A client who served over thirty years in prison – much of that time spent in solitary confinement, shared his fear that his panic attacks, often triggered by the sound of keys or sirens, would never go away. Another client who served thirty-nine years, described how after his release, he wanted to go back to prison because his symptoms were so debilitating and the change was so disorienting.

I’m a therapist in the mental health clinic at The Fortune Society, the nonprofit organization assisting formerly incarcerated individuals navigate the countless obstacles of reentry. At the clinic, my colleagues and I have the privilege of collaborating with Fortune Society clients in individual and group psychotherapy to provide them with support, resources, and tools that they can use to better manage their mental health and thrive in their day-to-day lives. But thriving after prison is not easy or simple.

On the occasion of Mental Health Awareness Month, we reflect on what we wish people knew about mental health and its intricacies after prison:

1. Prison is traumatizing – inside and out.

Prison is a kind of battlefield, and what incarceration looks like is unimaginable to those who haven’t experienced it. Recently, in our Recovery After Decades Lost group, the clients shared and compared with each other their time in solitary confinement, also referred to as “the box” or “SHU,” a cruel acronym for “Special Housing Unit.” One client shared his story of being in solitary confinement for fourteen days with absolutely no clothing, completely naked. Another client lost count of the number of years he spent in “the box.”  

My colleague, Stephanie Young-Geye, PNP, confirms the most common post-incarceration diagnosis is PTSD. “Like soldiers who have fought for their country,” she says, “prisoners who have witnessed and/ or participated in violence, who have feared for their lives, can be traumatized.”

Prison is intentionally traumatic and dehumanizing, and the trauma does not cease upon release. Hypervigilance, for example, is a survival skill that is often acquired while incarcerated but that inevitably causes harm post-release while navigating day-to-day tasks such as riding the subway. Much of the work we do in individual and group therapy involves providing psychoeducation and practicing techniques to manage trauma-related symptoms, such as simple diaphragmatic breathing, mindfulness, and grounding exercises. With these tools, clients can build self-efficacy and become confident in their efforts to assuage fears, reverse emotional paralysis, and build self-esteem.

2. A little compassion goes a long way.

At The Fortune Society, it is often said: “The crime isn’t who you are; it’s something you did.” Many of the clients who shared their thoughts on Mental Health Awareness Month talked about the importance of having someone to talk to. One client said, “Coming out, I thought the worst of the world. I didn’t want to eat. I didn’t want to survive. Then you realize there is someone there to help. A place like this exists. It’s not easy to trust anybody. It’s called a leap of faith. But having someone to talk to and see it from your end, that’s amazing.”

It is true that many are unaware of the resources available. Access to comprehensive mental health services for formerly incarcerated folks is made even more difficult as many providers illegally refuse to serve clients based on their legal history. When I was a social work intern training at a community clinic in Manhattan, there was an unwritten rule that we were to refer out anyone with more than three years of incarceration. Learning about the criminalization of mental health and structural racism’s role in mass incarceration impelled me to work with those impacted by the criminal justice system and provide them with the mental health resources they deserve.

3. Fear is common and understandable.

Fear manifests in many forms. One common fear is that asking for help equates weakness. Recently, clients in the Recovery After Decades Lost group exchanged the many ways in which they’ve struggled to ask for help–from depression and suicidal thoughts to using a smartphone and asking for directions. One client described “the fear [of] not knowing what to do or how to integrate back into society . . . feeling vulnerable and apprehensive . . . being judged.” Another client shared his fear of trusting mental health professionals after meeting with a psychiatrist in prison who never made eye-contact. Mental health problems are often not taken seriously in prison. What’s more, while incarcerated, many learn not to express or show emotion for fear it will be used against them.

4. Families carry the weight of mental health, too.  

The psychological impact of incarceration extends beyond the individual. Families carry the weight of the impact, too. Relationships are hard to rebuild or even start. “With all the joys of freedom come lots of emotional inadequacy,” a current counselor at the Fortune Society and former client explained: “I had to learn to trust in my family all over again as they had to learn to trust me.”

5. Don’t make assumptions.

While there are many ways in which people who have been incarcerated can relate, everyone is different. Their experience of incarceration is their own. Someone who was incarcerated even for a few days can experience mental health issues.

Assumptions only fuel the stigma already associated with incarceration, which in turn can lead to social isolation, further compounding depression and anxiety. One of our clients poignantly described that coming to the clinic and having the opportunity to talk “is a relief–like waiting to exhale.” Fostering communities that combat harmful stigmatization and provide a safe and supportive environment can give people the chance to heal.

By sharing these experiences, our hope is that those who have never been impacted by the criminal justice system will practice compassion rather than cynicism and that those who are struggling might feel more comfortable asking for help.