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Home > Uncategorized > Another Pink Elephant?

Another Pink Elephant?

December 20th, 2013

Some subjects are very hard to talk about. These are usually topics that involve addressing painful emotions, struggles and failures, or our personal fragile mortality. These matters are particularly hard to talk about by people who make a living out of projecting an aura of invincibility, power and control. Fragile is the last thing they want to be or appear to be. Of all these difficult subjects perhaps the hardest to address is that of suicide by “one of us.” And of all the professions that may have a difficult time talking about the suicide of “one of us,” corrections professionals are close to the top of the list—especially the security/custody staff.

After all, aren’t corrections professionals the ones who keep everybody in their care safe? Aren’t they the ones who have life and death duties, every day of the week, 24/7? Aren’t they the ones who often intervene in the case of inmate suicide attempts and save offender lives? Aren’t they the ones who keep whole communities safe through their supervision and management of society’s most dangerous?

In the 1980’s, when the literature seemed to explode on the subject of alcohol abuse and other types of family “dysfunctions,” helping professionals fervently highlighted the fact that the substance abusing individual and their family members often denied the issue or tried to rationalize it away. Helping professionals likened this minimizing or denying to having a pink elephant sprawled in the middle of the living room floor, with no one in the family acknowledging the presence of the beast. Instead of exclaiming, “What’s going on here? There’s this huge pink elephant in our living room!!!” they would figuratively continue to gingerly step around the animal, perhaps for years, acting like it did not exist. Not mentioning it, not commenting on it, not confronting it.

In some correctional settings a similar situation seems to be happening. In this case the pink elephant is staff suicide. The numbers indicate that there is truly an epidemic of suicides among corrections professionals, but very, very few are talking about this, and even fewer are doing something to proactively address the issue.

There are probably many reasons for this silence. It is hard for this tough group of “in control” individuals to admit that they have limits and that they too can break when pressures get bad enough. Many of them may also not know how to even begin to fix the problem, and so they opt to avoid it altogether. (It is easier to attribute the staff suicide to “weakness,” and move on, without exploring possible underlying issues.) And some may think that staff suicide has been going on for so long, that there is nothing that can be done about it anyway. For all these reasons, and probably many more, we continue to silently step around the pink elephant in the corrections living room.

Addressing the subject of corrections staff suicide involves facing and acknowledging some hard realities regarding corrections work. This requires tremendous integrity and courage.

In the general population the average suicide rate for the year 2010—the latest year for which national statistics are available—was 12.4 completed suicides per 100,000 persons (American Society of Suicidology, 2012). (Suicide rates are reported in terms of number of occurrences per 100,000, as—thankfully—suicide is a very rare event.) When examined by State, the highest reported rate was 23.2 per 100,000, for the State of Wyoming, and this is considered to be alarmingly high—almost twice the national rate.

A New Jersey study of active duty law enforcement professionals found that for male police officers the suicide rate was 15.1 per 100,000, and for adult males of the same age range (25 to 64 years old) in the general population the suicide rate was 14.0 per 100,000. For male Corrections Officers, however, the suicide rate was 34.8 per 100,000, more than twice that of the police officers and two-and-a-half times higher than that of the general population!

When an agency reports that they have a certain number of staff suicides per year, that number may appear small and negligible, as it is usually less than 5 staff suicides annually (unless the agency’s workforce is very large.) However, when the proportion is considered—the number of completed staff suicides com-pared to the total number of employees of that agency—the real impact and risk for suicide for that population becomes apparent.

For example, when a Department of Corrections with a workforce of 5,200 employees has five suicides in one year (which is an actual case), this translates to 96.2 suicides per 100,000. Yes, 96.2 per 100,000, compared to the average of 12.4 per 100,000 for the U.S. general population. This is the stuff of nightmares for behavioral scientists and behavioral health providers. Even three corrections staff suicides in one year out of 5,200 corrections employees translates to 57.7 suicides per 100,000—again frighteningly high compared to the general population.

Moreover, these numbers do not reflect suicide rates of retired staff for that agency. It has been our experience over the years that these rates are high as well, as we periodically receive information about retiree suicides.

What might contribute to these horrific suicide rates in the corrections profession? Could it be that corrections agencies inadvertently or selectively hire individuals predisposed to mental health struggles that may culminate in suicide? Upon reflection, this possibility does not seem very logical or likely.

Or might it be that the corrections work environment causes or contributes to a gradual erosion of staff’s well-being to the point that suicide becomes an acceptable option to them?

The latter seems to be a much more probable alternative, and there is substantial research evidence that supports this notion.

One recent study (Bierie, 2012) reported that a prison work environment of noise, clutter, dilapidation, lack of inmate privacy and lack of cleanliness contributed to increased substance use, increased sick days, and physical symptoms (e.g., recurring headaches, poor sleep, digestive problems) and psychological symptoms (e.g., feelings of anger, depression, worry) in corrections staff.

