An introduction to correctional psychiatry: Part III.

This article, which is the last of three parts, provides an overview of relevant national guidelines/standards for providing mental health services within a correctional setting and describes essential characteristics of mental health systems designed to meet constitutional standards. Part III addresses issues pertinent to treatment programs for inmates with serious mental illnesses; confidentiality; involuntary treatment; quality assurance; management information systems; and research.

Pennsylvania Department of Corrections et al. v. Ronald R. Yeskey: prisons and the Americans with Disabilities Act of 1990.

This article reviews a recent U.S. Supreme Court decision that addresses the issue of whether Title II of the Americans with Disabilities Act of 1990, which prohibits a public entity from discriminating against a person with a disability due to that individual's disability, applies to inmates in state prisons. Potential ramifications of this important decision are briefly addressed.

An introduction to correctional psychiatry: Part II.

This article, which is the second of three parts, provides an overview of relevant guidelines/standards for providing mental health services within a correctional setting and describes essential characteristics of mental health systems designed to meet constitutional standards. Part II focuses on organizational issues within correctional mental health systems, staffing issues, and psychiatric screening/evaluation processes.

An introduction to correctional psychiatry: Part I.

This article, to be published in three parts, provides an overview of relevant national guidelines/standards for providing mental health services within a correctional setting and describes essential characteristics of a mental health system designed to meet constitutional standards. Part I will provide a brief summary of pertinent epidemiological studies and an introduction to the most widely used national standards/guidelines. Part II will focus on organizational issues within correctional mental health systems, staffing issues, and psychiatric screening/ evaluation processes. Part III will address issues pertinent to treatment programs for inmates with serious mental illnesses, confidentiality, involuntary treatment, and management information systems.

Trends in a national sample of sexually abusive youths.

OBJECTIVE: To describe sociodemographic factors pertinent to sexually abusive youths, to define common characteristics of the offending behaviors and victims, and to identify issues relevant to treatment recommendations. METHOD: The Uniform Data Collection system (UDCS), developed by the National Adolescent Perpetrator Network, provided data from 90 contributors in 30 states on more than 1,600 juveniles referred to them for specialized evaluation and/or treatment following a sexual offense. The UDCS comprises four separate structured questionnaires that collect both factual information and clinical impressions. RESULTS: Physical and sexual abuse, neglect, and loss of a parental figure were common in these youths' histories. Twenty-two percent of the youths, who had been victims of sexual abuse, reported that the perpetrator of their own sexual abuse was female. The youths committed a wide range of sexual offenses, with twice as many of the referring offenses involving female victims than male victims. CONCLUSION: The discovery of sexually abusive youths across both urban and rural areas supports the need for comprehensive service delivery and a continuum of treatment services to be available in all communities.

Psychiatric stigma in correctional facilities.

While legislatively sanctioned discrimination against the mentally ill in general society has largely disappeared, it persists in correctional systems where inmates are denied earn-time reductions in sentences, parole opportunities, placement in less restrictive facilities, and opportunities to participate in sentence-reducing programs because of their status as psychiatric patients or their need for psychotropic medications. The authors discuss the prevalence of such problems from detailed examinations of several correctional systems and from the results of a national survey of correctional medical directors.

Mental health screening and evaluation within prisons.

Current national standards and/or guidelines for correctional mental health care programs emphasize the importance of various levels of mental health screening and evaluation that should be performed by qualified personnel on all inmates as part of the admission process to a prison. The authors describe the results of a study that included data from all 50 state departments of corrections regarding prison mental health screening and evaluation models. The vast majority of states appear to have adopted some variation of the most recognized guidelines and/or standards (e.g., American Psychiatric Association, National Commission on Correctional Health Care, American Public Health Association) concerning correctional health care systems. Results are also provided concerning the use of standardized psychological tests and informed consent issues.

A survey of university-prison collaboration and computerized tracking systems in prisons.

It is conservatively estimated that 8 percent of inmates in U.S. prisons have significant psychiatric impairment. Correctional mental health systems are often unable to provide adequate treatment to such inmates because of staff recruitment problems. Collaboration between universities and departments of corrections can help solve recruitment problems, and needs assessment studies and computerized tracking systems can help obtain needed resources. A national survey collected data on collaborations between universities and corrections departments and on needs assessment and computerized tracking systems in prisons. Results indicated that such collaborations exist in more than half of state prison systems. Of 42 states responding, only ten states reported having systemwide computerized tracking systems, but others are in the process of developing such systems. Two-thirds of the correctional mental health systems did not have an ongoing needs assessment program.

Prison mental health services: results of a national survey of standards, resources, administrative structure, and litigation.

The formation of adequate mental health systems within prisons has accelerated as a result of successful class action lawsuits. Our recent national survey questioned all state correctional departments about the existence of standards in each system, compliance with such standards, prevalence of class action lawsuits involving the issue of providing adequate mental health services for inmates, issues related to consent decrees, available mental health resources within the correctional system, and the administrative structure of the mental health system. Our purpose was to identify those factors correlated with certified class action lawsuits involving issues related to mental health services. Twenty-one states were involved in such litigation. Only the presence of psychiatric hospitals operated by the department of corrections correlated with the presence of certified class action lawsuits involving mental health services. Prison systems larger than 15,000 inmates were at higher risk for such litigation. Smaller systems having psychiatric hospitals run by the state mental health agency appeared to be at less risk for such litigation.

The role of the psychiatrist in evaluating a prison mental health system in litigation.

Federal courts during the past 14 years have recognized that many prisons in the United States have provided constitutionally inadequate medical and psychiatric services. Our recent national survey indicates that at least 20 states have had at least one part of their correctional system included in a certified class action suit that alleged insufficient mental health services for inmates. This article reviews the role of the expert psychiatric witness during the phases of litigation that involve proposed remedial plans and compliance in implementing remedial plans. Available epidemiologic data about psychiatric disorders among prison inmates, standards for correctional mental health care, and various mental health system models are briefly reviewed. A comprehensive approach to evaluating proposed remedial plans and assessing issues of compliance with accepted plans is described. Special attention is directed toward psychiatric issues unique to a correctional system.