Just one year ago, Allenwood, Pennsylvania, inmate Shawn Jackson, 41, would not have been allowed to go anywhere outside his cell without handcuffs or leg restraints.

Convicted at age 15 of manslaughter and placed in a high-security facility for juveniles, Jackson has since spent much of his time in maximum-security settings for other offenses including assaulting a correctional officer. With the added difficulty of a serious mental illness, prison officials deemed it too dangerous to give him unrestricted access to staff or other inmates.

Today, not only does Jackson attend events outside his cell without restraints, but he's helping fellow inmates work on the behavioral problems that landed them in prison."One of my goals is to be a role model, to help [my fellow inmates] overcome behavioral issues and mental illness issues—whatever the situation may be that they're going through," Jackson says.

This remarkable turnaround is the result of a bold experiment launched by the U.S. Bureau of Prisons in 2013 for violent, mentally ill inmates who had previously been confined to cells nearly full time. Inmates in a Secure Mental Health Step-Down Units or STAGES program (depending on the type of mental health condition the inmates have), are housed for at least 16 to 18 months in a treatment-oriented environment that fosters psychosocial and emotional growth. There, they engage in up to 20 hours a week of group and individual therapy sessions, peer bonding, recreation, shared meals and work and other activities, with the aim of moving to less restrictive environments when they are well enough.

"It's a much richer, more intensive experience than typical prison life," says Alison Leukefeld, PhD, chief of the bureau's mental health services, who oversees the programs.

Tailored programs

The units were created as a result of a class action lawsuit filed in 2012 by inmates at the U.S. Penitentiary, Administrative Maximum Facility, a supermax prison for male inmates in Florence, Colorado. In addition, audits initiated by the agency recommended expanding mental health care services for mentally ill inmates in restrictive housing. In response, the bureau's executive staff—along with input from a number of disciplines including correctional services, psychology, health and others—worked to tailor programs that were successful in other prison settings to this population. The first secure step-down program was launched at the U.S. Penitentiary in Atlanta in 2013, followed by a STAGES program at the U.S. Penitentiary in Florence in 2014 and a secure step-down program at the U.S. Penitentiary in Allenwood in 2015.

Due to the complexity of inmates' issues, each unit has an inmate-to-treatment provider ratio of six to one. (By contrast, typical restricted environments receive mental health services as needed from psychologists who also serve the larger institution.) To oversee the 30 inmates at the Allenwood site, for example, psychologist and program coordinator Maegan Malespini, PsyD, heads a staff that includes three licensed clinical psychologists and two master's-level mental health staff. Inmates at Atlanta and Allenwood tend to have psychotic and mood disorders including schizophrenia, bipolar disorder, major depression and post-traumatic stress disorders, while those at STAGES have personality disorders including borderline personality disorder and antisocial personality disorder. An inmate's violent behavior may or may not be related to his mental illness, and many of these offenders have long-standing histories of trauma, further complicating diagnosis and treatment plans.

"They've certainly done a lot of harm to others in the course of their lives," says Patti Butterfield, PhD, deputy assistant director of the Bureau of Prison's re-entry services division, "but many have had a lot of harm done to them, as well."

Teamwork with other staff members—especially corrections staff—is likewise a vital component of the program, says psychologist Phil Magaletta, PhD, the bureau's chief of clinical education and workforce development. They tend to know the inmates better than anyone, and inmates are often more comfortable communicating with them than with treatment providers or other staff. As such, they can and do provide valuable feedback on inmates' behavior, he says.

"Given the shared experience of 40-hour weeks working with difficult clientele, [mental health staff and corrections officers] learn it's in their best interests to understand that they're on the same team," he says. These days, they're also trained to learn the basics of the other's roles, so communication tends to be good, he adds. 

A central focus of inmates' activity time is group therapy sessions, where psychologists and other treatment specialists teach cognitive-behavioral and other strategies to help inmates manage their mental illnesses, regulate their emotions, develop social skills, and address thinking that can lead to violence and criminality, such as aggressive or antisocial behavior.

Opportunities to address these thinking errors come up regularly, allowing inmates to practice their responses, says Butterfield. Two inmates may fight over who gets to use the telephone first, while another may lash out at his case manager when he receives bad news. Inmates are taught how to analyze the thought patterns that led up to their reactions and to consider more rational, prosocial alternatives. There's group input, too, with inmates actively helping each other better understand their problems.

Peers also assist through a peer companion program that enables inmates like Jackson, who are working to recover, help those who are not as far along. These companions become experts in the core therapy curriculum and use their skills to support fellow inmates by meeting regularly to talk, attending activities with them, modeling good behavior—even bunking with their companions if an inmate has progressed sufficiently to enable him to move through the unit unrestricted, a gradual process that entails gaining sufficient skills, confidence and trust with treatment staff, Leukefeld explains.

While the peer companions don't provide mental health services per se, "they're very effective at engaging participants in the program," she says.

The Bureau of Prisons has been impressed by the program's success: At Allenwood, for example, 18 of the 30 participants had "clear conduct" for the year, receiving not a single incident report, Malespini says. "For a lot of them, that's never happened in their prison careers," she says. In fact, says Leukefeld, the programs are becoming a key part of the bureau's plan for providing mental health treatment to inmates with serious mental illness.

For his part, Jackson likes to tick off the strategies that have helped him improve his own thoughts and actions: breathing deeply, using respectful words to make feelings and needs known, helping others, and when something upsets you, distracting yourself and thinking about something else.

"I like to think of it this way: When you see that an accident is about to occur, before it happens, look ahead and get into another lane," he says.

"I'm still a work in progress," Jackson admits. "But as a unit, we're striving to get better. It's a climb up the mountain, but we can make it."

Visit a facility

To tour one of these prison units, contact the location you’re interested in:

U.S. Penitentiary, Atlanta, Secure Mental Health Step-Down Unit
(404) 635-5100

U.S. Penitentiary, Allenwood, Secure Mental Health Step-Down Unit
(570) 547-0963

U.S. Penitentiary, Administrative Maximum Facility, Florence, Colorado, STAGES program
(719) 784-9464