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Correctional Officer Mental Health Training: Analysis of 52 U.S. Jurisdictions



Research indicates correctional officer (CO) mental health training may be effective in facilitating the safety and security of both inmates and COs. We assessed Department of Corrections’ CO preservice (requisite for beginning an official post) mental health training requirements in 50 states, the District of Columbia, and the Federal Bureau of Prisons. We obtained information regarding instruction method, training duration, and courses required. Descriptive statistics showed that all jurisdictions require mental health training, ranging from 1.5 to 80 hr (M = 13.54, SD = 14.58, Mdn = 8). When considering course titles, the most common course topic is crisis intervention (n = 44, 84.62%). The next most frequent course topics are general psychoeducation (n = 24, 46.15%), special populations (n = 12, 23.08%), specific clinical interventions (n = 7, 13.46%), institutional procedure specific to mental health (n = 6, 11.54%), and CO mental health and self-care (n = 4, 7.69%). Future research should examine whether CO mental health training is related to positive mental health outcomes and other important institutional metrics, as well as variations in training and its impact at the national and international levels.
Criminal Justice Policy Review
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© The Author(s) 2019
Article reuse guidelines:
DOI: 10.1177/0887403419849624
Correctional Officer Mental
Health Training: Analysis of
52 U.S. Jurisdictions
Lauren E. Kois1, Kortney Hill2, Lauren Gonzales3,
Shelby Hunter1, and Preeti Chauhan2,4
Research indicates correctional officer (CO) mental health training may be effective
in facilitating the safety and security of both inmates and COs. We assessed
Department of Corrections’ CO preservice (requisite for beginning an official post)
mental health training requirements in 50 states, the District of Columbia, and the
Federal Bureau of Prisons. We obtained information regarding instruction method,
training duration, and courses required. Descriptive statistics showed that all
jurisdictions require mental health training, ranging from 1.5 to 80 hr (M = 13.54,
SD = 14.58, Mdn = 8). When considering course titles, the most common course
topic is crisis intervention (n = 44, 84.62%). The next most frequent course topics
are general psychoeducation (n = 24, 46.15%), special populations (n = 12, 23.08%),
specific clinical interventions (n = 7, 13.46%), institutional procedure specific to
mental health (n = 6, 11.54%), and CO mental health and self-care (n = 4, 7.69%).
Future research should examine whether CO mental health training is related to
positive mental health outcomes and other important institutional metrics, as well
as variations in training and its impact at the national and international levels.
mental health training, mental illness, offenders, correctional officers
1The University of Alabama, Tuscaloosa, AL, USA
2John Jay College, City University of New York, NY, USA
3Adelphi University, Garden City, NY, USA
4The Graduate Center, City University of New York, NY, USA
Corresponding Author:
Lauren E. Kois, The University of Alabama, Box 87034, Tuscaloosa, AL 35487, USA.
849624CJPXXX10.1177/0887403419849624Criminal Justice Policy ReviewKois et al.
2 Criminal Justice Policy Review 00(0)
The United States has the highest population of incarcerated individuals in the world
(Carson & Anderson, 2017), and research suggests that mental health is a major con-
cern within incarceration settings. Compared with the general population, individuals
in jails and prisons report disproportionately high levels of serious psychological dis-
tress (Bronson & Berzofsky, 2017) and are more likely to meet criteria for major
psychiatric disorders (Steadman, Osher, Robbins, Case, & Samuels, 2009). Although
this imbalance is well documented, we know little about how correctional officers
(COs)—those on the “front lines” in incarceration settings—are trained to work with
incarcerated individuals with mental illnesses (IMI). To address this research gap, we
examined required preservice mental health training for COs (i.e., training requisite
prior to beginning an official post) for all 50 U.S. states, the District of Columbia, and
the Federal Bureau of Prisons.
Mental Illness in Incarceration Settings
Some research exists on the prevalence of mental health problems among individuals
who are incarcerated. James and Glaze’s (2006) report on those incarcerated by U.S.
state and federal correctional facilities revealed that about 14% in federal prisons, 20%
in local jails, and 34% in state prisons endorsed mental health problems (diagnosed by
a professional, hospitalized for psychiatric reasons, prescribed medication, and/or
received professional psychotherapy) in the past year. In Maryland and New York
State, Steadman et al. (2009) attended specifically to gender differences and found that
15% of males and 31% of females who were incarcerated met criteria for at least one
severe mental illness—such as major depressive disorder, bipolar disorder, schizoaf-
fective disorder, or schizophrenia. Another study found that about 35% of individuals
in jails met criteria for co-occurring mental health and substance use disorders (Sung,
Mellow, & Mahoney, 2010). More recently, research found that about 14% of indi-
viduals incarcerated in state and federal prisons and 26% of individuals incarcerated in
jails experienced serious psychological distress (as measured per Kessler et al.’s
(2003) measure) within 30 days preceding a clinical interview (Bronson & Berzofsky,
2017). These results underscore that individuals incarcerated in the United States have
higher rates of serious mental health problems than the general public.
Research suggests that once incarcerated, individuals often lack access to critical
mental health services. Slightly more than a decade ago, a survey found that among 134
jails across 39 states, only 40% contained special purpose mental health units (Ruddell,
2006). IMI can experience greater difficulty adjusting to incarceration and commit
more infractions than incarcerated individuals without mental illnesses (Appelbaum,
Hickey, & Packer, 2001). As noted by Adams and Ferrandino (2008), infractions for
IMI often lead to punitive measures such as physical restraint and secure housing,
which may exacerbate anxiety, depression, anger, cognitive disturbances, perceptual
distortions, obsessive thoughts, paranoia, and psychosis. Furthermore, this increase in
the number of disciplinary incidents may contribute to longer lengths of stay, including
being less likely to earn early release, probation, or parole and serving an average of 12
months longer than incarcerated individuals without mental illnesses (see Amrhein &
Kois et al. 3
Barber-Rioja, 2010). Among a sample of individuals incarcerated in New York City and
placed in solitary confinement, Kaba et al. (2014) found that approximately half
engaged in self-harm behavior. Within this group, half engaged in potentially lethal
self-harm behavior.
