Professional Psychology Research and Practice1994, Vol. 25,.docx

Professional Psychology: Research and Practice
1994, Vol. 25, No. 2, 161-167
Copyright 1994 by the American Psychological Association,
Inc.
0735-7028/94/$3.00
Ethical and Professional Conflicts in Correctional Psychology
Linda E. Weinberger and Shoba Sreenivasan
The role of the mental health professional in a prison setting
has changed to reflect the prevailing
ideology of the correctional administration that deemphasizes
treatment and emphasizes security
and custodial concerns. As a consequence, mental health
professionals who work in corrections
have experienced unique ethical and professional conflicts.
Standards were developed to address the
conflicts and provide guidelines for professional conduct, but
dilemmas continue to exist. The au-
thors believe this can be attributed to (a) the standards being
vague and (b) correctional personnel
not understanding or supporting the standards or the
psychologist's role as a mental health profes-
sional. This article examines these propositions in more detail,
using vignettes and discussion, and
offers other approaches to resolving the dilemmas and
improving the delivery of mental health ser-
vices to incarcerated individuals.
Historical Perspective

Mental health professionals who work in corrections have ex-
perienced ethical and professional conflicts that are unique to
these institutions. Appreciating the mental health professional's
role within a prison entails an examination of how our society
has treated those who violate the law. Historically, most socie-
ties have adopted a philosophy that those individuals who com-
mit criminal acts should be punished. Modern Western judicial
systems have justified their use of punishment on four major
grounds: retribution, deterrence, incapacitation, and rehabili-
tation (Grilliot, 1983; Kerper, 1972). Retribution has Biblical
roots referring to "an eye for an eye." Deterrence operates from
the core belief that those who see individuals punished will be
less likely to follow the example of offenders because of the
fear
of punishment. Incapacitation has as its primary goal the pro-
tection of society by rendering offenders unable to repeat the
offense. Rehabilitation is conceptualized as treating or "correct-
ing" offenders so that they can live in society and not reoffend.
The theory of rehabilitation is a relatively new objective used
to justify punishment and has undergone many reformulations
as our society's attitude toward criminal offenders has changed
(Travin, 1989). Early American colonists believed that rehabili-
tation could be accomplished through severe punishment (e.g.,
stocks or gallows). It was not until the 18th century that an in-
stitution incarcerating offenders was viewed as having correc-
tional properties. Reflecting the largely held Protestant values
of
the time, it was believed that rehabilitation in such institutions
LINDA E. WEINBERGER is Associate Professor of Clinical
Psychiatry
at the University of Southern California School of Medicine and
Chief
Psychologist at USC Institute of Psychiatry, Law and

Behavioral Sci-
ence.
SHOBA SREENIVASAN is Clinical Assistant Professor of
Psychiatry at the
University of Southern California School of Medicine and
StafFPsychol-
ogist at West Los Angeles Department of Veterans Affairs
Medical Cen-
ter.
CORRESPONDENCE CONCERNING THIS ARTICLE should
be addressed to
Linda E. Weinberger, USC Institute of Psychiatry, Law and
Behavioral
Science, P.O. Box 86125, Los Angeles, California 90086-0125.
could be achieved through solitude, hard labor, and contempla-
tion of one's criminal acts. The mainstays of this rehabilitation
evolved into the "penitentiary" stage of corrections. Strong op-
position developed against the hardships of this mode of reha-
bilitation, and the late 19th century heralded the "reformatory"
era. Reforms included the use of indeterminate sentences, pa-
role, vocational training, and a system to reward good behavior
with early release. An additional reform advocated was that of
individualized treatment. From the early to the mid-20th cen-
tury, psychological interventions were based on the medical or
treatment model. Through the 1940s and 1950s, the Federal
Bureau of Prisons actively engaged the use of psychologists and
psychiatrists to rehabilitate prisoners (Roth, 1986). Initially,
mental health professionals focused on the treatment of the in-
dividual inmate toward the goal of psychological behavioral
changes (Adams, 1985). This medical model or treatment ap-
proach became tarnished somewhat in the 1960s and much
more appreciably so in the 1970s and 1980s. There were many
reasons for this, not the least of which was the failure of such
efforts to significantly lower recidivism rates (Roth, 1986).
Con-

