Lockup Doc

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. Read more…

As correctional health care professionals, there may be times when we are tempted to conduct ourselves in a less than professional manner simply because we can.

We may be able to get away with speaking to our patients rudely, using profanity profusely, or wearing inappropriate clothing. After all, we work in jails and prisons. This culture is far from prim and proper. And, our patients are inmates. Many may tolerate misbehavior from us that patients on the outside would not and should not tolerate.

I’ve previously written about how I’ve found the book, Games Criminals Play, to be an invaluable resource. One key point that I learned is that many inmates, especially those trying to set up and manipulate staff, want to know whether each prison worker is a fellow inmate or “the police.” In other words, do we side with the inmates, or are we professional workers who take our jobs seriously? Read more…

How many times do we condemn or agree before hearing the other side of a story? How many times do we stand accused of not listening carefully? How many times do we misinterpret or misunderstand a gesture, a word, an intention? Why do we assume that we know so much about other people’s lives even though we clearly do not? And, even if we did, why do we think we know what’s best when it comes to how others should live their lives?

Through our cumulative experiences in life, the figurative spectacles through which we see the world become tainted. We, unlike small children, lose the ability to see all things as they are. Instead, we see things through our tainted lenses and think we know best. Read more…

It’s an unfortunate scenario I’ve seen time and time again:

• Parent goes to prison.
• Child, who already felt neglected by parent, becomes more upset when parent ends up behind bars. Child either blames the parent for misbehavior that results in parent being taken away from child and/or blames him or herself (as children often do).
• Parent tries to have contact with child via phone calls, letters, or visits.
• Child decides that he or she wants nothing to do with parent
• Parent, often with poor parenting and poor coping skills, feels like a failure and simultaneously is upset about being rejected.
• Parent needs to decide how to handle situation and often chooses to Read more…

Fortunately most patients are honest. They mean what they say, and they realize that ultimately it is in their own best interests to be truthful about their health issues. However, it is a stark reality that many patients lie to health care professionals.

According to a WebMD survey about patients lying to doctors, out of nearly 1,500 respondents, 45% admitted they had either lied (13%) or “stretched the truth” (32%).

It is likely that an even larger percentage of jail and prison inmates lie to health care providers.

Patients are untruthful for different reasons.

People everywhere typically want Read more…

A few months ago I performed an inpatient consultation on a non-incarcerated patient. His psychiatric care was being managed by a neurologist in another community.

I was shocked and disappointed when his family informed me that the neurologist told them that if the patient sought a medical opinion elsewhere, the neurologist would no longer treat the patient.

Even on a bad day I cannot fathom exuding such arrogance and insecurity! Hopefully this doctor’s attitude about second opinions is the exception and not the rule among physicians. However, this situation sparked my curiosity about second opinions.

Throughout my career, I’ve often encouraged my patients to obtain second opinions, either when Read more…

Imagine that as a child you thought you had been born in the body of the wrong gender. If you were biologically male, in your mind you really thought of yourself as female. Likewise, if you were born in a girl’s body, you thought that you were actually a boy.

Yes, you were probably more interested in children’s role-playing games more often associated with the opposite gender as well, but the issue went much deeper than that. It was your core identity that was at stake. You knew that you were the other sex, at least in all ways except for the reproductive organs of your body.

You felt this way during childhood, but nobody seemed to understand or accept this about you.  But you were dressed in the clothing of your biological gender and expected to participate in the activities stereotypically associated with it as well. Imagine that as your body matured in adolescence, you hated your Read more…

As a psychiatrist who has now been practicing for over a decade, I think back to the days of residency and fellowship and realize how much my approach to prescribing benzodiazepines has changed.

One of the key faculty members in my psychiatry residency program was considered an expert in treating anxiety disorders. He was very liberal with his prescription of benzodiazepines, the anti-anxiety class of medications including diazepam (Valium), clonazepam (Klonopin), lorazepam (Ativan), alprazolam (Xanax) and others.

Having no other frame of reference, I naively adopted his unsparing prescription-writing habit of these not-so-benign medications. I unquestioningly steered down this path for the first couple years of my post-training practice.

Then I had the good fortune of working with a very competent group of experienced psychiatrists who were in full-time clinical practice. Regularly collaborating on cases with them helped to initiate my transformation to more conservative, and in my opinion, more appropriate,  prescribing habits.

My prescription style inevitably evolved further when Read more…

Many non-correctional health care providers will also treat inmates from time to time. This may occur in the office or hospital. How can one best approach the challenges of working with the incarcerated in order to deliver the best possible care while simultaneously managing risk?

1. Treat the patient with respect. Not submissive respect, but mutual respect — the way we all want to be treated. I believe that this principle alone goes a long way towards helping one to establish a therapeutic alliance and to minimize interpersonal conflict and hostility. Inmates are people, too. Those who do not agree with this statement should steer clear of treating them.

2. Listen attentively. It may be tempting to get this shackled person (who you may secretly be embarrassed to have in your office) out as expediently as possible. Squelch that temptation, and listen actively as you would to any patient. All patients want their concerns taken seriously. Inmates are no exception. I believe you minimize problems for yourself in the long run (and provide better care) if you ensure that  patients’ concerns are heard, especially if they seem to have more challenging personality styles.

3. Be honest. If there is a particular reason why you think something the patient is requesting is inappropriate, then politely tell them so. If you believe they have a particular diagnosis, psychiatric or not, then Read more…

You may be surprised to hear that despite being a physician tech enthusiast who has a blog, Twitter and Facebook accounts, and a MacBook, I do not own a smartphone. I’ll tell you why.

I’ve previously described the challenges and rewards of working as a correctional psychiatrist, but I did not go into any detail about electronics in correctional settings. Since the overriding objective of jails and prisons is to maintain a secure environment, all staff members give up certain conveniences that we’ve all grown accustomed to on the outside.

Today, so many electronic gadgets are capable of making phone calls and connecting to the internet. In the hands of  inmates, such devices could allow escapes to be planned, the coordination of gang activity, and the running of illegal businesses from within the prison walls. Because either careless or corrupt actions of staff can result in electronics being possessed by prisoners, staff cannot bring in their own devices.

Cell phones of all types are very high on this list of banned items. In fact, cell phones have become one of the major contraband items in prisons around the world. In “shakedowns” where surprise searches of inmate property are conducted, Read more…