Mental Health Training of COs
COs are considered integral to the safety and security of jails and prisons. In one study,
COs reported that compared to specialized mental health staff, they have more respon-
sibility in monitoring and correcting inmate behavior (Antonio, Young, & Wingeard,
2009). COs most frequently interact with IMI (Haney, 2003; Lavoie, Connolly, &
Roesch, 2006) and play key roles in monitoring and informing medical and adminis-
trative staff of symptom exacerbation or inappropriate behavior, as well as de-escalat-
ing crisis situations (Appelbaum et al., 2001; Dvoskin & Spiers, 2004). Crichton and
Ricciardelli (2016) found Canadian COs prefer to avoid force by using communica-
tion to de-escalate crises, when possible. These duties do not go unnoticed. In a study
that surveyed jail administrators regarding the most effective interventions for work-
ing with IMI, training COs in mental health ranked third in effectiveness following
initial admission intakes and suicide risk screenings (Ruddell, 2006).
Pompili et al. (2009) conducted a literature review of best practices for preventing
suicides in prisons and jails and identified successful strategies derived from inpatient
psychiatric units. These include ongoing training programs, development of thorough
screening and documentation procedures, encouraging communication between staff,
and debriefing staff following inmate suicide. They advocated for training programs
on suicide and for COs to learn to attend to signs of suicidal ideation or intent, such as
how to conduct brief mental health checks during critical periods (e.g., sentencing,
incident reports, family visits, active psychiatric symptoms).
In a Canadian study, COs reported that IMI require more attention, more discretion,
and a different approach to management than incarcerated individuals without mental
illnesses, frequently due to IMI’s difficulty in understanding or adhering to institu-
tional routines (Lavoie et al., 2006). Furthermore, 81% of COs reported IMI added
stress to their job, 80% did not feel prepared to manage IMI, and 90% felt the need for
more mental health training. Despite the high rate of contact and added stress reported,
fewer than half of the sample reported receiving mental health training. Building
research shows that COs themselves may be at higher risk of symptoms of mental
disorder, particularly those that are anxiety-related, than the general public and other
public safety personnel (Carleton et al., 2018a; Carleton et al., 2018b). Potentially,
providing COs with additional training could reduce stress on the job and subsequently
reduce the risk of CO mental disorder.
Although COs in Lavoie and colleagues’ (2006) study reported viewing IMI more
positively and indicated the need for additional mental health training, other research
has found that COs are not as interested in IMI treatment (Lambert & Hogan, 2009).
This suggests that there are potentially wide-ranging views among COs regarding their
role in mental health treatment and management. Stigma reduction in incarceration
4 Criminal Justice Policy Review 00(0)
settings is an important endeavor, as IMI face the double stigma combination of men-
tal illness and offender (see West, Yanos, & Mulay, 2014).
Regardless, the current literature suggests that mental health training has potential
benefits for reductions in CO stress and IMI distress, and consequently reductions in
infractions and punitive measures. Thus, mental health training can potentially increase
the safety and security of both IMI and staff. In civil psychiatric contexts, for example,
staff training in crisis de-escalation (using a detailed training manual, training video,
and in-person 1-day training) along with the implementation of patient-generated
advanced psychiatric directives was associated with an almost 99% decrease in physi-
cal restraint of patients (Jonikas, Cook, Rosen, Laris, & Kim, 2004).
Some researchers studied CO mental health training implementation in various
settings. Following a basic 2-hr training program on correctional treatment pro-
grams and operant behavioral principles (modeling and correcting inmate behavior;
Antonio et al., 2009), state facility COs in Pennsylvania reported that it benefited
their understanding of treatment concepts. Pan, Deng, Chang, and Jiang (2011)
instructed COs on conflict resolution (solution-focused approach [SFA]) with indi-
viduals who are incarcerated in Taiwan. Training emphasized the strengths (as
opposed to vulnerabilities and dysfunction) of individuals who are incarcerated and
instructed COs to encourage individuals who are incarcerated to adopt problem-
solving skills. About 90% of their CO sample found SFA training helpful, and 93%
believed SFA should be implemented to create behavioral change among individu-
als who are incarcerated. At 2-month follow-up, COs reported that SFA techniques
were moderately difficult to implement but were important nonetheless. A limitation
of this research is that it only looked at COs’ perceptions of training, without assess-
ing training impact on correctional mental health or administrative outcomes (e.g.,
symptomatology, number of infractions, physical restraints).
Researchers have not yet conducted randomized controlled trials of CO mental
health training. However, the sole quasi-experimental study, adopting a pre–post
design, showed promising results. Parker (2009) conducted an effectiveness study of
CO mental health training in a special housing unit. The training intervention was
developed and delivered by the National Alliance on Mental Illness (NAMI) Indiana
chapter. NAMI is the largest grassroots mental health organization in the nation help-
ing to educate the community, advocate on behalf of IMI, and provide resource sup-
port for those who live with a mental illness (NAMI, n.d.). The organization includes
IMI, their families, advocates, and mental health professionals. The training consisted
of 2-hr sessions over five 2-hr consecutive weeks. Course content included the biology
of mental illness, psychiatric symptoms, treatment of mental illness, and how to effec-
tively interact with IMI. Nine months after the COs completed the training, Parker
compared pre- and post-training frequency of use of force and assaults by bodily waste
by inmates. Findings indicated that COs’ use of force decreased by 55% and the num-
ber of assaults by bodily waste by inmates decreased by 29%. Given that the unit
housed individuals with and without mental illness, findings may not generalize to all
incarcerated samples. Still, the ability for mental health training to decrease use of
force and assaults in general is important and encouraging.
Kois et al. 5
Although there is scant research on CO mental health training, we can look to com-
munity law enforcement research to examine the effects of mental health training on
meaningful metrics, such as reducing punitive encounters, referring individuals in cri-
sis to mental health services, enhancing procedural justice perceptions, and increasing
officer understanding of mental illness while reducing mental health stigma. Crisis
Intervention Team (CIT) training has demonstrated success along these outcomes. The
primary purpose of CIT training was to instruct law enforcement on how to navigate
situations with persons in emotional distress. Typically, CIT trainings involve 40 or
more hours of in vivo mental health and crisis training, including role-play and in-the-
moment feedback from trained instructors (Tucker, Mendez, Browning, Van Hasselt,
& Palmer, 2012). Pearce and Snortum (1983) conducted one of the first CIT studies,
considering whether police officer CIT training affects disturbance calls. CIT-trained
officers reported fewer arrests, in that they believed they were able to de-escalate cri-
ses without arrest intervention. The researchers were able to contact 16 individuals
who placed the disturbance calls to assess their satisfaction with the officer response.
