What's Corrections Psychiatry Like?

[hippopotamusoath]

Can anyone opine on the pros and cons of prison psychiatry? I have a very busy and intense hospital job at the moment, and it will be impossible to achieve some of my other goals while I'm working this much (namely, getting some advanced psychotherapy training). I'm looking for something more structured, with less call, less cross-coverage of other services etc.

My thought is that a corrections job may have a slower pace and less pressure to be stretched in a million different directions that way it has gone with this hospital job.

It also seems like a genuinely underserved population, and maybe a chance to contribute something positive to a very marginalized population.

So for those of you who've worked in corrections in the last few years--what's it like? What type of person is a good fit for it? What are the downsides?

Is it ever possible to take on a few therapy patients as supervised cases if I end up doing psychotherapy training for treatment of personality disorders?

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[Celexa]

I can't speak from personal experience but I feel like I've heard stories ranging from it's a tough job but rewarding and can be quite lucrative to some of the most morally compromising **** I can imagine. So I imagine it very much depends on the individual place much like the experience of working for the VA where the specific VA matters more than anything else in whether the job is sustainable.

 

[BiscoDisco]

I do it now. I like it. It's safe, the facility is staffed by police officers not prison guards, so they are much more professional and better educated which makes my job easier. The pay is very high. I have a team of social workers which help support and do evals, safety assessments, etc. So we work as a team and I'm never left making decisions on my own about safety concerns.

Maybe I'm naive but I approach it just like I do other higher liability work - lay out my reasoning for or against suicide precautions, etc in a thoughtful way. Show that I've weighed both the risks and protecting factors. If a bad outcome happens, no one will be able to say I was negligent. Perhaps I was wrong in my assessment of risk but its not because I was careless or doing a half ass job. I think this mitigates the liability a ton.

 

[comp1]

I only ever did inpatient jail in residency. The psychopathology was very, very intense. It was much worse than general county inpatient psych with near constant screaming, homicidal threats or active self injury in many patients. I never felt like the unit was run by the physicians. It was run by the deputies. I'm sure there are reasons for that, but it felt very different from any other inpatient psych unit I've seen. Interviews were very brief mostly because patients did not engage or engaged grossly inappropriately with nudity, semen or fecal matter. You could easily do 18 patients as a team in 2.5 hours because it was mostly chart review and there was no discharge planning needed. I was also subpoenaed twice to testify as a fact witness just as a resident. It's a different kind of work. I think people who work in it earn their higher pay. That said, I did definitely feel safe. The patients were not allowed out of their cells, so there really was minimal (physical) risk to me and the rest of the staff.

 

[whopper]

Its almost always a state/government job which usually means no extra pay for doing good and hard work, being surrounded by plenty of people who try to do the bare minimum job that doesn't get them fired, but a great pension.

Depressing atmosphere, hard to get food from the outside due to all the security checks.

 

[yoloswagpoop42069]

I’m going to try to get credentialed at Riker’s island at some point soon, so hopefully I’ll let you know and not die.

 

[TheRightMedication]

Did I miss any of the pros, other than money? The only reason I could think of to do it is because that's where we keep people with SMI now.

I personally would not, for any price, come into daily contact with such severe personality and character pathology. Maybe someday I'd do it for the SMI folks, when I'm old and the consequences of a bit of a savior complex would be relatively mild.

 

[whopper]

The biggest thing I hated about working for the government was a sizeable percent of your coworkers hate their job, but refuse to quit cause "If I work here another 7 years I get my pension." These people are joyless, show no enthusiasm for their work and usually don't do a good job.

Then if you continue to work there their attitude will rub on you, and you then will be infected with the zombie virus that made them zombies.

Add to this, if you enjoy what you do, you're likely a very good doctor, and then if you do great work the state almost never pays you better for doing better work. All the while your (edited-grammar) colleague doctor also working on the unit who sucks, is making the same amount of money as you, and also tries to siphon off all the hard patients to you. Cause this guy never answers his beeps in a timely manner the unit starts calling you for this a-hole's patients when there's a problem and the management doesn't give a damn.

Lots of nice perks you can't get. If in a correctional facility food delivery will not show up (maybe your place is an exception) cause there's too many security checkpoints. If you leave to get lunch you're talking about 40 minutes wasted leaving all the checkpoints and coming back in so most people eat a ham sandwich in a paper bag. You're likely not eating any better than the inmates.

Also be prepared to deal with a-hole patients. I had one guy malingering that threatened to kill himself, so we told him no food with utensils. He only got ham sandwiches. After 4 weeks straight of ham sandwiches breakfast, lunch and dinner he finally gave up.

 

[milesed]

I trained a NP who was doing NP family practice medicine for a privately run prison and was severely assaulted. She did say they psychiatrists were make around $550k/year.

 

[BiscoDisco]

I’m going to try to get credentialed at Riker’s island at some point soon, so hopefully I’ll let you know and not die.

Good luck I too hope you don't die

 

[Mad Jack]

I’m going to try to get credentialed at Riker’s island at some point soon, so hopefully I’ll let you know and not die.

The thing I've heard about Riker's is that you had better run like clockwork. If you miss the boat you're stuck for a bit. Generally any psych correctional position is pretty safe though, at least in comparison to inpatient psychiatry

 

[soundnin]

Did I miss any of the pros, other than money? The only reason I could think of to do it is because that's where we keep people with SMI now.

I personally would not, for any price, come into daily contact with such severe personality and character pathology. Maybe someday I'd do it for the SMI folks, when I'm old and the consequences of a bit of a savior complex would be relatively mild.

I'm at a residency that is heavy in VA and prison. I prefer prison patients to the VA patients. While there can be a lot of character pathology in both populations, the prison population doesn't have the same level of entitlement often found with veterans. Another pro that makes working in corrections easy is that it's a highly controlled environment, you know everything that is going on.

Agreed that you can easily see massive numbers of patients in a day, so if you find a lower census inpatient gig, it's pretty cush.

 

[the5thelement]

I was gonna work there (state prison in corcoran with the sex offenders) but was strongly advised against it by my medical director at a county job. He said that the inmates there direct all their negative energy towards you and its not worth the money (maybe a reason why they continue to seek psychiatrists and keep offering more and more $$$).

 

[comp1]

I wonder what your county medical director meant by "negative energy." Threats? Lawsuits? Glares?

 

[the5thelement]

I wonder what your county medical director meant by "negative energy." Threats? Lawsuits? Glares?

Basically he said that all these dangerous sex offenders are locked up and you are the only one standing between them and freedom! If you can imagine a wine bottle , the patients are the wine and you are the cork keeping them inside (just to take an analogy from the TV show "Lost". )