Abstract
The practice of prescribing in jails and prisons is often different from that in the community. Serious mental illness is common among inmates, and so are co-morbidities such as substance use, impulse-control, attention-deficit/hyperactivity, and personality disorders. Operational requirements, staffing, and the physical plant of the institution may complicate the provision of treatment according to community standards. Problems related to medication nonadherence, as well as the pursuit of medications for nonmedical reasons, are often seen in these settings and may be managed differently than they are elsewhere. Existing practice resources rarely account for these challenges. Pursuant to a recommendation by the Correctional Committee of the American Academy of Psychiatry and the Law (AAPL), the AAPL Council in May 2015 approved the creation of a task force charged with producing a document on prescribing in correctional facilities.
Full Document: Tamburello A, Metzner J, Ferguson E, et al: AAPL practice resource for prescribing in corrections. Journal of the American Academy of Psychiatry and the Law Online Supplement 2018, 46 (2). Available at: http://www.jaapl.org/content/46/2_Supplement
This document is intended as a review of the literature and expert opinion to give guidance and assistance for providing psychiatric treatment, with a focus on psychopharmacology, to adults in correctional facilities. The process of developing this document incorporated a thorough review that integrated feedback and revisions from AAPL members into the final draft. The final draft was reviewed and approved by the Council of the American Academy of Psychiatry and the Law on May 21, 2017. It reflects a consensus among members and experts about the principles and practice of prescribing psychiatric medications in correctional settings. Although recommendations are sometimes articulated when backed by research evidence, ethics standards, or expert opinion, this document should not be construed as a practice guideline, or as dictating the standard of care. Rather, it is intended to inform practice in this area.
The AAPL Practice Resource for Prescribing in Corrections is organized as follows: Section 1 states the intent and limitations of the document. Section 2 describes the legal framework for prescribing in jails and prisons. Section 3 focuses on operational matters, such as medication administration and systems-level oversight of prescribing practices. Section 4 covers general prescribing matters including continuity and coordination of care, assessment, the role of education and nonpharmacologic treatment, and informed consent. Section 5 describes evidence-based practices related to specific mental health diagnoses or problems. Section 6 examines topics that are not addressed elsewhere but may have an impact on prescribing decisions, such as special settings within correctional institutions; adverse effects of medications; medication nonadherence; treatment over objection; misuse, abuse, and diversion of psychotropic medications; and electroconvulsive therapy. Finally, Section 7 discusses gaps in the existing literature that present opportunities to influence the quality of care in jails and prisons.
We encourage the use of this document for the education of students and trainees, as an orientation for those professionals new to practicing in jails and prisons, and as a resource for those currently providing psychiatric care for inmate patients.
Acknowledgments
The American Academy of Psychiatry and the Law acknowledges contributions to this document by Steven Berger, MD, Nickolas Culpepper, MD, Jose Hidalgo, MD, Jerry McKee, PharmD, BCPP, and Hal S. Wortzel, MD.
- © 2018 American Academy of Psychiatry and the Law