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Some Bureau of Prisons staff have recognized that, at least in some cases, approaching chronically self-destructive behavior as a treatment issue (not a disciplinary one) is the only way to rehabilitate someone with serious mental illness.

Mental Healthcare in Federal Prison: An Inside Look at the Bureau of Prison’s Mental Health Companion Program

The National Alliance on Mental Illness reported in 2015 that approximately 24 percent of state prisoners have “a recent history of a mental health condition.”1 Of course, that number includes only reported instances of mental illness. The actual numbers may well be higher. Regardless, mental illness plays a significant role in many prisoners’ criminal behavior.

hand in jail
hand in jail
Officials of the Federal Bureau of Prisons (BOP) have made providing mental health treatment a priority, but the need still outstrips the BOP’s resources. It is not uncommon for inmates with serious mood disorders – major depressive disorder and bipolar disorder, for example – to see an institution’s Psychology Department for just 10 to 15 minutes once per month for what’s known in BOP parlance as a “Care 2 check-in.” Such inmates may or may not receive psychiatric medication, but few of them have the opportunity to participate in the talk therapy, group sessions, or other counseling that research has shown can be just as effective as medication.

Why the lack of access to effective treatment? Essentially, because medication is cheap compared to trained therapists. Some might add that historically the BOP has been far more concerned with warehousing and managing inmates than in trying to rehabilitate or educate them.

But some BOP psychologists aren’t satisfied with the status quo.

Enter Peer Support

At the medium-security Federal Correctional Institution Petersburg in Virginia, the chief psychologist established a Mental Health Companion Program developed by the Psychology Services Branch of the BOP’s Reentry Services Division. Mental Health Companions are carefully vetted and trained inmates who the BOP determines have the “skills to assist other inmates with mental illness through modeling, listening, encouraging, and supporting.”2 Mental Health Companions work under the supervision of staff psychologists to:

• Monitor the well-being of inmates with mental illnesses.
• Help inmates to whom they are assigned to comply with treatment objectives.
• Assist with medication compliance.
• Teach and encourage the use of personal wellness and recovery skills.

As the BOP itself states, “Mental Health Companions do not provide professional mental health treatment. Rather, they work under the close supervision of psychologists to offer peer support services, which are intended to increase social connectedness, hopefulness, and engagement in mental health treatment among inmates with mental illness.”3

What Peer Support Looks Like

As often happens in prison, most things look different “on the inside” than people “on the street” might assume.

At FCI Petersburg Medium, one inmate said, “For me, my job is trying to head off any major blow-ups by being a good listener and a calming presence. If I see the guy I’m assigned to building toward an explosion, I have to notify Psychology immediately.”

Most of the companions affectionately refer to the inmates they are assigned to as “my guy.” Almost all of them see each other daily; many live together in the same cell.

“Sometimes I sort of feel like my guy’s secretary,” said another companion. “I live with him, so I’ve gotten him a calendar. I help him get to all of his appointments. I show him how to do things a lot of people just assume everyone knows. Like getting dental treatment. My guy hasn’t seen a dentist for four years because he didn’t know how to submit an electronic request.”

Of course, peer support isn’t all peaches and cream. The same companion said, “My guy has made a lot of progress in many areas, but frankly, he’s still a slob, and cleaning up after him gets real old, real quick. Now I just pay someone to clean.”

Another companion’s “guy” had an emotional outburst and threw chairs and reading materials across the law library for several minutes. While he did not harm anyone or inflict any real damage, the entire compound was locked down.4 Guards were summoned to restrain the man and escort him to solitary confinement, where he stayed for weeks before transferring to a more specialized psychiatric prison. His companion never saw him again.

A Path Forward

Historically, prison inmates and staff have considered one another enemies, or, at best, they ignore one another as much as possible. Peer support programs, however, require a re-examination of old patterns and paradigms.

At FCI Petersburg, some companions email or meet with Psychology Department staff on a regular basis, as often as several times a week. It’s not uncommon for inmate companions and psychologists to discuss an inmate’s “store man” bill5, gambling debt, or even sexual promiscuity. Technically, all of these behaviors are against the rules and could result in serious sanctions, but at least a handful of BOP staff have recognized that, at least in some cases, approaching chronically self-destructive behavior as a treatment issue (not a disciplinary one) is the only way to rehabilitate someone with serious mental illness.

“It isn’t easy,” said one companion, who didn’t send a single email for the first few months of his tenure. “I don’t want to be a rat, but I want this guy I’m somewhat responsible for to get better.”

Both companions and psychologists have had to extend themselves at times to learn to trust. FCI Petersburg is a SOMP yard – a Sex Offender Management Program – and some of the companions have committed sexual offenses.

How does a sex offender trust a psychologist who could recommend him for a lifetime of civil commitment? How does a prison psychologist trust a man who molested a family member?

“It’s hard, obviously,” concluded the companion with the reluctance to email. “There are some things I definitely feel uncomfortable entrusting to staff, but when it comes to my job, I’m open and honest.” After a laugh he added, “Sometimes I’m even vulnerable.”

As for prison staff, the chief psychologist who started the program recently told all of the assembled companions that she had “bragged on” them to a group of Virginia Department of Corrections officials at a recent conference.

Referring to the psychology chief, one companion said, “She holds us accountable, but she gives us what we’re tasked with giving our guys: hope. Hope that our lives can and do matter.” For someone serving a decade or just shy of 30 years in federal prison, it’s this hope that can see him through.

1-“Mental Health Fact Sheets in America.” National Alliance on Mental Illness. Accessed December 30, 2015 from

2-United States. Dept. of Justice. Federal Bureau of Prisons. Reentry Services Division. “Mental Health: Training for Inmate Companions.” Federal Bureau of Prisons, n.d. Print.


4-When a prison guard activates their radio’s duress button an alarm is sounded on all of the guard’s radios, which results in them running to the location of the alarm. Following such an event, if an inmate is then effectively arrested within the general population of the prison, they are handcuffed and the prison is placed on “lockdown”, where no movement is permitted, pending the inmate being escorted to the Special Housing Unit (i.e., “the hole”).

5-A “store man” is a fellow prisoner who operates an unofficial and prohibited store in an inmate housing unit. Such stores sell various types of commissary items, although at a mark-up.

About Christopher Zoukis

Christopher Zoukis, MBA, is the author of the Federal Prison Handbook., Prison Education Guide, and College for Convicts. He is currently a law student at the University of California, Davis School of Law, where he is a Criminal Law Association and Students Against Mass Incarceration board member, and a research editor for the Social Justice Law Review. Learn more about him at Federal Prison Consultants.

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