By Melisa Friel, M.S. (CHES)
Alison Perry, LICSW
Alison Perry is a Licensed Independent Clinical Social Worker (LICSW) with over 15 years of correctional experience. Alison began her career in corrections working as a Mental Health Clinician in the Massachusetts Department of Corrections (MADOC). She worked in multiple MADOC facilities and joined the CPS team in 2012 as a Mental Health Clinician. Throughout her career at CPS, Alison has held titles of Mental Health Director, Regional Mental Health Director, and most recently Director of Behavioral Health Services. In these roles, Alison was responsible for the administration, management, and delivery of mental health services within a correctional environment that meets NCCHC/ACA standards.
In this interview, Alison tells us what it’s like to work as a mental health clinician in correctional setting, how she got interested in this field and why after 15 years, she still loves what she does. She will also share 5 important things anyone interested in working in correctional mental health should know.
Can you tell us a little bit about how you started working in correctional mental health? Back in the day when you were a student, what made you and think about doing this type of work?
Sure, so, I completed my undergraduate degrees and worked in a community setting group home for a couple years. I remember seeing a lot of residents who had been to the state hospital and had evaluations and work you know involved in the legal system but also had major mental illness. Fast forward to getting my master’s and, I continued to remain curious about how so many individuals with mental health issues were involved in the legal system and how much overlap there was.
Did you have an idea of what it would be like to work at a correctional facility?
I hadn't had experience being in a jail or prison before so, it was very new which was a little scary, but also exciting at the same time. I was lucky enough to have my first-year internship at the men's state prison at MCI Norfolk which was an incredible experience.
The team that chose me as the intern felt like I would be a good fit there. They really supported me and made me feel part of the team, so I really did feel safe. They took the time to explain things to me and never sort of left me by myself or feeling like I was on an island by myself to do everything. Having such a positive first experience was what led me to this 15+ year trajectory at this point, which I'm grateful for.
#1 You’re part of a larger team that’s always there for you.
You mentioned something important, you are not alone doing this type of work. When you work in corrections, you have a team to train you and support you. Is that something a new clinician can expect going into this field?
Absolutely. So, working in corrections, you really are not only part of the mental health team, but you’re also part of the health care team and correctional system team in general so everybody's trying to work together for that safety, security, and treatment for individuals with mental health issues that just happened to be incarcerated.
I think that one of the really positive aspects of being a correctional clinician is having a mental health clinical team. You never feel like you must make a clinical decision on your own. Of course, you do have the ability to exercise autonomy with your license and make treatment decisions but, for higher profile cases or high-risk cases, you always have that support of the team to fall back on.
If you're feeling challenged or not quite sure diagnostically of what you're seeing you can always ask another clinician buddy to assist you. There's always another set of eyes that can take a look at a patient. You never feel alone or unsure of what to do next. I think that's a real strength the team dynamic that that is found in Corrections.
I think that's so important, and it might be a little bit different than working in the community setting in terms of how that support is so immediate and accessible.
Right, absolutely. It helps in so many ways. For example, you don’t have to deal with people showing up late to appointments because security is there to help facilitate. You also have an opportunity to have daily triage meetings, although that might vary from site to site, that's generally the best practice that we found where all the clinicians get together. Not only can you hear other people's feedback, but also bring something to the team. This is such an integral part of a successful mental health system in the facility for sure.
#2 You can truly focus on clinical work instead of paperwork and billing
What do you think is one of the biggest differences between doing mental health work in the community versus corrections?
Great question. I think about a lot about that and, I think this difference has kept me in corrections for so long is that we really focus on the diagnostic criteria and clinical work. We don't have to build third party payers you know we're not right sort of functioning under that insurance umbrella of managed care. We really stick to the diagnostics and are really focused on finding an accurate diagnosis. You can focus on the differential, you know, what is this person presenting with? Is it an adjustment disorder? Is it a combination of detox symptoms? Are they experiencing post-acute withdrawal syndrome? Are there personality traits that we're seeing in the clinical picture?
So, you can really have the opportunity to tease out for somebody what's happening without having to over pathologize it, just to be able to see them. So often in managed care in the community you see somebody for one or two sessions and right away, they want that diagnosis on the paper in order to bill and so you can provide this service to them. I see that’s an ethical dilemma that many clinicians face in the community but, I don't feel like I experienced that ethical dilemma in corrections because regardless of the diagnosis, I can still see that patient and provide assessment and treatment.
