Bank robber Willie Sutton said he robbed banks, “because that’s where the money is.” Mental health professionals practice in prison because, sadly, that’s where the patients are!
We incarcerate the mentally ill along with those we’re mad at and those we’re afraid of. Many of us wish for a return to the days where a reasonable percentage of our government budget was spent on more mental health friendly facilities for the seriously and persistently mentally ill who cannot always adapt to life in the community. But these days an increasing number of truly sick individuals end up wearing down the patience of their community and find themselves behind bars.
In the early 1970s the AMA recognized that health care in jails; prisons and juvenile confinement facilities were inadequate. They developed national standards that are still followed and refined today. If a facility wants to be accredited they can purchase the manual with the guidelines, do a self audit to determine if they think they are ready for accreditation. The facilities can then apply to the accrediting agency (usually the American Correctional Association or the National Commission on Correctional Healthcare), pay their fee, and schedule a visit. Visits are usually 4-8 people from ACA or NCCHC coming to the facility for 1-2 days.
Prisons often have the largest supported living units for the mentally ill in any given state. Prisons often have crisis beds that function like mini-hospitals handling most crisis care needs. Prison crisis units handle severe problems including frank psychosis and glaring mania, anhedonic depression, and suicidal impulses. The crisis units in prisons handle it all.
Prison is extremely stressful. Whether you think prisoners deserve stress or not doesn’t change the fact that stress will break anyone down. Intense stress makes everything worse including headaches, stomach problems, pain, anxiety, depression, psychosis, seizures, etc. And the health care needs that occur because of the stress require lots of health care providers.
So if you want to take care of the mentally ill, you’ll find that many end up in prison, and even those who did not seek services in the community may seek services in prison when their adaptive mechanisms come unraveled due to intense prison stress.
The TV sitcom M*A*S*H* had a visiting psychiatrist – Major Sidney Freedman. When the chaos of the war, the Army, the people, and the demands of caring for those in harms way got to the cast, Dr. Sidney was always there to offer words of comfort and occasionally wisdom. Our work is much like that. We offer lots of basic care with a frequent need to offer empathy and perspective.
Another important contribution of mental health professionals in prisons is to elevate the level of care. If good professionals don’t do this work then those less qualified will do so. In years gone by health care was delivered by a local general practitioner, other prisoners with a health care background, or providers with restrictions on their licenses who could not work anywhere else. Today, correctional medicine occupies a well defined niche for primary care as well as specialists. There are also other health services like psychology, x-ray, lab, eye care, and dental.
Prisoners and detainees are the only Americans who have a constitutional right to health care. Providing services to incarcerated individuals is an art and for many healthcare providers, a passion. Those professionals who develop their skills in correctional health care will find the need is great, and the system continues to grow and develop. Prison is where the patients are.
Dr. Nelson ‘Ben’ Bennett
MHM Services, Georgia