Webinar presenters Dr. Babatunde Okuleye, Dr. Robin Timme and Dr. Jennifer Horney answered a number of your questions after their presentation, Corrections & COVID-19: Enhancing Resiliency of Staff and Inmate Populations. Here are just a few of their responses.
Audience Question: Given the fact that there are some people that have the virus but don’t have any symptoms, is it even safe to be in close contact with the inmates? As a social service specialist, part of my job does require face-to-face, even with a mask in place. I would love your thoughts on that.
Dr. Robin Timme: Great question, and I think it’s one that we’re all struggling with everywhere. Maybe more so in confined spaces. I’m going to turn that over to Dr. Horney who’s an epidemiologist and let her grapple with that one.
Dr. Jennifer Horney: Yes, I think that epidemiologists have as a whole been a little cautious about the guidance for the broader public to use masks when out and about doing their essential business. I think the most important thing is that you’re trained to use that personal protective equipment properly. So if you need to use it, then you need the training to be sure that you’re using it properly and actually getting the protection that it can provide and not just the feeling of the protection that might you know not be there if it’s not used properly. The second thing I think you can you can look at a number of sources to see the recommendations certainly, a surgical mask or even worn by the person that you’re interacting with, if that person is sick but it’s asymptomatic and that could certainly help with them transmitting any sorts of respiratory droplets to you. So that’s an extra precaution that could be taken if you have the PPE supplies available. So hopefully people who are working in these settings have PPE that has been fitted and they’ve been trained to use and they have a supply available as well.
Dr. Robin Timme: Thank you, Jen. I would also add that these are really tough times in general and it’s so hard to give yes or no answers, isn’t it? It’s so hard to find like no, it’s too dangerous don’t go there or yes, it’s fine. You’re perfectly safe, go there. I think that’s a conundrum we face a lot in corrections, right? I mean, is it safer to enter a correctional housing unit, or is it not. It’s all relative kind of right now and so I think the guidance Jen just provided in the resources is really important for you to mitigate or minimize the risk of those things. The last point I wanted to make about this question that’s really interesting is that the question implies that the inmates are far riskier in terms of transmission, but I’m not so sure that the staff are any less risky. We have asymptomatic staff and symptomatic staff across the country and so, I think it’s really important that we remember that the disease doesn’t really care if you’re an inmate or a staff member and that we apply the same mitigation and risk management strategies to anybody that we come into contact with. Thank you, a great question.
Audience Question: Should mental health groups continue? If so, how did he manage them? Should there be more individual counseling?
Dr. Robin Timme: Great question. So different jurisdictions have approached this differently and I’ve seen it done a few different ways. If you are going to continue having in-person mental health groups, there are ways to do it that can reduce the risk, for example, as Dr. O mentioned if you can facilitate the classroom being a larger size with smaller numbers of people you can then practice some of those social distancing guidelines within that group of people so you could you can have people sit several desks apart, for example, which can again it’s not going to eliminate the risk, just like the mask, but it can be mitigate it or help to minimize that risk to the person. Another strategy is the introduction of Telehealth. I’ve seen some more advanced jurisdictions that have access to tablets that they can actually run group therapy through their tablet systems and so they can all communicate in a group setting from their cells or from a common area where they can be very far apart as well. Should we increase the use of individual therapies? I think we should just in general given the stress of the time if you’re able to. The thing about individual therapy is that is the case in a lot of facilities, is that you often will have a room for individual therapy that is partitioned so you might have glass between yourself and the patient in which case that can also help to mitigate the transmission of those respiratory droplets and so you may feel safer and be able to mitigate the risk as a result there. Some other jurisdictions are increasing the use of individual therapies via Telehealth and they’re determining that some of their mental health staff can stay at home and operate remotely and do Telehealth through VPN or other remote platforms to reach the patient. And then that service can be facilitated on the inside by custody or nursing staff who are considered essential for example, and that’s another reason why as Dr. O was saying it’s really important that we’re integrated as a united team right now and that we’re all cross-trained in these different tasks so that you could have an officer who doesn’t normally facilitate teletherapy being able to go and help to make that happen.
Audience Question: Absolutely agree that treating Mental Illness with help with medication adherence. What about the person that will not agree to treatment because they lack awareness that they even have a serious mental illness? Could the jail force treatment in these situations?
Dr. Robin Timme: The old anosognosia, a symptom of a serious mental illness. I’m going to kick that one over to Dr. O, he has an MD I have a Psy-D. He probably has a nicer car than I do. Go ahead, Dr. O.
