recovery. Mental illnesses are characterized by the diagnosis of a specific illness or disorder, the duration of symptoms, and the associated disability. In other words, the degree to which the person’s ability to perform activities of daily living is impaired. Some individuals may have disorders not associated with significant functional impairment but create challenges for corrections and program management, such as antisocial or borderline personality disorders in which relationships are destabilized by the individuals’ hostile, impulsive, or eccentric behavior.

The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” As Christians we define recovery to include our spiritual health as well. Spiritual health will be discussed more in your readings and future lectures.

Mental health and corrections has been a hot topic in the last few years with the changing and increased inmate population. According to the Bureau of Justice Statistics, over 50 percent of prison and jail inmates in the United States have a diagnosed mental illness, a rate nearly five times greater than that of the general adult population. The inmates with mental health problems are estimated to represent 56 percent of state prisoners, 45 percent of federal prisoners, and 64 percent of jail inmates. Female inmates have higher rates of mental health problems than male inmates with 73 percent of state female prisoners and 55 percent of males; and in jails, 75 percent of females and 63 percent of males.

In addition to being diagnosed with a mental illness, about 74 percent of state prisoners and 76 percent of jail inmates also met criteria for substance dependence or abuse.

Nearly one in five prison and jail inmates have a serious mental illness. In fact, there are more than three times the number of seriously mentally ill individuals in jail or prison than in hospitals; in some states that number is ten times. And prison is a terrible place for someone with mental illness or a neurological disorder that correctional staff are not trained to understand.

Being diagnosed and receiving treatment while incarcerated are two different percentages. In a report by the Bureau of Justice Statistics, over one in three state prisoners and one in six jail inmates who had a mental health problem had received treatment since admission. Taking a prescribed medication for a mental health problem was the most common type of treatment inmates received.

Coping with inmates with mental health problems is hard on staff and other inmates. Prison or jail inmates who had a mental health problem were more likely than those without to have been charged with breaking facility rules since admission. An estimated 24 percent of state prisoners who had a mental health problem, compared to 14 percent of those without, had been charged with a physical or verbal assault on correctional staff or another inmate. Jail inmates who had a mental health problem were twice as likely as those without to have been charged with facility rule violations (19 percent compared to 9 percent).

People with mental illnesses and co-occurring disorders tend to have greater difficulties behind bars and tend to stay an average of 15 months longer than prisoners without mental illness.

Corrections facility administrators experience challenges to meet the requirements of inmates. Corrections administrators are required to identify the health needs of inmates, including mental health needs, and to provide medication, treatment, and other supports. But they are often not equipped with the kinds of in-house expertise, housing assignment options, and funds to provide the range of services that can be accessed in the community.

As corrections populations have grown, the requirements for correctional facilities to provide health care to these inmates has stretched the limits of their budgets and available program personnel. They often lack the resources to provide the kinds of services many of these individuals need for recovery and to avoid reincarceration.

Inmates are often caught in the system between behavioral health care and community corrections operating in silos and not coordinating efforts and not prioritizing people who should receive treatment.

With the budget challenges and the movement from punishment to rehabilitation, there is an increase in diversion programs such as specialty courts. Mental health courts are a type of problem-solving court that combines judicial supervision with community mental health treatment and other support services in order to reduce criminal activity and improve the quality of life of participants. The first mental health court was established in Florida in 1997.

Research has demonstrated that strategies targeting stronger relationships between corrections-involved individuals and their families correlate with better outcomes. Individuals leaving corrections facilities expect that family members, above all others, will provide financial resources, housing, and emotional support on release; and families do, in fact, often provide that tangible and emotional support. Supporting family and parental relationships with their children and their caregivers is an important consideration.

Research suggests that these outcomes can be improved through the accurate screening and assessment of individuals’ risk to public safety and their clinical needs, and then matching these results to appropriate accountability and treatment measures. And, as with other interventions, there is no one-size-fits-all. Treatment, support, and supervision must be tailored to individuals’ needs and risk levels.

The incarcerated with mental illness, substance use disorders, or both, live in a cycle of relapse and an inability to comply with the requirements of their incarceration, supervision, and release. Their conditions tend to deteriorate, and they find themselves back in the criminal justice system again and again because they lack effective integrated treatment and supervision. According to the Justice Center,

The costs to states, counties, and communities in excessive expenditures of scarce resources that have a limited effect on public safety, recidivism, and recovery are unacceptable. The impact on individuals and their families can be devastating.

The Mental Health America (MHA) board of directors passed what is known as Position Statement 56: Mental Health Treatment in Corrections Facilities.

MHA is both concerned by and opposed to the increasing use of criminal sanctions and incarceration, replacing the state mental hospitals with much more drastic curtailment of personal liberty and preclusion of community integration and community-based treatment. Prisoners with mental health conditions are especially vulnerable to the difficult and sometimes deplorable conditions that prevail in jails, prisons, and other correctional facilities. Overcrowding often contributes to inadequacy of mental health services and to ineffective classification and separation of prisoner classes. It can both increase vulnerability and exacerbate mental illnesses. For these and other reasons, MHA supports maximum reasonable diversion.