sequently, the role of the mental health professional changed to
better reflect the prevailing ideology of the correctional admin-
istration (viz., deemphasizing treatment of the individual and
emphasizing security of the institution as well as protecting the
community at large; "Board Approves," 1989; Ochipinti & Bos-
ton, 1987).
Organizational Models
Currently, the delivery of mental health services for individu-
als sentenced to correctional facilities tends to fall within four
basic organizational patterns. The individual may receive treat-
ment under one of the following: (a) in a correctional setting
where both the mental health services and security needs are
provided by the department of corrections; (b) in a correctional
setting where the mental health services are provided by a sepa-
rately administered mental health agency and security needs
are administered by corrections; (c) in a mental health facility
(e.g., a state hospital with a forensic unit) where both the
mental
health services and security needs are provided by the depart-
161
162 LINDA E. WEINBERGER AND SHOBA SREENIVASAN
ment of mental health; and (d) in a mental health facility where
the mental health services are provided by the department of
mental health and the security needs are administered by the
department of corrections (Nelson & Berger, 1988). The states
vary with respect to mental health services being provided by a
department of mental hygiene versus a department of correc-
tions. In those state systems where mental health services are
administered by the department of corrections, the institution's

warden has authority over chief psychologists and other mental
health departmental heads.
A national survey was recently published regarding mental
health services (i.e., 24-hr hospital mental health care, residen-
tial treatment programs, counseling/therapy, medication mon-
itoring, and testing/assessment) for state adult correctional fa-
cilities (Morrissey, Swanson, Goldstrom, Rudolph, & Man-
derscheid, 1993). The results of the survey found a pattern that
"as one moves from intensive to less intensive services, the
more
likely it is that services are provided under the auspices of the
individual prison or another State department of corrections
(DOC) facility" (p. 2). As a large proportion of psychologists
tend to provide outpatient care (i.e., less intensive treatment),
this trend suggests that their services to inmates are more likely
to fall under the correctional system than the mental health sys-
tem.
The delivery of psychological services within the federal sys-
tem is managed by the Federal Bureau of Prisons. There is an
overall chief administrator of psychology located at the central
office in Washington, DC. The next level in the organization
reflects a division of the states into various regions (e.g.,
western,
eastern, southern, etc.) with a regional administrator who over-
sees the activities of the chief psychologists within the
individual
federal prisons. Each federal prison has a chief psychologist
who
supervises the activities of staff psychologists working at that
institution. Although the organizational hierarchy in psychol-
ogy is responsible for providing direction and support for gen-
eral policy, the actual day-to-day administration of psychologi-
cal services is directed by the chief psychologist of that prison.
In turn, the chief psychologist's direct administrator of these

services is the associate warden of programs who reports to the
warden. Although policies may be formulated at the central
office level, the warden of each prison holds the ultimate deci-
sion-making authority concerning the implementation of policy
inside that facility.
In some states as well as in the federal prison system, the jus-
tification for placing mental health services under the admin-
istration of corrections is that there would be fewer problems
and more available resources. For example, psychologists would
not be seen as "outsiders," and departments of corrections tend
to obtain resources more easily than do departments of mental
health because of their priority status in getting funds (Levin-
son, 1985; Nelson & Berger, 1988). In addition, if mental health
care were delivered within the department of corrections, legal
issues regarding the transfer of individuals from the jurisdiction
of corrections to mental health would be averted (Vitek v.
Jones,
1980). Under these organizational contexts, staff psychologists
who encounter ethical dilemmas may seek the support of their
profession's departmental head. However, given that these psy-
chology administrators do not hold ultimate authority, the di-
lemmas may not be resolved. This article will primarily focus
on those systems where mental health does not function auton-
omously but under the auspices of corrections.
Treatment Versus Security Model
The move of correctional institutions from a treatment
model to a security model has not always been a comfortable fit
for psychologists working in the system. The primary role of
mental health professionals as perceived by correctional admin-
istrators has evolved into that of applying their expertise and
skills to custody matters (viz., ensuring a compliant and man-
ageable inmate population). Under these conditions, the psy-

