Corrections Facilities

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My out-patient family medicine doc was also the county coroner and jail doc. We went there every Thursday. I saw some really cool pathology. I saw the largest zoster infection of my life (it covered from about L3 down both extremities). According to the Doc, if it weren't for mental illness, we wouldn't have jails. He thinks that they all have a mental illness.

I didn't enjoy working there too much. I didn't really like having to ask the guard to get the patient to sit down, worrying that the patient was going to retaliate against us.
 
Well I'm working in a forensic facility. Not exactly a corrections facility but there are a lot of parallels.

Things that right now is the most challenging is learning all the legal terms that are state specific. Probate Court in the facility I'm at is the term for Civil court. Why its called Probate court, & called Civil (or commitment) Court in other states I do not know, and to add to the confusion, probate court in general means estate court.

But that's my point. I got plenty of jargon to memorize which is state specific. An IST-J, IST-CJ, FRT, Special Precautions level 1, 2, 3, 4, 5 etc.
 
what about the locum tenen corrections positions?? Anyone have any experience with them..
 
The answer is that it's going to be largely prison-dependent. It depends largely on the state you're in, how they treat or mistreat doctors, the acuity and potential violence level of the population, and the support (or lack thereof) of support staff. County or state-run facilities are laden with paranoia and CYA all day long (by the staff) and you often dumped upon to make a diagnosis or transfer a patient that may be against your particular opinion. On the other hand, the hours are predictable and easy, and there is basically no take-home responsibility. Call is most often paid-extra, etc.
 
1viking said:
According to the Doc, if it weren't for mental illness, we wouldn't have jails. He thinks that they all have a mental illness.
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He's an idiot and is unfit to practice.
 
Faebinder said:
Agreed.
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How do you figure he's an idiot? Every inmate I have met has a mental illness. Maybe you don't count ASPD, abuse/dependence, paraphilias?
 
Anasazi23 said:
A large proportion of inmates have psychiatric disorders and/or are low IQ. The notion isn't that far fetched.
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Please explain what you mean by "large proportion", and please at least site a source for this assertion.

Also, one must consider how prison life has affected one's mental health. In other words, did the individual have a mental illness before entering the prison or did he or she develop it following prison admittance?

If you are implying that criminal acts are, by and large, the direct result of mental illness (and that illness' effects on behavior), then I think you are making a gross generalization that isn't so black and white.
 
Some points that should be clarified that may have lead to the comment(s) above....

1) Just because someone is mentally ill does not excuse them from a crime. If someone for example has Antisocial Personality DO & no other psychiatric illness, that person should not be excuse in any way shape or form for committing a crime. People with mental illness trying to use it as an excuse need to fulfill the Mcnaughton standard. This is a difficult standard to achieve. If you don't know what McNaughton is, read up on it,

http://en.wikipedia.org/wiki/M%27Naghten_Rules
because otherwise if you continue to debate on this area without knowing it, you really don't know what you're talking about (I mean this in a friendly manner).

Some people are under the very erroneous notion that just because someone is mentally ill, then that person should be excused from a crime they committed.

2) Mental illness has somewhat relative use. In the broadest sense, I would agree that most people in prison have mental illness. Since someone above asked for a source..http://www.psychiatric-disorders.com/articles/personality-disorders/antisocial.php
An estimated eighty percent of male inmates have antisocial personality disorder. Female sociopaths are thought to make up 65 percent of the populace in women's prisons.
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Unfortunately and this creates confusion, several people-depending on the way the individual group communicates do or don't discuss Antisocial PD as if its a mental illness. For example-within my treatment team, if one of my patients attacks another, I ask the team"Did he do it because he was being an A-hole (meaning he knew what he was doing) or was it because of his mental illness? (psychosis, mania)".

(Kinda like how within a hospital, no one refers to the surgeons as the "medical doctor". They only call them surgeons even though surgeons have M.D.s. Reason why is it causes confusion between surgeons & IM docs. Outside the hospital people will call the surgeon a "medical doctor".)

Now yes--most people in prison do have a mental illness in the broadest sense, but several of them are not entitled within a legal sense an excuse based on that.

The DSM has put a label on almost every single mental state where someone can act out of line. E.g. Intermittent Explosive DO, Adjustment DO, Antisocial PD, cannabis abuse, cocaine dependence. Several of these disorders do not justify an legal excuse/defense.

a mental disorder is
Mental disorder or mental illness are terms used to refer to a psychological or physiological pattern that occurs in an individual and is usually associated with distress or disability that is not expected as part of normal development or culture.
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Most disorders could never achieve the Mcnaughton standard.