So, your focus is truly clinical, and you concentrate on what you want to be doing as opposed to dealing with insurance billing paperwork and the restrictions associated with managed care.
Absolutely.
# 3 You have a wealth of collateral information to provide the right care
Another layer to that is because these individuals are incarcerated, we monitor them 24/7. If a patient is telling me that they're eating their meals, going outside to recreation but they're presenting as profoundly depressed to me and I'm concerned about them, I can call the unit officer. Without disclosing any protected health information about this patient I can ask the officer: “Hey how is this individual functioning on the unit, what do you see them doing?”. They might tell me something different than the patient would. They might say, “Oh, he's in bed all day, he doesn't go to his meals, he doesn't go to recreation”.
So, getting that collateral information is so valuable when I determine what clinically is happening and, you might not have that opportunity to get that collateral information working with somebody in the community. In that sense, I feel that we can provide some enhanced mental health treatment and maybe pick up on subtleties that that we might miss in the community. I think ultimately, this means providing better care.
# 4 You hone one of the most difficult clinical skills: Differential diagnosis
What's one clinical skill that you feel like you've really mastered working working in a correctional setting that maybe you wouldn't have gained in a community setting?
Good question. It's hard to pick just one. I will say that my differential diagnosis skills have really improved. As a clinician, I think that's one of the most important parts of doing your work, being able to tease out the presenting concerns or concerns.
Another clinically interesting part about working corrections is that the population you're faced with often has personality disorders, or strong personality disorder traits that interfere with their functioning, so you really get to tease out what is happening. It really allows you to see the difference between somebody who might be faking psychosis versus an actual psychosis patient. You really can see that stark contrast when you know you're able to have those two experiences side-by-side.
I imagine also too with the substance use sometimes individuals can present with some symptoms that seem to mimic a psychotic disorder and you have to figure out what the right diagnosis is.
Absolutely. We work really closely with the medical team for that reason. To examine a detox related presentation, I might refer somebody to the medical staff and say, “Hey can you check this patient? They didn't report that they were detoxing upon admission but the symptoms they're presenting with now appear like a delayed detox.”
The ability to treat the patient for what you're seeing in that moment and to appropriately respond to what the clinical presentation is in that moment, is a really great part about corrections. It’s something that allows us to provide that person centered treatment.
#5 Corrections provides a clinically rich environment for mental health clinicians.
I imagine that for clinicians who want to focus on honing their diagnostic skills, this is a great environment to do so. Would you agree? Could you tell us if you see a wide range of symptoms and needs in correctional settings?
I would say working in corrections is by far the most clinically rich environment I have personally ever worked in, and I have spent some time as an emergency service provider working in emergency departments, also in the community and, as I mentioned in the group home with individuals with major mental illness and as well as outpatient therapy.
There are so many layers to people becoming incarcerated. Sometimes they end up in jail because things in their life were going poorly and this is kind of the last stop. Or, you could have a case where an individual has never been in trouble in their life but substance abuse got out of control and then let them make a decision that got them in legal trouble. So, there's such a wide range of individuals with different presenting problems.
Do you have any advice for those considering a career in correctional mental health?
Sure. If your local jail or prison has an internship opportunity and you're starting out, definitely explore that option. I think that's the best way to experience it without having to commit to a more formal job or a role. If there's one thing I can guarantee, is that you will increase your clinical knowledge and expertise 100%, even if you’re just starting out.
Does CPS have any internships available?
Absolutely. We do partner with Bridgewater State College, Boston College, Boston University and, we also have individuals from William James college and the PHP program.
What kind of degree or license would someone need to work in correctional mental health?
As far as licensure goes you can start as an intern with a master’s in social work, mental health counseling or a similar field but be on a licensure track [e.g., LICSW and LMHC]. Pursuing that licensure track is always what we're seeking so that people can work independently and gain that experience and continue to grow.
Are you interested in becoming a correctional mental health clinician?
If you are in New England and want to learn more about our internships, please contact Aimee Stock, our Recruitment and Internship Coordinator at astock@cpsmh.org
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