It’s no secret that many jail and prison inmates have problems with impulsive anger. To put it simply, they “snap” easily. They do not think about the consequences of their actions–they simply react quickly and violently to any situation in which they perceive even a slight threat to their egos or physical safety. Prisoners both with and without mental health histories have this problem.
While it’s true that the mentally ill often experience a reduction in anger problems when they are treated with psychiatric medications, Western society in general relies too much on medication to change behavior. One frequently overlooked but potentially helpful tool in reducing impulsive anger is exercise.
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I’ve previously written about how cell phones are not allowed in correctional settings. In fact, I still use a an old-fashioned PDA in prison settings if I need to access mobile medical applications.
Some people seem perplexed when I tell them that cell phones are considered contraband items in prison. In fact, in addition to illegal drugs and weapons, cell phones are very high on the list of items that prisons and jails want to find and keep out of their institutions.
It all boils down to one simple issue: security.
How much harm can be caused by a cell phone falling into the hands of inmates?
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Doctors, nurses, and other health care professionals often find themselves in situations where they must speak up for their patients. Typically such patients either do not realize what they need, do not know how to ask for what they need, or they lack the authority to obtain what they need.
The circumstances and challenges of advocating for patients vary significantly depending on the practice setting. I’ve previously written about how practicing in correctional settings presents unique challenges. Essentially the main challenge in any jail or prison, regardless of how “treatment-friendly” it may be, is that a correctional facility exists for the primary mission of security, not treatment.
So, if you’re a health care professional in corrections and you have a patient who needs your voice, how can you go about being an effective advocate?
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It’s probably safe to bet that most of the readers of this blog, if they found themselves in the unfortunate position of being incarcerated, would want more than anything to go home.
After many years of treating inmates I can say that most of them want to go home, too. But a sizable minority of them do not.
It’s not that these particular prisoners like being locked up. Most of them despise it. But, for various reasons, many feel that the structure and certainty that comes with prison outweighs the problems they’ll face when they return to the real world.
Although the reasons that inmates give for preferring not to leave vary, I’ll mention some of the more common ones. Some of them overlap. This is an honest look at the reality that many prisoners face, and I’d like to share it with you.
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Many correctional systems classify their inmates as “elderly” beginning at age 55. Some do so as early as age 50.
Why?
In general, inmates age faster than the non-incarcerated. The stress of incarceration, substance abuse, and the lack of access to medical care before incarceration are some of the more significant contributors to the accelerated aging.
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by Toni Brayer, MD
I spent this morning on the “yard” at San Quentin Prison, playing tennis with the inmates. The prison has a tennis court, built right in the middle of the yard with hundreds of inmates shuffling about, shooting hoops, playing dominoes, working out or just milling about.
The guys who play tennis are a remarkable bunch. They are serious about their game, play whenever they can during the week and are really happy on Saturday morning when authorized “outsiders” come to play with them.
I’ve previously written about the many challenges of practicing medicine in correctional settings. But if there are so many cons (pun intended), why should anyone consider such a career?
Well, there are many benefits to it as well. If you are a psychiatrist or primary care physician and are either looking for a change or just starting your career, you may want to consider correctional medicine.
Although I’ve done correctional work for quite a few years, my experience has been limited to one geographical area of the country. I contacted correctional healthcare recruiter, Vikkie Schill, from MHM Services, Inc., to help me to convey accurate information about this topic. I want to take this opportunity to thank her for her input. I have no relationship either with Ms. Schill or with MHM Services, Inc.
Here are my top 5 reasons to consider a career in correctional medicine:
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T
he provision of quality health care in any setting is the product of a concerted effort. Correctional settings are no different in this regard. Although practicing psychiatry in a prison or jail setting is challenging in many ways, a well-orchestrated team not only makes it easier but also better.
Detecting mental illness or psychological distress in inmates can be challenging, and the more observers that are involved in their care, the less likely that something significant will be missed. And, determining whether a given intervention is effective is likely to be much clearer and more accurate.
Unfortunately, patients in forensic and correctional settings also exhibit malingering at a much higher rate than do non-forensic mental health patients. Therefore, if a psychiatrist or other mental health professional attempts to do his or her job in isolation, it will be much more challenging to determine whether a given patient may be exaggerating or feigning symptoms. Even if they are, they still may be suffering from psychological distress that could benefit from having several disciplines involved in their care.
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Reducing health care costs is a daily news topic lately. Correctional health care costs are also very high and continue to rise.
While I believe that we should continue to explore ways to reduce correctional health costs, the obvious but politically unpopular issue that needs to be addressed is the fact that these costs would be much lower in the U.S. if we didn’t have by far the world’s highest rate of incarceration.
This exorbitant and increasing incarceration rate combined with an aging inmate population is going to drive costs steeply higher. The percentage of older inmates (over 50) is expected to rise sharply over the next decade. In fact, according to this post from California Budget Bites:
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The below YouTube video is a decent overview of how, since the deinstitutionalization movement of the 70′s, the prisons and jails in the U.S. have been housing a large percentage of people who previously would have been in mental insitutions. It explains some of the challenges of providing mental health treatment behind bars. What it does not address, though, is the significant problem many mentally ill inmates face continuing their psychiatric treatment in the community after they are released.
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