chologist is compelled to address the needs of the institution as
primary.
The United States Department of Justice, Federal Bureau of
Prisons offered a good illustration of this. It was mandated that
recently hired psychologists attend and successfully complete
an intensive training program at Glynco, Georgia, site of the
Federal Law Enforcement Training Center. The 3-week pro-
gram was titled "Introduction to Correctional Techniques"
(Federal Bureau of Prisons, 1986) and was designed to teach
the new employee basic correctional concepts and tasks, which
included inmate discipline review, self-defense, use of firearms,
and searching for contraband. The basic purpose of this training
program was to orient all employees to their custodial-disci-
plinary roles and duties in the Federal Bureau of Prisons. What
was noteworthy about this training program is that no distinc-
tion was made between psychologists and other correctional em-
ployees. The underlying philosophy was that all employees were
considered correctional officers first and foremost. Such expec-
tations of psychologists are not peculiar to the federal system
but endemic to most correctional institutions ("Board Ap-
proves," 1989; Clingempeel, Mulvey, & Reppucci, 1980). Con-
sequently, psychologists are expected to engage in custody-ori-
ented activities that may at times undermine the traditional
therapeutic goals and relationship between the therapist and the
individual inmate, thus causing ethical and professional dilem-
mas.
Over a decade ago, Brodsky (1980) and Clingempeel et al.
(1980) described a variety of dilemmas faced by psychologists
working in corrections. Some of the dilemmas they discussed
were confidentiality, use of psychological assessment, and treat-
ment interventions. The conflicting issues raised by the mental
health professional's role as a custodial agent prompted the de-
velopment of standards specific to correctional mental health.
These standards arose from associations such as the American

Public Health Association (Dubler, 1986), the American Medi-
cal Association (1979), and the American Association of Cor-
rectional Psychologists (1980). The areas of confidentiality,
pro-
fessional autonomy, medication, use of involuntary restraints,
and licensure requirements were similarly addressed by the var-
ious standards. In addition, the standards provided guidelines
for professional conduct sensitive to the needs of both mental
health and corrections (Levinson, 1985;Travin, 1989). In 1991,
"Specialty Guidelines for Forensic Psychologists" was devel-
oped by the American Psychological Association's Division 41
in an effort to "provide more specific guidelines to forensic psy-
chologists in monitoring their professional conduct" when
functioning in correctional and forensic mental health facilities,
ETHICAL AND PROFESSIONAL CONFLICTS 163
as well as in other areas of forensic professional practice (Com-
mittee on Ethical Guidelines for Forensic Psychologists, p.
655).
The creation of this standard plus the addition of "Forensic Ac-
tivities" in the American Psychological Association's Ethical
Principles of Psychologists and Code of Conduct (1992) illus-
trate the growth of psychologists engaging in forensic work and
the need for guidance in performing ethically and toward the
"highest ideals of psychology."
Despite the existence of the various standards, many ethical
and professional dilemmas continue to plague psychologists
working in corrections. This is particularly so if mental health
does not function independently but under the administration
of the department of corrections. We believe this can be attrib-
uted to the following: (a) the standards for psychologists are
vague and (b) correctional personnel do not understand or sup-

port the standards and/or the psychologist's role as a mental
health professional. The remainder of this article will examine
these propositions in more detail using vignettes and discussion.
Vignette 1
Psychologist A receives a call in his office from the associate
war-
den, directing him to report to Unit C, where they are short of
correctional officers. Psychologist A reports to Unit C and
partici-
pates in the evening count. Subsequently, he is approached by
the
captain and directed to perform a search for contraband of the
inmates' property. The psychologist is also told he will have to
"pat
search" all inmates in his section. The psychologist is to seize
any
contraband and report all infractions to the captain.
The above vignette represents an example where the psychol-
ogist is asked to perform a correctional officer's duties. In ex-
amining the various professional associations' standards
(American Medical Association, 1979; American Association
of Correctional Psychologists [AACP], 1980; Dubler, 1986),
there is no clear statement as to the circumstances under which
a psychologist should or should not perform correctional offi-
cers' tasks. Generally, psychologists who work in correctional
institutions accept the importance and primacy of security
(Goldstein, 1983). Further, the Bureau of Prisons Psychology
Manual (Federal Bureau of Prisons, 1987) states that under
emergency situations "psychologists function first and foremost
as correctional workers" (Sec. 3.4). However, under nonemer-
gency conditions, the manual cautions psychologists to avoid
violations of the American Psychological Association's Ethical
Standards (American Psychological Association [APA], 1989).
In that the manual does not define or describe what situation

