Gisele Craswell, OTR/L: OT in Prison Mental Health
In this post, we will be learning about the role of Occupational Therapy in Prison Mental Health, an Uncommon OT practice setting for Occupational Therapy practitioners. You will hear from the professional experiences of Giselle Craswell, OTR/L, an occupational therapist working for the federal prison system in Canada. She has been practicing in prison mental health for over 12 years,and has a passion for developing and delivering recovery-oriented mental health services in the prison system. Her scholarly focus is in the areas of occupational justice, emotional regulation, sensory intervention, trauma-informed care, and trauma recovery. She has a recent publication in the journal Occupational Therapy in Mental Health (An Integrative Review of Sensory Approaches in Adult Inpatient Mental Health: Implications for Occupational Therapy in Prison-Based Mental Health Services; DOI: 10.1080/0164212X.2020.1853654) Her interests also include aging in prison, mental health interventions for clients with intellectual disabilities in the prison system, and post traumatic stress in prison workers. She has developed and delivered several mental health programs for the prison hospital where she works, and she provides ongoing education and support to prison staff on trauma, trauma-informed care, recovery-oriented mental health services, emotion regulation, and sensory intervention.
Q & A with Gisele:
Please tell us a little about yourself.
I have been a practicing occupational therapist for over 20 years, and I love my profession. I have a passion for working in mental health, especially trauma and stress recovery. I also love teaching and sharing my passion for occupational therapy's role in trauma and stress recovery. I consider myself to be a lifelong learner, and take every opportunity I can to learn and grow in my profession. (see more in bio and responses to other questions below). From a personal perspective, I am an outdoor enthusiast. I love nature walks/hikes, gardening, and just being outdoors and enjoying God's creation. Thankfully, my husband shares the love of nature, so we enjoy our lives together among the trees and wildlife as much as possible :)
What motivated you to contribute to this series?
I want to encourage OTs and OT students to consider working in prison mental health, as well as other non-traditional roles. Occupational therapy can really shine in these non-traditional settings, and we have much to contribute.
Please describe the UncommonOT work that you do and the setting in which you work, the population you serve and the needs that you address.
I work in prison mental health with incarcerated men who live with mental health issues. My primary role involves the development and implementation of mental health programming, as well as functional assessments for intervention planning and community release planning, and life skills development. As one can imagine, the incarcerated population lacks occupational opportunities, and experiences very real occupational deprivation. An important role for the OT is to advocate for occupational opportunities that can improve their lives inside the prison, but also help them develop skills that will assist them with life in the community upon their release. One of my own passions is using sensory intervention to assist the individuals I work with in developing emotion regulation skills that can carry over into all aspects of their lives. Learning how to use one's body for regulation can lead to improvements in occupational engagement, and can serve as a pre-cursor to more cognitively oriented mental health interventions. It can be especially helpful when in heightened states of distress, and when the thinking processes get hijacked by the physiological arousal. Learning how to use the body to lower the physiological arousal is a very helpful life skill. Body-based interventions such as yoga, exercise, deep breathing, and sensory interventions are amazing tools when working with populations who have experienced significant trauma in their life histories, such as incarcerated populations.
What drew you to this type of OT work?
Prior to working in the prison system, I worked in the private sector with individuals who had suffered injuries following workplace or automobile accidents. Most of the people I worked with lived with chronic pain and/or head injuries. I found myself always drawn to how their mental health impacted their physical health and experience of life. This led me to desire work that would have more of a mental health focus. Also, prior to completing my occupational therapy degree, I had completed an honors degree in psychology. I guess you can say that I was always drawn to mental health.
How did you get there?
I basically heard through someone that I knew (word of mouth) that the local prison was interested in hiring an occupational therapist to work in their psychiatric treatment centre. Although I had never really given any thought to working in a prison, the thought of working in a mental health position appealed to me, so I applied. It is a government position, so it did take about 6 months from the time I applied to the time I started the position (Interview process, language testing, paperwork, etc. is all quite time consuming). Although I really wanted to work in mental health, it was not an easy decision to leave the private sector, as I loved my work in the private sector as well. As such, I continued to do private work on the side even after starting my full-time position in the federal prison system. I continued to do private work on the side (just because I love it so much) up to the point where I started my post professional master's degree. It took me 3 years to complete my post-professional master's degree, which I did while continuing to work full-time (no easy task). I actually just graduated May 18th , 2021.
Please describe a typical day or OT session at your setting?
