Psychiatry Behind Bars: Practicing in Jails and Prisons: Suicide Risk Assessment, Psychotropic Management Are Mainstays of Clinical Work

Burns, Kathryn A., Current Psychiatry

Over the last 2 decades mandatory prison sentences, longer prison terms, and more restrictive release policies have lead to a dramatic increase in the number of persons in jails and prisons. Currently, more than 2 million individuals are incarcerated in the United States. (1) Psychiatric illness is over-represented in correctional populations compared with the general population--more than half of all inmates have a mental health diagnosis. (2) Correctional facilities are legally obligated to address the medical and mental health needs of the persons committed to them. As a result, more psychiatrists are practicing in jails and prisons.

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This article explains correctional facilities' obligation to provide for inmates' mental health needs and describes correctional mental health processes and how psychiatrists can play a role in screening, evaluation, and suicide prevention.

Lack of training

Despite the increasing number of psychiatrists working in correctional institutions, most have had little or no training, education, or even orientation to these settings. Forensic psychiatry fellowship requirements include experience in treating acutely and chronically ill patients in correctional systems. (3) Although general psychiatric training doesn't preclude correctional experience, it is not required. The forensic component of general psychiatric residency is limited to evaluation of forensic issues, report writing, and testimony.

Professional organizations--including the American Psychiatric Association, (4) the American Public Health Association, (5) the National Commission on Correctional Health Care, (6) and the American Correctional Health Services Association (7)--have developed standards and position statements on providing medical and mental health care in correctional facilities. Although psychiatrists' work in correctional settings generally has been reserved for consultation and medication management, it is important for these clinicians to understand and appreciate the wider landscape and environment in which they practice. Psychiatrists can help develop and implement mental health processes that lead to better services and improved clinical outcomes.

Right to treatment

Convicted persons have a constitutional right to medical and mental health treatment under extension of the Eighth Amendment of the U.S. Constitution, which prohibits cruel and unusual punishment. (8) In 1976, the U.S. Supreme Court concluded that "deliberate indifference to serious medical needs of prisoners constitutes the 'unnecessary and wanton infliction of pain' ... proscribed by the Eighth Amendment." (9) This coverage was …

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Publication information: Article title: Psychiatry Behind Bars: Practicing in Jails and Prisons: Suicide Risk Assessment, Psychotropic Management Are Mainstays of Clinical Work. Contributors: Burns, Kathryn A. - Author. Journal title: Current Psychiatry. Volume: 10. Issue: 2 Publication date: February 2011. Page number: 15+. © 2007 Dowden Health Media, Inc. COPYRIGHT 2011 Gale Group.

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