Relative to officers who did not receive CIT training, those who did were more often
described as calm, reassuring, and competent in managing the crisis. Other research
indicated CIT-trained officers were more likely to link individuals in crisis with mental
health services, whereas those without CIT training were more likely to take these
individuals into custody (Teller, Munetz, Gil, & Ritter, 2006; Watson et al., 2010).
Ellis (2014) found that CIT training can lead to a significant increase in law enforce-
ment officers’ knowledge of mental illness.
In addition to decreasing problematic outcomes, officers in Ellis’ (2014) CIT study
reported increased comfort interacting with IMI, as well as more positive attitudes
toward this group. More recent research shows that CIT training can reduce stigmatiz-
ing attitudes toward mental illness across diverse settings (Strassle, 2019). Tucker
et al. (2012) observed parallels between community law enforcement and incarcera-
tion settings and strongly encouraged implementation of the community CIT model in
jails and prisons.
The Current Study
There is a significant number of IMI that are incarcerated in the United States, and
COs spend a significant portion of their time interacting with them. However, COs
report little training in working with this group, and many COs wish for additional
mental health instruction (Lavoie et al., 2006). Furthermore, incidents borne out of
mental health problems can impede the safety and security of individuals who are
incarcerated as well as staff (Appelbaum et al., 2001; Callahan, 2004; Dvoskin &
Spiers, 2004). Potentially, CO mental health training could reduce stress and improve
safety for both individuals who are incarcerated and COs. Yet, despite some support
for CO mental health training, there is little systematic research that examines training
requirements. Thus far, researchers surveyed mental health training and services
among isolated correctional facilities. To elucidate the frequency and nature of CO
preservice mental health training, we sought preservice CO mental health training
6 Criminal Justice Policy Review 00(0)
requirements in all 50 U.S. states, the District of Columbia, and the Federal Bureau of
Prisons. Clarifying the prevalence of mental health training is a first step in evaluating
mental health training adequacy and areas for future research. We focus on CO train-
ing for prisons, given that the U.S. prison population is approximately 2 times larger
than the jail population (Kaeble, Glaze, Tsoutis, & Minton, 2016) and assessing men-
tal health training at the prison level would account for the practices that affect a large
number of individuals who are incarcerated. Furthermore, pragmatically, there are
more than 3,000 jails in the United States with no unifying training requirements
(Wagner & Rabuy, 2019). We anticipated that all jurisdictions would require mental
health training, but analyses were largely exploratory and there are no other a priori
We contacted the Department of Corrections (DOC) in all 50 states, the District of
Columbia, and the Federal Bureau of Prisons using information gathered from respec-
tive websites from October 2017 through March 2018. Data were collected via tele-
phone and email contacts with administrative and training staff and/or Freedom of
Information Act requests. We obtained mental health training requirements from all 52
jurisdictions (100% response rate). For each jurisdiction, we requested (a) instruction
method (e.g., instructor qualifications), (b) hours of preservice mental health training,
and (c) the title of mental health courses required.
Using guidelines set forth by qualitative experts (e.g., Levitt et al., 2018; Nowell,
Norris, White, & Moules, 2017), we report steps of our qualitative approach for ana-
lyzing the instruction method and course titles. Thematic analysis is a commonly con-
ducted, intuitive approach to analyzing qualitative data. When sifting through the data,
researchers can code themes deductively (“top-down”) or inductively (“bottom-up”).
Our coding approach was inductive, that is, we allowed the data (instruction methods
and course titles) to inform theme development rather than begin data analysis with a
priori coding themes.
We used NVivo v.12 (2018) software to conduct thematic analyses with our qualita-
tive (instruction method and course title) data. Two researchers, a licensed clinical
psychologist and clinical psychology doctoral student, independently coded method of
instruction and course title data. Thematic analyses revealed five categories for instruc-
tion method: training facilitated by mental health professionals (psychiatric nursing
staff, and master’s and doctoral-level clinicians), training academy personnel (indi-
viduals employed within a respective prison system, who were not mental health pro-
fessionals), contracted agencies, online modules, and other. Training approach was
classified as other in the event that instruction modality or instructor credentials were
unclear. Although the actual course content was not reviewed for the purpose of this
article, six course title themes emerged: general psychoeducation, specific treatments
and programs, CO mental health, crisis intervention, institutional procedure specific
to mental health, and special populations. Across these 11 variables (five categories
for instruction method and six categories for course titles), the average initial kappa =
Kois et al. 7
.82, with percent agreement ranging from 89.53% (general psychoeducation) to
100.00% (CO mental health), with an average of 96.50%. Coders met to reconcile
coding differences for 100.00% agreement.
Regarding our quantitative data—length of training—we summed individual
course hour requirements to calculate total duration. When jurisdictions provided a
range, for instance, 4 to 8 hr of required training, we used the average (6 hr). When
jurisdictions reported training lengths in “days,” we adopted the conventional rule for
a full workday (i.e., 8 hr training per day). We calculated descriptive statistics for all
variables of interest.
Training programs most often utilize mental health professionals (n = 37, 71.15%) and
training academy personnel (n = 31, 59.62%) for course instruction. Two (3.85%) juris-
dictions reported using online modules. Training facilitation falls into an other modality
for nine (17.31%) of the jurisdictions. In many cases, jurisdictions use multiple forms of
instruction (n = 23, 44.23%), such as pairing mental health professionals with training
academy personnel, for providing education on varying mental health topics.
With respect to mental health training duration, hour requirements range from
1.5 (Tennessee) to 80 (Florida) hr of instruction (Table 1). Across jurisdictions,
COs are required to complete a mean of 13.54 hr (SD = 14.58, Mdn = 8).
Jurisdictions often cite additional required mental health training for COs assigned
to special housing units or appointed to special force teams. Several contacts report
that their jurisdiction was in a time of transition and anticipate longer requirements
in upcoming years.