constitutes an "emergency" for psychologists assuming correc-
tional duties, this allows a wide range of events to be
interpreted
as "emergencies." The scenario we described is one where the
unit is short-staffed and correctional officers' tasks need to be
fulfilled for security purposes. Does this represent an emer-
gency situation condoning the captain's request for the psychol-
ogist to perform various custodial activities, ranging from an
innocuous count to an invasive "pat-search" and reporting of
infractions?
As stated earlier, the standards do not specifically address
some issues, such as (a) psychologists' correctional versus men-
tal health duties and (b) what is meant by an "emergency" situ-
ation for psychologists to perform correctional duties. This state
of affairs places clinicians in a "no-win" position. If clinicians
cannot turn to standards to guide them or use the standards
to decline participation in potentially dilemmatic activities, the
correctional administration may have every right to expect psy-
chologists to cooperate with their requests. Although the "Spe-
cialty Guidelines for Forensic Psychologists" (Committee on
Ethical Guidelines for Forensic Psychologists, 1991) was de-
signed for forensic psychologists who may be working in
correc-
tional settings, no clear direction is offered to help the psychol-
ogist resolve this particular conflict. Some experts such as
Clingempeel et al. (1980) have concluded that when the stan-
dards do not provide definitive guidelines, psychologists are
"forced to rely in large measure on personal values. . .in mak-
ing decisions regarding custody vs. treatment" (p. 129).
In addition, when mental health professionals engage in cor-
rectional duties, the inmates' perception of psychologists is
affected. Among the costs of engaging in correctional activities
is the compromise of psychologists' credibility and efficacy.

Per-
mitting psychologists to function in dual roles destroys their
therapeutic image and thus leaves them being perceived solely
as a "cop." This is problematic beyond the perhaps esoteric is-
sue of role distortion. Prisons by and large do not have adequate
mental health staffing; hence, this practice effectively results in
leaving an institution that uses a psychologist as a correctional
officer with one more of many other "cops" and one less of very
few clinicians.
In our vignette, the short-term gain to the institution of the
psychologist who serves custodial needs does not, on balance,
outweigh the long-lasting detriment to rehabilitation efforts that
could be initiated by psychologists working within their mental
health role. We accept that all staff members should function in
ways that assure the maintenance of security. It does not seem
unreasonable, however, to suggest that psychologists participate
in such maintenance only in a manner that is congruent with a
more traditional professional role.
Vignette 2
Inmate R is scheduled to appear before the prison disciplinary
board for having violated the institution's rules. Specifically,
In-
mate R was verbally abusive to one of the correctional officers
and
refused to report to her work assignment. This is the third such
incident in the last week. If the board decides to impose a
disciplin-
ary measure, Inmate R could lose a number of earned "good-
time"
days and possibly be placed in administrative segregation.
Psychol-
ogist B is asked to serve as one of the members of the
disciplinary

board. The psychologist does not know Inmate R and believes
there
is no conflict of interest.
Many believe that psychologists' participation on prison dis-
ciplinary boards does not pose an ethical dilemma if there is no
dual-role conflict present. A common perception is that as long
as the psychologist is not the inmate's treating clinician, no di-
lemma arises in being a decision-maker regarding the inmate.
In fact, both the American Public Health Association (Dubler,
1986) and the American Association of Correctional Psycholo-
gists (1980) accept mental health professionals functioning as
members of decision-making teams when they are not the in-
mate's therapist. The standards, however, do not specifically ad-
dress the issue of psychologists participating in decisions that
result in punishment or discipline for the inmate. For example,
prison disciplinary boards could exact measures such as (a) loss
164 LINDA E. WEINBERGER AND SHOBA SREENIVASAN
of privileges, (b) loss of earned "good time," (c) transfer of the
inmate to a high-security institution (e.g., where more hard-
core inmates are housed and the risk of victimization is higher),
and (d) placement in solitary confinement for a lengthy period.
The standards' lack of specificity do not give the psychologist
any support or direction in what to do when asked to serve on a
disciplinary board. Should the psychologist assume a role where
the sole purpose of participation is meting out punishment for
the inmate? This does not appear to be in agreement with the
American Psychological Association's Ethical Standards (APA,
1989, 1992; Williams, 1986) on psychologists' primary com-
mitment to the welfare and protection of individuals. Although
the Ethical Standards of the American Psychological Associa-