The MHA reports, in 2011, the United States Supreme Court decided Brown v. Plata, and ordered California to release over 40,000 prisoners because the medical services—including mental health care—that the state provided did not reach the minimum level of care required under the Eighth Amendment. The court highlighted in its opinion that prisoners in California with serious mental illness did not receive minimal, adequate care.

Because of a shortage of treatment beds, suicidal inmates may be held for prolonged periods in telephone-booth sized cages without toilets . . . A psychiatric expert reported observing an inmate who had been held in such a cage for nearly 24 hours, standing in a pool of his own urine, unresponsive and nearly catatonic. Prison officials explained they had “no place to put him.”

This decision is significant because it makes clear that if prison officials do not provide adequate mental health services to inmates, they risk facing similarly serious sanctions.

Their Position Statement lists what prisoners in need of mental health treatment, confined in correctional facilities, are entitled to. I will highlight a few rights. Visit their website for the full list of specific rights. The inmates have a right to adequate medical and mental health care and protection from harm in a safe, sanitary, and humane environment. They should be required to give informed consent to treatments. Eliminate seclusions and restraints in therapeutic facilities. Medications should not be used for the purpose of “chemical restraint” for prisoner control.

While this is not part of Position 56, I believe chaplains have an ethical, moral, and Christian responsibility to work with corrections to ensure those with mental health conditions receive decent and humane mental health services while incarcerated.

We now look at the role and attitudes of the church and mental health. Dr. Diane Langberg, a noted Christian psychologist, speaker, and author, describes the role of the Christian community in offering care. She states,

As the body of Christ, we are called to minister to the broken and hurting, not to ignore them, shut them up, and tell them to get over it and move on. Too often gossip and judgment within the church keep people from getting the help they so desperately need.

There are times when Christians label people by their crime, circumstances, or actions, not their heart, such as sex offender, murderer, abused, addicted, abortionist, depressed, bipolar, or drug addict.

Inmates already feel rejected by society, but at times the body of Christ continues to push them away or shame them. When we define a person by a word—crazy, exoffender—we reduce them to that one shameful thing about them. It doesn’t matter what they have accomplished or how they have changed, their trauma is there defining, shaming, frightening, and holding them in bondage to their past.

Langberg goes on to say, “When the church adds to a person’s pain through an accusing, indifferent, or unloving attitude, we are in direct opposition to the gospel of Jesus Christ.”

In Luke 4:18–19, Jesus declares His mission on earth “to proclaim good news to the poor. He has sent me to proclaim freedom for the prisoners and recovery of sight for the blind, to set the oppressed free, to proclaim the year of the Lord’s favor.”

You and I cannot change people. As chaplains, we cannot transform their minds and cannot heal their brokenness. But we know One who can. And God gives us the privilege and responsibility of embracing those He brings to us in their pain, weeping with them, listening to them, and ultimately, leading them to Jesus, who knows each of them intimately and longs to make them whole.

LifeWay Research conducted a “Study of Acute Mental Illness and Christian Faith” through surveys with Protestant pastors, Protestant individuals with acute mental illness, and Protestant families of someone with an acute mental illness. I will make a few highlights from the findings in the study but encourage you to read the full report listed in the bibliography.

There continues to be stigma and shame surrounding mental illness, even in the church. Parents may believe their child will “outgrow” the illness and live in denial. Education can help reduce stigma, shame, and denial.

People with mental illness often turn to the church first for help. This is an opportunity for the church to be a place of healing. While helping someone with a mental illness is time consuming, pastors who offer help need to be prepared for the long journey of recovery and the cycles of relapse; and they need to know their own limitations.

Mental health experts responded that labeling mental illness as only a “spiritual issue” is not helpful, and it can be detrimental. Be realistic about how much spiritual growth or progress is to be expected of loved ones dealing with mental illness. In most cases, the illness needs to be stabilized before spiritual growth will take place. Strong faith does not make a mental illness go away. People who deal with mental illness tend to be more honest about their relationship with God.

Other areas studied were the role of medication and the role of psychological therapy in treating acute mental illness. Are these treatments appropriate? If so, when and for how long? What is the role of the church in caring for individuals? Education may be needed to help inmates understand mental illness and how to care for others in their community. It is helpful to think about your own answers to these topics and why you believe what you believe. Your beliefs will influence how you treat those with acute mental illness. To help you discern your beliefs, you are assigned to write a paper on your theological foundations and philosophy for a ministry of care and counseling.

Dear Father, we pray for those who live with the pain and stigma of mental illness. We ask that You watch over those who live without medication they so desperately need. We pray that You would help us to move toward rather than away from those with mental illness, that You would grow in us the love we need to take action and to make their struggle our own. We pray that we, Your church, be a healing presence, a safe community, and a strong advocate for the mentally ill. Thank You for Your continued love, presence, hope, and peace. May we extend that hope to every person we encounter so that they come to know You personally. In Jesus’s name, amen.