All 52 jurisdictions require some form of preservice mental health training (Table
1). Regarding specific topics, crisis intervention is the most commonly required (n =
44, 84.62% of jurisdictions). It is important to note that while not all training programs
dedicate a specific course to suicide prevention and response, all report providing
education on the topic. The second most common course is general psychoeducation
(n = 24, 46.15%; mental health broadly as well as awareness and decreasing stigma
programs), followed by special populations (n = 12, 23.08%; for example, correc-
tional practices with elderly individuals, individuals with special needs, females).
Required coursework on specific treatments and programs, such as dialectical behav-
ior therapy, motivational interviewing, and trauma-informed care, is relatively rare
(n = 7, 13.46%). Institutional procedure specific to mental health (n = 6, 11.54%),
which includes courses such as psychiatric restraints and operational procedure of
inpatient mental health care, is also uncommon. Of note, four (7.69%) jurisdictions
require courses in CO mental health.
Research indicates that a significant number of IMI are incarcerated in the United
States (Bronson & Berzofsky, 2017), that COs play a key role in working with this
Table 1. Required Preservice CO Mental Health Training.
duration Required preservice mental health training course topic
treatments and
CO mental
Federal 7.5 X X X
District of Columbia 4 X X
Alabama 8 X
Alaska 16.33 X X
Arizona 3.5 X X
Arkansas 4 X
California 38 X
Colorado 22 X X X
Connecticut 7 X X
Delaware 8 X
Florida 80 X X X X
Georgia 6 X X
Hawaii 46 X X
Idaho 4 X
Illinois 8 X
Indiana 20.5 X X
Iowa 8 X
Kansas 6 X
Kentucky 10 X X X
duration Required preservice mental health training course topic
treatments and
CO mental
Louisiana 4 X X X
Maine 26 X
Maryland 8 X
Massachusetts 8 X X
Michigan 2 X
Minnesota 2 X
Mississippi 52 X X X
Missouri 4 X X
Montana 10 X
Nebraska 9 X
Nevada 7.5 X X
New Hampshire 4 X
New Jersey 12 X X X
New Mexico 16 X X
New York 24 X X
North Carolina 10 X
North Dakota 4 X
Ohio 16 X X
Table 1. (continued)
duration Required preservice mental health training course topic
treatments and
CO mental
Oklahoma 4 X X
Oregon 8 X X
Pennsylvania 10.5 X
Rhode Island 15 X X
South Carolina 12 X X
South Dakota 14 X X
Tennessee 1.5 X
Texas 41 X X X X X
Utah 6 X X
Vermont 16 X X
Virginia 24 X
Washington 4 X X
West Virginia 11 X X
Wisconsin 6 X X
Wyoming 6 X
M = 13.54 n (%) n (%) n (%) n (%) (%) n (%)
SD = 14.58 24 (46.15) 7 (13.46) 4 (7.69) 44 (84.62) 6 (11.54) 12 (23.08)
Note. CO = correctional officer.
Table 1. (continued)
Kois et al. 11
group (Dvoskin & Spiers, 2004), and that CO mental health training can be effective
in improving safety and security in correctional environments (Parker, 2009). We sur-
veyed DOCs for all 50 U.S. states, the District of Columbia, and the Federal Bureau of
Prisons regarding CO preservice mental health training. It is encouraging that all juris-
dictions require this training to some degree. However, there is marked variation
according to length of training, instruction, and course content. Our findings represent
an important step in continuing the discussion on training adequacy, as well as impli-
cations for practice and research.
Mental Health Training Instruction
Mental health professionals most frequently teach training courses, which sug-
gests that COs often are instructed by individuals with some level of mental health
specialization. Slightly more than half of the instructors are identified as training
academy personnel. Although these instructors may hold expertise in incarceration
settings, they may lack a comprehensive understanding of mental illness. In
Parker’s (2009) study, which found a decrease in officer use of force and assaults
by bodily waste by individuals housed on the unit, mental health training was
developed and taught by NAMI instructors. Potentially, NAMI instructors may
better understand mental health nuances and intervention approaches. It is impor-
tant to note, however, that research has yet to examine the effectiveness of training
based on instructor knowledge, background, and discipline, and we do not assume
that individuals experienced specifically with mental health are more effective
correctional mental health instructors than academy personnel. Partnerships
between academy personnel and mental health professionals may be the most
effective approach to training.
The collaboration approach may result in more effective training, but it is not
without challenges. One state reports that clinical psychologists once instructed its
mental health courses, however, “it was difficult to get the applied aspect since (the
psychologists) were outside of the DOC.” A potential remedy is to specifically seek
psychologists with forensic or correctional mental health specialization and who
have extensive experience with criminal justice contexts. For those jurisdictions
with limited finances and mental health resources, they may look to the National
Institute of Corrections (NIC;, the website of which includes
broadcasts, videos, webinars, and empirical reports and implementation recommen-
dations, with topics such as Inmates with mental illness; Mental illness and violent
events: Identifying, managing, and reducing risks; Mental health of prisoners:
Prevalence, adverse outcomes, and interventions; Correctional officers and the
incarcerated mentally ill; and Responses to psychiatric illness in prison. The
American Correctional Association (ACA) also has multiple online modules on
mental illness and treatment in correctional settings at DOCs can
adopt a “train-the-trainer” approach in which mental health professionals train CO
academy instructors in issues specific to mental health, which the instructors can use
when providing preservice training to new COs.
12 Criminal Justice Policy Review 00(0)
Mental Health Training Duration
Jurisdictions are markedly different in the length of required mental health training,
but training is typically described as lasting between 1 and 2 days and likely comprises
only a small portion of CO training overall. We found the average duration of mental
health training across jurisdictions is slightly lower than the 10 hr of training COs
received in Parker’s (2009) study and one fifth the duration of traditional CIT training.
Recall that Parker’s work suggested that even 10 hr of mental health training may reap
safety benefits in correctional settings. In the community, law enforcement depart-
ments that adhere to the CIT model provide 40 training hours. We do not suggest that
“more” training is better or that quantity is more important than quality. Still, correc-
tions administrators may consider increasing the duration of preservice mental health
training to allow time for sufficient content coverage, thereby increasing the opportu-
nity for new COs to develop a refined understanding of the interface of mental illness
and the correctional environment.
