Stress in Prison

by Dr. Nelson ‘Ben’ Bennett
Psychiatrist

Stress weakens our emotional reserves and taxes our mental and physical health. Prison stress is intense – but life outside can be equally as stressful. Having worked many years in mental health centers in both Chicago and Atlanta, it is clear that stressors on the street rival those that occur in prison. Outside stressors may include the death of loved ones, being raped, being shot, held hostage, financial hardship, physical disability, access to health care problems, and caring for sick loved ones to name just a few.

 The difference in stressors inside versus outside is more in the quality of the stressors – not the intensity or frequency. That said, people inside the barbed wire have one tremendous disadvantage when it comes to stress management. Outside the wires you can usually walk away from your stress – at least enough to catch your breath. In prison, however, you often must remain where you’re told and have limited freedom to get temporary relief. This can create some intense, pressure cooker situations.

 Prison stresses start with the trauma most experience on arrest. Can you imagine the emotional reaction you would have to being told you’re under arrest, then handcuffed and brought to jail where you wait for weeks to months for the slow legal wheels of justice to turn and tell you your future? Jail and legal stressors can be catastrophic and then by the time they get to, “The big house,” they are well into grieving the loss of family, friends and career. Family financial hardships often weigh heavily on former bread-winners and separation from children and family are devastating for all; but especially for women. Another unique thing about prison stressors is that you are forced to be in such close quarters with inmates and staff who may cause you stress. And it is often very difficult to get away from those who cause you distress.

 SO – what do you do about all this stress? Most people are adequately resilient and do remarkably well managing the stress of prison. But stress takes its toll and learning to manage stress and preparing your body for stress can be the most important things you do for your health.

 Begin by getting back to basics and making healthy choices for yourself. The three cornerstones of a healthy prison lifestyle are: (1) exercise, (2) avoid junk food, and, (3) practice stress management techniques such as focused relaxation, meditation, yoga, and deep breathing. By strengthening our emotional reserves we add to the reserves so necessary to combating the effects of stress. Healthy lifestyle choices are self-care interventions that may be more important in many cases than the treatment offered by professionals.

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Why are fewer MDs going into psych residency?

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Can You Stomach This?

All Bacteria are not Dirty! Getting your health in tip-top shape may include making sure you have the right mix of bacteria (flora) in your digestive tract. Beneficial flora make vitamin K, biotin, help with digestion, and help you get rid of toxins including excess estrogen.  Beneficial flora are an important part of the immune system and are essential in absorbing nutrients.

Stress is not good for gut health. With excess stress comes more of the fight or flight hormone; cortisol. When cortisol is present the body thinks you are in danger and that digestion is not important. So with stress, you get a weakening of the mucosal lining of the intestines, increased inflammation in the gut, and a depletion of serotonin; all necessary for gut function. Other things that decrease healthy gut bacteria are:

  1. medications like antibiotics, oral contraceptives, NSAIDS like motrin, proton pump inhibitors like nexium, prevacid, Prilosec.
  2. Sugar and artificial sweeteners
  3. Allergies
  4. Toxins including pesticides, heavy metals and alcohol

 Did you know that 70% of all antibiotics in the U.S are used for livestock? We consume what our food consumes.

 So be careful – use you head – be nice to your gut!

 To fix your gut, check with your doctor. Your doctor may recommend you eat lots of fruits and vegetables – preferably uncooked. Eliminate simple sugars that feed the bad bugs. If you are older consider digestive enzymes. Take probiotics – supplements with a variety of healthy bacteria. Only take antibiotics if they are prescribed and needed. Eliminate toxins such as pesticides, herbicides, by washing vegetables, buying organic, and drinking filtered or distilled water.  

Prisoners and those with limited finances have somewhat limited ability to modify their lifestyle.  However, they can do some very significant things to help their gut health by (1) avoiding junk food, (2) moderate exercising, and (3) learning to manage their stress.  In MHM’s contract to provide mental health services to inmates in Georgia Department of Corrections, we include these recommendations in our “Back to Basics” program, promoting wellness among inmates with mental illness.

So next time you’re not feeling right – think of about repairing your gut. You may be very surprised at the improvements in wellness, mood, and health.

Dr. Nelson ‘Ben’ Bennett
Medical Director
MHM Services, Georgia
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Prisons…where the patients are!

Bank robber Willie Sutton said he robbed banks, “because that’s where the money is.” Mental health professionals practice in prison because, sadly, that’s where the patients are!

 We incarcerate the mentally ill along with those we’re mad at and those we’re afraid of. Many of us wish for a return to the days where a reasonable percentage of our government budget was spent on more mental health friendly facilities for the seriously and persistently mentally ill who cannot always adapt to life in the community. But these days an increasing number of truly sick individuals end up wearing down the patience of their community and find themselves behind bars.

 In the early 1970s the AMA recognized that health care in jails; prisons and juvenile confinement facilities were inadequate. They developed national standards that are still followed and refined today. If a facility wants to be accredited they can purchase the manual with the guidelines, do a self audit to determine if they think they are ready for accreditation.  The facilities can then apply to the accrediting agency (usually the American Correctional Association or the National Commission on Correctional Healthcare), pay their fee, and schedule a visit. Visits are usually 4-8 people from ACA or NCCHC coming to the facility for 1-2 days.

