Correctional psychopharmacology: pitfalls, challenges, and victories of prescribing in a correctional setting

Mentally ill patients are entering the criminal justice system at alarming rates, representing a significant percentage of those incarcerated. Correctional facilities are mandated to provide mental health treatment to inmates. The increasing number of inmate patients has made psychiatry an important part of institutional operations. Psychiatrists are called to provide psychopharmacological interventions to aid in the safe operation of institutions and provide effective treatment to those with mental illness. This article discusses the uniqueness of prescribing within correctional settings and delineates important aspects of correctional psychiatry. It includes information on navigating the rigid structure of correctional environments, providing effective interventions for behaviourally disruptive and manipulative inmates, prescribing within the limits of formulary restrictions, considerations for dispensing medication, preventing medication diversion, involuntarily medication practices, and treatment of aggressive inmates. The article concludes with case illustrations that depict the pitfalls, challenges, and victories of working with inmate patients.