By Rebecca Vauter, Psy.D., ABPP, CCHP-MH
Even prior to the COVID-19 pandemic, about 20% of Americans experienced a significant mental health issue every year, with major depressive disorder alone costing the U.S. economy more than $210 billion annually.
Research is now finding that up to 42% of American workers report that they have experienced serious mental health issues during the pandemic. This is not surprising, given that during the past year most Americans have experienced at least one (if not several) of the following: family income loss, residential displacement, unemployment, depression, anxiety, loneliness, social isolation, or the loss of a loved one.
For individuals working in correctional settings, most of whom cannot work remotely, the stress of potential daily exposure to the coronavirus and, by extension, the risk this posed to their families, has created a range of mental health issues.
For the incarcerated population, there have been lengthy lockdowns during staffing crises, resulting in increased isolation and changes in service delivery.
Additional difficulties have resulted from concerns about being able to adequately protect oneself from the virus in crowded residential conditions where there is significant variability in individual adherence to infection control guidelines.
Fortunately, there is much that correctional leadership can do to support the mental health of their staff and inmates through the remainder of the COVID-19 pandemic, and beyond.
Communication, communication, communication
As the pandemic wanes and we begin to transition back to “normal” functioning, it will be important to communicate early and often with employees about safety and ongoing planning. Anxiety and worry are high and will remain high for many people for a long time. Frequent communications that make clear the organization is thoughtfully planning for safety at each stage (as opposed to simply letting things drift back to the norm) will go a long way toward easing fears and helping to retain employees who are, in many cases, exhausted and maxed out.
When anxieties are high, it can be difficult for the human brain to process information the way it normally does. Therefore, it’s important to be overly redundant and multimodal in the communication approach. For example, sharing information via email, staff meetings, posters, electronic message boards, internal websites, social media and leadership rounds will result in the highest likelihood of understanding, internalization and retention. When information is repetitive and available in multiple locations, it is much more likely to penetrate and be understood.
Likewise, when the news is not good, staff appreciate hearing it promptly and frankly. When an organization faces a significant challenge, employees want to face it as part of a team. Giving them this opportunity by sharing tough news respectfully and transparently builds trust and loyalty, which has the potential to result in a more manageable emotional reaction to adverse events. Over the past year, many of us have had to share news of employee deaths. While adverse events are always difficult to process, when staff hear the news promptly and have the opportunity to turn to each other for support, it can be a little easier to bear.
Employee mental health
The importance of our employees’ mental health to their effective work performance has never been clearer than during the pandemic. Having structures and a culture that support employee mental health will be important as we move through and beyond the pandemic, and foundational to such a culture is the manager/employee relationship.
Employees need to feel that their managers genuinely care about them as individuals, and thus frequent supervisor check-ins are a relatively low-cost way to have a significant positive impact on employee mental health. Some other suggestions include:
- Include a mental health component in your workplace health and safety plan/protocol. Ask staff what they need and integrate it to the extent possible.
- Examine the allocation of permanent roles to hygiene, safety and facilities management, with an eye toward infection prevention. This could take the form of more custodial positions, new leadership positions to manage and monitor protocols/messaging, etc. Not only does this support a healthy environment going forward, but it is also a tangible demonstration to staff (and inmates) that we care about their health and well-being.
- Work with staff to ensure they have a plan to take their vacation days and do everything possible to ensure they take them. Even in the best of times, Americans tend to underutilize vacation time, and the psychological benefits of time away from the workplace are exponentially greater right now for staff in correctional settings, many of whom have been working long hours and extra shifts to cover staffing holes associated with vacancies and quarantine.
- Arrange onsite sessions with Employee Assistance Program (EAP) staff, or onsite stress management, exercise, or psychoeducation programs.
- Consider organizing social or team-building activities where and when possible. Until social gatherings are more consistently safe, consider virtual activities, or outdoor activities with smaller groups.
- Examine mental health benefits offerings to ensure they are maximized to the best of the organization’s ability.
Finally, many individuals never take advantage of mental health resources available to them because of the stigma associated with experiencing mental illness and seeking help for it. Confront the stigma head-on by normalizing and universalizing mental health challenges ‒ discuss the issue at team meetings and in newsletters. Make it clear it’s safe for people to talk about not feeling ok, and to ask for the help they need. Some workplaces have even developed employee mental health policies, as a concrete indicator of the high value they place on employee mental health. This is another no-cost way to demonstrate the organization’s commitment to employee well-being.
