Neuropsychological assessment in prisons: ethical and practical challenges

Cognitive deficits, substance abuse, and mental illness are common among prisoners. Thus, for many prisoners, neuropsychological evaluations may be indicated to assess the degree of impairment and how these impairments may affect their behavior in the prison environment. However, many neuropsychological tests were not designed for or normed on prisoners. This article highlights the unique ethical and practical challenges to providing neuropsychological services to incarcerated individuals. Specifically, it discusses (a) limits to confidentiality, (b) issues related to informed consent, (c) how prison conditions may compromise the validity of testing, and (d) the impact of third-party observation of the evaluation. Recommendations and suggestions for resolving some of these difficulties are offered.