tion do not specifically comment on psychologists serving in
de-
cision-making roles where an individual could be punished, the
standards do endorse psychologists taking "reasonable steps to
avoid harming their patients or clients. . .and to minimize
harm where it is foreseeable and unavoidable" (APA, 1992,
Standard 1.14). Psychiatrists appear to be excluded from sitting
on disciplinary boards because of their credo to "do no harm."
Further, allowing psychologists to serve on disciplinary
boards leads to the breakdown of our unique position to serve
only mental health needs. Permitting psychologists to make dis-
ciplinary decisions erodes the traditional professional role. This
occurs both externally (e.g., losing credibility among inmates;
custody personnel viewing us as primarily correctional workers)
as well as internally (e.g., the psychologist beginning to adopt a
"jailer's" mentality). Vague or nonspecific guidelines on this
point leave the therapeutically oriented psychologist feeling lost
and thwarted. It also grants the correctional administration the
ability to influence the naive and pliant psychologist into adopt-
ing a disciplinary orientation. The "Specialty Guidelines for
Forensic Psychologists" acknowledges that forensic psycholo-
gists' personal values and moral beliefs may affect their ability
to practice competently, and as such, they are "obligated to de-
cline participation or to limit their assistance in a manner con-
sistent with professional obligations." (Committee on Ethical
Guidelines for Forensic Psychologists, 1991, p. 648). Unfortu-
nately, without a clear prohibition against psychologists serving
as punishment/discipline decisionmakers appearing in any of
the standards, there is room for interpretation, with the possible
result of correctional psychology drawing those attracted to-
ward controlling and punishing inmates rather than those in-
clined toward understanding and treating them.
On the other hand, some might argue that if psychologists
serve on a disciplinary board, they could apply their knowledge

and expertise to evaluating the inmate. Conceivably then, this
could be used to help the inmate. Rather than serving as board
members, we believe this desired effect could be similarly
achieved if psychologists acted as consultants to the board.
However, in accordance with preserving psychologists' commit-
ment to maintaining a therapeutic role, their involvement as
consultants should only occur at the request of the inmate.
Vignette 3
Inmate X has a long history of violent behavior, which has
resulted
in his current imprisonment. While incarcerated, he has been a
model prisoner. Inmate X has now been scheduled for a parole
board hearing. Upon reviewing Inmate X's central file, the
warden
believes that the inmate is still a dangerous individual who
should
not be granted parole despite his record of no institutional
infrac-
tions. Accordingly, the warden requests that Dr. R evaluate
Inmate
X using psychological tests. The warden would like information
about the inmate's personality relating to his continued threat to
public safety, and he would like this evaluation to be performed
without the inmate being informed of its purpose because he be-
lieves Inmate X might otherwise refuse to participate in the
evalu-
ation.
The identification of dangerousness by mental health profes-
sionals has remained a much-debated issue. There are, however,
a sizable number of clinicians who assert that through proper
training, education, and experience, they can identify those fea-
tures relevant to an individual's threat of harm. One means of
accomplishing such an evaluation would be through a thorough

clinical interview, review and consideration of collateral
sources
of information, and the administration of select psychological
measures.
In this scenario, the warden's concern revolves around the
issue of release of an individual whom he considers dangerous
into the community. The warden, in his quest to obtain all rele-
vant information to the issue of dangerousness for presentation
to the parole board, solicits the assistance of the psychologist.
The warden's request for such an evaluation is qualitatively no
different from commonly accepted requests made by judges to
forensic psychologists and psychiatrists for probation and sen-
tencing purposes. Moreover, psychologists and psychiatrists
routinely evaluate hospitalized insanity acquittees as to their
readiness for release into the community on the basis of their
mental condition and the threat of harm to others. Therefore, it
is not unreasonable or unrealistic for the warden to anticipate
this as a job responsibility for the correctional mental health
worker.
The problematic element in this scenario refers to the war-
den's request for a "covert" evaluation where the inmate is de-
prived of his right to informed consent. The application of psy-
chologists' skills in such an important issue as the identification
of dangerousness in an incarcerated individual demands respect
and adherence to this fundamental ethical principle; however,
an exception to this principle exists. Standards developed for
mental health professionals in corrections have defined "emer-
gency" conditions where one does not need to obtain informed
consent prior to evaluation (AACP, 1980; American Medical
Association, 1979; American Psychiatric Association, 1989;
Dubler, 1986). These standards define the "emergency" as lim-
ited to life-threatening circumstances where there is a risk of
escape or "the creation of internal disorder or riot" (American
Psychiatric Association, 1989). We believe that to allow this

