Some incarcerated offenders have serious mental health and chemical dependency issues, so there is a need for prompt, competent psychiatric care. While the essential duties of a prison psychiatrist aren't any different from those practicing in an outpatient setting, there are nuances of working in this environment, including the need to maintain security and the common types of diagnoses.
Becoming a prison psychiatrist takes about 12 years. After finishing a four year bachelor's degree, you complete another four years in medical school, which requires participating in a clinical rotation, which you can elect to take in a prison. During this rotation, you practice diagnoses and treatment of inmates, under the supervision of a licensed psychiatrist. The final step is to complete your psychiatric residency, which typically takes about another four years and covers concepts such as general psychiatry, diagnoses, medication management and working with different populations, which can include inmates.
Psychiatrists need to keep up with the latest trends in research when practicing clinically, and some even conduct their own original research studies. In a prison setting, data are interpreted in light of how "typical" criminals respond but data are also compared to a nonoffender population. Areas in which correctional psychiatrists study and conduct research include malingering in prison populations, dual diagnosis of substance abuse and mental health disorders and how to work with resistant patients.
Patients are typically treated by a prison psychiatrist for major mental illnesses that respond to medication, such as impulse control disorder or major depressive disorder. Secondary problems, however, are also common, and these frequently cannot be treated with medications. Examples include personality disorders, like antisocial personality disorder or psychopathic personality disorder. A prison psychiatrist faced with an offender with this kind of dual diagnosis has to be on her guard because a dual diagnosis inmate can behave in ways that sabotage his treatment, such as only pretending to take his medications or he may sell them.
There's no way around it -- working in a prison exposes a psychiatrist to dangerous, sometimes violent patients. While rare, when an episode of individual or group violence does break out, prison psychiatrists are especially vulnerable since they are locked up "behind the walls," just like the inmates. A prison psychiatrist always has to keep safety in the front of his mind, he can't, for example, give an inmate a pencil, a stick of chewing gum or even let him make a phone call, because all these devices may be used against the psychiatrist as a weapon or stored for later use.
As in non-prison environments, a prison psychiatrist teaches his patients about their mental health problems, outlining the risks and benefits of treatment in a way the patient can understand. The psychiatrist functions as the head of a multidisciplinary team and is frequently responsible for education other non-mental health oriented staff such as guards or medical hospital workers about working with offenders. While there are opportunities for professional accolades for those who publish their research efforts, most of the teaching that prison psychiatrists do is very low key and informal.
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