Handbook of Correctional Mental Health

Correctional psychiatry has traditionally been considered a part of the general topic of forensic psychiatry. However, correctional psychiatry has been evolving as a specialty of its own during the past two decades. Many accredited forensic psychiatric fellowships have connections with local jails or state and federal prisons as part of training for forensic psychiatric fellows. In addition, a number of federal cases have occurred that have encouraged the development of correctional psychiatry in order for the prison to meet the accepted and established criteria for adequate mental health care within the prison system.

Drs. Scott and Gerbasi have captured the essence of this burgeoning field by publishing a unique handbook addressed to those mental health professionals who work within a correctional setting. The editors clearly define the various types of correctional settings and the criminal justice system for those unfamiliar with the procedures.

This is an extremely helpful book and is aptly named a handbook because it gives the potential or current practitioner within the correctional system guidelines that can only be helpful for more effective care of the mentally ill within the correctional system. The editors have gathered together the elite in the field of correctional psychiatry, many of whom have had years of experience in working within prisons and jails.

The book presents a comprehensive view of the mentally ill, the mentally disabled, and special groups of individuals within the correctional system. For example, there is discussion of the suicidal inmate, the developmentally disabled or mentally retarded inmate, special consideration for women in prison, and treatment and management of offenders with mental illnesses in maximum security settings and in outpatient settings. A very helpful chapter is written by two attorneys, Fred Cohen and Joan Gerbasi, on the legal issues regarding the provision of mental health care in correctional settings.

The chapter on women in correctional settings was appropriately written by a female psychiatrist, Dr. Catherine F. Lewis, and presents the particular difficulties that women may have in a correctional setting, including sexual victimization, pregnancy, sexually transmitted diseases, and treatment of personality disorders. It is primarily in this chapter that the editors bring together issues of sexual abuse. However, the book does not include homosexual victimization among male inmates, and there is no listing in the index for homosexual assaults. Clearly, this is one of the most feared experiences in a prison setting by those who anticipate being sent to jail. Treatment of the victim of sexual attack or rape is a very important issue in the care of the mentally disturbed within the correctional setting. There is no discussion on violent victimization in the correctional setting, which is also a major issue among those who work in corrections. There is some allusion to gangs, but primarily of those who had belonged to a gang on the outside before their incarceration. However, the formation of gangs within the prison is a major problem for security and for administration and can lead to violent behavior and mental health problems for those who are victimized.

I find this book to be extremely helpful for individuals working within the correctional system because it has covered most aspects pertinent to the practicing mental health professional. There are summary points at the end of each chapter and very thorough references to other works that relate to the issues covered. However, the bias appears to be in favor of working within the correctional system, thereby giving an impression that it is a valuable, worthwhile, and satisfying experience for mental health professionals. In his chapter “Practicing Psychiatry in a Correctional Culture,” Dr. Ken Appelbaum sums up the issue as follows: “Although the challenges of working in a prison can seem daunting, the rewards more than compensate for many psychiatrists. Correctional work appeals to some individuals for a mix of altruistic, clinical, financial, and lifestyle-related reasons. Many health care providers, including psychiatrists, have a commitment to public service for historically underserved populations, such as inmates.”

Some challenges are noted in the chapter on psychopharmacology in correctional settings by Dr. Kathryn A. Burns, who points out some of the difficulties in the utilization of medication within the correctional setting.

Other chapters of interest and importance are those involving the assessment of mental disorders in correctional settings, written by several authors supervised by Dr. Henry C. Weinstein, who has chaired the American Psychiatric Association Committee on Corrections for many years. The chapter on suicide prevention in correctional facilities is also very important and alludes to some of the issues of victimization noted above. Treatment within the correctional setting is discussed briefly, as is the issue of malingering in correctional settings. The chapters covering these two issues do have adequate references but could have given more information for the newer practitioner working within a correctional setting.

Dr. Gary E. Beven discusses treatment of offenders with mental illnesses in maximum security settings. Dr. Beven alludes to those inmates who have been violent to others and are placed in administrative segregation. The issue of violence within the correctional setting is a most important one and needs to be discussed more thoroughly, as does the treatment of those who have been sexually abused or raped.

Even with some minor shortcomings, it is my strong recommendation that any psychiatrist or psychologist working in the correctional system should read this handbook of correctional mental health. It is thorough, well researched, well referenced, easily read, and a helpful guide for those who choose to help the underserved in our prison system.