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Working in correctional mental health?

ara96

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I just saw some of the phenomenal rates of working in Correctional Mental Health from a recruiter. Upwards of $230/hour. Does anyone have any insight on why it is so lucrative compared to other settings? it seems like a traditional outpatient gig with 12-14 patients per day. What are the challenges working in this setting?

My experiences with forensics in Residency was limited but I did enjoy working with the kids when I worked in a Juvenile Detention facility during fellowship.

Any insight would be appreciated. Thanks in advance.
 

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You will have limited staff, resources, formulary, etc. And if/when you speak up you run the risk that nothing will change, and no one will care. If/when there is a bad outcome, the correctional facility will do what they can to sell you down the river rather than make any real effectual change.

I've never worked corrections psych.
 
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clausewitz2

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You will have limited staff, resources, formulary, etc. And if/when you speak up you run the risk that nothing will change, and no one will care. If/when there is a bad outcome, the correctional facility will do what they can to sell you down the river rather than make any real effectual change.

I've never worked corrections psych.

I think you have the real possibility of worse happening than just nothing if you make trouble or tick off the wrong people. Make enough enemies and maybe if there's a violent incident, maybe the COs take their sweet time responding. Maybe they aren't as careful about the right doors being secured at all times or maybe they don't warn you about a particular inmate and appropriate security precautions.
 
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WisNeuro

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People in prison have a lot of time and may just want to sue you for whatever they think you haven’t done right.

People in general in the US have a lot of time and just want to sue you. Is the incarcerated litigation of providers rate different than providers in the community when demographics are adjusted for? I work in a litigious area (some mTBI work), so I'm just used to the occasional patient advocate complaint or threatened lawsuit, so maybe I'm not as phased by it.
 

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I have a few friends who do corrections telepsych and seem very happy. No safety issues bc they are never on site and they get paid even if no one shows bc they don’t want to, riots etc. definitely not for everyone.

I have heard that prisoners have a lot of time to file complaints etc but not sure if the numbers support this claim bc people outside of prison tend have more $ even if they have less time
 
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Alemo

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Some of these replies seem like worst case eventualities rather than typical work. Of course it’s dangerous, it’s a prison. But the precautions put in place (I would think) work most of the time. I’d hope someone could chime in on why this work might be rewarding, regardless of the (maybe?) good salary.
 

sluox

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I think supply is thin because of the theoretical risks that are mentioned above. In actuality, the quality of the job itself probably depends on many details and is hard to generalize. Onsite $230 is maybe not such a great rate. If you are interested in the best way is to talk to the agency and maybe do a trial, walk around talk to a few people. Few of us here actually have real experience with forensic psych except during training (if that).
 
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BiscoDisco

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I just saw some of the phenomenal rates of working in Correctional Mental Health from a recruiter. Upwards of $230/hour. Does anyone have any insight on why it is so lucrative compared to other settings? it seems like a traditional outpatient gig with 12-14 patients per day. What are the challenges working in this setting?

My experiences with forensics in Residency was limited but I did enjoy working with the kids when I worked in a Juvenile Detention facility during fellowship.

Any insight would be appreciated. Thanks in advance.

From what I've seen, rates in correctional go up to as high as low 300s. That seems a little low tbh.
 

ara96

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I have a few friends who do corrections telepsych and seem very happy. No safety issues bc they are never on site and they get paid even if no one shows bc they don’t want to, riots etc. definitely not for everyone.

I have heard that prisoners have a lot of time to file complaints etc but not sure if the numbers support this claim bc people outside of prison tend have more $ even if they have less time

Can you please give me a contact info for them or put me in touch? I am wanting to do telepsychiatry for them from the hub and I want to know the pros/cons of dealing with this population.

Thanks again.
 
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Sushirolls

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Working for a prison aren’t you shielded from liability since they’d be suing the government? Unless your 1099 I guess
Many prisons are not government, but run by a third party company that has the government contract.
 