For COs, maintaining custody while considering mental health may be at odds
with each other, and COs may consider custody as incompatible with treatment.
Placing increased emphasis on mental health training could help to create a culture
of understanding and compassion and decrease stigma of mental illness. In Lambert
and Hogan’s (2009) study, commitment to organizational goals was one of the stron-
gest predictors of support for IMI treatment. Developing a shared value system
through CO mental health training may boost staff morale and willingness to prac-
tice learned skills, and ultimately promote effective implementation of their mental
health training.
Mental Health Training Content
We found that all jurisdictions require some form of mental health training, and many
requirements were recommended by Parker (2009): education regarding psychiatric
disorders, treatment of mental illnesses, and crisis de-escalation. Parker also recom-
mended instruction on biology of mental illness, although this is not identified as a
specific course provided by any of the jurisdictions surveyed in this study. The most
commonly required course is specific to crisis intervention, with well over three
fourths of jurisdictions requiring this course. Courses on general psychoeducation
dovetail with this tactic, in that COs may be taught in both courses how to identify
signs of suicidal ideation and agitation. This trend appears in line with recommenda-
tions in the literature.
Very few jurisdictions require courses explicitly dedicated to specific treatments
and programs available for IMI and special populations. We might expect that for CO
staff to be successful in implementing their mental health training, they must be famil-
iar with the services available and how to, at least informally, refer individuals who are
incarcerateed and in need of mental health treatment. In Dear et al.’s (2002) study,
individuals incarcerated in prisons were less likely to approach COs regarding their
personal or emotional problems than COs expected. On average, they approached COs
Kois et al. 13
with their concerns about half of the time. If individuals who are incarcerated are
aware that COs can direct them to needed services, they may be more likely to engage
COs. As a result, COs may have more opportunity to monitor mental health symptoms
and IMI may be more likely to utilize mental health services.
Several jurisdictions require instruction on institutional procedures specific to men-
tal health. These procedures are likely addressed to some degree in general training,
just as other topics (e.g., communication techniques) likely overlap across mental
health–specific and general trainings. We commend these jurisdictions for spending
reserved time to discuss these procedures with IMI in mind. Very importantly, a hand-
ful of jurisdictions require unique programming with a focus on CO mental health.
Requiring CO mental health training may be a wise tactic, in that some COs may feel
uncomfortable volunteering for a topic that is, unfortunately, stigmatized. It should be
noted that although not required, Minnesota offered a particularly rich array of pro-
gramming on CO mental health: correctional fatigue, benefits of stress, stress manage-
ment for officers, and managing depression.
Stigma appears to be a relatively novel topic in prison settings, despite past work
indicating COs are misinformed of IMI and that stigma reduction instruction shows
promise in other settings. Specifically, Ellis’ (2014) study on the effectiveness of com-
munity CIT training found that training improved law enforcement personnel’s
reported perceptions of IMI. As previously noted (West et al., 2014), IMI are at par-
ticular risk of experiencing stigma. One Floridian training staff states that in her juris-
diction, the Hearing Voices that are Distressing course was particularly “eye opening
for a lot of staff” and increased COs’ understanding of the challenges faced by IMI.
Practice Implications
Scholars and researchers underscored that mental health training is needed for COs to
effectively execute job duties and that COs indicate a need for training specific to
mental health (Appelbaum et al., 2001; Callahan, 2004; Lavoie et al., 2006). It appears
that all COs in the jurisdictions surveyed receive some mental health training, although
duration and course content varies. Of note, instructors and agencies responsible for
developing and implementing mental health training are also heterogeneous. Overall,
we are unsure how consistently course content is taught across jurisdictions. To ensure
adequate training, prison policy makers might consider seeking uniform CO mental
health training, potentially from professional organizations such as the NIC or the
ACA. Each institution has unique policies, procedures, and resources that are unlikely
to be covered by broad ACA mental health training, and so supplemental training spe-
cific to the employing institution would also be necessary. Broad mental health train-
ing could include psychoeducation, identifying risk and crisis de-escalation techniques,
suicide prevention, and mental health stigma reduction. Site-specific mental health
training could focus on DOC mental health services and procedures regarding psychi-
atric restraints and use of force.
In Antonio et al.’s (2009) study, COs reported they felt burdened with greater
responsibility in managing IMIs compared with other staff. The authors speculated
14 Criminal Justice Policy Review 00(0)
this might explain high rates of CO “burnout.” Somewhat similarly, COs in Lavoie
et al.’s (2006) study reported IMI added significant stress to the job. Although several
jurisdictions required courses on CO mental health and self-care, training departments
might consider enhancing instruction on stress and coping for COs, given their risk for
mental disorder (Carleton et al., 2018a; Carleton et al., 2018b). Stress reduction may
help COs to maintain optimal mental health and job performance and to offer addi-
tional skills they can provide to IMI in times of crisis.
Future Research
Although this study represents an important first step in assessing preservice CO men-
tal health training, it is only a descriptive “snapshot” and cannot offer insight into the
effectiveness of training programs. Given prior research indicating mental health
training has institutional benefits and COs have a desire for training, future research
should examine mental health training effectiveness, CO satisfaction, and the avail-
ability of continuing education specific to mental health. They may also assess whether
mental health training (regarding IMI and CO mental health) increases positive out-
comes for COs, including decreased work-related stress (e.g., CO mental health) and
employee turnover. Researchers might consider a replication of Parker’s (2009) study
in various correctional contexts, and in particular, assessing whether such a training
intervention can reduce behavioral incidents of injury for COs and IMI. Outcome met-
rics such as frequency of infractions, administration segregation, crisis interventions,
acts of self-harm, and completed suicide are also important outcome measures. Skills
acquisition, retention, adherence to mental health training, and its efficacy can be
examined using longitudinal study designs. Future research should also examine the
impact of training in jails specifically, as they generally have a greater number of
annual admissions and constitute a unique criminal justice population. Quantity and
content of mental health training may differ according to whether specific facilities are
accredited by national bodies (e.g., Commission on Accreditation for Corrections,
National Commission on Correctional Health Care). Finally, mental health training
effectiveness in improving communication between individuals who are incarcerated
and COs, reducing mental health stigma, decreasing the emotional labor of CO work,
and training adherence are novel and important research areas to explore.
