In the U.S., correctional facilities are required by law to provide inmates with access to medical care. As health care costs have spiraled out of control everywhere, jails and prisons have attempted to develop innovative ways of reducing this hefty financial burden while simultaneously meeting their legal obligation to provide care.
One approach that has gained significant popularity in recent years is to require inmates to pay a small fee, usually less than $10, to gain access to medical care in certain situations. There are arguments both for and against these co-pays. I’ll list just the main points.
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Correctional psychiatrists inevitably treat patients who have been convicted of a broad array of crimes. There is a correlation between the security level of the institutions in which one works and the severity of the crimes of the inmates being housed there.
Since I’ve treated inmates of minimum, medium, and maximum custody levels, I’ve had the opportunity to work with people who have been convicted of everything from drug possession to multiple murders.
What’s it like treating patients who have killed other human beings?
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Malingering, which means to feign or exaggerate symptoms for secondary gain, occurs in all medical settings but is especially prevalent in jails and prisons. While it essential for all health care professionals working in corrections to become proficient in detecting malingering, even those working in non-correctional environments will be better clinicians if they learn this skill.
In the December 2009 issue of Current Psychiatry, Lawrence Reccoppa, MD, a correctional psychiatrist from Florida, wrote a brief article entitled, “Mentally ill or malingering? 3 clues cast doubt.”
The “3 D’s,” as he calls them:
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(The following is a fictional vignette based on thousands of real patient encounters. Any resemblance to an actual person is purely coincidental.)
The heavy door slammed with an echo he’d never forget. He thought he could trust her, but he had been proven wrong. He should’ve known not to trust anybody in prison. In fact, throughout most of his life he’d known only a few people he ever could trust. Naked, cold, humiliated and feeling as though he had been violated again, “David” now wanted to die more than ever. He didn’t care how; it didn’t matter if it hurt. He just needed to end it all. But, he would soon realize that it would be nearly impossible to do. Nearly ever imaginable method of suicide had been removed from him. He was now “safe” in the eyes of the prison, but he sunk into a deeper depression.
It was David’s first time in prison. He had spent a few days in jail prior to his current age of 22, but it was remarkable that he hadn’t gotten himself into more trouble. His father was a career criminal who had repeatedly emotionally, physically, and sexually abused him as he was growing up. David had grown up far too fast. He had had few boundaries and rules and almost no adult supervision in his younger years. He started smoking cigarettes at age 10, started drinking at 12, and was using marijuana regularly by 13.
Despite having the deck stacked against him, David was
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