Psychiatric treatment for offenders.

Forensic psychiatry, correctional psychiatry and psychiatric criminology are the major medical disciplines which address the problems of criminal behavior. Interest in these disciplines has fluctuated from decade to decade and reflects advances in medical knowledge and the realities of practice patterns and changes in professional attitudes.! At present, forensic psychiatry has achieved a certain refinement and discipline and claims subspecialty status. Correctional psychiatry, a direct derivative of the healing medical function of medicine and once a prestigious branch of American psychiatry, is not popular. The field is confused about goals and associated with low professional status and poor working conditions. The large numbers of seriously mentally ill inmates in correctional facilities,2 civil litigation over inadequate correctional medical care,3 and an increasing medical orientation for psychiatry as a whole, are factors which may move correctional psychiatry back into the mainstream of medicine. Correctional psychiatry consists of at least two related activities which can be distinguished on the basis of their goals: criminal rehabilitation and psychiatric treatment. Criminal rehabilitation has as its goals the reduction of criminal behavior and is an instrument of the corrections process. The field is dominated by the techniques and principles of mental hygiene and is not a uniquely medical enterprise. Psychiatric treatment, in contrast, has as its goals the diagnosis and treatment of psychiatric illness and is dominated by the treatment philosophy of medicine. Patients with acute and chronic psychiatric illness receive care following standard medical practice. The medical profession is uniquely responsible for the medical care of the psychiatrically ill offender. The lack of adequate psychiatric treatment for the seriously mentally ill inmate is amply documented.4 Guidelines and practical information on the design and operation of psychiatric treatment programs in jails and prisons are not readily available or are incomplete.s This paper will outline the elements of a comprehensive psychiatric treatment program for inmates in jails and prisons.