Psychiatrists Can Make a Difference

One of the most important tasks psychiatrists working in correctional settings can do when evaluating suicidal inmates is to obtain and document the inmate’s psychiatric history, according to Karl Weaver, M.D., chief psychiatrist at the California Men’s Colony, a prison in San Luis Obispo, Calif.

Locating an inmate’s mental health records from the community or from prior stays in other prisons or jails can be difficult due to the “insular” nature of corrections systems, he acknowledged, but can be crucial in helping treating clinicians better understand the inmate, he told attendees at the annual meeting of the American Academy of Psychiatry and the Law in San Antonio in October.

Obtaining mental health records will also help the inmate’s future clinicians to understand him or her better. “The crisis is likely to happen again in the future,” Weaver noted. “Do the system a favor and get the history.”

In addition, the psychiatrist should “listen to the observations of as many of the staff as possible—never operate from your observations alone” when evaluating an inmate who may be at risk for suicide, Weaver said.

He also advised psychiatrists to ensure an inmate’s safety by placing him or her in a protective environment while suicide risk is high. “This may involve transfer to an inpatient psychiatric unit or using leather restraints” along with observation by nursing staff, he said.

An inmate placed on psychotropic medications should be kept in a more-restrictive setting until the medications begin to take effect. “The inmate should never be transferred back to an unsupervised setting until he or she is adequately stabilized,” Weaver said.

At a minimum, he added, the inmate must have no access to sharp objects or the means to hang himself or herself and should not be permitted to hoard medications.

For inmates who develop acute agitation or anxiety, Weaver recommended treatment with benzodiazepines. “It should be clear to the inmate that this treatment is short term and will be discontinued as other medications are phased in,” he said.

When psychiatrists are in doubt about an inmate’s mental health status, Weaver said, they should not hesitate to consult with colleagues. “Sometimes, however, if there is just a small number of clinical staff, transfer to another facility is the only way to get a second opinion from an experienced clinician.”