Nothing Bars This Psychiatrist From Helping Inmates

Although most of us only “go to jail” while playing the board game Monopoly, it’s something that Kahlil Johnson, M.D., does regularly in real life.

He works as the lead psychiatrist at the Washington, D.C., jail, or at what is officially known as the District’s Central Detention Facility. It is an expansive brick building that visitors can penetrate only after extensive security clearance.

The dismal surroundings haven’t discouraged Johnson, however. “I enjoy this job a lot more than I thought I would,” the soft-spoken, 35-year-old and 2009 graduate of the George Washington University psychiatry residency program, told Psychiatric News.

The hours are regular, which leaves him time to spend with his wife, a lawyer, and 10-month-old twins.

“There have been people here—this is open knowledge—who have been involved in espionage,” he said. “So we’ve had some interesting people here.

“My patient no-show rate is pretty low here,” he continued. “If patients don’t come for appointments, I can always go down to the housing units and see them.”

He finds his work intellectually stimulating in that it has exposed him to a variety of psychiatric illnesses. For example, he works with pedophiles, sees a lot of cases of delirium due to brain injury or substance abuse, and occasionally handles patients who are suicidal. “We have safe cells here, which are equivalent to quiet rooms,” he said. “We rarely use restraints.”

Helping inmates has brought him extensive professional satisfaction. “When I grew up in Chicago, it was in a middle-class neighborhood,” he recalled. “But many of the people in my peer group were poor. Seeing them suffer was one reason why I wanted to go into psychiatry—to serve underserved populations.”

One of his most gratifying experiences to date, he said, was determining that an inmate who had carried a diagnosis of schizophrenia for almost a decade and received routine treatment with poor response didn’t have the illness at all, but an underactive thyroid gland. Another difficult but rewarding experience has been helping an inmate who was arrested for viewing child pornography online but who had never acted on his pedophilic urges. He came to understand the reasons for these urges, which may have been linked to his own sexual trauma as a child. Although it remains to be seen whether the inmate will be able to change what Johnson describes as the inmate’s “pedophilic orientation,” Johnson is hopeful that he will be able to do so, especially since the inmate expressed what appeared to be genuine remorse for what he has done.

Finally, Johnson’s work offers him opportunities for advancement, as he was recently named director of psychiatry at the jail. “I hope to broaden my focus as my career advances … to include some aspect of mental health policy,” he said.

Of course, his work presents challenges as well.

He wishes he could use the psychotherapy skills he learned during residency more often than he does, but he is grateful for the psychologists and social workers who provide most therapy services in the jail.

When asked whether the types of crimes prisoners have committed influence his outlook on them, he replied, “I’d like to say no, but I’d be lying.” For example, he has found it difficult to hear about some of the things that pedophiles have done because it makes him think of the vulnerability of his own children. He has also found it tough working with some of the more violent prisoners who lack remorse.

“However, I do try to stay aware of how my knowledge of their crimes or their lack of remorse can affect the care I provide to them,” he pointed out. “And by keeping it conscious, I hope that it has not impaired the care I provide.”

It is often a hurdle helping inmates who dissemble, he admitted, and he estimated that “at least half of them do so,” at least in part. For instance, a patient might say, “I see little green men, and they are all over my cell. It only happens at night when I’m trying to sleep. I need something to help me sleep, Doc.” Yet the reality is that the patient is having trouble sleeping not because of psychosis, but because he has been in a violent altercation or has been sexually assaulted by other inmates or is just trying to obtain medications.

And, yes, there have been some times when Johnson has feared for his safety. For example, there was an inmate who was manic and extremely aggressive. “I have had patients who were manic and violent in the community, but this was a little different,” Johnson explained. “He was about 6 feet 4 inches in height and looked as if he was an avid weight lifter. Nonetheless, I tried to remain calm and to get him to agree to take that first dose of medication that I hoped would calm him.”

There was the time that Johnson attempted to treat a convicted, violent murderer for depression. “Once the man’s depression resolved, he was the epitome of an antisocial personality-disordered person—a sociopath,” said Johnson. “Every time I met with him, I got the feeling that I was being assessed. So there was always a hair or two bristling on my neck. I was concerned that he might try something at one point or another.”

Then a few weeks ago, Johnson recalled, “I heard a rumble, the building shook, and the patient I was seeing at the time asked, ‘Is there a fight going on?’ I visualized an even worse scenario: an inmate uprising was taking place. Actually it was pretty scary. Finally, it became apparent that an earthquake had hit the Washington area, including the jail.”

But all things considered, Johnson believes that the pluses of practicing psychiatry in the jail far outweigh the minuses. Indeed, he looks forward to spending quite a few years working in the jail, especially now that he has been promoted to director of psychiatry. He has some ideas on how psychiatry practice in the jail could be streamlined and improved. Also, the fact that he worked on Capitol Hill during part of his psychiatry residency as an APA Jeanne Spurlock Congressional Fellow (Psychiatric News, April 2, 2010) and has completed course work toward a master’s degree in public health could benefit him as far as jail health policymaking is concerned. And there is an active group of psychiatrists who work in jails and prisons whom he could contact as mentors.

He wanted to emphasize for his colleagues that “correctional psychiatry is a very rewarding experience. We need more psychiatrists who are willing to do it, especially as jails and prisons have become the country’s new psychiatric asylums.”