sce-
nario to fall under this exception would be grossly inappropri-
ate.
The issue of informed consent also illustrates a basic differ-
ence between the correctional administrator and the mental
health worker. For the latter, professional ethics and standards
strongly dictate obtaining informed consent, maintaining con-
fidentiality, and discussing the limitations of confidentiality
with the client (APA, 1989,1992; Committee on Ethical Guide-
lines for Forensic Psychologists, 1991). Correctional admin-
istrators, on the other hand, may not understand the need for
this because they are not expected by their colleagues or the
inmates to adhere to the above principles.
It is possible that correctional psychologists in certain situa-
tions could view themselves as having to function in a role sim-
ilar to that of correctional administrators and thus justifiably
deviate from their professional standards. For example, in this
scenario, an argument could be made that by informing the in-
mate of the nature and purpose of the psychological assessment,
one, in essence, sabotages the evaluation. Along these lines, it
could be stated that the greater good of protecting public safety
outweighs the compromise of informed consent. Ultimately,
these arguments would fail because they would not be accepted
by the mental health community. Idiosyncratic interpretations
by individual clinicians as to what constitutes an exception to
confidentiality and informed consent essentially undermine the
validity of the written standards and ethics. The credibility of a
profession requires that those who identify themselves as be-
longing to the professional group must respect and adhere to its
shared concept of ethical behavior. Confidentiality and in-

formed consent are by definition the cornerstones of psycholog-
ical practice and our professional identity and therefore must be
vigorously protected.
Vignette 4
Inmate Y is a 40-year-old individual who has a reported history
of
suicide attempts while in the community and has obvious scars
on
his wrists. He is also a known substance abuser. A new policy
of
monthly urinalysis screens for randomly selected inmates went
into effect in the prison. When asked to give a urine sample by
Unit
Manager S, Inmate Y refused and stated that he is being singled
out
because the unit manager does not like him. Inmate Y then went
to his bunk area and cut his wrists. He was subsequently
placed.in
the infirmary, where Dr. T, a psychologist, evaluated him. The
unit
manager told Dr. T that the inmate is a savvy convict who had
cut
his wrists to avoid the urinalysis. Unit Manager S also suspects
that
Inmate Y has been involved in smuggling drugs into the institu-
tion. The unit manager believes that Inmate Y should be
punished
for refusing the urinalysis because not to do so would encourage
other inmates to also refuse drug testing and possibly use
manipu-
lative acts to avoid it. Dr. T identifies Inmate Y as suffering
from a
borderline personality disorder and recommends that he attend a
group therapy program for suicidal inmates. Dr. T also recom-

mends that Inmate Y not be selected in the near future for
random
drug screens. Unit Manager S informs the warden that he
disagrees
with Dr. T's opinions and suggests that the warden veto the
doctor's
recom mendations.
This vignette illustrates the different explanations and reac-
tions of correctional staff and mental health professionals to an
inmate's behavior. Generally, the correctional staff's training
and experience lead them to view disruptive behavior as related
to criminality and requiring punishment. The clinician's per-
spective, on the other hand, derives from a treatment model
(i.e., the disruptive behavior represents a symptom in an identi-
fiable disorder that can be treated). Herein lies a basic conflict
between corrections and mental health.
Several authors have suggested that beyond this custody-
treatment dichotomy, other differences also exist. Correctional
administrators and workers may view themselves as profes-
sional managers whose primary concern involves maintaining
security and addressing issues of overcrowding and day-to-day
activities of meals, work details, and orderly unit functioning
(Smith, 1987). Corrections workers, perhaps rightly, may view
themselves as the "backbone" of the prison, and mental health
professionals as playing an ancillary role (Hilkey, 1988).
Within
this context, psychological symptoms and treatment then may
be viewed either as irrelevant or as interfering with the orderly
maintenance of an institution. Additionally, if correctional staff
perceive disruptive conduct as a manipulative attempt by an
inmate to escape punishment, the staff may have a negative re-
action to mental health professionals "psychologizing" the be-
havior. This in turn may foster a generalization that psychologi-

