Correctional Psychiatry: Practice Guidelines and Strategies

Correctional Psychiatry: Practice Guidelines and Strategies offers a detailed look at correctional behavioral health. The expertise of the authors along with the necessarily limited scope of the chapters leaves the reader looking forward to the planned second volume.

The book contains four sections. The section entitled “The Correctional Setting” is a concise history of detention centers and mental illness in the United States that offers readers a foundation for the philosophy and practice of correctional psychiatry in the 21st century. The section also contains a chapter entitled “Liability Management and the Correctional Psychiatrist,” which will be useful to students of correctional mental health. It is important to note, however, that the section of this chapter that addresses the Americans with Disabilities Act (ADA) is out of date. Psychiatrists asked to perform disability assessments in prison must be aware of the Americans with Disabilities Amendment Act, passed in 2008, as well as relevant case law.

The book's second section, “The Practice of Psychiatry in Correctional Settings,” reviews guidelines and strategies for managing the challenges of working in corrections, including suicide prevention, hunger strikes, malingering, and chemical dependency. Dr. Thienhaus’ sleep disorders chapter addresses the controversy about using pharmacotherapy to treat sleep disorders and contains an appendix with information about educational and behavioral interventions that are conducive to improved sleep habits.

Clinicians and staff in correctional settings are apt to develop strong attitudes regarding some inmates and their behavior. This section contains an informative chapter designed to help clinicians deal with their emotional reactions. There also is a good overview of correctional reentry that may interest correctional health care administrators responsible for mental health and primary health care.

“Special Populations” are examined in the third section of the book, which contains useful information for correctional clinicians working with the following groups of offenders: people in administrative segregation, elderly persons, females, intellectually disabled persons, sex offenders, and juveniles. The chapter that describes salient matters affecting juveniles is written by Todd Elwyn and Erika Ryst, who skillfully examine the interplay between conduct disorder and ADHD, as well as approaches to treating ADHD in correctional settings. Coni Kalinowski's review of the vulnerability of persons with intellectual disabilities to criminal behavior and exploitation should be essential reading for anyone treating this population.

The chapter on women in correctional settings examines the socially disadvantaged nature of female inmates; their high prevalence of PTSD and substance use; pregnancy and motherhood; and the need to consider innovative rehabilitative interventions for women. The authors fail to mention, however, that there are epidemiological studies, beyond the 1997 study by Linda Teplin et al.,¹ that estimate the percentage of women needing mental health treatment to be much higher. The increased national attention focused on mentally ill inmates in administrative segregation makes Shama Chaiken's experience in Pelican Bay and continued work in the California Department of Corrections especially relevant for today's correctional psychiatrist. The author's credibility in dealing with important treatment concerns is obvious, even in this brief overview.

The section on ethics contains two essential chapters. The first, written by Kathryn Burns, describes how best to navigate the dual agency of being a mental health professional in a correctional environment. It should be basic reading for a novice correctional psychiatrist. She correctly points out that the dual agency of correctional psychiatrists is the norm rather than the exception. The research chapter makes the argument that mentally ill inmates are an overprotected population and that the paucity of research on this population harms the inmates themselves. The current standards and the present opportunities for research, including the need for translational research, are aptly reviewed by Robert Trestman.

Because correctional behavioral health care affects mental health services in the community at large, this book is recommended to new and experienced behavioral health clinicians and administrators, including those who do not work in correctional settings.

• American Academy of Psychiatry and the Law