Study Limitations
These data were collected from October 2017 through March 2018, and the require-
ments reported here might not be in place at this time. For example, some jurisdic-
tions, such as Alabama, update trainings yearly. Furthermore, these data reflect broad
preservice CO mental health training requirements at the individual state, District of
Columbia, and Federal level. COs serving in individual jails may receive different or
additional training within that state (e.g., as reported by Louisville Metro staff, per-
sonal communication), and these training practices should be documented in the
Kois et al. 15
An additional limitation is that while the COs may be receiving mental health train-
ing, they may not be retaining the knowledge or utilizing it in their day-to-day interac-
tions with individuals who are incarcerated. Furthermore, it would be important for
future research to examine content retention and use as well as the impact of ongoing
and in-service mental health training on metrics relevant to incarceration.
Perhaps the biggest study limitation is the difficulty faced when categorizing course
content. However, while we saw variability in course titles, training themes emerged and
were used accordingly. Importantly, we were only able to examine course titles rather
than course materials and content. We acknowledge that despite the discrete categoriza-
tion used for this study, there was almost certainly content overlap across courses. Course
titles alone cannot detail all training content. Despite these limitations, our study is the
first survey of CO mental health training and is nevertheless informative.
COs have the most interaction with IMI in jail and prison settings and are on the “front
lines” for de-escalating inmate crises. Research indicates CO mental health training is
an important endeavor that can help maintain safety and security in jails and prisons.
Although much research has focused on high rates of mental illnesses within incar-
ceration facilities and their association with violations and infractions, little research
has examined CO mental health training in prison settings. In our survey of 52 U.S.
jurisdictions, we found a high degree of variability in mental health training delivery,
duration, and content. Overall, it appears mental health training comprises a small por-
tion of CO training. We encourage jurisdictions to consider placing increased impor-
tance on this issue and hope our findings serve as a benchmark for future work
examining CO mental health training.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication of
this article.
Lauren E. Kois
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Author Biographies
Lauren E. Kois is an assistant professor of Psychology at the University of Alabama. Her work
focuses on forensic assessment, with particular emphases on competence to stand trial and crim-
inal responsibility.
Kortney Hill received a B.S. in Crime, Law, and Justice from The Pennsylvania State University
and a M.A. in Forensic Psychology from John Jay College of Criminal Justice. She is currently
working in the field and completing evaluations for the Office of Defense Services at a state
Lauren Gonzales is an assistant professor of Psychology at Adelphi University. Her work
examines factors affecting recovery and community integration of persons with serious mental
illnesses in civil and criminal justice settings.
Shelby Hunter is a doctoral student of Clinical Psychology (Law Track) at the University of
Alabama. She works under the supervision of Dr. Lauren Kois and her primary area of research
interest is neuropsychological assessment and psycholegal decision-making.
Preeti Chauhan is an associate professor in the Psychology Department at John Jay College of
Criminal Justice and the Director of the Data Collaborative for Justice. Her work is aimed at
informing criminal justice policies.
... This should move away from the sole aspect of security and into rehabilitation, to abide by Rule 81 of the European Prison Rules (2006) which states that prison staff should have the opportunities to improve their knowledge and skills, including any specialised training. Substantial literature (e.g., Kois et al., 2020 in the US; Lavoie et al., 2012 in Canada) has pointed to the need for more specialist training in health and well-being related aspects of the job, since such training aimed specifically at such specific needs have led to more positive perceptions and therefore support. Despite this, Musselwhite et al. (2005) revealed that officers in the UK were not confident with dealing with individuals with mental health issues. ...
This paper sheds light on male Maltese people in prison and their perception of help and support when incarcerated. Through thematic analysis, the viewpoints, thoughts, and feelings of 39 males incarcerated at Corradino Correctional Facility (CCF), Malta’s only prison, were explored in relation to programmes aimed to help them in their desistance journey. Many individuals spoke to the lack of support they felt within this prison. Themes emerging from this paper suggest that relationships between incarcerated people and staff are not supportive of any rehabilitative ideal. Participants speak of the lack of induction, information, and support, and of being mocked when requesting information or assistance. They state that support is conditional on who they knew, including direct references to corruption
... Much of the literature as it related to the theme of training in health and well-being focused on the issue of mental health. This included a recently published national survey (Kois, Hill, Gonzales, Hunter, & Chauhan, 2020) of the preservice mental health training requirements for prison officers in the U.S., and research by Lavoie, Connolly and Roesch (2006) which found that training related specifically to mental illness was associated with more positive perceptions of prisoners with a mental disorder. Officers in this study advocated for supplementary training to effectively manage mental disorders. ...
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The role of the prison officer is complex and challenging. In order to discharge their duties effectively, prison officers require relevant and comprehensive training and education upon recruitment and throughout their working career. The following paper presents the findings of a scoping review of the published literature as it relates to the training and education of prison officers. Employing a descriptive-analytical approach, we stratified this literature into three overarching themes; namely entry-level training and education programs, emerging issues and developments in prison officer training, and specialist health and well-being training programs. Findings are discussed with reference to significant current trends in the literature and potential areas of future research and practice.
... In correctional settings, those interacting the most with patients are also the individuals who often have the least amount of mental health training. Correctional Officers (COs) receive a minimal amount of mental health training, training primarily dedicated to crisis intervention (Kois et al., 2019). COs are present in the institution 24 hr a day, 7 days a week, during which they are regularly interacting with patients in various ways. ...
... Correctional Officers (COs) receive a minimal amount of mental health training, commonly dedicated to crisis intervention (Kois et al., 2019). COs are present in the institution 24-hours a day, seven days a week, during which they are regularly interacting with patients in various ways. ...
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Mental health services provided in correctional facilities require improvement (Fazel et al., 2016). One strategy for improving care in these facilities may be to give consideration to a patient’s personality dynamics when planning interventions or interacting with the patient. Understanding a patient in the context of their personality dynamics can give members of a treatment team an increased ability to predict a patient’s experience of, and response to, different interventions, situations, and stimuli. This brief report identifies three treatment issues relevant to correctional settings and then uses clinical material from three cases to illustrate how conceptualizing each patient’s personality dynamics helped address these issues by facilitating more considerate and patient-centered interactions between staff and patient, assisting in the planning of behavioral interventions that are better suited for a patient’s personality, and by guiding approaches to building rapport and encouraging a patient’s engagement in their own treatment. These brief cases demonstrate the diverse utility of attending to each patient’s personality dynamics in correctional settings.
