Psychiatric Services in Correctional Facilities

This document represents the consensus of a number of eminent psychiatrists in the field of correctional psychiatry. It sets out the history of correctional psychiatry, and many of the important principles related to the delivery of psychiatric services to correctional facilities in an easily digestible format. This working paper is a thorough, well written review, which should be read by every mental health practitioner working in corrections. Graham D. Glancy, M.B., Ch.B., F.R. C.Psych., F.R.C.P.(C), Founder Forensic Psychiatry, Royal College of Physicians and Surgeons (C), Assistant Professor Department of Psychiatry University of Toronto Providing psychiatric services in correctional settings brings a range of clinical, professional, ethical, legal and organisational challenges to those who assume this noble task. Clinically adept and concise, yet wide ranging in scope, this excellent text provides a foundational framework for all psychiatrists who work within the walls of lock-ups, jails, and prisons. Trestman and colleagues have given us an essential guide, long overdue, that serves also as a call to action for greater engagement in the treatment of this marginalised population. Johann Brink, M.B.Ch.B., B.A. Hons., F.C.Psych.(S.A.), F.R.C.P.C., Clinical Professor and Head, Division of Forensic Psychiatry, University of British Columbia, Vancouver, British Columbia Similar to previous editions, this third edition of the APA's Psychiatric Services in Correctional Facilities provides invaluable guidelines to correctional psychologist in their provision of mental health care. Particularly important is the contribution regarding non-suicidal self-injury and its distinction from suicidal behavior, as well as advocating that psychiatrists take a more "active role" and collaborating with custody personnel in addressing this challenging behavior. There is also an increased focus on the use of segregation for inmates with serious mental illness, as well as use of seclusion and restraint, and the advent of telepsychiatry. While discussion of these issues can be found elsewhere, their inclusion in this text is particularly important. Lindsay M. Hayes, Project Director, National Center on Institutions & Alternatives This work group report underscores the realities, opportunities, and challenges encountered over the years and currently by psychiatrists and other mental health professionals practicing in correctional settings as the real numbers and overall percentages of prisoners who have serious mental illness, transient adjustment states, and co-occurring substance use, intellectual disabilities, and/or other medical conditions have continued to increase. This extraordinary work group, comprising highly skilled psychiatrists with extensive correctional and forensic experiences, has greatly expanded the knowledge base since the second edition published 15 years ago. The report is a comprehensive and essential roadmap that is a necessity for all psychiatrists who practice or anticipate practicing in correctional settings. This roadmap includes principles, guidelines and special applications detailed in the report that are excellent and have great utility and relevance for psychiatrists and other mental health professionals newly entering these settings as well as seasoned veterans who have, by necessity, become an integral component for the management and provision of clinical services in correctional facilities and community corrections. Raymond F. Patterson, M.D., D.L.F.A.P.A., Associate Professor of Psychiatry, Howard University College of Medicine, Associate Professor of Psychiatry, Georgetown University This work group report underscores the realities, opportunities, and challenges encountered over the years and currently by psychiatrists and other mental health professionals practicing in correctional settings as the real numbers and overall percentages of prisoners who have serious mental illness, transient adjustment states, and co-occurring substance use, intellectual disabilities, and/or other medical conditions have continued to increase. This extraordinary work group, comprising highly skilled psychiatrists with extensive correctional and forensic experiences, has greatly expanded the knowledge base since the second edition published 15 years ago. The report is a comprehensive and essential roadmap that is a necessity for all psychiatrists who practice or anticipate practicing in correctional settings. This roadmap includes principles, guidelines and special applications detailed in the report that are excellent and have great utility and relevance for psychiatrists and other mental health professionals newly entering these settings as well as seasoned veterans who have, by necessity, become an integral component for the management and provision of clinical services in correctional facilities and community corrections. Raymond F. Patterson, M.D., D.L.F.A.P.A., Associate Professor of Psychiatry, Howard University College of Medicine, Associate Professor of Psychiatry, Georgetown University

Correctional psychiatry is an evolving field, and serious questions remain. The work group sees an expanded role for clinicians as physician leaders, managers, and directors, more effectively advocating for their patients and helping to shape care delivery systems that empower patients and support successful transition back to the community.

The long-awaited report of the APA's Work Group to Revise the APA Guidelines on Psychiatric Services in Correctional Facilities, Psychiatric Services in Correctional Facilities comes at a time of growing incarceration rates, more rigid sentencing policies, harsher sanctions, and tougher public attitudes toward crime. The result is a near-doubling of the incarcerated population since the first report was issued in 1989 and a significant increase of inmates with serious mental health issues. The work group members address the implications of this troubling state of affairs for psychiatrists and other mental health practitioners who diagnose and treat within the correctional environment.

On the basis of extensive input from multiple sources and perspectives, they have developed clear guidelines that equip clinicians to navigate the special challenges they face. This edition has been thoroughly updated and is structured to flow from the foundational principles that govern the delivery of psychiatric care in correctional facilities, to the guidelines for screening, referral, evaluation, treatment, and community reentry planning, to special applications of the principles and guidelines to specific disorders/ syndromes, patient populations, housing locations, treatment modalities, and inmate special needs.

Readers will find the book well written, with clear guidance for the clinician, as well as challenges to think beyond the needs of individual patients to the larger relationship between mental illness and incarceration.

• Approximately three of every four incarcerated people with a serious mental illness have a co-occurring substance use disorder, complicating both diagnosis and treatment. The book offers strategies for treating co-occurring disorders and explores the need for evidence-based screening tools.
• Because some inmate populations have unique evaluation and treatment needs because of their disorders, demographics, or other characteristics, separate sections are devoted to women; youths in adult correctional facilities; geriatrics; lesbian, gay, bisexual, and transgender patients; veterans; and patients with intellectual and developmental disabilities.
• New management and programmatic topics include hospice, mental illness and segregation, seclusion and restraint, telepsychiatry, and the spiritual lives...read more...