Working inside the walls

Abstract

This chapter is a pragmatic discussion of the experience of working as a psychiatrist in correctional settings, whether jails or prisons. To work inside the walls, the psychiatrist must come to terms with the realities of the correctional setting in order to be secure, satisfied with the work, and clinically effective. There is no monolithic correctional culture. Each system and facility has its own unique culture and has evolved in some degree of isolation, emphasizing different philosophical approaches to the correctional mission and to criminal causation. This chapter examines the context in which clinical work is embedded: physical environment and security, correctional culture, personal safety, typical stressors, and individual liability. It is clearly not for everybody but the rewards can be tremendous. The quality of care in many facilities, especially prisons, is superior to care in the community. The clinical problems are unendingly fascinating. And, despite its downsides, having a setting with limited access to drugs that provides food, clothing, shelter, and medical care can allow a degree of patient improvement that may be difficult to realize in the community. Opportunities for creativity in treatment and program development are unparalleled. In many ways, correctional psychiatry is poised to lead the way in the treatment of some of the most ill and behaviorally disordered members of society.

A Call to Action: A Blueprint for Academic Health Sciences in the Era of Mass Incarceration

“…The stress of balancing safety and security demands while working to build therapeutic relationships can be significant. 54 During court-mandated oversight, improvements are made; often, subsequent to formal oversight, the system regresses due to the inevitable pressures of budget reductions and changes in administration. Furthermore, federal funding is precluded to states and counties in cases where inmates are excluded from Medicaid and Medicare.…”

Correctional mental health administration

“…What separates them from contemporaries in the community is that administrators working in these settings must understand and work within the correctional 'culture'. While often unique to each facility and system (Gage, 2015), common themes include mutual respect amongst professionals, understanding the hierarchy of the correctional agency, and valuing input. Correctional mental health administrators must appreciate the need to find a balance between security concerns and treatment concerns, and effective leaders will maintain open lines of communication with decisionmakers within the correctional agency (Patterson, 2015).…”

“…Besides the obvious human costs, suicide in these settings is a common source of litigation (Gage, 2015). It has been shown that reforms including better screening and monitoring have greatly reduced the incidence of suicides in jails and prisons (Hanson, 2010).…”