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Mad Jack

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I think you have the real possibility of worse happening than just nothing if you make trouble or tick off the wrong people. Make enough enemies and maybe if there's a violent incident, maybe the COs take their sweet time responding. Maybe they aren't as careful about the right doors being secured at all times or maybe they don't warn you about a particular inmate and appropriate security precautions.
I know a psych nurse practitioner who reported abuse that was happening to her patients and ended up being charged for the very abuse she reported despite being all of 85 pounds and 4'10". Basically ruined her life
 
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NewmansOwn

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One point that hasn't been mentioned here is that prison systems are extremely state dependent - more than most people realize.

Certain states, usually in the South, have reputations for being callous, violent and abusive.

A few states are more reform-minded, safety-driven and take civil rights relatively seriously. The state where I did residency is one of them. Often these are states where an academic medical center holds the contract to provide the health care (but not always, as in the case of my state).

Most probably fall somewhere in the middle.

Agree strongly with the point about increasing third-party/contractor encroachment in correctional health care. This is, again, company-dependent, but I think on the whole not a positive/progressive development.

Also, when working with incarcerated populations, remember to differentiate between medical malpractice suits (which are handled in the state court system) and civil rights lawsuits (which are handled in federal court, and less likely to be against you personally).
 
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Taddy Mason

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I did several correctional medicine rotations at a maximum security prison in med school and the penitentiary I was at had a hell of time finding psychiatrists willing to do anything beyond some intermittent locums work. My attending (IM) was often doing a lot of psych in addition to medicine. Malpractice really isn’t an issue as some have suggested. The biggest barriers to attracting and retaining a psychiatrist that I noticed were:

1 - minimal resources with lack of administrative support and the bureaucracy that comes with government jobs. In corrections, psych is generally under the auspice of the department of corrections (or equivalent for that state) but the patient population bleeds over into the department of human services, particularly upon entering and being released from prison and when dealing with severe and persistent mental illness. Often these are separate government departments which don’t play well together (despite considerable overlap in the population(s) served) and patients can fall through the cracks and continuity issues constantly arise. There are also similar issues when dealing with state v. federal inmates.

2 - dislike for the patient population - LOTS of malingering and personality disorders.

3 - misperceptions of working in that setting (e.g., the safety issues alluded to already in this thread). You’re honestly much more likely to be assaulted on a general inpatient community unit.

4 - location and perception of “prestige”.

5 - personal ethics if considering working for private/for profit prisons.

Personally, aside from the bureaucratic issues, I really enjoyed working with this population and found it really rewarding as they are grossly underserved.
 
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birchswing

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One point that hasn't been mentioned here is that prison systems are extremely state dependent - more than most people realize.

Certain states, usually in the South, have reputations for being callous, violent and abusive.

A few states are more reform-minded, safety-driven and take civil rights relatively seriously. The state where I did residency is one of them. Often these are states where an academic medical center holds the contract to provide the health care (but not always, as in the case of my state).

Most probably fall somewhere in the middle.

Agree strongly with the point about increasing third-party/contractor encroachment in correctional health care. This is, again, company-dependent, but I think on the whole not a positive/progressive development.

Also, when working with incarcerated populations, remember to differentiate between medical malpractice suits (which are handled in the state court system) and civil rights lawsuits (which are handled in federal court, and less likely to be against you personally).
Yes, if you want to see the horrors of prison in the south read the book Crazy by Pete Early. He's a journalist who explored Florida's prison/mental health system because of his son's situation. It's been so long since I read the book, but it made me not want to step foot into Florida. Psychotic patients were held naked in their cells and the psychiatrist was only allowed to prescribe Risperdal.
 

NickNaylor

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Rotated at our large county prison and absolutely hated it. It was a pretty demoralizing experience for me. That said, the docs who worked in correctional health full-time really enjoyed it, and it seemed to be pretty lucrative for the time worked. For the right person it would probably be an enjoyable gig, but I could never do it.
 

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Rotated at our large county prison and absolutely hated it. It was a pretty demoralizing experience for me. That said, the docs who worked in correctional health full-time really enjoyed it, and it seemed to be pretty lucrative for the time worked. For the right person it would probably be an enjoyable gig, but I could never do it.

what did you hate so much about it? And why did they enjoy it?
 

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what did you hate so much about it? And why did they enjoy it?

