Cali Prison Psychiatry

[champion1]

Hi,

Recently, during my time off, I was researching prison psychiatry. After reading the forums, it is stated that psychiatrists in prison are in very high demand.

1) If one graduates from ANY university ACGME accredited psychiatry program, how hard is it to get a job in a California federal/state prison?

2) in all seriousness, are there any other unstated requirements (yrs of inpatient/outpatient exp, forensic fellowship, political connections, etc) necessary to get those jobs?

Thanks for the help!

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[splik]

your status says you are a pre-med so this information won't be helpful for you at all.

There aren't any current vacancies for the california federal prisons. The bureau of prisons in general, however has lots of vacancies.

CDCR (the state prison system) on the other hand has a ton of vacancies. This is because most prisons are far from where any psychiatrist would want to live. Most psychiatrists dont want to work with criminals in institutionalized settings. The history of psychiatry is such that psychiatrists have spent the past century trying to escape the asylum, so it takes a special kind of person to enter what are out modern day asylums, but without any semblance of a primary goal of treatment or rehabilitation.

I am sure they will consider anyone psychiatrist with a pulse. Depending on how far from any civilization will determine how much they pay and how easy it would be to get a job.
San Quentin for example is located in the bay area and thus actually has too many psychiatrists working there. Because of the location, the quality of psychiatrists they get is much higher, with a larger proportion of forensic fellowship-trained psychiatrists often from highly regarded training programs. This is the exception though. The overwhelming majority of psychiatrists in prisons are not fellowship trained in forensics. However AAPL (the forensic psychiatry organization) is very keen to bring correctional psychiatry under its purview, and I think we will see it being advocated as a standard for prisons to have fellowship trained docs, even though there is no hope in hell of this ever becoming the standard.

Psychiatrists can also contract with one of several contractors that provide psychiatric services to prison, and their selections standards are even lower.

Government jobs of subject to whims and fancies of whatever bandwagon or ill-thought out policies the incumbent administration thinks of. Although correctional jobs are well renumerated currently, there is no guarantee that this will continue in the future (it is only fairly recently this has been the case). It used to be the worst of the worst psychiatrists working in prisons, and Im sure in many places that may still be the case. We are also seeing more telepsychiatry in prison, and it is likely collaborative care will be the next step (i.e. psychiatrists consulting with prison systesm, not hired by corrections and not seeing inmates in person). These could further expand access to psychiatric care for incarcerated individuals and decrease psychiatrist earnings in these settings.

 

[champion1]

Thanks for the reply. I got into a DO school a few weeks ago, but I haven't changed my status yet. How would I do that?

 

[clausewitz2]

your status says you are a pre-med so this information won't be helpful for you at all.

There aren't any current vacancies for the california federal prisons. The bureau of prisons in general, however has lots of vacancies.

CDCR (the state prison system) on the other hand has a ton of vacancies. This is because most prisons are far from where any psychiatrist would want to live. Most psychiatrists dont want to work with criminals in institutionalized settings. The history of psychiatry is such that psychiatrists have spent the past century trying to escape the asylum, so it takes a special kind of person to enter what are out modern day asylums, but without any semblance of a primary goal of treatment or rehabilitation.

I am sure they will consider anyone psychiatrist with a pulse. Depending on how far from any civilization will determine how much they pay and how easy it would be to get a job.
San Quentin for example is located in the bay area and thus actually has too many psychiatrists working there. Because of the location, the quality of psychiatrists they get is much higher, with a larger proportion of forensic fellowship-trained psychiatrists often from highly regarded training programs. This is the exception though. The overwhelming majority of psychiatrists in prisons are not fellowship trained in forensics. However AAPL (the forensic psychiatry organization) is very keen to bring correctional psychiatry under its purview, and I think we will see it being advocated as a standard for prisons to have fellowship trained docs, even though there is no hope in hell of this ever becoming the standard.

Psychiatrists can also contract with one of several contractors that provide psychiatric services to prison, and their selections standards are even lower.

Government jobs of subject to whims and fancies of whatever bandwagon or ill-thought out policies the incumbent administration thinks of. Although correctional jobs are well renumerated currently, there is no guarantee that this will continue in the future (it is only fairly recently this has been the case). It used to be the worst of the worst psychiatrists working in prisons, and Im sure in many places that may still be the case. We are also seeing more telepsychiatry in prison, and it is likely collaborative care will be the next step (i.e. psychiatrists consulting with prison systesm, not hired by corrections and not seeing inmates in person). These could further expand access to psychiatric care for incarcerated individuals and decrease psychiatrist earnings in these settings.

