Dr. David Koehn is a psychologist practicing in Fort Myers, FL. Dr. Koehn specializes in the treatment of mental health problems and helps people to cope with their mental illnesses. As a psychologist, Dr. Koehn evaluates and treats patients through a variety of methods, most typically being psychotherapy or talk therapy.... more
Chapter Three from Unpublished Manuscript entitled Carpe Diem – Seize the Day
Dr. David Koehn
My Prison Life
Rehabilitation - An Oxymoron
As a licensed clinical therapist I was inquisitive about what was going on in the prisons. While semi-retired, I took a contracted position to provide psychological services for those who were in prison in the State of Florida. I did this for a whole year. I would travel up to the prisons in northern Florida and spend 4 ten hour days working there each week. I would go up on Sunday afternoons and return on Thursday evening – it took five hours and around three hundred plus miles to get there and back. I would stay in a hotel and travel back and forth between there and the prison. Towards the end of my stint, I would go between three different prisons adding an additional three hundred sixty five miles in travel and six hours in travel time. My friends on the tennis team would kid me that the prison would let me out for good behavior on the weekends. The types of prisons I worked at were mostly medium correctional institutions and were all men.
The State of Florida like I assume many states has no interest in rehabilitating their prisoners. The injustices that take place are way were worse than that depicted in the Netflix series, Orange is the New Black – now in its fifth season. If you go into prison and you are not physically or mentally incapacitated you will be. The food you would not feed to a dog – extremely processed, poor tasting and unhealthy. The mental health services are contracted run and their only purpose is to provide case management with no therapy. Documentation is done to “cover your ass.” More time is spent recording what you did not do then recording what you did do. There is no attention to continuity of care or quality of care. The processes set up are so arduous, inefficient and ineffective that much wasted time is being spent doing the least amount that needs to be done. Numerous outside audits are conducted and the only concern is whether you crossed your “T”s and doted your “I”s correctly.
Because of State regulations, the psychiatrist will only give antidepressants for mental health issues to keep them tranquil and quiet. Other than that medications for ADHD and Bipolar are non-existent, and are not to be administered. What mental health medications are given have little or no follow. Whether the prisoner is assigned living arrangements of open dorm, close management, or confinement for disciplinary reasons, they are constantly sleep deprived due to disruptions, threat of harm or downright maliciousness of the prison guards.
The prison guards for the most part are a step below the prisoners – typically obese, under-educated, poorly paid and trained, overtaxed from working too much and too long as well as being mentally drained from the stress of the position. Given these conditions it is no wonder that they mistreat the prisoners as being less than human. Freud said man is driven by sex and Piaget said man is driven by power. The guards are definitely driven by power and humiliate the prisoners any time they could and make them kowtow to their every whim. Many guards risk bringing in illicit drugs and cigarettes to sell to prisoners to supplement their meager incomes. Most get away with it – occasionally one will get caught but not enough to keep the drug traffic from occurring. Three times I brought up to senior management the physical abuse of a prisoner by submitting an incident report. Each time the prisoner was no longer in that prison the next day with no one to be able to tell me what happened. The Warden is not to be seen – during my one year tenure I saw him once. Obviously, he did not believe in managing by walking around.
Most mental health professionals, health care administrators, and psychologists as well as medical doctors, nurses, and psychiatrist go through the motions to provide the minimum amount of services they can. They become numb to what is needed by rationalizing that these prisoners are bad people and do not deserve better. Any professional who shows the least bit of treating the prisoners fairly, with respect and empathy are denigrated and demeaned by the culture of the prison organization. Several colleagues could not take it anymore and left because of the pressure to do less rather than what is right. Many security officers sit in their car stressing over whether to take their shift or just go back home. What is left to continue at the prisons is a working pool of degenerates. The name for these prisons has the word rehabilitation attached to it but there is no rehabilitation intended. The prison system in the State of Florida has at least one prison per county, many in rural areas of northern Florida – a big business.
My services while in the prison system included: (1) doing case management for prisoners who were in open dorms and confinement, (2) attending to prisoner’s psychological emergencies, (3) seeing and reviewing prisoners’ status while in isolation management cells -there supposedly for self-harm issues, (4) observing and providing individual and group therapy for prisoners in close management, (5) occasionally doing impatient rather than outpatient services and (6) participating in multi-disciplinary team meetings to review status of prisoner cases.