Dr. Babatunde Okuleye: How did I get that question was coming my way. So I think that with the treatment of the seriously mentally ill who are refusing medication or because of their lack of insight are once again are refusing medication. I think the different jurisdictions handle that in different ways. I think overall the two main criteria that typically determine whether you can force a patient to take medication through the legal system or through systems that are set up within the jail facility or structure or system, basically boils down to two things. Is the individual a danger to himself? Is the individual a danger to others? Is the individual gravely disabled and by the definition of greatly disabled, we imply that the individual is unable to care of the basic life necessities in terms of food, clothing, and shelter. So typically unless a patient or inmate meets one of those three criteria, I would say it’s uncommon that they would be forced to take medication. So basically the inmate has to be so severely mentally ill that we have to intervene to keep them safe out of it themselves to keep others safe or to basically allow them to be able to maintain the basic necessities of life.
Dr. Robin Timme: Thank you, Dr. O. Yeah, I would also add that that question is incredibly jurisdiction-specific and most states will have either a law governing the administration of involuntary medication and so you should check with your state code and otherwise often This falls under a case called Washington v. Harper that you can find on Wikipedia. But definitely consult with your medical directors and your state laws. They’re often governed by that. In some states, for example, only a judge can order it. In other states, you can never involuntarily medicate somebody outside of an emergency situation unless they’re in a state hospital and in others, there are these Harper panels that can happen inside of a correctional facility where they have a quasi-judicial process for determining the so check with your jurisdiction and important question though.
Dr. Jennifer Horney: Can I just add one comment there? Sorry, this is Jennifer Horney so you mentioned in your comment about if it were an emergency so as long as your state is operating under emergency declaration, we are operating under a Stafford Act Emergency Declaration at the federal level. There are actually public health emergency powers that can be drawn upon to compel treatment, vaccination, isolation, quarantine, and other things and so that’s an element to consider here that we are under an emergency declaration.
Dr. Robin Timme: Thank you so much for that. I wasn’t aware of that. That would be a reference of the Stafford Act?
Dr. Jennifer Horney: Yeah so the Stafford Act of 2002 is the jurists give the president the authorization to make those disaster declarations but Jacobson v. Massachusetts back in 1903 was actually the case that set this all in motion in terms of the public health law. Another thing folks can Wikipedia if they’re interested.
Dr. Robin Timme: Wow, that’s really fascinating and I think that comes back to those unique ethical and legal dilemmas that come up that would be a really fun and interesting seminar to do one day. Thanks, Jen. Aaron?
Audience Question: Do you have suggestions on dealing with compassion fatigue when working from home so you’re not on 24/7?
Dr. Robin Timme: Great question. I was joking with Aaron and Cris and Dr. Falcon and the panel before we started about how my neighbor told me I look like Ted Kaczynski yesterday. I have felt like I am on 24 hours a day because it’s not even just work right? We’re expected to be working. Those of us with children are expected to now be teaching our children as well, which if it were possible I would have been doing this for years. So it’s a really important question and what I’ve found that’s really critical for me is that I have sort of abandoned a typical workday so to speak. I don’t necessarily work nine to five. I’ll work for a few hours and then I will schedule breaks into my day and force myself to go outside, go for a walk every single day. Do these things that actually bring me joy in life, wrestle with my children, you know, just try to actually formally schedule that stuff into my life. I’m curious though. Dr. O and Jen, you guys are staring at monitors all day also. What kinds of things are you guys doing?
Dr. Babatunde Okuleye: I think you hit the nail right on the head. I think it’s very important to realize to schedule those breaks. Take care of ourselves, do the things that we love to do personally. I like to listen to music so I’m whenever I’m not working I’m trying to listen to music. My son Shane shares the same I would say passion for music in his own way which typically involves singing on his phone and his social media. I think it’s very important that we connect with our families that helps to decrease stress in multiple ways and also to find time to practice just relaxation things. Deep breathing, mindfulness and going outside for physio, weather permitting and social distancing permitting. All of the things that we would normally take for granted that are now I would say more precious to us some of the things that we’ll need to try to make sure that whenever possible we can implement those things or practice those things.
Dr. Robin Timme: Dr. Horney, are you finding anything to be particularly helpful for you?
Dr. Jennifer Horney: I don’t think I’m doing a very good job at it. But I think I’m some kind of time that you things you get off of the screens and maybe I’ve been trying to read a book about the history of Chez Pannise, it’s a restaurant in California that was founded the farm-to-table movement. And so that gets me out of my COVID mindset a little bit before going to sleep. So yeah. Need I think we need to be better about building these things and sticking to them.
Dr. Robin Timme: Totally. Yeah, and I really just want to say thank you both for sharing those and thank you for the question for forcing us all to pause and reflect on our own wellness.
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