Background: There is little research with people who experience intellectual/developmental disabilities and imprisonment. Methods: The study linked health and correctional data to examine prevalence of intellectual/developmental disabilities and health and correctional characteristics among adults experiencing their first federal incarceration between 1 January 2002 and 31 December 2011 (n = 9278) and two non-incarcerated groups (n = 10,086,802). Results: The prevalence of intellectual/developmental disabilities was 2.1% in the incarcerated group and 0.9% in the non-incarcerated group. Before incarceration, those with, versus without, intellectual/developmental disabilities were at greater risk of traumatic brain injury, mental illness, and substance use disorders. While incarcerated, those with intellectual/developmental disabilities were more likely to incur serious institutional disciplinary charges. Post-incarceration, persons with intellectual/developmental disabilities were at greater risk of emergency department visits, and psychiatric and acute hospitalizations, than the non-incarcerated groups. Conclusions: People with intellectual/developmental disabilities are overrepresented in Canadian federal correctional institutions. The authors offer strategies to support people prior to, during, and post-incarceration.
The features of the influence of cognitive training methods on the improvement of the level of professional culture of prison staff and the growth of their creative potential are considered. The features and peculiarities of the penal system employees, who are in close contact with convicts, and engaged in the prevention of conflicts, criminal aggression, escapes, drug abuse, and riots have been investigated. The author concludes that the regular use of cognitive technologies contributes significantly to the professionalism of the penitentiary staff, to creative thinking, quick social/psychological adaptation to unfavorable situations, and prevention of burnout. The author's program of cognitive training contains six thematic sections related to specific methods that are aimed at: (1) the formation of creative thinking; (2) the formation of a high subjective significance of professional culture and effectiveness; (3) constructive change of interpersonal (in the broadest sense) relationships; the acquisition of communication skills; (4) the study of adaptive coping strategies, methods of self-analysis and autogenic training; (5) study of methods of rapid diagnosis of psychological qualities of a person and assessment of his emotional state, as well as the most effective ways to influence a person; (6) development of organizational skills. This program will be useful for such purposes as the selection of candidates, training and retraining of law enforcement officers, as well as the prevention of their professional deformation.
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Research on the Crisis Intervention Team (CIT) as a method to deal with mental illness in policing encounters has primarily focused on officers from large urban areas. The current study examined officer‐level outcomes in a non‐urban geographical setting using a pre/post‐CIT training design. The sample included 46 police officers from seven departments that would be considered rural and 13 that would be classified as suburban. Officers completed scales to gauge change in mental illness attitudes at the beginning and end of their one‐week CIT training. CIT training resulted in reductions in stigmatic attitudes with seven large effect sizes (ranging from η² = .24 to .59) across the two measures. The findings from this research are a direct response to the call for greater diversity in the size of police settings in the CIT literature and serve to expand the empirical base for CIT in relation to officer‐level outcomes.
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Substantial media attention has focused on suicide among Canadian Public Safety Personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police). The attention has raised significant concerns about the mental health impact of public safety service, as well as interest in the correlates for risk of suicide. There have only been two published studies assessing lifetime suicidal behaviors among Canadian PSP. The current study was designed to assess past-year and lifetime suicidal ideation, plans, and attempts amongst a large diverse sample of Canadian PSP. Estimates of suicidal ideation, plans, and attempts were derived from self-reported data from a nationally administered online survey. Participants included 5,148 PSP (33.4% women) grouped into six categories (i.e., Call Centre Operators/Dispatchers, Correctional Workers, Firefighters, Municipal/Provincial Police, Paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported past-year and lifetime suicidal ideation (10.1%, 27.8%), planning (4.1%, 13.3%), or attempts (0.4%, 4.6%). Women reported significantly more lifetime suicidal behaviors than men (ORs = 1.15 to 2.62). Significant differences were identified across PSP categories in reports of past-year and lifetime suicidal behaviors. The proportion of Canadian PSP reporting past-year and lifetime suicidal behaviors was substantial. The estimates for lifetime suicidal behaviors appear consistent with or higher than previously published international PSP estimates, and higher than reports from the general population. Municipal/Provincial Police reported the lowest frequency for past-year and lifetime suicidal behaviors, whereas Correctional Workers and Paramedics reported the highest. The results provide initial evidence that substantial portions of diverse Canadian PSP experience suicidal behaviors, therein warranting additional resources and research.
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As qualitative research becomes increasingly recognized and valued, it is imperative that it is conducted in a rigorous and methodical manner to yield meaningful and useful results. To be accepted as trustworthy, qualitative researchers must demonstrate that data analysis has been conducted in a precise, consistent, and exhaustive manner through recording, systematizing , and disclosing the methods of analysis with enough detail to enable the reader to determine whether the process is credible. Although there are numerous examples of how to conduct qualitative research, few sophisticated tools are available to researchers for conducting a rigorous and relevant thematic analysis. The purpose of this article is to guide researchers using thematic analysis as a research method. We offer personal insights and practical examples, while exploring issues of rigor and trustworthiness. The process of conducting a thematic analysis is illustrated through the presentation of an auditable decision trail, guiding interpreting and representing textual data. We detail our step-by-step approach to exploring the effectiveness of strategic clinical networks in Alberta, Canada, in our mixed methods case study. This article contributes a purposeful approach to thematic analysis in order to systematize and increase the traceability and verification of the analysis.
