The Psychiatrist's Role in Correctional Facilities

• Author: Neil Conacher and Eric Prost
• Pages: 713-726

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CHAPTER 33

The Psychiatrist’s Role

in Correctional Facilities

Neil Conacher and Eric Prost

I. INTRODUCTION

e psychiatrist working within Canada’s corrections system faces rewards and challenges dierent from

both those encountered by general psychiatrists and forensic psychiatrists. is chapter deals with this

specialized role by outlining the organization of Canada’s correctional services and then introducing

how the psychiatrist ts into this setting with its unique culture, safety concerns, and psychopathologies.

Management of various disorders during incarceration and in preparation for release as well as special

topics such as predatory sexual behaviour, self-mutilation, and prison suicide are dealt with.

A. Correctional Psychiatry as a Specialty

Correctional psychiatry is a specialty emerging in response to a growing understanding of the preva-

lence of mental health issues within correctional facilities and the importance of managing these issues

properly to prevent harm within the institution and by a prisoner on release. A reection of the growth

of this specialty is the expanding literature on the issues of importance to those practicing in the eld.

(Conacher, 1996; Lamb & Weinberger, 1998; Brink et al., 2001; Metzner, 2003; Kantor, 2003; Metzner &

Dvoskin, 2004).

Psychiatrists working in prisons are usually performing general adult psychiatry in a special setting

rather than forensic psychiatry proper that involves issues such as criminal responsibility and court testi-

mony (see Conacher, 1996). e correctional services environment oers the clinician a rich opportunity

to understand and participate more actively in the issues that confront oenders, particularly mentally

disordered oenders, as they navigate the complexities of arrest through to return to a supervised com-

munity setting. Nonetheless, some psychiatrists do practice comfortably in both settings.

It is important to note the distinction between the specialty of forensic psychiatry and that of cor-

rectional psychiatry. In the former, which has been the subject of many chapters in this book, is a prac-

titioner who focuses on preparing evaluations and assessments to be used in a judicial setting. Such an

expert does not provide treatment to the subject of the assessment and strives for objectivity and clarity.

In contrast, the psychiatrist working in a jail or detention centre provides consultation on or treatment

of particular inmates. e relationship between patient and psychiatrist is more similar to that between

a psychiatrist and patient in any other health care setting — with exceptions that will become clear

through this chapter. It is true that those who practice forensic psychiatry oen, due to their familiar-

ity with the prison population (having done assessments for court purposes on those same individuals),

decide to provide services within the correctional facilities as well. at being said, the characteristics of

the specialties remain dierent with some crossover.

Correctional psychiatrists are oen contracted to provide consultations to a prison physician or

psychologist, and rarely engage in long-term treatment. Because the individual patients within the jail or

detention centre are held by the authorities against their will, clinical notes prepared in the management