Management and Supervision of Jail Inmates With Mental Disorders

Drapkin's book outlines the main functions that a mental health service must perform in a jail, and it does so in a highly accessible fashion. As the number of people incarcerated in U.S. jails and prisons continues to rise steeply, sheriffs and other correctional administrators find it necessary not only to house offenders with serious mental disorders safely but also to identify and treat them.

This book is a valuable tool for jail administrators who want to build a program or audit an existing one, for community-based mental health providers who are asked to serve a jailed population, and for medical and mental health care staff who work in jails. Drapkin developed this book not only to be useful but also to help combat one of the greatest obstacles to high-quality mental health services in jails—the professional isolation of the staff. Professional staff who work in correctional facilities often feel that they are on the periphery of their disciplines. They find that information does not pass easily through the walls of a custodial institution.

Many thoughtful touches are evident in the format of the book. It includes forms that can be copied, and the loose-leaf binder permits users to rearrange material or add supplements as their service changes and professional standards evolve.

The scope of Drapkin's book is comprehensive. Chapters or sections on the law that specifies the minimum standards for medical treatment in jails, on screening new admissions to a jail, and on suicide prevention, medication management, crisis intervention, and specialized housing units are well written and comprehensible to a reader with no prior correctional experience or legal knowledge. The book furnishes ready-to-use policies and procedures for gathering clinical information and for triaging, to name only two of many areas covered. It has sample behavioral treatment plans for use with jail inmates with character disorders who exhibit antisocial, borderline, or paranoid features and engage in repeated, goal-directed self-injury by cutting.

The strength of the book is also its weakness. Like Oedipus, who tried mightily to avoid a bad outcome, this book may lead well-intentioned users, seduced by its accessibility and comprehensiveness, down the path to misfortune. In the face of demands to handle larger jail populations with no concomitant increases in staff and space, administrators and treatment providers are told to above all avoid major, preventable error. The kinds of errors that result in successful lawsuits against municipalities and their correctional facilities can be made by capable people if they adopt the forms and implement the practices so well described in the book in the absence of qualified staff practicing within their areas of competence.

Such situations are most likely to occur in smaller jails, and most jails in the U.S. are small. Small jails aren't likely to hire a consultant to tell them how to establish mental health services that will keep them out of legal trouble, nor do they typically have the full array of specialists needed to perform medical screenings, assess risk for suicide, and diagnose and treat people who are mentally ill. The book's comprehensiveness and utility could tempt a well-intentioned person to proceed without qualified staff, relying too heavily on the book.

For example, the guide contains a list of psychotropic medications and their recommended dosages. In addition to management and supervision plans for inmates with antisocial, borderline, and paranoid disorders, the book offers sections on identifying and managing depression, bipolar disorder, and schizophrenia. Is the user supposed to diagnose, medicate, and treat these disorders on the basis of this comprehensive guide? Might someone do just that in a pinch? All of the pertinent information is here; nothing important is missing. Similarly, sample policies and procedures cover important areas quite well, but their success depends wholly on how they are implemented. In the absence of a larger body of contextual information, derived from experience, training, or both, a little knowledge might be a dangerous thing.