Inmate mental health
Whether or not they had underlying mental health conditions before the pandemic, inmates have had to face stresses associated with the pandemic along with the non-incarcerated population. For some, this has included longer periods of incarceration than the norm, as a result of backlogs in the court system.
Many may have ongoing needs to process anxiety and fears they have been experiencing, and they may have unique concerns about re-entry into a post-pandemic world. De-stigmatizing mental health challenges with our staff makes it more likely they will contribute to a safe, therapeutic environment where inmates will feel safe disclosing their concerns and seeking the help they need.
As staffing and other variables make it safe to do so, allowing increased access to sunlight, the outdoors and other green spaces will be a critical step forward for a population that has been on lockdown much more frequently over the past year. Increasingly, research is showing that exposure to nature provides not only significant mental health benefits to inmates, but also contributes to a reduction in self-harm and institutional violence.
Likewise, as it becomes safe to re-establish visitation, this will be another source of potential support to inmates. However, visits could also serve as potential crisis triggers for some individuals, as they reflect on the separations and losses of the past year. Therefore, close observation of inmate emotions and behaviors before, during, and after visits will be important for identifying potential crises, including suicidal ideation. Communicating promptly with health care staff about any concerns will maximize opportunities to intervene successfully. Staff can also help support inmate mental health as the pandemic wanes by encouraging them to utilize resources that become available again within the institution.
Embracing technology
Although most positions in correctional settings do not lend themselves well to remote work, technological supports have helped the industry navigate the pandemic and one of the most ascendant examples is telehealth services. As facilities sought to halt all unnecessary traffic into and out of their doors in order to avoid outbreaks, more and more institutions have opted to integrate telehealth services to ensure prompt, quality care, particularly from specialists such as psychiatrists.
Research has long shown that telehealth can be delivered effectively in correctional settings, and the pandemic has provided abundant real-world success stories consistent with those findings. Going forward, the use of telehealth services also represents significant potential cost savings, particularly in rural areas where states and localities have long paid premium prices to lure scarce specialists. When care is delivered virtually, not only is it easier to secure talented providers at a reasonable price, but those providers can also typically see significantly more patients per day than they could when they had to factor in travel time to the facility, and time spent navigating security.
From the security perspective, telehealth can also result in significantly fewer visits outside of the institution for specialist appointments. This contributes to overall safety, and also reduces stress on staffing and logistics.
Looking forward
As herd immunity takes hold and the pandemic begins to wane, our natural human tendency will be to get “back to normal” as quickly as we can. However, we have an opportunity to reflect on lessons learned from the pandemic and how they can inform/improve our operations into the future. To the extent we can, taking that time and capitalizing on those lessons may represent a once-in-a-lifetime opportunity to innovate and improve our operations, as well as our ability to best support the mental health of our staff, inmates and patients.
NEXT: COVID-19 vaccine safety: Answering FAQ and dispelling myths
References
Chari KA, Simon AE, DeFrances CJ, Maruschak L. National Survey of Prison Health Care: Selected Findings. National Health Statistics Reports, 2016, 96.
Greenberg PE, Fournier A, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010). Journal of Clinical Psychiatry, 2015, 76(2), 155-162.
Moran D, Jones PI, Jordaan JA, Porter AE. Does Nature Contact in Prison Improve Well-Being? Mapping Land Cover to Identify the Effect of Greenspace on Self-Harm and Violence in Prisons in England and Wales, 2021.
Senanayake B, Wickramasinghe SI, Erikkson L, Smith AC, Edirippulige S. Telemedicine in the correctional setting: A scoping review. Journal of Telemedicine and Telecare, 2020, 24(10), 669-675.
Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results From the 2019 National Survey on Drug Use and Health. 2020, Washington, D.C.
The Standard. COVID-19 Pandemic Impact on Behavioral Health in the Workplace.
About the author
Rebecca Vauter, Psy.D., ABPP, CCHP-MH, is a licensed clinical psychologist and board-certified forensic psychologist who serves as chief behavioral health officer for Armor Health. She has devoted her career to assisting individuals with mental illnesses who are involved with the criminal justice system and supporting the staff who work with them.