Saturday, September 23, 2006

In The Family Way

I think there's a rule among correctional switchboard operators that any telephone caller who sounds angry or has a strong foreign accent must immediately be routed to the psychology department. That's the only explanation for some of the calls we get; usually it's a family member calling to demand a reason why their loved one hasn't been transferred to a maintaining facility yet or hasn't had a parole hearing or why he wasn't taken to court on the appointed day. Sometimes they need to yell at someone because of that very unfair sentence that will keep Loved One from paying their bills. Now, keep in mind that the psychology department doesn't have anything to do with any of these issues. The purpose of our involvement mainly is to give the caller someone to vent at, and occasionally to provide a little community education about the prison intake process.

Most folks don't usually think about family involvement in correctional healthcare but they definitely do get involved. As a general rule I don't mind talking to family members who call if the inmate says it's OK. It's a good thing for me to have someone on the "outside" helping me keep an eye on my patients. They have more regular contact with my patients than I do and they are fairly good at identifying early symptoms of relapse. Regardless of their reason for calling, at some point in the conversation I make a habit of telling them to keep an eye on Loved One and to call the psychology department if they notice anything of concern. That quickly turns a potentially adversarial relationship into an alliance---and I think it surprises them. They expect to get dismissed or blown off, or they call expecting that any prison doc is going to be a heartless Nazi. And it gives me a chance to emphasize to them that Loved One has been seen and is going to be followed regularly. I tell them to remind Loved One about his next scheduled appointment and to take his medicine.

The sad phone calls are the ones involving first-time inmates. By the time someone ends up in prison they have usually run the gamut of lesser sanctions and failed repeated 'second chances'. Then I hear from the naive current girlfriend or the exhausted mother in their last futile attempt to rescue Loved One from the consequences of his stupidity. I must tactfully suggest that it would be best for them to care for themselves during this time of reprieve and let Loved One fend for himself. It's hard to do that without sounding like a heartless Nazi, but someone has to suggest that it's time for Loved One to grow up. Mostly I think they need someone who can empathize with their frustration and emotional fatigue.

Once in a blue moon I'll get a call from a family member after someone has been released. Those are the phone calls I like because it means my patient has actually decided to stay in treatment---they're calling for prescription refills or referral information, or records for a free society psychiatrist. Those are the patients I don't usually see again. And that's a good thing.