cal symptoms are simulated for secondary gain (Adams, 1985;
Nelson &Berger, 1988).
This tendency for the correctional staff to ignore, dismiss, or
misidentify problematic behavior may be a function of their
lack of training. Moreover, some mental health professionals'
inclination to label such behavior as always a product of mental
illness may reflect their naivete of the prison community. Cer-
tainly not all correctional staff are insensitive to psychological
symptoms, nor are all clinicians gullible to an offender's "con
games." In our vignette, however, it appears that the staff from
both professions rigidly maintained a unidimensional orienta-
tion; viz., the unit manager viewed the inmate's behavior as ma-
nipulative, whereas the psychologist considered it a symptom of
a psychological disorder.
Maintaining an inflexible and stereotypic approach does not
encourage the smooth running of an institution. This issue
must be remedied through education. Correctional personnel,
therefore, should be trained at minimum in basic psychological
concepts and symptomatology. Further, clinicians should be
aware of correctional practices and priorities as well as un-
derstand offenders and their behavior in prison. We, however,
are not proposing that psychologists receive training to the ex-
tent that they could assume the duties of a correctional officer,
nor are we advocating that correctional staff be instructed to
such a degree that they could be considered lay mental health
practitioners. Rather, both professional groups should be sensi-
tized to and demonstrate a respect for each other's contribution
and expertise.
Another important issue to consider is the basis for manipu-
lative behavior that is so commonly seen in prison. One might
concede that the inmate's actions in our vignette were in fact
"manipulative." Simply identifying this as such does not offer
the correctional staff a method for properly managing this in-

mate. To deal more effectively with "manipulative behaviors,"
it is necessary to understand that there are various causes for
such conduct. The manipulative behavior could be the product
of a genuine mental illness, malingering, or a mixture of these
two factors in an individual who is both disturbed and antiso-
cial. Properly assessing the reason for the manipulative conduct
is essential if we are to eliminate such acting out. If the manip-
ulations are determined to be the result of a mental illness, then
treatment is indicated and warranted. If the behavior stems
from a sociopathic style, then it should be curtailed and not
reinforced.
Summary
As the Criminal Justice System has modified its view of the
role corrections should play in addressing offenders, the expec-
tation of what psychologists can and should do within correc-
tions has also been affected. In recent years, the sociopolitical
166 UNDA E. WEINBERGER AND SHOBA SREENIVASAN
climate has been skewed toward harsher sentencing, with the
public by and large less sympathetic toward the needs of
offenders and more concerned with keeping such individuals
out of the community. In response, prisons have shifted away
from providing adequate rehabilitative services to inmates.
Prisons have continued to employ psychologists; however, their
traditional role of providing rehabilitation to prisoners has
changed to include institutional concerns of security and inca-
pacitation. Standards were developed in an attempt to offer the
psychologist guidelines in making this transition, that is, being
sensitive to the security needs of the institution while
preserving
the clinician's therapeutic alliance. Despite the existence of

these standards, ethical and professional dilemmas continue to
exist as illustrated in our vignettes. Underlying reasons for
these
persistent dilemmas may include the vagueness of the guidelines
thus far developed and the lack of correctional administrators'
understanding of and support for the therapeutic role of psy-
chologists.
Proposed Recommendations
It is our opinion that psychologists who work under the ad-
ministration of corrections within a prison setting in essence
often serve as "window dressing" and frequently do not provide
true clinical services. We believe that this situation cannot be
remedied solely by amendments to the existing guidelines and
standards, some of which are vague. Moreover, the suggestion
that the psychology administration negotiate with the correc-
tional administration regarding the type of work they will or
will not perform would not appear to be a generally effective
solution. We strongly believe that correctional administrators
are interested in the welfare of inmates. For many, however,
their current mission and goals (a smooth running of the insti-
tution) are not the correctional rehabilitative goals of the past
(provide therapeutic services to address inmates' current ad-
justment problems in addition to future ones they may have
in the community). Thus, conflicts arise when mental health
providers' goals are not congruent with those of correctional
administrators.
Given this shift of correctional administrative concerns, what
solution can be offered? Some have suggested the implementa-
tion of peer review committees as a method of monitoring the
clinical care given within prison and jail settings (Brodsky,
1980; National Commission on Correctional Health Care,
1987). Recommendations from peer review committees would
be useful only to the extent that there would be an incentive for

