The Incarcerated Family

Forgive me for stating the obvious, but incarceration is rough on families.

Intact families are important for prisoners because good external relationships are associated with better adjustment after release and lower recidivism rates. Unfortunately, some prisoners don’t always have the best family dynamics to begin with, if they have family at all.

The family might have more than one incarcerated member who all rely on the same overwhelmed mother. The prisoner might be the disciplinarian of the family, and in his absence the children might run wild over the more passive partner. The abandoned girlfriend might be at home struggling to pay the rent while managing her own addictions.

Regardless of the specific scenario, the correctional facility can become the focal point of the external family’s displaced frustration and anger. Angry family phone calls often get routed to the institutional psychology department. The relative – usually a mother – wants to know why her loved one hasn’t been transferred to another facility or placed in a program or hasn’t had a parole hearing.

These are issues that do not involve the psychology department. Yet the mental health practitioner must allow some time to listen and explain the incarceration process, offering guidance about whom to contact for each issue.

Now, add to these problems the concern about a prisoner who also has a mental illness. What role, if any, does outside family play in the care of a mentally ill prisoner?

Some aspects are similar to free society care: I cannot give out information about the patient without his consent, and prisoners also have a right to be free of involuntary treatment if they are not dangerous. However, family contact in the correctional setting can be even more valuable than in free society care. Family members can be engaged as an ally and partner in the care of mentally ill prisoners. When a family member calls, I immediately thank her for calling and explain ways that she can help me care for her relative. It’s important for her to know that she can provide a great deal of care, even from a distance.

I recommend that she write a letter outlining the patient’s symptoms – particularly ones the patient would be reluctant to reveal or those he might not be aware of – as well as any pertinent early warning signs of relapse. This letter also should document which medicines seem to help, which he definitely had bad reactions to, and ways to relate to the patient so he will be more likely to take his medicines and keep his appointments.

I encourage the relative to contact prison administration to find out what kinds of programs and resources are available at the facility the patient is sent to, and then follow up with that facility’s social work department to coordinate release and aftercare planning. It’s important to keep expectations clear, invite participation, and solicit feedback.

Finally, I ask the family member to stay in touch with the patient and to call the psychology department if she notices anything of concern. During the course of this conversation, it might become clear that the relative is exhausted and overwhelmed, or secretly relieved to be turning over the responsibility of care to someone else. In this case, I tactfully suggest that it would be best for her to care for herself during the incarceration rather than invest energy in a situation beyond her control. This relieves some degree of guilt she might be experiencing, and allows her time to recover from fatigue and frustration.

Incarceration does not mean permanent disruption of family relationships. When managed properly, the time can be used to enhance patient self-reliance and teach proper distance between overly engaged or enmeshed relatives. I know I’ve struck the right level of engagement when I get a family phone call after the patient has been released, asking for referrals or a medication renewal. I enjoy these calls, which to me are a sign that the family has moved from anger and frustration, to hope and rededication. It also means I might never hear from them again, for all the right reasons.

—Annette Hanson, M.D.

DR. HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

Forgive me for stating the obvious, but incarceration is rough on families.

Intact families are important for prisoners because good external relationships are associated with better adjustment after release and lower recidivism rates. Unfortunately, some prisoners don’t always have the best family dynamics to begin with, if they have family at all.

The family might have more than one incarcerated member who all rely on the same overwhelmed mother. The prisoner might be the disciplinarian of the family, and in his absence the children might run wild over the more passive partner. The abandoned girlfriend might be at home struggling to pay the rent while managing her own addictions.

Regardless of the specific scenario, the correctional facility can become the focal point of the external family’s displaced frustration and anger. Angry family phone calls often get routed to the institutional psychology department. The relative – usually a mother – wants to know why her loved one hasn’t been transferred to another facility or placed in a program or hasn’t had a parole hearing.

These are issues that do not involve the psychology department. Yet the mental health practitioner must allow some time to listen and explain the incarceration process, offering guidance about whom to contact for each issue.

Now, add to these problems the concern about a prisoner who also has a mental illness. What role, if any, does outside family play in the care of a mentally ill prisoner?

Some aspects are similar to free society care: I cannot give out information about the patient without his consent, and prisoners also have a right to be free of involuntary treatment if they are not dangerous. However, family contact in the correctional setting can be even more valuable than in free society care. Family members can be engaged as an ally and partner in the care of mentally ill prisoners. When a family member calls, I immediately thank her for calling and explain ways that she can help me care for her relative. It’s important for her to know that she can provide a great deal of care, even from a distance.

