Psychiatry behind bars: Practicing in jails and prisons
Suicide risk assessment, psychotropic management are mainstays of clinical work
Pharmacotherapy
Traditionally, the primary role of psychiatrists working in correctional facilities has been psychotropic medication management. Understanding the correctional context and procedures permits more informed prescription choices and recommendations for psychotropics to be included in the formulary.
Antipsychotics, antidepressants, and mood stabilizers should be included in a facility’s formulary. Considerations concerning types of psychotropic medication within a formulary depend on the facility’s size and mission, psychiatric illnesses encountered in the population, and lengths of inmates’ stay.12 A mechanism should be in place to prescribe off-formulary and access other types of psychotropic medication on a case-by-case basis to ensure inmates are not denied appropriate treatment. A psychiatrist may have to advocate strongly for these principles.
Most correctional facilities require that staff administer every dose of psychotropic medication directly to the inmate for whom it is prescribed. In some facilities, only nursing personnel can administer medication, while others use trained corrections staff to deliver medication. Psychiatrists who prescribe psychotropics in correctional institutions must be familiar with the facility’s medication administration procedures, which may impact medication choice and form, dosing frequency, timing of laboratory studies, and inmate medication compliance. Prescribers’ capacity to order emergency or “as needed” medications may be limited or nonexistent if nursing staff is unavailable.
Appropriate use of psychotropic medication for treating psychiatric illness is the standard of care, but is only 1 component of an effective treatment plan for inmates with serious mental illness. Others include group and individual therapy, psychoeducation, and therapeutic activities such as recreational therapy, activity therapy, and opportunities for education and work within the correctional system.
Related Resources
- Scott CL, ed. Handbook of correctional mental health. 2nd ed. Arlington, VA: American Psychiatric Publishing, Inc.; 2009.
- Thienhaus OJ, Piasecki M, eds. Correctional psychiatry practice guidelines and strategies. Kingston, NJ: Civic Research Institute, Inc.; 2007.
- National Commission on Correctional Healthcare. www.ncchc.org.
- Society of Correctional Physicians. www.CorrDocs.org.
Disclosure
Dr. Burns reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
