My first appointment of the morning was an intake interview with a new arrival.  Initial interviews take at least an hour, and they always involve a lot of paperwork, including the treatment plan.  One section of the treatment plan involves listing the patient’s current “strengths and needs.”  When we got to that part of the interview, I asked the patient to tell me what he considered his strengths.

“I’m not sure,” he said.  He sat there and I let him think about it for a minute.  He looked at me helplessly.  “I don’t know.”

“Okay,” I said.  “That’s okay.  We can come back to that part later.”

I moved on to the rest of the form and then got to the Suicide Risk Evaluation.  I went through the questions with Mr. M until I got to the part where I had to assess whether he had any current suicidal thoughts, intent, or plans.

“Basically,” I said, “are you having any thoughts or plans to end your life, right now, today?”  When conducting a suicide risk assessment, you don’t leave any room for vague answers.  You have to be blunt and direct.

I looked up from the form and saw that he was taken aback, almost affronted.

“No!” he said.  “I love me.  I wouldn’t hurt me.”

“Well, there you go,” I said.  “I think we found one of your strengths.”

One of the better things about my job is working with inmate-patients consistently for a couple of years and seeing them make progress and develop insight and change and grow emotionally.

Back in 2013, a young new arrival was assigned to my caseload.  He had been on parole and was back in prison on a new term.  He was twenty-four years old and struggling with a lot of emotional issues.  He had a lot of unresolved anger, and his primary coping skill was substance abuse.  The combination of being pissed off at his girlfriend while drunk led to his offense and arrest.

At first, he had a hard time sharing anything personal with me because he thought that would be a sign of weakness and vulnerability.  So when I saw him for his first few appointments, our conversations were short and superficial—nothing more than case management.  Eventually, he began to feel more comfortable talking to me and confessed that he felt nervous and scared about being released into the community.  He was constantly worried that he would mess up somehow and wind up back in prison, or that he would do something violent while still in prison so that he’d receive more time added to his existing sentence.

Once he was honest with his feelings, I was able to really start working with him on a deeper, more therapeutic level.  I referred him to treatment groups for additional opportunities for psychoeducation and guidance.  Gradually, he stopped being so anxious and started feeling more confident about himself and his ability to succeed.

Today was his last appointment with me.  His release date is Monday the 11^th, my day off.  When he came in to see me this afternoon, I asked him how he was doing.

“I’m feeling excited this time,” he said.  “I don’t have to come back unless I want to come back.”

At work, I carry a Personal Alarm Device (PAD) that will activate a loud alarm and flashing blue lights in our building, should I feel the need to push the button and alert officers that I need immediate assistance.  Once (in my first year of working at the prison) I accidentally pushed the button, and about eleven officers came running down the corridor to make sure I was okay.

Usually, I keep the PAD in my coat pocket and take it everywhere I go.  Today as I was crossing the plaza for my afternoon break, I put my hand in my pocket and accidentally bumped the PAD out, where it promptly fell to the ground.

Later, when I returned to the mental health building from my walk, I told the on-duty sergeant that I’d dropped my PAD in the plaza and I was afraid that I might have broken it.  “Can we test it?” I asked.  “To make sure it still works?”

This particular sergeant happened to be a buddy of mine who has spoken frankly with me on previous occasions regarding prison- and inmate-related issues.  Today was no exception.

“When you dropped your alarm,” he said, “and there were inmates in the plaza.  How did you pick it up?”

I knew what he was getting at.  “Don’t worry,” I said.  “Like this.”  I demonstrated by leaning over to the side with bent knees and carefully picking up an imaginary PAD.  After all, I’m not stupid.

There is an art to not flashing your rear end in prison.