A Focus On: Correctional Psychiatry



Image: Courtesy of Robert Trestman

In the 1840s, Dorothea Dix played an instrumental role in the founding or expansion of more than 30 hospitals for the treatment of the mentally ill. She began the asylum movement that shifted those with serious mental illness (SMI) out of jails and prisons to asylums. At its height in 1955, there were 340 public psychiatric beds available per 100,000 U.S. citizens. Today, most of those beds are gone.  

At the end of 2014, it is estimated that over 350,000 people with SMI were incarcerated in US jails or prison. While the problem is greatest in the US, it is by no means exclusive, people with SMI are disproportionately detained and incarcerated in jails and prisons around the world. The move from psychiatric hospital, to the community, to jail, or prison now has a professionally recognized term: transinstitutionalization.

Correctional psychiatry has evolved with great speed over the past two decades, but substantial challenges and opportunities still abound. How can we best help individuals to recover and lead successful lives? How should we respect confidentiality and provide meaningful informed consent in secure correctional settings? How do we empower people to change and grow, while requiring them to follow rigid rules? 

Correctional systems have become the de facto mental health systems of care. Complex, comorbid disorders are now commonplace presentations. Typically 12 to 16 percent of the incarcerated population has a serious mental illness. 75 to 80 percent have comorbid substance use disorders. Psychotic disorders, personality disorders, posttraumatic stress disorders, traumatic brain injury, and intellectual disability are highly prevalent. Psychopharmacological treatment represents a substantial proportion of correctional healthcare costs. An entire continuum of care exists in jails and prisons, each level presenting unique demands of collaboration with other disciplines, including custody. 

Effective treatment makes a difference: treatment of illness, recovery-focused care, and appropriate planning for community reintegration can help our patients succeed in the community upon release. 



Robert L. Trestman is a Professor of Medicine, Psychiatry and Nursing at UCONN, and heads UCONN Health Correctional Managed Health Care. He received his PhD in Psychology and MD from the University of Tennessee, and trained in psychiatry and neurobiology at the Mt. Sinai School of Medicine. Dr. Trestman has studied the neurobiology and treatment of people with severe mood and personality disorders, and conducts transnational research on correctional health.



Further reading:


  1. Lamb R.H. and Weinberger L.E. (2014). Decarceration of U.S. Jails and Prisons: Where Will Persons With Serious Mental Illness Go? J Am Acad Psychiatry Law 42:4:489-494.
  2. Trestman, R.L., Appelbaum, K., and Metzner, J. (eds). Forthcoming. Oxford Textbook of Correctional Psychiatry. New York: Oxford University Press.
  3. Bartlett, A., and McGauley, G. (eds). 2009. Forensic Mental Health: Concepts, systems, and practice. Oxford: Oxford University Press.
  4. Wassermann, D., and Wassermann, C. (eds). 2009. Oxford Textbook of Suicidology and Suicide Prevention. Oxford: Oxford University Press.
  5. Treatment Advocacy Center Report on Severe Shortage of Hospital Beds. Accessed 23 January 2015.
  6. Kohen, D. (ed). 2010. Oxford Textbook of Women and Mental Health. Oxford: Oxford University Press.

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