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Introduction to Mental Health Treatment in Corrections: A Clinician’s Perspective

Emil R. Pinta (2010).   Kingston, NJ: Civic Research Institute, 102 pages.

In this slim volume, retired psychiatrist Emil Pinta, who taught for 20 years as full-time faculty member in The Ohio State University's Department of Psychiatry, offers "a commonsense guide for mental health professions who begin work in the prison system." Dr. Pinta rounded out his 35-year career as a "psychiatry consultant" for the Ohio Department of Corrections in its men's and women's prisons, where he worked until 2007.

 Introduction to Mental Health Treatment in Corrections consists of seven chapters covering prison culture and environment, general treatment considerations, implications of mental disorder prevalence rates for prison-based treatment options, prescribing medicine for prisoners, suicide prevention, violent prisoners, and special issues and ethical issues, such as institutional safeguards for controlled medications, sleep complaints, prisoners who make "special requests," confidentiality matters, and making decisions about ethical concerns. Each chapter consists of brief descriptions of various issues, plus related "practice pointers."

 In "Understanding the Prison Culture and Environment," Dr. Pinal refers to prisons as a "foreign country," wherein prisoners and staff alike have different values, codes, dress, and language.  "In general," he says, "prisons are not good places for inmates' mental health." Psychological stress accumulates for prisoners because of isolation from family, friends, and community, deprivation of sexual and other personal freedoms, and fear of sexual and non-sexual assault. New prisoners, he says, experience hopelessness and helplessness, resulting in higher risk of suicide and manipulative responses to fears of violence. More seasoned prisoners worry about disciplinary actions and their impact, visitation-related stress, and parole- and reentry-related stress. Clinicians themselves also have safety fears, as well as security-related restrictions, that affect them. Dr Pinal urges mental health workers to be alert and aware of parole release dates and other significant benchmarks in prisoners' confinement; he presses informal communications among prison staff on prisoners' problems.

 Dr. Pinal believes working in prisons is rewarding. In "General Treatment Considerations," he covers patient confidentiality, the balance between security and treatment, constitutional rights, lines of authority and accountability, mental health staffing and standards, and disciplinary processes and therapeutic relationships. In "Prevalence Rates for Mental Disorders in Prison - Implications and Treatment Programs," Dr. Pinal acknowledges high prevalence rates for mental disorders among prisoners, but is less certain about what causes them. He covers treatment goals, outpatient treatment, crisis stabilization and residential treatment units, and psychiatric hospital transfers; he examines links between mental illness and violence and the various reasons for high prevalence rates. While bearing a critical perspective, Dr. Pinal's sources are often curiously  old, and at least marginally out of date.

 In a chapter on "Prescribing Medication for Prison Populations," Dr. Pinal offers some basic principles, along with references for further review. He covers informed consent, voluntary choice, proper documentation, the right to refuse treatment, problems with mandated medication, prescription drug abuse, institutional cost control, and methods of reducing prescription mistakes. "Correctional departments are bureaucratic organizations," he points out, "that can make even simple procedures difficult. At one institution, requests for a weight scale to be available in mental health services became so bogged down with red tape that a staff member purchased one at his own expense to monitor patients taking drugs associated with weight gain and abnormal lipid metabolism. Clinicians working in prisons should advocate for changes in health care policies that interfere with patient care. Advocacy can come from participation in institutional committees, by discussions with mental health supervisors and clinical directors, and by using influence with prison administrators."

 Dr. Pinal's chapter on suicide stresses collaborative working relationships and "open lines of communication."  His chapter on violent prisoners highlights precautions that can be used to prevent or deescalate violent situations, including an uncomfortable mix of privacy, shackling, cautionary measures, and attentiveness to prisoner feelings. In a final chapter on ethics, he admits "there are no easy answers."

 As it turns out, this really is a volume for mental health workers entering, or otherwise new to, corrections.  Clearly one of the central tensions for mental health workers, as well as others, including correctional officers, working in prisons is the line that is drawn between security and treatment (or security and non-security) issues. In prisons, however, security dominates, and it is difficult for anyone to escape that fact. Dr. Pinal hints at challenging this paradigm, in the interest of good psychiatric care, but more needs to be said about how to go about that. Dr. Pinal tells few stories from his 35-year career, and perhaps some of these stories would have offered insights otherwise missing here.


Posted Fri, Mar 11 2011 4:31 PM by Tracey Vessels


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