These things usually aren't taught in medical school, but only in residency--psychiatry residency.
 
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http://ojp.usdoj.gov/bjs/pub/pdf/mhppji.pdf


State Prison:
Percent with mental illness
female: 73% male: 55%

Local Jails: female 75% male: 63%
Federal Prison: female 61.2% male: 44%

• About 74% of State prisoners and 76% of local jail inmates who had a mental health problem met criteria for substance dependence or abuse compared to 56% (state) and 53% (jail) of prisoners without a mental health problem. ​

Which if you think about it that means that about 80% of of male prisoners have a mental illness/and or substance abuse problem. ​

You can read the report
details increased rates of homelessness
increased rates of past physical and sexual abuse
increased history of parental drug abuse
in mentally ill prisoners compared to non prisoners. ​

I don't think anyone is implying criminal acts are the result of mental illness - it would be quite difficult to apportion the various contributions of mental illness, lack of access to mental health care, poverty, substance abuse, parental substance abuse, etc. However, I do think our nation's drug laws and approach to substance abuse can be safely assigned a significant contributing role (edit in: for the large numbers of individuals with drug problems who are incarcerated). ​

There was interesting editorial in the NY Times last year comparing institutionalization in the 1940s and 1950s with institutionalization today. Check out the graph. ​

http://www.nytimes.com/2007/01/15/opinion/15harcourt.html


 
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grandslam521 said:
Please explain what you mean by "large proportion", and please at least site a source for this assertion.
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Google is your friend:

http://www.nytimes.com/2006/09/07/us/07prisons.html
Diamond PM, Wang EW, Holzer CE III, et al: The prevalence of mental illness in prison. Admin Policy Ment Health 29:21–40, 2001
Steadman HJ, Veysey BM: Providing services for jail inmates with mental disorders. Research in Brief Report. Washington, DC: U.S. Department of Justice, National Institute of Justice, 1997
Smith C, O'Neill H, Tobin J, et al: Mental disorders detected in an Irish prison sample. Crim Behav Ment Health 6:177–83, 1996
Teplin L, Abram K, McClelland G: Mentally disordered women in jail: who receives services? Am J Public Health 87:604–9, 1997[Abstract/Free Full Text]
Baillargeon J, Contreras S, Grady JJ, et al: Compliance with antidepressant medication among prison inmates with depressive disorders. Psychiatr Serv 51:1444–6, 2000[Abstract/Free Full Text]
Fazel S, Danesh J: Serious mental disorder in 23,000 prisoners: a systematic review of 62 surveys. Lancet 359:545–50, 2002[Medline]
Dean-Gaitor HD, Fleming PL: Epidemiology of AIDS in incarcerated persons in the United States, 1994–1996. AIDS 13:2429–35, 1999[Medline]
Farley J, Vasdev S, Fischer B, et al: Feasibility and outcome of HCV treatment in a Canadian federal prison population. Am J Public Health 95:1737–9, 2005

This just a start.

Also, one must consider how prison life has affected one's mental health. In other words, did the individual have a mental illness before entering the prison or did he or she develop it following prison admittance?
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In most cases, when we speak of mental illness in the prison system, we're talking about antisocial PD, psychosis, bipolar, and things like intermittent explosive. Not adjustment reactions secondary to being incarcerated. There is data, which I don't have time at the moment, showing that "prison life" does not generally increase the incidence of new disorders.

If you are implying that criminal acts are, by and large, the direct result of mental illness (and that illness' effects on behavior), then I think you are making a gross generalization that isn't so black and white.
Click to expand...

I'm not making a gross generalization, and I never said or meant to imply that it's black and white. However, there is a relation. To ignore it completely is another gross generalization.
 
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grandslam521 said:
Please explain what you mean by "large proportion", and please at least site a source for this assertion.

Also, one must consider how prison life has affected one's mental health. In other words, did the individual have a mental illness before entering the prison or did he or she develop it following prison admittance?

If you are implying that criminal acts are, by and large, the direct result of mental illness (and that illness' effects on behavior), then I think you are making a gross generalization that isn't so black and white.
Click to expand...

Criminal acts are, by and large, the direct result of mental illness. Sazi's citation was excellent regarding reported mental illness.

Of course, someone with an antisocial personality disorder is a bit less likely to report their symptoms. I've never had a patient come in with a CC of: "Doc I just can't shake this desire to cheat, deceive and manipulate others for my own gain!"

