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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In 1971 a psychology experiment at Stanford University occurred that would be considered too unethical to conduct today. It was supposed to last 2 weeks, but it got out of hand and was stopped after only 6 days. The “prison guards” exhibited very demeaning and even sadistic behaviors. The “prisoners” eventually became very inhibited and showed signs of severe stress.
It was the Stanford Prison Experiment. A mock prison was created in the basement of the psychology building. Male undergraduate students were carefully screened, and 24 ultimately were chosen. They were randomly assigned to be either guards or prisoners. The guards worked 8 hour shifts, went home, and then returned the next day as typical shift workers do. The prisoners were “arrested” by police at their residences and then transported to the makeshift prison. The prisoners were not allowed to leave.
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