Prison gangs pose new clinical challenges for correctional psychiatrists

Before I worked in corrections, what I knew about organized crime was limited to reruns of “The Godfather” and later episodes of “The Sopranos.” Little did I know that crime rings would eventually become part of my day-to-day clinical life.

Recently, my local jail was shaken with the news that 25 people, including 13 correctional officers, had been federally indicted as a result of a 2-year-long investigation into corruption within the detention center. Several members of the Black Guerilla Family were charged with drug distribution and money laundering, as well as witness tampering and other offenses, all directed from within the facility. What made the allegations particularly shocking was the fact that the alleged leader also had sexual relations with female correctional officers while incarcerated and impregnated four of them.

While I would like to say that this was a shock to me, the unfortunate truth is that I’ve watched the gradual infiltration of gangs into the state prison system over the last several years. My clinic patients discuss their concerns about gangs and institutional security. Some are former gang members, some gang informants. Most are careful to keep their confidences well circumscribed, talking only about general concerns or issues without ever giving enough detail to trigger a reporting duty and without giving up specific names. They talk about the frustration of being denied jobs on the tier or being the last to get on the phone when these opportunities are controlled by gang members on the unit. They talk about being pressured to hold contraband or transmit messages to and from free society. They talk about being caught in the cross-fire of rivalries and turf issues.

Rarely, they talk about being the target of a gang contract killing. An inmate condemned to death by a gang is one of the most frightened prison patients I’ve ever encountered. He is frightened for himself but also for his family, who might be at risk as well. In this situation, the guilt of incarceration is compounded by the guilt and fear of being unable to protect a loved one.

When an inmate tells me these things, I have to question why they entrust me with this information. Sometimes the reason is simply that they need to tell someone trustworthy who can be counted on to keep a confidence. Sometimes the purpose is to get placed in a housing unit or moved to a facility that he deems safe. Sometimes he wants me to contact a prosecutor or outside investigator who has promised protection or release in return for cooperation.

Rarely, a patient wants the information passed along to command staff without any promise of reward or any gain in return. He wants the information forwarded to prison administration through mental health staff, because this is less likely to be overheard or intercepted by front line tier officers. When a patient wants to turn informant, I talk openly with him about the potential hazards, although he’s usually always thought this through on his own long before our appointment. Once I’m sure he understands the risks and consequences, I will contact the institutional security chief.

Many correctional systems have a designated gang intelligence officer or security threat group who collect information about organized criminal activities within the institution. They will verify the accuracy of an inmate’s information then take appropriate steps to protect that inmate through institutional transfer – either within the system or out of state. If an inmate returns to the system later, they also take appropriate steps to ensure that he is not sent back to a facility where he was known as an actual or suspected informant, or where he was targeted during a previous incarceration.

As state delegates gear up to hold a hearing on jail corruption and the governor plans legislation to crack down on penalties for institutional contraband, I wonder how many of my colleagues may be working with jail or prison patients with gang connections. Knowing what concerns to expect and what advice to give a detained patient may soon become part of the correctional health care training curriculum.

 —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.

Before I worked in corrections, what I knew about organized crime was limited to reruns of “The Godfather” and later episodes of “The Sopranos.” Little did I know that crime rings would eventually become part of my day-to-day clinical life.

Recently, my local jail was shaken with the news that 25 people, including 13 correctional officers, had been federally indicted as a result of a 2-year-long investigation into corruption within the detention center. Several members of the Black Guerilla Family were charged with drug distribution and money laundering, as well as witness tampering and other offenses, all directed from within the facility. What made the allegations particularly shocking was the fact that the alleged leader also had sexual relations with female correctional officers while incarcerated and impregnated four of them.

While I would like to say that this was a shock to me, the unfortunate truth is that I’ve watched the gradual infiltration of gangs into the state prison system over the last several years. My clinic patients discuss their concerns about gangs and institutional security. Some are former gang members, some gang informants. Most are careful to keep their confidences well circumscribed, talking only about general concerns or issues without ever giving enough detail to trigger a reporting duty and without giving up specific names. They talk about the frustration of being denied jobs on the tier or being the last to get on the phone when these opportunities are controlled by gang members on the unit. They talk about being pressured to hold contraband or transmit messages to and from free society. They talk about being caught in the cross-fire of rivalries and turf issues.

Rarely, they talk about being the target of a gang contract killing. An inmate condemned to death by a gang is one of the most frightened prison patients I’ve ever encountered. He is frightened for himself but also for his family, who might be at risk as well. In this situation, the guilt of incarceration is compounded by the guilt and fear of being unable to protect a loved one.