I recommend that she write a letter outlining the patient’s symptoms – particularly ones the patient would be reluctant to reveal or those he might not be aware of – as well as any pertinent early warning signs of relapse. This letter also should document which medicines seem to help, which he definitely had bad reactions to, and ways to relate to the patient so he will be more likely to take his medicines and keep his appointments.

I encourage the relative to contact prison administration to find out what kinds of programs and resources are available at the facility the patient is sent to, and then follow up with that facility’s social work department to coordinate release and aftercare planning. It’s important to keep expectations clear, invite participation, and solicit feedback.

Finally, I ask the family member to stay in touch with the patient and to call the psychology department if she notices anything of concern. During the course of this conversation, it might become clear that the relative is exhausted and overwhelmed, or secretly relieved to be turning over the responsibility of care to someone else. In this case, I tactfully suggest that it would be best for her to care for herself during the incarceration rather than invest energy in a situation beyond her control. This relieves some degree of guilt she might be experiencing, and allows her time to recover from fatigue and frustration.

Incarceration does not mean permanent disruption of family relationships. When managed properly, the time can be used to enhance patient self-reliance and teach proper distance between overly engaged or enmeshed relatives. I know I’ve struck the right level of engagement when I get a family phone call after the patient has been released, asking for referrals or a medication renewal. I enjoy these calls, which to me are a sign that the family has moved from anger and frustration, to hope and rededication. It also means I might never hear from them again, for all the right reasons.

—Annette Hanson, M.D.

DR. HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.

Forgive me for stating the obvious, but incarceration is rough on families.

Intact families are important for prisoners because good external relationships are associated with better adjustment after release and lower recidivism rates. Unfortunately, some prisoners don’t always have the best family dynamics to begin with, if they have family at all.

The family might have more than one incarcerated member who all rely on the same overwhelmed mother. The prisoner might be the disciplinarian of the family, and in his absence the children might run wild over the more passive partner. The abandoned girlfriend might be at home struggling to pay the rent while managing her own addictions.

Regardless of the specific scenario, the correctional facility can become the focal point of the external family’s displaced frustration and anger. Angry family phone calls often get routed to the institutional psychology department. The relative – usually a mother – wants to know why her loved one hasn’t been transferred to another facility or placed in a program or hasn’t had a parole hearing.

These are issues that do not involve the psychology department. Yet the mental health practitioner must allow some time to listen and explain the incarceration process, offering guidance about whom to contact for each issue.

Now, add to these problems the concern about a prisoner who also has a mental illness. What role, if any, does outside family play in the care of a mentally ill prisoner?

Some aspects are similar to free society care: I cannot give out information about the patient without his consent, and prisoners also have a right to be free of involuntary treatment if they are not dangerous. However, family contact in the correctional setting can be even more valuable than in free society care. Family members can be engaged as an ally and partner in the care of mentally ill prisoners. When a family member calls, I immediately thank her for calling and explain ways that she can help me care for her relative. It’s important for her to know that she can provide a great deal of care, even from a distance.

I recommend that she write a letter outlining the patient’s symptoms – particularly ones the patient would be reluctant to reveal or those he might not be aware of – as well as any pertinent early warning signs of relapse. This letter also should document which medicines seem to help, which he definitely had bad reactions to, and ways to relate to the patient so he will be more likely to take his medicines and keep his appointments.

I encourage the relative to contact prison administration to find out what kinds of programs and resources are available at the facility the patient is sent to, and then follow up with that facility’s social work department to coordinate release and aftercare planning. It’s important to keep expectations clear, invite participation, and solicit feedback.

Finally, I ask the family member to stay in touch with the patient and to call the psychology department if she notices anything of concern. During the course of this conversation, it might become clear that the relative is exhausted and overwhelmed, or secretly relieved to be turning over the responsibility of care to someone else. In this case, I tactfully suggest that it would be best for her to care for herself during the incarceration rather than invest energy in a situation beyond her control. This relieves some degree of guilt she might be experiencing, and allows her time to recover from fatigue and frustration.

Incarceration does not mean permanent disruption of family relationships. When managed properly, the time can be used to enhance patient self-reliance and teach proper distance between overly engaged or enmeshed relatives. I know I’ve struck the right level of engagement when I get a family phone call after the patient has been released, asking for referrals or a medication renewal. I enjoy these calls, which to me are a sign that the family has moved from anger and frustration, to hope and rededication. It also means I might never hear from them again, for all the right reasons.

—Annette Hanson, M.D.

DR. HANSON is a forensic psychiatrist and co-author of Shrink Rap: Three Psychiatrists Explain Their Work. The opinions expressed are those of the author only, and do not represent those of any of Dr. Hanson’s employers or consultees, including the Maryland Department of Health and Mental Hygiene or the Maryland Division of Correction.