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Diagnostic review and revision 

Diagnostic review and revision
Chapter:
Diagnostic review and revision
Author(s):

Sohrab Zahedi

DOI:
10.1093/med/9780199360574.003.0020
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date: 17 January 2020

The criminalization of people with mental illness is a sad commentary on the United States’ mental health system. Yet, the phenomenon presents the field of psychiatry with an opportunity that is now scarce in civil society: lengths of sentence in terms of weeks to years that allow for in-depth observation and treatment of the inmate with mental illness. A few days in a hospital fails to provide the needed opportunity for a detailed and accurate evaluation. Today, people with mental illness account for more than one million annual arrests and many among these individuals will spend weeks to months in jail before being either transferred to a prison for sentences beyond one year or released back into the community. At its core, psychiatric diagnosis relies on the subjective complaints of the patient and objective signs noted on examination. Considering the chronic and fluctuating course of most psychiatric diagnoses, a thorough assessment also requires a review of past documented behaviors. When someone is hospitalized for a psychiatric condition, the first goal is often observation, followed by diagnosis, and then treatment. Psychiatric hospitals are being greatly constrained in the amount of time available for observation and accurate diagnosis; the correctional setting, as an unintended consequence of mass incarceration, provides an extended opportunity to achieve improved diagnostic accuracy. This chapter reflects on the diagnostic opportunities that a jail or a prison setting affords.

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