In an Australian study, corrections officers serving in high-stress and social-isolation posts were found to have increased negative emotions and outlook the longer they worked at these posts (Dollard and Winefield, 1998).

A Canadian study reported a 26% Post-traumatic Stress Disorder (PTSD) rate for corrections officers (Stadnyk, 2003).

A French study (David et al., 1996) determined that 24.0% of corrections staff of several disciplines met criteria for depression.

DWCO’s 2011 Initiative found that, for a nationwide U.S. sample of corrections professionals, 27% met criteria for PTSD (Spinaris, Denhof & Kellaway, 2012), and 26% met criteria for Depression (Denhof & Spinaris, 2013)—both of which are very high compared to other high-risk professions and the general population (Perrin, et al., 2007; US Centers for Disease Control and Prevention, 2010). Occurrence of both of these conditions increased with workplace exposure to incidents of violence, injury or death. Even more disturbingly, 17% of the DWCO Initiative sample was found to suffer from both PTSD and Depression at the same time. This is a highly significant finding in relation to staff suicide concerns, because the co-occurrence of PTSD and Depression has been repeatedly found to significantly increase suicide risk (Pietzrack, et al., 2011; Sareen, et al., 2007).

Could it be, therefore, that the high suicide rate among corrections professionals is fueled by undiagnosed and untreated occupationally-related PTSD and Depression, often coupled with substance abuse? These, and perhaps other disorders as well, may arise for the first time as a result of employment or they may have existed prior to corrections work and made worse due to high-trauma and other high-stress work conditions.

The evidence suggests that this is a likely explanation of the suicide epidemic among corrections staff.

So what should our response be to these realities?

As with every tough occupational subject, we need to start by acknowledging the problem at the highest executive levels. This must be followed with long-term committed conversations and studies that seek to explore causes and solutions for the issue. Engaging in this endeavor requires inspired leadership vision for the future of corrections as a profession. It takes courage and the tenacity to go against the status quo (a resigned stance that says, “This is the way it’s always been in corrections, and we can’t change it”). It also takes the courage, caring and tenacity to go against the system-wide denial that oftentimes characterizes corrections professionals of all ranks. In other words, it takes no longer tolerating or ignoring realities and conditions that would be deemed intolerable to most other professions and populations.

Courageous leaders acknowledge, without judgment, that the challenges they themselves and their executive colleagues may have faced (and apparently overcome) during the course of their careers are still present in the work environment for others.

Leaders are taught to believe that the health of the working environment is their duty to maintain, as it’s “on their watch,” as the saying goes. Therefore, when evidence indicates that the environment still contains chal-lenges which prove to be too much for some to overcome, some leaders might take this as a criticism of their lead-ership effectiveness, when in fact it is not.

The reality is that the profession’s numerous challenges constitute inescapable occupational hazards. It is the unsuccessful or unhealthy individual and collective adaptation to those unavoidable and recurring challenges that create corrections staff’s funerals and memorial services. Acknowledging the inherent difficulties, without pointing fingers, by noting that they are real and impactful and “the nature of the beast,” helps leadership to validate and maintain the committed conversations that follow: “It’s not just you. It’s not just our agency, office or facility. It’s the job. And we’re all in it together. So let’s do our best to try to make it better and safer for us all.” Those conversations can then focus on training on, instituting and providing for healthy adaptations to these challenges at both the individual and the organizational levels. In other words, the aim needs to become one of identifying and making possible the implementation of healthy tools for overcoming the challenges in a way that keeps body, mind, spirit, work teams and families together.

Appearances can be deceiving, and the appearance by “macho” corrections professionals of adapting successfully to difficult work environments may be the most deceiving of all. Corrections staff make their living by convincing others that they are in control at all times, which is a necessary part of the job if those around them are to remain safe. Corrections staff also know that their employers have their retirement and their family’s finances in their hands. And so the last thing they would want to show to their supervisors or administrators is the depth of the difficulty they may be experiencing adapting well to the challenges of the job. Appearing to be in control at all times allows them to continue to come to work day after day without drawing negative attention to themselves. In actuality though, they may be one of the walking wounded.

They may be grinding along on the power of unhealthy and even toxic coping strategies until, for whatever reason, they sadly decide that life just got to be too much and they opt to end it suddenly (hopefully without harming someone else first).

We at Desert Waters believe that the corrections profession now has enough information and tools on hand to begin implementing changes and providing training and relevant resources to corrections employees regarding the maintenance of their well-being and the health of the organization.

