Staying well inside: mental health care, routines & hope

“Incarceration & mental health” explains the stress of life inside. “The first days in jail or prison: shock, fear & finding your feet” covers arriving. “Staying safe inside: bullying, gangs, violence & pressure” covers safety. “Solitary confinement & isolation: coping in the hole” covers time alone in a cell.

This guide is about the long haul: getting care, keeping your mind steady, and holding on to purpose and hope.

Caring for your mental health can make each day easier to get through. It can help you stay out of trouble, keep relationships with family, and be ready for the day you go home.

In general terms, facilities are expected to respond to serious health needs, including serious mental health needs. The Court also said that a mistake or poor care alone is not always a violation of the Constitution. The bar is high, and every case is different.

Most facilities have a written grievance process for complaints, including about health care. A federal law says people in jail or prison generally must use the available complaint process before bringing a federal lawsuit about prison conditions.

Practical habits

• Ask how the grievance process works and what the deadlines are
• Keep copies or notes of every request and answer, with dates
• Stay calm and specific in writing: what you need, since when, and how it affects you

The United Nations’ Nelson Mandela Rules say health care for people in prison is a government responsibility, and that people in prison should have the same standards of health care available in the community, free of charge.

The ACLU National Prison Project publishes “know your rights” information about medical and mental health care in prison. Your public defender or a legal aid group in your state may also help or refer you.

You may be offered

• A crisis check if you are at risk
• A mental health screening or assessment
• Groups on stress, anger, trauma or recovery
• One-on-one counseling
• Referral to your clinical provider for anything medical

It is okay to ask mental health staff what they can keep private and what they must share. In most places, staff will act if someone is at risk of harm. Knowing the rules can help you decide what to say.

Examples

• “I haven’t slept more than a few hours a night for two weeks.”
• “I feel hopeless most days and I don’t want to get out of bed.”
• “Memories of what happened keep coming back and I can’t stop them.”
• “I was seeing a counselor before I came in, and it helped.”

Try this

• Cover your eyes with a folded cloth, if allowed
• Go to bed and get up at about the same time
• Do slow breathing or a body scan when you lie down
• Write worries on paper before lights out, so your mind can let go

Ideas

• Push-ups, squats, planks or stretching in your cell
• Walking laps in the yard
• Yoga or sports if your facility offers them
• Start small: even 10 minutes counts

Try planning your week with a little of each: movement, learning, connection with others, and something that gives you meaning, like faith, art or helping someone.

Try this

• Name 5 things you can see and 4 you can hear
• Press your feet into the floor and notice the ground
• Slow breathing: in for 4, out for 6
• Tense and release your fists, then your shoulders

Thinking about the whole sentence at once can feel crushing. Many people find it easier to focus on today, this week or this month.

Ideas

• Set goals for this month: a class, a book, a skill
• Mark small milestones, not just the release date
• Notice how you have grown, year by year

Technology, prices and the people you know keep changing. That can make the outside world feel strange and far away.

Ideas

• Read newspapers, magazines or library books
• Ask family to tell you what’s changed in the neighborhood
• Learn new skills that will matter later, if classes are offered

Over the years, some friends and family may stop writing or visiting. That can feel like being forgotten. It is a real loss, and it is okay to grieve it.

What can help

• Keep writing to those who still answer
• Build new friendships with people who lift you up inside
• Ask a chaplain about pen-pal or mentoring programs

Many people serving long sentences grow older in prison. Health, energy and friendships may change. Keep asking for care when you need it, and look for ways to share your wisdom, like mentoring younger people.

Losing a loved one when you can’t be there is especially painful. The “Incarceration & mental health” guide has ideas for grieving from a distance, and a chaplain or mental health staff can help.

Ask about

• Basic reading and math classes
• College courses or correspondence study
• High school diploma or equivalency classes
• Job training and certificates
• The library and books by request

A job inside can give your day structure, help you build skills and give you a sense of contribution. Even simple work can be a chance to practice patience, teamwork and pride in doing something well.

Ideas

• Learn a language from library books
• Read about a subject you love
• Write stories, poems or a memoir
• Practice drawing or music if allowed

Chaplains often support people of any faith, or no faith. They can be someone to talk to about grief, guilt, purpose and hope. Faith services and study groups can also bring structure and community.

The Mandela Rules say people in prison should be allowed, as far as practicable, to practice their religion.

In the UK and Ireland, Samaritans trains people in prison to be “Listeners,” who give confidential emotional support to others who are struggling or feeling suicidal. About 1,500 Listeners answer more than 50,000 requests for support each year.

Some U.S. facilities have similar peer support or mentor programs. Ask whether one exists where you are.

Ask about

• Anger or stress management groups
• Mentoring by people who have done long time
• Recovery groups
• Restorative justice or victim-awareness programs

Tutoring, mentoring younger people or simply being a steady, kind presence can give your days meaning. Many people say helping others helped them make peace with their past.

Ideas

• A book you’re reading and what it made you think
• A memory you share with them
• Questions about their life
• Something you are working on
• What you are grateful for this week

A journal, or letters to your future self, can help you track growth and work through hard feelings. Some people write letters they never send, to someone who hurt them or someone they lost.

The “Parenting from prison: visits, calls & staying close” guide has ideas for letters, calls, visits and what to say to kids at every age.

The National Institute of Mental Health lists signs such as

• Changes in eating or sleeping
• Feeling empty, hopeless or trapped
• Giving away belongings or saying goodbye
• Pulling away from others
• Talking about being a burden, or about wanting to die
• Unbearable emotional or physical pain

1. Tell any staff member that you are having thoughts of suicide.
2. Ask to see mental health staff right away.
3. Stay near other people if you can.
4. Talk to a chaplain, Listener or trusted peer.

1. Ask them directly: “Are you thinking about killing yourself?” Asking does not put the idea in their head.
2. Listen without judging.
3. Stay with them if you safely can.
4. Tell staff right away, even if they ask you not to.

A safety plan lists your warning signs, things that help you cope, people you can turn to, and staff you can tell. Writing it down on a calm day makes it easier to use on a hard one.