When an inmate tells me these things, I have to question why they entrust me with this information. Sometimes the reason is simply that they need to tell someone trustworthy who can be counted on to keep a confidence. Sometimes the purpose is to get placed in a housing unit or moved to a facility that he deems safe. Sometimes he wants me to contact a prosecutor or outside investigator who has promised protection or release in return for cooperation.

Rarely, a patient wants the information passed along to command staff without any promise of reward or any gain in return. He wants the information forwarded to prison administration through mental health staff, because this is less likely to be overheard or intercepted by front line tier officers. When a patient wants to turn informant, I talk openly with him about the potential hazards, although he’s usually always thought this through on his own long before our appointment. Once I’m sure he understands the risks and consequences, I will contact the institutional security chief.

Many correctional systems have a designated gang intelligence officer or security threat group who collect information about organized criminal activities within the institution. They will verify the accuracy of an inmate’s information then take appropriate steps to protect that inmate through institutional transfer – either within the system or out of state. If an inmate returns to the system later, they also take appropriate steps to ensure that he is not sent back to a facility where he was known as an actual or suspected informant, or where he was targeted during a previous incarceration.

As state delegates gear up to hold a hearing on jail corruption and the governor plans legislation to crack down on penalties for institutional contraband, I wonder how many of my colleagues may be working with jail or prison patients with gang connections. Knowing what concerns to expect and what advice to give a detained patient may soon become part of the correctional health care training curriculum.

 —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.

Before I worked in corrections, what I knew about organized crime was limited to reruns of “The Godfather” and later episodes of “The Sopranos.” Little did I know that crime rings would eventually become part of my day-to-day clinical life.

Recently, my local jail was shaken with the news that 25 people, including 13 correctional officers, had been federally indicted as a result of a 2-year-long investigation into corruption within the detention center. Several members of the Black Guerilla Family were charged with drug distribution and money laundering, as well as witness tampering and other offenses, all directed from within the facility. What made the allegations particularly shocking was the fact that the alleged leader also had sexual relations with female correctional officers while incarcerated and impregnated four of them.

While I would like to say that this was a shock to me, the unfortunate truth is that I’ve watched the gradual infiltration of gangs into the state prison system over the last several years. My clinic patients discuss their concerns about gangs and institutional security. Some are former gang members, some gang informants. Most are careful to keep their confidences well circumscribed, talking only about general concerns or issues without ever giving enough detail to trigger a reporting duty and without giving up specific names. They talk about the frustration of being denied jobs on the tier or being the last to get on the phone when these opportunities are controlled by gang members on the unit. They talk about being pressured to hold contraband or transmit messages to and from free society. They talk about being caught in the cross-fire of rivalries and turf issues.

Rarely, they talk about being the target of a gang contract killing. An inmate condemned to death by a gang is one of the most frightened prison patients I’ve ever encountered. He is frightened for himself but also for his family, who might be at risk as well. In this situation, the guilt of incarceration is compounded by the guilt and fear of being unable to protect a loved one.

When an inmate tells me these things, I have to question why they entrust me with this information. Sometimes the reason is simply that they need to tell someone trustworthy who can be counted on to keep a confidence. Sometimes the purpose is to get placed in a housing unit or moved to a facility that he deems safe. Sometimes he wants me to contact a prosecutor or outside investigator who has promised protection or release in return for cooperation.

Rarely, a patient wants the information passed along to command staff without any promise of reward or any gain in return. He wants the information forwarded to prison administration through mental health staff, because this is less likely to be overheard or intercepted by front line tier officers. When a patient wants to turn informant, I talk openly with him about the potential hazards, although he’s usually always thought this through on his own long before our appointment. Once I’m sure he understands the risks and consequences, I will contact the institutional security chief.

Many correctional systems have a designated gang intelligence officer or security threat group who collect information about organized criminal activities within the institution. They will verify the accuracy of an inmate’s information then take appropriate steps to protect that inmate through institutional transfer – either within the system or out of state. If an inmate returns to the system later, they also take appropriate steps to ensure that he is not sent back to a facility where he was known as an actual or suspected informant, or where he was targeted during a previous incarceration.

As state delegates gear up to hold a hearing on jail corruption and the governor plans legislation to crack down on penalties for institutional contraband, I wonder how many of my colleagues may be working with jail or prison patients with gang connections. Knowing what concerns to expect and what advice to give a detained patient may soon become part of the correctional health care training curriculum.

 —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.