In the case of an actual staff suicide, the subject needs to be addressed with the surviving coworkers respectfully, compassionately and non-judgmentally—but also head-on, without being vague or indirect. We need to acknowledge the fact that even the toughest of the tough can break when their load gets heavy enough and/or when a staff member’s constitution gets undermined to the point where even a relatively light load causes their knees to buckle. The proverbial last straw that breaks the camel’s back accurately illustrates this concept. It has been our experience over the years that corrections staff relate to that metaphor only too well—hence our proposed term “Corrections Fatigue” and its analogy to the phenomenon of metal fatigue.

Regarding corrections staff suicide, we need to start somewhere and we need to start NOW. We need to continue designing data-driven methods to “vaccinate” staff against the suicide “virus” and whatever feeds it through the teaching of effective coping strategies and through effective workplace climate interventions— coupled with the provision of ample and affordable resources. More specifically, the impact of repeated exposure of corrections staff to psychological trauma on the job, whether directly or indirectly, must be at the forefront of discussions and interventions, as we know that it contributes to staff’s psychological undoing (Denhof & Spinaris, 2013).

We also need to train staff to handle and intervene safely and compassionately in the case of distraught coworkers. And we need to have appropriate protocols in place regarding postvention—handling the issue of a completed staff suicide and communicating to staff about it. Doing so effectively can provide healing closure to coworkers as well as an opportunity for a powerful pitch for the importance of staff wellness and the promotion of mental health. Staff are usually listening at that point. A coworker’s suicide allows for a breach in their walls of denial, even if briefly, as staff’s defenses go temporarily down when they are faced with the undeniable reality of the frailty of one of their own.

Not doing anything significant to target staff wellness from an occupational standpoint, in spite of the mounting evidence of the dire need for such interventions, could be perceived as deliberate indifference—which is certainly not the intent.

So let’s acknowledge the pink elephant in the corrections living room and begin to take the necessary steps to get it safely transported out of the house.

As C.P. Sennett has said, “If nothing changes, then nothing changes.”

And we are in desperate need for POSITIVE and PROACTIVE CHANGE regarding corrections staff wellness, including suicide prevention.

References

American Society of Suicidology (2012). U.S.A. Suicide: Official Final 2010 Data. Available at: http://www.suicidology.org/c/document_library/get_file?folderId=262&name=DLFE-636.pdf.

David, S., Landre, M.F., Goldberg, M., Dassa, S., & Fuhrer, R. (1996). Work Conditions and Mental Health among Prison Staff in France. Scandinavian Journal of Work Environmental Health, 22, 45-54.

Denhof, M.D., & Spinaris, C.G. (2013a). Depression, PTSD, and Comorbidity in United States Corrections Professionals: Impact on Health and Functioning. Available at: http://desertwaters.com/wp-content/uploads/2013/06/Comorbidity_Study_6-18-13.pdf

Dollard, M.F. & Winefield, A. H. (1998). A test of the demand-control/support model of work stress in corrections officers. Journal of Occupational Health Psychology, 3, 243-264.

New Jersey Police Suicide Task Force Report. (2009). Available at: http://www.state.nj.us/lps/library/NJPoliceSuicideTaskForceReport-January-30-2009-Final(r2.3.09).pdf.

Perrin, M.A., DiGrande, L., Wheeler, K., Thorpe, L., Farfel, M. & Brackbill, R. (2007). Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. American Journal of Psychiatry, 164, 1385-1394.

Pietrzak, R.H., Goldstein, R.B., Southwick, S.M., & Grant, B.F. (2011). Prevalence and Axis I Comorbidity of Full and Partial Posttraumatic Stress Disorder in the United States: Results from Wave 2 of the National Epidemiologic Survey on Alcohol and Re-lated Conditions. Journal of Anxiety Disorders, 25, 456-465.

Sareen, J., Cox, B. J., Stein, M. B., Afifi, T .O, Fleet, C., & Asmundson, G. J. G. (2007). Physical and Mental Comorbidity, Disability, and Suicidal Behavior Associated with Posttraumatic Stress Disorder in a Large Community Sample. Psychosomatic Medicine, 69, 242–248.

Spinaris, C.G., Denhof, M.D., & Kellaway, J.A. (2012). Posttraumatic Stress Disorder in United States Corrections Professionals: Prevalence and Impact on Health and Functioning. Available at: http://desertwaters.com/wp-content/uploads/2013/09/PTSD_Prev_in_Corrections_09-03-131.pdf.

Stadnyk, B.L. (2003). PTSD in corrections employees in Saskatchewan. Available at: http://rpnascom.jumpstartdev.com/sites/default/files/PTSDInCorrections.pdf.

United States Centers for Disease Control and Prevention (US-CDC). (2010). Current Depression Among Adults—United States, 2006 and 2008 Morbidity and Mortality Weekly Report, October 1, 2010 Erratum. Available at: http://www.cdc.gov/features/dsdepression/revised_table_estimates_for_depression_mmwr_erratum_feb-2011.pdf.

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