Also, the lack of empathy and failure to conform to lawful behavior that would allow an individual to end the life of another human being (for example) cannot be considered good mental health.

Please do not mistake this as an appeal for an end of the penal system. The best treatment for such an individual is (in my opinion) removal from society.
 
Please do not mistake this as an appeal for an end of the penal system. The best treatment for such an individual is (in my opinion) removal from society.
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Whole-heartedly agree. There are things people only understand once they're on the inside. Most lay-people I know equate mental illness with an automatic excuse for any wrong that person has done. That in reality applies to so few people.
 
Anasazi23 said:
Google is your friend:

http://www.nytimes.com/2006/09/07/us/07prisons.html
Diamond PM, Wang EW, Holzer CE III, et al: The prevalence of mental illness in prison. Admin Policy Ment Health 29:21–40, 2001
Steadman HJ, Veysey BM: Providing services for jail inmates with mental disorders. Research in Brief Report. Washington, DC: U.S. Department of Justice, National Institute of Justice, 1997
Smith C, O'Neill H, Tobin J, et al: Mental disorders detected in an Irish prison sample. Crim Behav Ment Health 6:177–83, 1996
Teplin L, Abram K, McClelland G: Mentally disordered women in jail: who receives services? Am J Public Health 87:604–9, 1997[Abstract/Free Full Text]
Baillargeon J, Contreras S, Grady JJ, et al: Compliance with antidepressant medication among prison inmates with depressive disorders. Psychiatr Serv 51:1444–6, 2000[Abstract/Free Full Text]
Fazel S, Danesh J: Serious mental disorder in 23,000 prisoners: a systematic review of 62 surveys. Lancet 359:545–50, 2002[Medline]
Dean-Gaitor HD, Fleming PL: Epidemiology of AIDS in incarcerated persons in the United States, 1994–1996. AIDS 13:2429–35, 1999[Medline]
Farley J, Vasdev S, Fischer B, et al: Feasibility and outcome of HCV treatment in a Canadian federal prison population. Am J Public Health 95:1737–9, 2005

This just a start.



In most cases, when we speak of mental illness in the prison system, we're talking about antisocial PD, psychosis, bipolar, and things like intermittent explosive. Not adjustment reactions secondary to being incarcerated. There is data, which I don't have time at the moment, showing that "prison life" does not generally increase the incidence of new disorders.



I'm not making a gross generalization, and I never said or meant to imply that it's black and white. However, there is a relation. To ignore it completely is another gross generalization.
Click to expand...

Just to be clear with what I thought you were implying from a previous post above...

Originally someone said:

My out-patient family medicine doc was also the county coroner and jail doc. We went there every Thursday. I saw some really cool pathology. I saw the largest zoster infection of my life (it covered from about L3 down both extremities). According to the Doc, if it weren't for mental illness, we wouldn't have jails. He thinks that they all have a mental illness.
Click to expand...

and you responded indirectly with:

A large proportion of inmates have psychiatric disorders and/or are low IQ. The notion isn't that far fetched.
Click to expand...

You seemed to agree with the notion that "if it weren't for mental illness, we wouldn't have jails". Therefore, I thought you were implying that mental illness is responsible for criminal behavior or is a very large, yet possibly indirect, cause of criminal behavior.
 
grandslam521 said:
You seemed to agree with the notion that "if it weren't for mental illness, we wouldn't have jails". Therefore, I thought you were implying that mental illness is responsible for criminal behavior or is a very large, yet possibly indirect, cause of criminal behavior.
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That wasn't what I was implying, per se, or meant to anyhow. And also as a point of disclosure, I also think that removal from society is very often the most prudent thing to do with those found guilty of crimes. NGRI and competency are separate, complex issues.

You'll always need jails, and although a relatively large proportion of the jail or prison population has some form of mental illness, this would in no way preclude us from needing said jails in the first place. What I am saying is just that. The concept of jail serves many purposes, some of which are deterrant to the public, to provide punishment, and to provede a modicum of safety from those deemed not fit to live in society.

The discussion can get complicated. Some experts have made correlations between the skyrocketing building and use of jails and deinstitutionalization. This seems to make sense. Others note the pattern of shifting demographics with increased incarceration rates (race-based or otherwise). I will stand by the notion above that crime, in some part, is correlated, at least indirectly, with criminal behavior. Again, this is pretty consistent in the literature, particulary if you include antisocial PD. That again, is another discussion.
 
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