Perhaps more than any other group, mentally disordered offenders are the major clinical responsibility of forensic mental health professionals. What happens in correctional settings affects the meaning of what occurs in criminal courts. Especially if correctional mental health services are considered to be overlapping with forensic mental health services, then the treatment, rehabilitative and humanitarian efforts that take place behind bars should be of great concern to anyone who takes the witness stand as an expert on mental health issues. For that matter correctional mental health care should be of concern to any lawyer, judge, parole officer, or probation officer who has some discretionary authority in determining who should be jailed or imprisoned.
Today jails and prisons are a growing industry. As Veysey et al. point out in the ten years from 1986 to 1996 the total population in U.S. jails has more than doubled, and about 9.8 million persons are booked into U.S. jails every year. Prison populations too have been climbing at unprecedented rates. Many who end up in jail or prison have serious mental illness. Many others have significant emotional distress or an alcohol or drug abuse disorder.
The dynamics of change have brought substantial improvement to the care of mentally ill jail inmates and prisoners. We must credit the legal system, through lawsuits and progressive legislation, with improving the standard of care in many correctional settings. Now cost containment measures may further render services more efficient and better tailored to patient/inmate needs, but there must be checks against cutting corners that would turn the calendar back on the progress that has been made. Today quality programs exist behind bars that would not be available to indigent persons in the ``free world'', but we also see flagrant examples wherein the standard of care is far below what exists in the extramural community.
Of primary importance is bringing health services into jails and prisons. Many jails still lack these services. One would hope that mental health providers in the jail would liais with agencies in the community to ensure the mentally disordered offender transitions smoothly into uninterrupted treatment upon release. The study by Veysey et al., describes seven different programs and follow-up outcomes after jail release. The results are rather surprising! Litigation, the bane of professionals who provide correctional health care, is arguably the most powerful force available to improve the quality and breadth of mental health servicesΓan otherwise socially and politically unpopular endeavorΓ for those society would prefer to overlook. Unfortunately, effective learning from potent experiences in litigation is restricted by the natural reluctance to discuss recent, painful legal cases. Yet, no one doubts, mistakes unheeded lead to greater errors and disasters.