Case management typically involved seeing a prisoner either on a thirty day cycle or a ninety day cycle depending on his mental health status of being S- two (needing mental health services but not meds) and S-three (mental health services plus meds). A prisoner whose status was S-one was seen per prisoner request usually within a week of the request. Most S-1s had the opportunity to be assigned to the work camp or work release program. Based upon my conversations with those assigned to work camps, life there was no picnic with many demeaning tasks being assigned and periodic disrespectful body cavity searches for drugs being conducted.
More often than not I tried to see prisoners much more often than required so that their needs could be met. I was fast but good and got a reputation among the prisoners that “Dr. Koehn got things done.” Many resisted being recommended for meds because they knew it was a crap shoot as to what S three camp they would go to if they already were not at a S three camp. Those who took the chance, had to wait usually a month and a half to be evaluated by a psychiatrist and suffer through their problems without medication support during this waiting time.
During these case management sessions I began to become aware of the atrocities of not just the prison system but the court system. Many prisoners were poorly represented by public defenders who forced them into taking pleas under the potential threat that they would receive extraordinary long term sentences if they did not accept the plea. Others would rather not take their sentence even if offered probation because they knew the parole system would find some technicality they violated while on probation and throw them into prison for a much longer period than their original sentence. In the State of Florida, if you are uneducated and poor regardless of ethnic background you are hosed.
Psychological emergencies ninety eight per cent of the time were not valid pleas on part of the prisoners. The emergencies mostly involve a lack of getting mental health services to include medication or complaints about security officer’s abuse or being unjustly dealt with through the security disciplinary system. No matter what the prisoner said happen or did not happen, the Security Officer’s word was sacred – most of the time the security officers were lying or fabricating falsehoods or bating the prisoners to react. The security officers would write up disciplinary reports to which were upheld at the disciplinary hearing. Normally, such actions got the prisoner’s sentence extended or they were thrown into confinement for ninety days or lost their gain time. In the State of Florida there is no probation for good behavior -only reduction of sentence with good behavior, typically ten days per month if not in for a mandatory sentence. The security officers get off on making it difficult for prisoners to reduce their sentence through gain time by conjuring up all sorts of bad things.
Those prisoners who had legitimate concerns were placed in Self Harm Observation Status (SHOS). Many prisoners begged to go there out of being scared for their life or escaping from being mistreated/threatened or just needing a timeout from the chaos of prison life. To show you just how jaded the mental health administration and security system could be is the answer they came up with for so many false claims of pleading a psych emergency by the prisoners. Their answer was to strip them down to their underwear and do a room search of their abode, handcuff them, chain their ankles, and place them in a closed waiting cell. Requirements were that a mental health professional had to observe them within an hour of their plea but did not have to talk to them until they could fit into their schedule – often they would wait two-three hours to be seen.
SHOS mental health observation rounds were done daily and after seven days if it lasted that long, a decision had to be made as to whether to recommend crisis management services (CSI) or transitional care services (TCS) or send them back to the dorm. The SHOS environment involved being locked up in an isolation management room with no bed, a toilet, a mattress and blanket, and a rap around gown – prisoner was naked underneath. By the way, prisoners were never identified as clients or patients but as inmates – quite derogatory paralleling being called a primate – an animal. If a decision was made to send a prisoner to inpatient services (CSI or TCS) it was not unusual to wait up to 30 days before they would be sent to such a service, meaning they would be in isolation for a very long period of time acerbating any issues they may have. Somewhere the State of Florida has not woken up to the fact of just how debilitating isolation is to a human being.
A quick scenario to demonstrate again how crass the security officers could be. The weather was cold and the isolation cells had no heat and the prisoners were walking in circles to keep warm. I asked if the prisoners could have an extra blanket due to the conditions. The guards said no because it was in violation of the requirements – not one care or consideration by the security officer for what was happening to the prisoners. I went to the Lieutenant (security has a military like status system – security officer, sergeant, lieutenant, captain, Lt. Colonel, Colonel, and Warden) who got the maintenance people to come in after three hours waiting to fix the heating system. Again the prisoners suffered unduly.
Close management (CM) can best be described as a chaotic animal farm. Each cell is locked with normally two prisoners in it. The cells are similar to isolation cells with the exceptions of having a metal bed with a quarter inch mattress/blanket and being able to wear ragged prison clothes that hardly ever got washed or if they did never to be returned. It is like living in a self-contained toilet room in which often the toilets do not work nor are they given toilet paper. They do have a pull out drawer for a few personal items – no sharp instruments due to safety reasons. Once a week the prisoners get to go out for recreation (8 hours) – typically this opportunity is massed into one day because of inadequate staffing (many of the prisons are 20-25 per cent short of the required security personnel causing a huge amount of overtime). The prisoners are each handcuffed and ankle chained prior to going out for their recreation in an enclosed small area wired fenced system.