What is your take on this move by forensic psychiatry as a body attempting to take over correctional psychiatry? My forensic experience is limited, but based on my understanding there is frequently a very different approach than how I have seen correctional psychiatry operate to date.

 

[SomeDoc]

What is your take on this move by forensic psychiatry as a body attempting to take over correctional psychiatry? My forensic experience is limited, but based on my understanding there is frequently a very different approach than how I have seen correctional psychiatry operate to date.

Correctional psychiatry has for a while been one of the three prongs of forensic psychiatry-the other two being expert witness work, and clinical service to individuals in forensic institutions (individuals undergoing restoration of competency to stand trial, and not guilty by reason of insanity acquitees).

State forensic, and correctional facilities have historically attracted clinicians from the bottom of the barrel of the professional pool. It is therefore not uncommon to see clinicians practicing in these areas who have revoked licenses in other states, or a history of egregious malpractice. You will not see this generally with fellowship-trained individuals.

Qualifications aside, there are several character types encountered in correctional settings - those that practice in the civil arena who work extra hours behind bars for the income, the physician who can't cut it in the civil arena due to blemishes on their professional history, and the formally trained forensic psychiatrist, who generally practices out of an interest in serving what is considered one of the the most undeserved mental-health populations. AAPL simply aims to improve the quality of care provided in correctional settings, and fellowship-trained individuals tend to gravitate towards administrative roles in these settings.

 

[clausewitz2]

Correctional psychiatry has for a while been one of the three prongs of forensic psychiatry-the other two being expert witness work, and clinical service to individuals in forensic institutions (individuals undergoing restoration of competency to stand trial, and not guilty by reason of insanity acquitees).

State forensic, and correctional facilities have historically attracted clinicians from the bottom of the barrel of the professional pool. It is therefore not uncommon to see clinicians practicing in these areas who have revoked licenses in other states, or a history of egregious malpractice. You will not see this generally with fellowship-trained individuals.

Qualifications aside, there are several character types encountered in correctional settings - those that practice in the civil arena who work extra hours behind bars for the income, the physician who can't cut it in the civil arena due to blemishes on their professional history, and the formally trained forensic psychiatrist, who generally practices out of an interest in serving what is considered one of the the most undeserved mental-health populations. AAPL simply aims to improve the quality of care provided in correctional settings, and fellowship-trained individuals tend to gravitate towards administrative roles in these settings.

Very interesting, thanks. I am interested in working with correctional popilations, but am deeply uncomfortable with doing so in any capacity outside of a physician-patient relationship. My understanding had been that forensics focuses much more on evaluative, non-therapeutic practice contexts, so this is very useful information.

 

[splik]

What is your take on this move by forensic psychiatry as a body attempting to take over correctional psychiatry? My forensic experience is limited, but based on my understanding there is frequently a very different approach than how I have seen correctional psychiatry operate to date.

Historically American Forensic Psychiatry has been predominantly about the psychiatrist as expert witness, and explicitly not about treatment. Conversely, British Psychiatry was explicitly about the treatment of mentally disordered offenders (mostly with personality disorders) in secure (non-correctional) settings, and not about expert witness work. Increasingly both aspects are considered part of "forensic psychiatry" in the respective countries.

We have seen that increasingly the mentally ill have been incarcerated since the 1970s. This has had nothing to do with deinstitutionalization, but rather "tough on crime" approaches that issue heavy penalties for transgressions of trivial laws, and these laws disproportionately affect the mentally ill. As a result, the chronically mentally ill have moved into the prisons and psychiatrists are following them there.

There are forensic aspects to correctional psychiatry. In california for example, the psychiatry will be called to testify in front of a judge in administrative hearing for involuntary hospitalization (Vitek hearings) or forced medication (Keyhea hearings) which parallel the probable cause and Riese Hearings that happen in civil settings. Correctional psychiatrists may also participate in post-sentencing reports (Z-cases), parole hearings, rule violation reports (i.e. whether a rule violation was the result of a person's mental disorder or mental state at the time), evaluation of mentally disordered offenders (i.e. whether mentally ill criminals are safe to be released into the community or should go to a state hospital), sexually violent predators evaluations, assess competency to participate in hunger strikes, or evaluations for gender-affirming surgery.
Correctional psychiatrists may also be asked to opine or whether someone is competent to be executed. When working with death row inmates, the ethical conflict of treating seriously mentally ill individuals may arise, as doing so may restore their competency to be executed.

Forensic psychiatrists would theoretically be best placed to do violence risk assessment, manage violence, and detect malingering and deception. They may be better place to navigate the role as healthcare providers within a system with a separate, and times, divergent agenda.