Correctional Psychiatry: Practice Guidelines and Strategies

The stature and academic foundations of correctional psychiatry have advanced by leaps and bounds in recent years. Accredited forensic psychiatry fellowship programs must provide correctional rotations, and forensic boards test for knowledge in this area. Also, a growing group of medical schools provide mental health services to jail and prison systems. Unprecedented numbers of clinical experts, scholars, and researchers have also been entering the field of correctional psychiatry and contributing to the expanding literature. Correctional Psychiatry: Practice Guidelines and Strategies adds to the literature an overview that will appeal to both neophytes and experts in this field.

The editors have pulled together many experienced and thoughtful scholars in this field. The chapters, in general, have clear and accessible writing and relevance to all professional disciplines that work in correctional mental health.

Twenty chapters, organized into four parts and authored by 28 contributors, cover a wide range of topics. The three chapters in part 1 address historical, structural, and liability considerations. Part 2 consists of nine chapters focused on treatment and management of specific problems. These problems include sleep disorders, intoxication and withdrawal, suicide risk, self-injurious behaviors, hunger strikes, malingering, chemical dependence, countertransference, and reentry programs. Part 3, with six chapters, considers the needs of special populations, such as juveniles, inmates with intellectual disabilities, women, geriatric patients, sex offenders, and inmates in segregated housing. The last chapters, which appear in part 4, examine ethics and research in correctional settings.

Despite the breadth and depth of issues covered, some important topics receive scant attention. Correctional mental health administrators will not find a comprehensive review of the organizational structure and essential components of an effective program. Accreditation standards, such as those promulgated by the National Commission on Correctional Health Care, are mentioned only in passing. A few of the many well-written chapters touch upon the acculturation of correctional psychiatrists and the challenges they face. For example, the chapter on correctional structure examines the potential development of malignant staff attitudes. That chapter and the chapter on segregated housing acknowledge the drawbacks of cell-front interviews. The chapter on boundaries analyzes confidentiality limitations and the problem of dual agency. Correctional health care providers, however, can develop complacency with questionable standards of practice because of the tremendous pressure to accommodate. A detailed exploration of this tendency to habituate and a discussion of the place for appropriate advocacy would have been welcome additions to Correctional Psychiatry. The editors acknowledge some of these limitations in their introduction and plan a second volume that will address these and other uncovered issues.

Given the complexity of issues in correctional psychiatry, the editors have done a commendable job in selecting relevant topics and thoughtful contributors. The resulting text would be a welcome and useful addition to the library of anyone who practices in the field of correctional mental health.