Incarcerated Mentally ILL

Deinstitutionalization of people with mental illness, which began in the late 1950s, has led to the release of thousands of individuals with chronic mental illness. Since the reduction of long-term inpatient psychiatric beds was not accompanied by an increase in funding for community mental health, the prison system has become the modern-day warehouse for those with mental illness unable to live independently. Without the ability to care for themselves, coupled with the lack of treatment, many have found themselves in trouble with the law and sentenced to prison (Psychiatric News, October 20).

Unfortunately, the prison system has not been able to fill the void left by the closing of long-term psychiatric institutions. Although the prison system has been able to warehouse these patients, it has not provided the treatment or compassion once offered by state mental institutions. Furthermore, due to the inherent stress, exposure to abuse, and lack of legitimate treatment in prison, inmates with mental illness typically have a progression in their illness that does not return to baseline after release. Eventually, these individuals return to the streets in an even more disorganized state, which can lead to a vicious cycle of future incarceration and decompensation.

In the winter of 2005, I accepted a position as a psychiatrist for the Department of Corrections in Florida. Since I had only recently completed a residency program, I held the naïve belief that the quality of psychiatric treatment with which I was familiar in the university setting was universal. Although I worked for the prison system for only four months, the abuse I witnessed under the disguise of treatment will remain in my memory for life. It was apparent to me that the abuse and neglect I was witnessing were being legitimized by my presence as a medical doctor. For this reason I left the prison system.

Although there are some who are sadistic and seek employment in corrections for the sake of power, I believe that many start out with good intentions and change as a way of coping. Unfortunately, many of the physicians employed by the Department of Corrections have no other options. A review of recently requested public records revealed that three-fourths of the psychiatrists employed by the Florida Department of Corrections are not board certified. Board certification is required by most hospitals and insurance plans but not by the state. Also, a disproportionate number of the doctors have restricted licenses due to a history of substance abuse, boundary violations with patients, or mental health issues. A restricted license in some cases allows the practitioner to work only in areas of need, like the prisons. These doctors, unfortunately, may be more prone to being manipulated by the administration. They also may be less likely to speak out against abuse because their options for employment elsewhere are limited or nonexistent.