Each prisoner in CM does get the opportunity to receive both individual and group therapy. Based on whether they are S-two or S-three as with the open population they are seen once every thirty or ninety days individually. Groups would be seen once every week for an hour. What is unique about CM is they are handcuffed, ankle chained and enclosed behind a Plexiglas wall room for “supposed” security purposes – the Plexiglas had holes drilled in a circle in the middle of the see through window so prisoners and therapist could hear each other but not touch each other. Extremely difficult situation to provide any meaningful services – when I asked for upper management to at least provide an audio system it was denied and laughed at as being silly.
The CM environment is organized into four secured quads – each having a lower and upper floor with about twenty two cells per floor that could hold two prisoners each. Each quad was controlled from a central control room that was also secured. Getting into the CM doom required access from the central control room. The security officers made the life of those prisoners in CM miserable. Most security officers in CM would ask prisoners if they wanted to go to their individual or group sessions and would lie to me that the prisoner said no when actually they said yes. The other thing they would do is pair their recreation time at the same time as their therapy time – the prisoners for the most part would choose their recreation time since it got them out of the cell for a longer period of time. It was not also unusual for security to make me wait four hours until they would bring them out for a session – sometimes I would have to wait a whole day and often sessions were finally cancelled because security just would not go the extra effort to make it happen.
Prisoners in CM are also classified not only from a mental health perspective, but for what level of behavior risk management problem they are. CM one, two, and three exist. All designations are done by an entitled classification group at the prison who act as though they are gods and for the most part are unjust in their assignments to the prisoners. CM three is designated for those who got along with everyone, caused no problems and received no disciplinary actions. Typically they were assigned to single cells, double occupancy, and had limited but free access to the enclosed grounds. They were assigned a variety of menial, odd jobs – i.e., grounds keeping, housekeeping, food service, canteen, barber, shoe shining, and general maintenance. In a way these activities represent modern day’s version of slavery! For prisoners to maintain this status is very difficult given the fabrications by security guards who handed out disciplinary actions at a “drop of a dime” for what they state are “disrespecting” them. Those assigned CM two are based on the degree of severity of behavioral offense and number of disciplinary actions they received. A CM one was considered a real “bad ass” having caused riots, been in fights causing physical harm, violated others, committed a serious crime, and caused physical damage to prison property. If they caused a death or major physical harm, they could be sent to maximum security prison. Regardless of CM classification, the prisoners had to remain ever vigilant due to being threatened constantly by the gangs that existed in the prisons or sadistic behaviors (contaminating food, not providing essential supplies, unwanted sexual favors, and being physically/verbally accosted) of the security officers.
The group programs that I delivered even in this difficult environment were very successful – plus I would provide an incentive for the prisoners to attend by downloading music and finding resource information they wanted from the internet. Once the prisoner completed a course, a certificate of completion was given to the prisoner as well as put in their record – this made them feel very proud. The courses were based on a series of excellent library programs provided by the contracted mental health provider – no other mental health provider actually used them when they did group programs but either found a way not to do a group program or just had a frivolous, meaningless, chat session. After I left this prison because of being assigned to another prison, no other mental health professional picked them up and anything meaningful was dropped.
Remember, security was required to ankle change and handcuff behind the back any time a prisoner left his CM cell – this took time and effort to which many security officers just did not give a damn and could care less if the prisoners got the basics they were entitled to get. Since many did not get what they deserved, major problems would occur – from riots, to stabbings, to water heads being busted flooding not only the cell but the quad too, to shaking and pounding on doors and to outright constant long term yelling that would go on for hours. If the prisoners did not calm down the security officers would use force to control them by putting on riot gear, a group of no less than four security officers ganging up on the prisoner, spraying the prisoner with pepper spray (nasty stuff) and subduing the prisoner all done under the witness of being recorded by a camera. God forbid undue force would be employed! These type of situations happened two-three times a week disrupting what little services the prisoners were getting anyways.
If CM is analogous to a chaotic animal farm, then inpatient services is nothing short of what is displayed in “One flew Over the Cuckoo’s Nest.” Two basic types of inpatient services are to be provided – one involves crisis management (CSI – S level four classification) and the other longer term therapy (TCS- S level 5 classification). CSI should be short term, typically no longer than two weeks to get the aberrant behavior under manageable control. Some of the behaviors observed included cutting the body, suicidal and homicidal thoughts and actions, psychotic-like behavior (hallucinations, delusions, paranoia, catatonia, disconnected communication and impaired intelligence). If the behavior could not be managed, then the prisoner was supposed to go into TCS for longer term if not permanent therapy since they could not make it back in outpatient services. Daily attention and therapy by all mental health staff (psychiatrist, psychologist, and licensed mental health counselors) was to occur – this never happened to the extent that it was supposed to occur. Typically, this staff provided minimum services and in all honesty no therapy. It was not unusual to see a CSI prisoner sent back within a day to their outpatient environment in which the problem manifested by the prisoner was never dealt with at all. Most staff including security officers were very jaded and did as little as possible to get by.