administration to follow the committee's proposals. Accredita-
tion of mental health programs could be one method for secur-
ing adequate clinical services to prisoners; however, it would be
necessary that the lack or loss of accreditation result in some
economic sanctions to the correctional facility if the concept
of "accreditation" is to be meaningful. The imposed economic
sanctions could be a reduction of funding for mental health pro-
grams and services.
It should be noted that a reduction of funding for mental
health programs and services may not be a sufficient incentive
for some wardens to adhere to accreditation guidelines, because
they may not believe in the need for such services. Although
these wardens may have the opinion that mental health treat-
ment is not justified in a correctional setting, the judicial
system
has opined otherwise. In a number of cases, the courts have
ruled that the unavailability or willful neglect of psychiatric
care is actionable and may be viewed as a violation of the 8th
Amendment ban on cruel and unusual punishment (Wellman
v. Faulker, 1983; Joseph v. Brierton, 1984; Bowring v. Godwin,
1977; Laaman v. Helgemoe, 1977). Thus, the filing of civil suits
against correctional administrators may be the more persuasive
inducement needed to change their beliefs and practices. More-
over, if these correctional administrators were informed as to
how mental health services are beneficial to the institution (e.g.,
assisting in inmate adjustment problems, particularly with the
overcrowding situation), they may be more responsive to sup-
porting quality mental health care (Adams, 1985).
In the final analysis, accreditation or lawsuits, even with eco-
nomic or other sanctions, represent only a partial means of im-
proving the delivery of mental health services to incarcerated
individuals. We believe that mental health services suffer when
subsumed under departments of corrections. Correctional ad-

ministrators do not usually possess expertise to properly evalu-
ate the quality of mental health services, nor can they ade-
quately assess what constitutes clinically sufficient levels of
staff
and other resources. Indeed, Metzner, Fryer, and Usery (1990)
found that there was a high risk of litigation under those mental
health systems operated by the departments of corrections.
Consequently, a far better approach would be to have mental
health services administered under the departments of mental
health or health services. Under such an organizational scheme,
not only would the above-mentioned issues be addressed, but
professional autonomy would also be assured. In addition, re-
sources would be more frequently directed toward treatment
goals than completely toward maintaining security (Nelson &
Berger, 1988). Agencies operating under departments of mental
health and health are more familiar with recruiting mental
health and health professionals. Moreover, many mental health
professionals are more willing to work in settings that operate
under traditional therapeutic goals.
It should be noted that in recent years psychiatric profession-
als have reasserted their traditional medical role. That is, there
has been a move toward psychiatric services becoming indepen-
dent of correctional administration or, at minimum, offering
dual management wherein psychiatrists operate with the same
level and type of care as they provide in the community (Amer-
ican Psychiatric Association, 1989; Travin, 1989; Von Holden,
1983). Generally, psychiatrists are more likely to be found
working on inpatient units with the acutely mentally ill offender
than in outpatient settings; their work with outpatient inmates
is usually medical in nature. When there is clinical leadership
that has the authority to create a therapeutic environment, the
quality of mental health services as well as staff morale and sat-
isfaction are greatly enhanced.
Although we acknowledge that there are some disadvantages

to the mental health care delivery system being based under a
department separate from corrections (e.g., corrections viewing
mental health professionals as outsiders; fewer resources be-
cause more funding is allocated to departments of corrections
than to departments of mental health), we agree with previous
authors that our services should be in keeping with those in the
community as directed by mental health/health administrators.
Given the variety of conflicts faced by psychologists who work
under the auspices of a department of corrections, we do not
believe that such dilemmas can be effectively and sufficiently
resolved by the following: (a) refining existing professional
stan-
dards; (b) psychology administrators negotiating with their cor-
rectional administration employers about the type of work they
will or will not perform; (c) implementing peer review commit-
tees; and (d) imposing economic sanctions either through a re-
duction of funding or lawsuits. Consequently, we strongly be-
lieve that the long-term resolution of psychologists' role con-
flicts can best be achieved by placing the locus of control for
mental health services under health or mental health depart-
ments. The balance between custody and treatment needs can
be accomplished, as evidenced by states where mental health
agencies administer both security and treatment, or security
needs alone are administered by the department of corrections.
In conclusion, if mental health services provided in correc-
tional settings do not reorganize under the auspices of mental
health or health departments, the ethical dilemmas mentioned
by Brodsky and his colleagues over a decade ago will continue
to plague mental health professionals in the future just as they
do now.

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Received May 3, 1993
Revision received September 20, 1993
Accepted October 5, 1993 •

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