Prisons often have the largest supported living units for the mentally ill in any given state. Prisons often have crisis beds that function like mini-hospitals handling most crisis care needs.  Prison crisis units handle severe problems including frank psychosis and glaring mania, anhedonic depression, and suicidal impulses.  The crisis units in prisons handle it all.

 Prison is extremely stressful. Whether you think prisoners deserve stress or not  doesn’t change the fact that stress will break anyone down.  Intense stress makes everything worse including headaches, stomach problems, pain, anxiety, depression, psychosis, seizures, etc.  And the health care needs that occur because of the stress require lots of health care providers.

 So if you want to take care of the mentally ill, you’ll find that many end up in prison, and even those who did not seek services in the community may seek services in prison when their adaptive mechanisms come unraveled due to intense prison stress.

 The TV sitcom M*A*S*H* had a visiting psychiatrist – Major Sidney Freedman. When the chaos of the war, the Army, the people, and the demands of caring for those in harms way got to the cast, Dr. Sidney was always there to offer words of comfort and occasionally wisdom. Our work is much like that. We offer lots of basic care with a frequent need to offer empathy and perspective.

 Another important contribution of mental health professionals in prisons is to elevate the level of care. If good professionals don’t do this work then those less qualified will do so. In years gone by health care was delivered by a local general practitioner, other prisoners with a health care background, or providers with restrictions on their licenses who could not work anywhere else. Today, correctional medicine occupies a well defined niche for primary care as well as specialists. There are also other health services like psychology, x-ray, lab, eye care, and dental.

 Prisoners and detainees are the only Americans who have a constitutional right to health care. Providing services to incarcerated individuals is an art and for many healthcare providers, a passion. Those professionals who develop their skills in correctional health care will find the need is great, and the system continues to grow and develop. Prison is where the patients are.   

Dr. Nelson ‘Ben’ Bennett
Medical Director
MHM Services, Georgia
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New Thoughts on Solitary Confinement

A recent NY Times article featuring letters from inmates subjected to solitary confinement sheds new perspective on the practice.

Click HERE to read the article.

What are your thoughts on the use of segregation in prison?

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MHM Services Surveys Telepsych Patient in MI Correctional Facilities

      Michigan, along with several other programs, conducted a patient satisfaction survey of inmates receiving traditional in-person care and inmates receiving care through a combination of in-person and telepsychiatry. The use of telepsychiatry is relatively new toMichiganprisons; it is important that inmates are comfortable using video-conferencing technology and satisfied that they are receiving the same level of care that would otherwise be provided in-person. The survey measured patient satisfaction with psychiatry service and was completed by both inmates seeing a psychiatrist at the facility for the first time, and inmates who had seen a psychiatrist at the facility at least once previously. The same survey was given to all inmates and participants were able to select if the visit was completed in-person or through the use of telepsychiatry.

            The seven facilities asked to participate in the survey returned a total of 358 surveys. After removing surveys marked with “did not want to participate” and surveys that were not clear enough to be understood, 297 surveys were used; 152 received from inmates receiving in-person services and 145 from inmates receiving service through telepsychiatry the day the survey was completed. The survey listed six statements and inmates were asked to select their reactions to each statement on a 5 point scale (5 being “strongly agree” and 1 being “strongly disagree”). The six statements included items such as, “The psychiatry staff explained my medication and follow-up care” and “The psychiatry staff showed concern for my questions and worries”.

            The results of the survey revealed that inmates perceived psychiatric services received via telepsychiatry as positively as psychiatric services received in person. Also, the results were positive as to inmates’ perception of psychiatry services as a whole.

From a patient satisfaction standpoint, the survey results support that not only is telepsychiatry a viable option, but an equivalent alternative to traditional in-person treatment. As telepsychiatry use expands, we will continue to evaluate its use and continuously look for ways to improve this method of service.

submitted by  Darcy Tate, Telepsych Coordinator, MHM Services, Inc, Michigan

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Dementia behind bars makes caregivers of killers

Check out this article on unique ways some prisons are dealing with health issues of aging inmates and the costs associated with their care.

Dementia behind bars makes caregivers of killers.

What are your thoughts?

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Physicians’ Use of Social Media

Do you participate in social media?  If not, you  may want to reconsider.  Check out this interesting article on Five Reasons Why Physicians Need to Use Social Media.  Maybe contributing to Correctional Psych.com would be a great way to tiptoe into social media.  We’d love to hear your thoughts!

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Psychiatry in Prison- How does it measure up?

Click HERE to check out this arrticle from the Psychiatric Times blog for a first hand psychiatrist’s perspective on practicing psychiatry in prison. Please note: free registration on Psychiatric Times site required.

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Solitary Confinement and Mental Illness

CorrEthics Following up on Solitary Confinement and Mental Illness

Source: Originally published March 22, 2011 By Michael T. Puerini, MD, CCHP-A, and Dean P. Rieger, MD, MPH,

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