Assessments in a prison setting are effectively the same, but it is natural to feel some nerves. It is important to be understanding of the person’s situation from a functional perspective, as there is less opportunity to engage in regular activities, while not being there to judge a person’s previous actions. Working with people once they have transitioned back into the community should be targeted around ensuring they have a coordinated support network, understanding the impact of institutionalisation and promoting engagement in meaningful activities. Below are some key takeaways and things to consider when working in a prison setting.
The Environment
- Getting into a Correctional Facility
- Professional Requirements and documents required
- Know the visiting Information (participant visiting, time & date)
- Understanding different facilities – Men’s, Women’s, Pre-release, Remand Centre, Forensic Mental Health, Rural
- What do I do once I get in?
- Entry requirements (ID, Scanning, personal items)
- Getting to the participant
- Staff Impressions
- Addressing generalisations (of you and the staff)
- Getting to the participant
- Always make sure to ask for an escort!
- Meeting with the participant
- This will depend on the level of Division security.
Addressing Environmental Misconceptions
Environmental misconceptions when working in a prison setting would involve what we as visitors with no experience of a correctional facility would expect to see at a prison, particularly from an allied health perspective. Many may think work is conducted directly in the person’s cell or unit and we might feel nervous about this. Or we might have a pre-conceived idea that prisons might be very cold, unwelcoming, potentially hostile and derelict.
Now, there are dedicated spaces for professional visits, so the person is brought to us in this environment and it’s much easier to complete assessments without distraction. Most prisons are now quite modern and while some may be still strict on security, it is a much easier place to conduct assessments and work in general.
The Assessment Process
Conducted as normal
- Be sure to back your skills and repetition of the same assessment for non-incarcerated participants.
- Other considerations:
- Awareness of their environment and access to IADLs, leisure and community access
- Institutionalisation
- Their life history is more likely to be inclusive of trauma (sensitivity)
- There is a higher likelihood of completing Supported Independent Living (SIL) Assessments
- Access to services whilst incarcerated and demonstrating that support is available to them after release
- Our role as a clinician is to be someone who is there to assess a person’s functionality (not their innocence/guiltiness, previous actions and life history).
Client/participant interactions
- Who are our participants?
- Prisoners are predominantly young, adult males from lower socioeconomic groups
- Over-representation of Indigenous people
- 3/4 prisoners have been in prison before
- 1/4 prisoners have received medication for mental health issues
- 1/3 prisoners were homeless or without stable accommodation in the 4 weeks before entering prison
- 1/3 have self-reported that they have been diagnosed with a chronic health condition (Australian Institute of Health and Welfare 2023).
Some observations from our team
General population groups may include:
- Younger – middle-aged males
- A higher rate of Indigenous participants
- Is this also misrepresentative of how many Indigenous individuals have access to and are approved for NDIS funding?
- Primary Diagnosis: Psychosocial (Schizophrenia, Bipolar Disorder, Personality Disorders), Intellectual Disability
- Differences with participants with ID
- Emotions
- Nervousness
- Marginalisation
- Disenfranchisement
- Depressed
- Remorseful
- Over-confidence.
Report Writing
- To be done as normal!
- Other considerations
- NO tech!
- Stick to the scope and purpose of the assessment
- Be wary of collateral reports from within the prison setting (allied health, medical, etc.)
- Heavy and sensitive content
- Scope of these reports
- Clinical reasoning with several domains will be necessary
- e. John Doe isn’t able to do his shopping whilst in prison, so what do we think about his capacity?
- Be aware that what you’re writing will probably be used/read by Corrections staff responsible for the person’s discharge/release/parole, etc.
Working with Clients Who Have Been Released
When working with clients who have been released, we must remember to look at this from our perspective as a therapist and the client’s as well. When working in this situation, we may face personal challenges like working with someone with a legal/criminal history in a community setting which is not as controlled an environment as a correctional facility and how comfortable we might be with this. However, it is important to note that this may be a stigma that therapists carry rather than a legitimate safety risk, although it is still important to always ensure one’s safety. If necessary, formal risk assessments can be considered if genuine concerns appear. However, there are generally no pressing concerns.
It is also important to look at the impact of institutionalism on a person and how this can impact them, particularly if they do not have adequate support (i.e. from core support providers, support workers, Support Coordinators and other allied health). We can see people become socially isolated, occupationally deprived and low mental health which become risk factors for health, wellbeing and reincarceration. As an OT, their role is to identify areas of interest and using a strengths-based approach, but with these considerations in mind, understanding the challenges that a person is presented in this situation.
Some Other Important Considerations
- Staff will not always be friendly and ready to help
- Some participants are easier to work with!
- Working in a prison with the opposite gender
- You will see people who have committed serious offences
- If you don’t feel comfortable, that’s ok!
- You will also see people who have made one-off, out-of-character, psychosis, alcohol and/or drug induced mistakes
- Telehealth and rural prisons
- Access to technology
- Assessments via phone.
At Ability Partners, we strive to ensure that assessments undertaken in a prison setting promote engagement in meaningful activities and understand the impact of institutionalisation. We have an excellent team of therapists experienced at working in a prison setting and working alongside incarcerated clients to achieve goals that really matter.
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