Working in a prison is quite different from working in a hospital setting, as there is a very structured prison routine that you need to schedule around. Overall, on a typical day (without any interruptions, such as lock downs), I would have, at most, 4 hours in a day when I can actually see the individuals I work with. Meetings, lock-up times, med and meal times, and outside recreation times, all impact the available times in the day to see the service users. That means that in those 4 hours/day, I need to schedule programs, interventions, and assessments. I find that having days dedicated to assessment and days dedicated to programs/interventions seems to work better. On a typical program/intervention day, I would have one program in the morning, and two programs (or 1 program and 1 intervention session) in the afternoon. On assessment day, I would do file review or assessment in the morning (1.5 hours), and assessment in the afternoon (2.5 hours). The rest of my day includes responding to e-mails and phone calls, a morning interdisciplinary meeting (usually 1 hour) that takes place every day, a case conference or team meeting (from 11:00 to 12:00), and file review, chart notes, report writing at the end of the day.
Can you talk about some recent highs (successes) and lows (challenges) of your current role?
Highs: (1) After being the only occupational therapist in my regional sector of the prison system for over 12 years, we have finally just hired 2 more occupational therapists. Seeing OT growing in the prison system brings me great joy! (2) My recent publication on sensory intervention in prison mental health has been drawing some international attention, and has led me to opportunities to educate individuals on how to implement sensory intervention in the prisons where they work. This is an area of practice that I love to see spreading. Lows: (1) Covid has had a negative impact on the occupational opportunities available to all populations, but perhaps felt more profoundly in institutionalized populations ( as they did not have much to begin with). It has been very challenging to try to overcome the many barriers to provide opportunities for meaningful engagement. I developed different self-help manuals and art teaching materials to provide them something to work on from their cells, as they did quite a bit of cell time during Covid lock downs. For those interested, I also distributed a yoga handout that was developed for them by a local yoga instructor that specialized in yoga for trauma, as yoga is something they could practice in their cells (and very beneficial for physical and mental health). At the current time, we are more open, but we can still only have a maximum of 3 participants in a program. This means fewer people receiving programs, which is another unfortunate consequence of Covid. (2) Staff turnover can be a considerable challenge. We have been well underway for further developing our sensory intervention services at the prison, but I just learned that our correctional manager is taking another position, and we will have another correctional manager stepping in. The Correctional Manager (CM) has a lot of influence over what can take place in the treatment centre. When you are trying to implement new services, it can feel like starting from square one when a new CM comes into the picture. The CM that is leaving was on my sensory committee and I worked very well with him. Now I have the challenge of developing a new relationship, and hopefully convincing them of the value of sensory intervention to get them on board.
How do you continue to learn in order to stay on top of things within your role?
I am a lover of learning. I just recently completed my post-professional master's degree, I attend our national OT conference, and I do at least 2 professional development courses in the field of mental health per year (I recently attended a course on Acceptance and Commitment Therapy and another course on Dementia care). I also read a lot, and I find that LinkedIn is a great resource to get links to learning resources.
Anything you can share about the typical salary and compensation, How OT is funded?
This is a federal government position, so it is government funded. The full-time salary ranges from $88,879 to $105,528 Cdn (~$72,107.53 to $85,625.42 USD), with 4 weeks vacation to start, over 9 hours/month accumulating sick time, 5 additional days/year for family related reasons, and 2 personal days/year. You also have a great medical package and pension.
Any career advice for our followers and listeners on how to get started in this setting?
I can't speak to how it works in the U.S., as I am aware that there are privately run prisons, so it might be quite different than in Canada. In Canada, all prisons are government run, either provincially (for sentences less than 2 years) or federally (for sentences greater than 2 years). In Canada, you can sign up to be notified of government position openings, and apply when openings become available. It is also a good idea to contact a local prison and ask to meet with OTs working there (if there are OTs), or the mental health manager, to learn about the work there, and get a feel for whether or not it is an environment you can see yourself working in.
What’s a common myth or misconception about your job you’d like to call out?
Myth: Working in a prison is frightening and unsafe. Truth: I carry a personal portable alarm on me at all times when working with service users in the prison. In my (over 12) years of working in the prison, I have never had to press the alarm. That means that I have never felt threatened, in an unsafe situation, or required emergency assistance in all that time. Also, it is important to know that if I ever end up in a situation where I need assistance, I will press the alarm and a very large group of correctional officers will come running to my aid in seconds. I can assure you that I have been in situations in the private sector where I would have loved to have had that level of security. I would actually feel safer working in a prison that in a hospital or in the community.
How do we find you , follow you, be in touch with you, and promote your unique work?
LinkedIn (linkedin.com/in/gisele-craswell-27459099) and/or twitter (@gmcraswell)
RESOURCES:
Journal Publication: Occupational Therapy in Mental Health (An Integrative Review of Sensory Approaches in Adult Inpatient Mental Health: Implications for Occupational Therapy in Prison-Based Mental Health Services; DOI: 10.1080/0164212X.2020.1853654)
As always, I welcome any feedback from all of you or if you are interested on being a guest on future episodes, please do not hesitate to contact Patricia Motus at transitionsot@gmail.com or DM via Instagram @transitionsot
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