Just not really a big fan of people being housed in cages in a pretty horrible environment - regardless of the circumstances that resulted in them being there. That's just not the environment I would want to work in. Depending on your temperament, that may be more or less easy to ignore (and frankly, that was the only big downside of the job from what I saw, but to me that's a pretty big downside).
 
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psyguru

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$230 is pretty good. I am getting $220 an hour at an FQHC (one day a week). The local prison (where I worked) is offering $200 an hour via locums (could be negotiated up). I enjoyed working in the prison. I worked on the psychiatric high-security pod and covered the Death Row unit (more outpatient but got to see a lot of higher-profile patients). As most of my work was in a psychiatric correctional "hospital", it was interesting. I don't think it would have been as interesting doing general outpatient correctional work.

I was not too worried about lawsuits. They can happen in the free world. It may harder to sue government institutions and their employees.

I am a forensic psychiatrist fyi. If you work over 1-2 years in corrections you would be eligible to sit for the Community Psychiatry certification and also a CCHP. There is a lot of correctional litigation out there and you could charge 1.5-2 x $230 an hour (over double for testimony) in correctional med-mal cases as an expert witness. The company I work with is offering mentorship and case referrals.

There are drawbacks to corrections (as mentioned above). There are also a lot of good upsides. One is you get to provide treatment to an underserved population that can benefit from your work. (PM me for more upsides). It's not for everyone

I left corrections to focus more on my expert witness work. However, I would recommend trying it out. You may or may not like it. At least you will have the $230 an hour and some interesting stories to tell.
 
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When is graduation again?

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I also hated my experience working at a large county jail during residency. In terms of workload, it was one of my easier rotation, but ethically and morally, I found it deplorable for a variety of reasons.

1) As a black male, seeing mainly black and brown men in cages was... very difficult to overcome at first.
2) The quality of care was atrocious. People on suicide watch were naked in glass cells, a few were hospitalized for hypothermia. The less acute people sat on beds, in a large dormitory style room, all day with no actual group or individual therapy and no activities to occupy their time.
3)If a patient gets into a fight with another person, even if justified, you are encouraged to medicate with mood stabilizers or antipsychotics, even if not indicated.
4)Most people had situational depression because they were in jail. Sertraline ain't helping that.
5)Due to lack of funding in public settings and seeking profit in for-profit jail/prisons, I highly doubt you will be given any ability to actually change the conditions in these places and I imagine they will find ways to cut more corners over time.

I'm sure I can keep this list going, but these were definitely my biggest issues with it. If 5 could be improved somehow, I think there is real work that could done in correctional mental health, but it doesn't seem very likely.
 
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Jules A

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I had always heard the rates of suicide and being sued in corrections is higher and in my state all the jails and prisons are contracted now so no govt protection. I've done some locums, it was ok. I like working with underserved but the high rates of substance abuse issues and personality disorders could be exhausting. Back then I was making 20% more than my employed position. Now since they are using a lot of telepsych which for some reason people are willing to do for lower rates as well as NPs who are lowering the rates it isn't as lucrative or attractive.
 

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Does anyone have any insight on why it is so lucrative compared to other settings?

You go to your office, that office has no sunlight, it's got cinderblock walls, it smells like bleach, you go to see an inmate and have to go through about 5 security checks to do so making your walk that would've otherwise taken 30 seconds had this been in a hospital 15+ minutes (I'm not joking). You deal with very depressing people. No I'm not talking they're depressed, I'm talking they're going to get you depressed, like the correctional officer that frequently bullies the inmates, is overstepping his professional guidelines etc.

Lots of creature comforts are denied or hard. E.g. you can't just order lunch. You either got to leave the premises, and that takes like 30 minutes to enter and leave again cause of all the security checkpoints, or you got to pack a school like lunch in a paperbag. You can't go to a doctor's lounge and shoot the $hit with your well-to-do colleagues and talk science.

Many of the people you work with outside the healthcare part don't give a damn about the people you're treating.

If you try to fix the problems expect to get nowhere. Our society's leaders like to score points by treating inmates like animals.

The pay is to draw someone into this type of dungeon like setting. Unofficially the high pay could be part of a hush hush scheme to make you keep silent cause there's likely at least a few things going on that aren't meeting minimum requirements.
 
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