A quick story that illustrates just how maladaptive this inpatient environment was. An ombudsman is assigned by the State to oversee that basics are done and no injustices were to occur. The ombudsman brought up to higher management that security was abusing the prisoners and that the mental health staff were not doing their job. The security officers fabricated a story that the ombudsman (a woman) was spreading her legs in front of prisoners to get them to tell what was happening. The Warden the next day without any due process escorted the ombudsman off campus, never to be seen or heard from again. I had many conversations with this ombudsman over a lengthy period of time, and the likelihood of this accusation ever happening is extremely remote.
There is one additional inpatient service that is called Correctional Mental Health Treatment Facility (CMHTF). Here, if a prisoner really needed service but would not accept the service, they would be court ordered to receive these services. I never got a chance to work in this environment. A CMHTF was being implemented at one of the prisons I was assigned to just prior to my leaving to go to another prison. The staff assigned to this unit were the worst of the worst – all they did was do as little as possible to keep their jobs. Can’t imagine the hoary stories that were to come out of this service unit.
Mental Health Multi-Disciplinary Team meetings were a joke. Representatives from mental health, medical, security and education were present, guided by the most senior mental health professional in the “team.” What went on was rubbing stamping approval of new and updated Individual Service Plans (ISP) of prisoners classified as level S two and three. These ISP typically would have to be developed within the first thirty days of arrival at a prison and updated yearly. There was a standard format and protocol to be followed. What was downright discouraging was the ineptitude and incompetence in the treatment identified and the wrongful diagnoses described in these ISP. The perfunctory comments made about progress in the updates were outright lies and poorly articulated. As long as the words stated what was required in the protocol that was okay even if completely inaccurate.
A component of the ISP was called the aftercare plan. If a prisoner was designated a S three he was assigned an aftercare care specialist to help him with required transition services to the outside world. The problem was that the case manager was assigned this role and was poorly trained in what he/she was to do. Normally this process was to start one hundred an eighty days prior to the prisoner’s release date. Not only did this not occur in the required timing period but little or no follow through happened. What is even more disconcerting is that if a prisoner was a S two or one, they were left to their own means to deal with their leaving prison. Most were clueless as to what to do – recidivism being rampant and out of site, reinforcing the big business of running prisons.
Another short story to demonstrate the lunacy of the mentality of Florida’s State Prisons. I came across a free resource printed by the state called “Financial Freedom.” This wonderful resource provided a guided means to help the prisoner be successful back in society upon his release. I began helping prisoners use this valuable resource. After providing this service at three prisons, I began to use it at a fourth prison I was assigned to. I asked the health service administrator to order more copies to which he bridged the question of its use with upper management from the contracted mental health firm. The answer came back that is not our job and he would not order any copies. This kind of attitude so frustrated me that I no longer could be a part to this abyss. My only hope is that someone at the State level has the moral courage and leadership to transform this ugliness happening in the “sunshine state.”
So the story continues down this wrong yellow brick road to Oz...
A POSTSCRIPT – JOANN’S MURDER
If you do not think the state correctional system is broke let me tell you about Joann’s tragedy. Joann was a respected elder in the church who I met at one of the dinners for eight activities held monthly across the church. She knew my wife well and always encourages my wife in her choir activities. Well, the news broke that a woman had been brutally murdered, raped, beaten in the face, hands tied, and a restraint around her neck in her sixth floor apartment complex. Due to some excellent forensics by local investigators, they arrested a black man who had been released from a twenty five year sentence for having committed multiple offenses over his life. All the news focused on how great Joann was and how terrible this event was. The blame kept going back to the black man without looking through the looking glass and seeing how badly the prison system is. The prison hardened this black man to be an even worse person when he got out plus provided him no follow-up services so he became even bitterer. Did he commit the murder? Yes. Did the State prison system contribute to his demise? No doubt in my mind. Could this criminal have turned out different and a potential crime be averted? Absolutely. The news never focused on the debacle of the State prison system only on the poor tragedy that happened to Joann.
In my conversations with others, similar stories have occurred across the state and the prison system continues to put out people who are worse than when they entered.