A Conversation with Raequel Madara, Coordinator of Mental Health Services at the George W. Hill Correctional Facility

West Caldwell, NJ March 17 -

Tell us how you came to work at the George W. Hill Correctional Facility?

I graduated from LaSalle University in 2003 with a BA in Psychology and a minor in Criminal Justice. I worked in child and adolescent mental health as an Intensive Case Manager and case management supervisor until receiving my Master’s in Social Work from Widener University in 2008. I then provided individual, family, and group therapy within the children’s behavioral health system while working toward clinical licensure. I received my license as a Clinical Social Worker (LCSW) in December, 2012. Immediately prior to coming on board at George W. Hill Correctional Facility in April, 2014, I was working full-time as a Clinical Coordinator of a children’s behavioral health program, in which I supervised clinicians providing behavioral interventions for children with various mental health diagnoses.

I have always been interested in working with the forensic population, which is why I pursued a minor in Criminal Justice; however, my current position as the Mental Health Coordinator at George W. Hill Correctional Facility is my first exposure to working in a corrections environment. I always saw myself working in a setting with juvenile offenders and never expected to work in the adult jail system. Interestingly enough, I found the transition from the child and adolescent community mental health system to the adult prison system to be fairly seamless.

The Bureau of Justice Statistics estimates that 56% of state prisoners, 45% of Federal prisoners, and 64% of jail inmates have a mental illness. What suggestions do you have for coordinating mental health services at a large 1883-bed county jail?

The very large population of inmates in need of mental health services and support at GWHCF does create quite a challenge at times. Managing the number of individuals who need mental health treatment can be quite overwhelming, as it seems that most inmates who pass through our doors could benefit from support from mental health professionals. Triage and prioritization of needs are crucial elements in order to provide effective coordination. As we are seeing a significant influx of inmates with serious and persistent mental illness, the mental health team is often forced to prioritize service provision based on the level of acuteness of symptoms. Individuals who are suicidal, homicidal, and/or fluridly psychotic and unable to maintain behavioral control in order to function in a community living environment are evaluated and treated immediately on an emergency basis, while inmates with less acute symptoms are seen in order of referral. It is imperative that security staff act as the eyes and ears for the mental health staff and make proper referrals in order to preserve the order of the facility.

What type of post-release planning/services do you suggest for inmates with mental health illnesses?

I make it a point to ensure that all inmates with whom I come into contact have access to proper resources upon release. As someone who has worked in the Delaware County mental health system for the entirety of my professional career, I am quite familiar with the mental health and drug and alcohol programs that are available in this area. If our facility has initiated medication management for an individual, it is imperative that he or she knows where to obtain psychiatric care upon release. For individuals without insurance coverage, it is important that information is given on how to access benefits. Individuals who require additional support are referred to the Mental Health Liaisons.

What are some common misconceptions about mentally ill inmates?

I believe that there are a lot of misconceptions about mental illness in general. From my experience, the most common misconceptions include: mentally ill individuals have less intelligence than those who are not mentally ill; individuals with psychotic disorders will always exhibit psychosis and can never truly present as “normal;” and individuals with mental health problems use their illness(es) as a “crutch” or “excuse” to be pardoned for inappropriate behaviors. Although intellectual disabilities are considered mental illness, simply because someone has a mental health diagnosis does not render that individual to be less intelligent or deserve less respect than anyone else. Mental illnesses take a course, and individuals can often present as “normal” one day and decompensate the next day, both with and without medication. Many individuals who experience mental health symptoms that render them “disabled” would gladly trade their reality for the ability to function without mental illness.

In corrections, we have an especially heightened awareness regarding suicide. A myth that is widely held and believed is that talking about suicidal ideation will put the idea in a person’s head. Not only is this notion untrue, but it can also be quite dangerous, as staff may avoid asking individuals if they are feeling suicidal. As part of the required training for all employees, the importance of dispelling this myth and overcoming fears to ask people directly about suicide is discussed at length.

What motivates you each day?

I am motivated each and every day by the prospect of making some positive impact in the lives of individuals while they are separated from their loved ones, normal lives, and coping skills. People are often surprised by how much I enjoy working in a correctional facility. I look forward to coming to work each day because I find it intrinsically rewarding to do what I can to serve as a support for individuals facing what they believe to be insurmountable odds and helping them make more healthy life choices.