Prison/Correctional Psychiatry

[phattestlewt]

I'm a recent graduate of a 4 year university and have started looking more aggressively into residencies, namely psychiatry. (I wish I could do psychiatry without having to do med school, it seems likes like an unnecessary, long, and costly trifle, but sacrifices need to be made). Psychiatry seems like it offers a fresh and unique experience everyday, with meaningful patient interaction, and the potential to do a lot of good.

More specifically, I came across prison psychiatry and it sounds really interesting.

Can anyone who's worked in the field give me a better perspective of what the average day is like?

Do you have therapy sessions with the patients/inmates. I really value this aspect of psychiatry and, after doing some research, found out that it's dying out as medicine becomes more commodified 'pill-pushing.' Any truth to this?

What journey does one typically take through med school, residency, fellowship? to land a job in prison psychiatry.

Also, what's the pay like?

Thanks!

---

Members don't see this ad.

 

[hamstergang]

I wish I could do psychiatry without having to do med school, it seems likes like an unnecessary, long, and costly trifle
...
Do you have therapy sessions with the patients/inmates. I really value this aspect of psychiatry and, after doing some research, found out that it's dying out as medicine becomes more commodified 'pill-pushing.'

Is there a reason you're interested in psychiatry and not psychology?

 

[phattestlewt]

Is there a reason you're interested in psychiatry and not psychology?

Ideally, I would love to go into psychiatry- no doubt about it, but I'd rather take the med school route as a backup in case things don't turn out the way I expect them to.

 

[F0nzie]

Prison psych is in desperate need for psychiatrists. Most places will let you work anywhere between 1-5 days a week depending on your availability. 8-10 hour shifts seem standard. You pack your lunch, go through security and empty your pockets including your cell phone. They'll have inmates lined up to see you. Caseloads are 20-30 per day sometimes an inmate will refuse to see you. You can also do telepsych from a remote location.
I doubt you will have time for therapy. Aside from academics I do not think any employer will pay you to do therapy.

Pay is slightly higher than a community MH job due to the risk factor.

 

[notdeadyet]

Pay is slightly higher than a community MH job due to the risk factor.

This job varies more by locale than almost any in mental health. Some states pay CMHC wages, in others it is literally the highest salary in psychiatry.

 

[phattestlewt]

Aside from academics I do not think any employer will pay you to do therapy.

What the hell...
That sucks. So the only way I can have therapy sessions with patients is if I have my own practice or am in academia? Which means I'd have to get either a PhD or have close affiliations with an academic/university hospital right?

Maybe I'm glorifying therapy sessions here. I really see them as a valuable tool in helping patient recovery.

From your perspective, are therapy sessions useful? fun? interesting? or do you do as hospitals do and not care much for them as long as you can prescribe pills, do a quick and dirty diagnosis for bipolar and send the patients off?

reading with hungry eyes, so all responses are appreciated

 

[OldPsychDoc]

What the hell...
That sucks. So the only way I can have therapy sessions with patients is if I have my own practice or am in academia? Which means I'd have to get either a PhD or have close affiliations with an academic/university hospital right?

Maybe I'm glorifying therapy sessions here. I really see them as a valuable tool in helping patient recovery.

From your perspective, are therapy sessions useful? fun? interesting? or do you do as hospitals do and not care much for them as long as you can prescribe pills, do a quick and dirty diagnosis for bipolar and send the patients off?

reading with hungry eyes, so all responses are appreciated

Well, I think you're seeing this as more of an "all-or-nothing" proposition than it is in real life. As we discussed in this recent thread, almost every patient encounter can be approached from a therapeutic mindset, and that is very intellectually and humansitically satisfing, IMHO. The great thing about being a psychiatrist is getting to use ALL the valuable tools that will help in patient recovery--and if that is your goal, then psychiatry might be a good fit for you.

BTW, the blogger "Clink Shrink" at the "Shrink Rap" blog: http://psychiatrist-blog.blogspot.com/ does about half of her time in correctional psychiatry, really likes it, and writes well. Check her columns out.

 

[phattestlewt]

Thanks doc

 

[whopper]

Correctional psychiatry will highly vary per state in terms of formulary, hours, expectations, and pay. It's considered a subset of forensic psychiatry. I recommend you get the textbook written by Charles Scott, called Correctional Psychiatry.

Some things about it I'd point out that are very different from regular psychiatry...

Prison has it's own culture, from the rape hierarchy, deterrents to suicide (E.g. sticking a patient in a room intentionally too brightly lit at 65 degrees F, while the person is only allowed to wear a paper gown and stays in there until he's no longer "suicidal"), lower standard of medical care, things the inmates are willing to do to get high (e.g. abuse Seroquel, Cogentin, Wellbutrin, make prison wine, etc), inmates being on put on chemical castration, etc.

There's often a loss of creature comforts. E.g. Some places you can't leave work for lunch. You can't bring in certain types of food items.

 

[F0nzie]

I've posted this link before on the concept of psychodynamic psychopharmacology http://www.psychiatrictimes.com/articles/psychodynamic-psychopharmacology-0 illustrating the advantages of using our therapy training when prescribing meds.

Also, you might have a slow day every now and then with some no-shows. You can take advantage of this extra time and fit in a few therapy sessions. For example, when I was moonlighting at an inpatient unit on slower days I'd do 45 min to 1 hour follow ups with some patients.

 

[chakdephatte]

Hi,
Recently, there have been jobs from prison advertised in major psychiatric journals, offering hefty salaries, promising visa. Having fallen prey to one of such institution CDCR Stockton, I wanted to alert my fellow psychiatrist considering those opportunities. I have been a part of here program for 8 months now, the more my back is pressed against the wall with visa situation the more abuse continues. They will promise you flexible time and work locations with in system and as soon as they know your time constraints they will start abusing you, demanding to change time, threatening you with bureaucratic non sense. 15 psychiatrist have left CDCR Stockton in last 12 months. Speaks a lot about about institution. Those willing to know specifics can send me a private message.
Thanks.

 

[whopper]

Also wanted to add.
1-Get used to having an office that looks like a bomb shelter.
2-Hardly any sunlight in any area you work.
3- Leaving your pen in the nurse's station in the infirmary and realizing this when your back in your office, and you got to spend 20 minutes walking to the infirmary cause you have to go through about 10 sets of locked doors to go back and forth and a guy behind a camera waits about 30 seconds before he opens each door.
4-Taking literally about 15 minutes to get to your car when the day is done, then another 15 minutes just to get out of the prison or jail cause of all the security in the parking lot.
5-Having to pack your lunch like you're in school every single day or having to drive out (like 20 minutes) cause you can't order food in, there's no local places that want to make a decent restaurant right next to the jail, and any food you bring in can only be in certain types of containers
6-An oh so nice (sarcasm) chemical smell as if someone sprayed a can of Lysol or other detergent in every room you work in.
7-A guard (correctional officer) doesn't like you and there's a bully system between the CO's (it happens quite often)? If an inmate gets rowdy with you, expect help to come from that guard, about 5 minutes later than usual, after they've gotten in some good punches against you. Never happened to me but has happened to some attendings I know.

 

[Indodo]

Don't forget the cell phone...I would work at a prison etc but I just gotta have my cell phone. Total deal breaker.