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Background: Canadian public safety personnel (PSP; e.g., correctional workers, dispatchers, firefighters, paramedics, police officers) are exposed to potentially traumatic events as a function of their work. Such exposures contribute to the risk of developing clinically significant symptoms related to mental disorders. The current study was designed to provide estimates of mental disorder symptom frequencies and severities for Canadian PSP. Methods: An online survey was made available in English or French from September 2016 to January 2017. The survey assessed current symptoms, and participation was solicited from national PSP agencies and advocacy groups. Estimates were derived using well-validated screening measures. Results: There were 5813 participants (32.5% women) who were grouped into 6 categories (i.e., call center operators/dispatchers, correctional workers, firefighters, municipal/provincial police, paramedics, Royal Canadian Mounted Police). Substantial proportions of participants reported current symptoms consistent with 1 (i.e., 15.1%) or more (i.e., 26.7%) mental disorders based on the screening measures. There were significant differences across PSP categories with respect to proportions screening positive based on each measure. Interpretation: The estimated proportion of PSP reporting current symptom clusters consistent with 1 or more mental disorders appears higher than previously published estimates for the general population; however, direct comparisons are impossible because of methodological differences. The available data suggest that Canadian PSP experience substantial and heterogeneous difficulties with mental health and underscore the need for a rigorous epidemiologic study and category-specific solutions.
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The framework of the new penology will be applied to reveal how the contemporary objectives of incarceration have functioned to alter the role of Canadian provincial correctional officers (COs). Specifically, changing policy and legislation toward a more punitive agenda shape the daily operations of correctional facilities and how COs interact with those in their custody. Rehabilitative initiatives of any kind appear to be pushed aside, as the new or intensifying challenges associated with the growing prisoner populations and changing penal discourses are addressed. Semistructured face-to-face interviews were conducted with Canadian provincial COs and data from these interviews were analyzed to explicate the ways in which the new penology has reshaped COs’ employment in part due to their obligatory adherence to increasingly punitive managerial directives including an increased reliance on using disciplinary segregation. Findings suggest officer strain is impacted by their lack of agency and decision-making capabilities in light of these occupational changes. Our findings also evince that although COs work in a too often negative environment, many believe in the rehabilitative potential of incarceration and, further, oppose the use of segregation.
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Objectives: We sought to better understand acts of self-harm among inmates in correctional institutions. Methods: We analyzed data from medical records on 244 699 incarcerations in the New York City jail system from January 1, 2010, through January 31, 2013. Results: In 1303 (0.05%) of these incarcerations, 2182 acts of self-harm were committed, (103 potentially fatal and 7 fatal). Although only 7.3% of admissions included any solitary confinement, 53.3% of acts of self-harm and 45.0% of acts of potentially fatal self-harm occurred within this group. After we controlled for gender, age, race/ethnicity, serious mental illness, and length of stay, we found self-harm to be associated significantly with being in solitary confinement at least once, serious mental illness, being aged 18 years or younger, and being Latino or White, regardless of gender. Conclusions: These self-harm predictors are consistent with our clinical impressions as jail health service managers. Because of this concern, the New York City jail system has modified its practices to direct inmates with mental illness who violate jail rules to more clinical settings and eliminate solitary confinement for those with serious mental illness.
The American Psychological Association Publications and Communications Board Working Group on Journal Article Reporting Standards for Qualitative Research (JARS–Qual Working Group) was charged with examining the state of journal article reporting standards as they applied to qualitative research and with generating recommendations for standards that would be appropriate for a wide range of methods within the discipline of psychology. These standards describe what should be included in a research report to enable and facilitate the review process. This publication marks a historical moment—the first inclusion of qualitative research in APA Style, which is the basis of both the Publication Manual of the American Psychological Association (APA, 2010) and APA Style CENTRAL, an online program to support APA Style. In addition to the general JARS–Qual guidelines, the Working Group has developed standards for both qualitative meta-analysis and mixed methods research. The reporting standards were developed for psychological qualitative research but may hold utility for a broad range of social sciences. They honor a range of qualitative traditions, methods, and reporting styles. The Working Group was composed of a group of researchers with backgrounds in varying methods, research topics, and approaches to inquiry. In this article, they present these standards and their rationale, and they detail the ways that the standards differ from the quantitative research reporting standards. They describe how the standards can be used by authors in the process of writing qualitative research for submission as well as by reviewers and editors in the process of reviewing research.
Stigma involves negative beliefs and devaluations of people in socially identified groups, which some people internalize. Research has increasingly explored mental illness self-stigma, when people with mental illness believe society's negative beliefs are true of them (e.g., they are hopeless due to mental illness). Self-stigma predicts poorer functional and treatment outcomes. Forensic psychiatric patients experience multiple stigmas, yet no research has explored how stigmas due to mental illness, race, and criminal history influence each other. This review discusses relevant stigma research, which suggests that self-stigma in forensic psychiatric populations likely interferes with rehabilitation and avoiding re-arrest. Forensic psychiatric stigma is particularly relevant given increasing social attention on violence, incarceration, mental illness, and race. Conclusions discuss targets for future research.
In communities across the United States and internationally, police officers frequently come into contact with individuals experiencing mental health crisis despite not having the skills to safely intervene. This often results in officers resorting to excessive or even deadly force. The Crisis Intervention Team (CIT) is heralded as a revolutionary and transformative intervention to correct this gap in practice. Several previous interdisciplinary national and international studies, including criminology and sociology, have examined these concepts using quantitative and qualitative methodological designs, however, no prior nursing studies have been done on this topic. The purpose of this study was to determine the effect of CIT training on police officers' knowledge, perception, and attitude toward persons with mental illness. Twenty five police officers participated. An explorative, quasi experimental, descriptive design was used to collect the data on the three major concepts. Results on knowledge about mental illness improved at p<.0125 (p<.05 after Bonferroni correction). Perception scores improved at p<.0125 (p<.05 after Bonferroni correction), and attitudes were more favorable at p<.0125 (p<.05 after Bonferroni correction). The results of this study validated the CIT program as an innovative community health program that benefits law enforcement, consumers, mental health professionals, and stakeholders.
In July 2006, the Pennsylvania Department of Corrections began delivering a 2-hour training session titled “Reinforcing Positive Behavior” (RPB). Findings from an attitude survey showed that the training was effective for changing staff attitudes and awareness about inmate treatment and rehabilitative programs. Specific findings revealed that correctional officers, when compared with treatment staff, were less concerned about showing inmates respect and also minimized the impact of their own actions on inmate behavior and rehabilitation efforts. Policy implications and recommendations for improving the RPB training and for furthering data collection efforts during basic orientation and inside the state institutions will be discussed.