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correctional psychiatry

I am finally finished my current assignment west of Baltimore, and the last day was textbook for what goes on in too many Community Mental Health Clinics these days.  Addicts, antisocials, and dissenters to standards of care, that sums up at least 60% of what comes in for alleged mental health care.  But, these antisocials who have perfected how to be irresponsible, impulsive, and immature and make it a psychiatric disorder, well, how many of these folks can a provider see day in and out before it gets annoying and disruptive to the clinic, I just don’t get it!

The last few weeks both in the news and my personal travels have reinforced what I really believe is inherent about antisocial disorder:  there are cultures, religions, and governments that have an entrenched, if not growing element of this sociological nightmare that is truly equally nature and nurture in cause.  I will not spell out specifics, but, I think the attentive and responsible readers know who and what I am talking about.  Here in the US, they claim the stats for real Antisocial Personality Disorder is about 2-4%, but, I think it is now over 5-6% easy, so, above random chance folks.  That means, in my opinion, there are at least 1 out of every 20 in a room who are antisocial, if not even worse, sociopathic.  And there ain’t a damn thing I can do as a psychiatrist to help these folks, not that 95% of them want any help to begin with!

So, getting to this top story in the August issue of Psychiatric Times, another APA hack newsletter at the end of the day by the way, here is the story:

http://www.psychiatrictimes.com/forensic-psychiatry/treatment-persons-mental-illness-prisons-and-jails-untimely-report

In there was a lot of interesting statements, this is one to intrigue and enlighten:

“The first recommendation, foreseen in the Joint Report’s introductory paragraph as well as in how the
data were obtained and presented, was: “Provide appropriate treatment for prison and jail inmates
with serious mental illness.” Even within the discussion of this recommendation, hospitalization is
not mentioned for the seriously and acutely mentally ill, who, were they not incarcerated, would
most certainly be hospitalized. Instead, legislation is proposed to allow involuntary medication, and a
“model law” patterned after the Washington v Harper2 decision is included in the appendix.

The Washington v Harper decision has been generalized to correctional settings, including jails.3
The policy that met constitutional approval in Washington v Harper was a policy specific for the Special
Offender Center, the purpose of which was “to diagnose and treat convicted felons with serious
mental disorders,”2(p214) also referred to as a hospital, not the rest of the Washington State Prison
System and not for non-medical correctional facilities. No mention of these distinctions was made in
the Joint Report. Although the Joint Report has no legal authority whatsoever, it will now most
certainly be relied on to support and expand the practice of involuntary medication in jail and prison
facilities, thereby further reducing the perceived need for and use of mental hospitalization.”

Also was this, “As the practice of involuntary medication in non-medical correctional facilities becomes more widely
institutionalized, any political or clinical motivation for restoring hospitalization will continue to fade.
Policymakers, correctional administrators, and correctional mental health providers will do what
comes naturally: they will justify their actions and, consequently, the newly devolving status quo in
correctional health care.”

My interpretation is this:  yeah, they don’t want these people in the hospital, because that costs the states money, and it is easier to just dump them back on the streets.  But, who is going to provide this “involuntary medication” treatment?  Yeah again, the CMHCs, and what are the antisocials gonna do when they get out and realize they are free to prey again, but, to not overtly violate parole and probation, who they gonna pick on first, dudes?  Providers, because we are now an extension, without being asked mind you, of the courts.  Sure, we will be respected and loved by many from these institutions of corrupted learning.  We feel your pain, folks!

I get it, there are real psychiatrically impaired people in prison for fairly much minor felonies, if not trumped up misdemeanors as the police want these people out of their jurisdiction, because cops are becoming equally antisocial and can’t figure out how to deal with impaired people, well, outside their own personality disordered ways (I’ll deal with the growing antisocial element in the police force in the coming weeks).  But, these sweeping generalizations by politicians and judges, is anyone else sick of this crap besides me?

I want to finish with this though, as probably one of the most offensive things that parallels the earlier post this week how a Muslim woman was offended to read the word “Bacon” on a street sign:

http://www.independent.co.uk/news/people/billy-crystal-leads-robin-williams-emmys-tribute-awards-show-criticised-for-choosing-racist-joke-about-iranian-woman-9690355.html

What is wrong with this religion, are Muslims/Islamists so shallow, vain, and without any ability to be a bit self depreciating for one moment of the day that there is absolutely nothing funny in their religion?  Williams right after the Iranian Woman bit then made a joke about Jews, which to me was equally hilarious, and are Jews demanding a retraction?

No, and you know why I honestly believe is one strong reason people across the world hate Jews?  Because we can laugh at ourselves, because we have the ability to be self depreciating when it is tactful, yet appropriate as well.  And that seems to be a tough trait for a lot of cultures, religions, and political bodies.  Gee, which seems to mirror my opening, and believe me when I say this, antisocials have a tough time honestly laughing at something that makes fun of them.  There’s a test that could trump a polygraph!  Oh, and by the way, I know Madoff is jewish, so don’t go there I am making a claim there are no antisocials in Judaism.  But, as far as Hamas goes, well…

Next post, believe it or not, is number 500.  Have no freakin’ clue what to write about.  Maybe during the weekend?…

Robin-Williams-iran-Getty  ENJOY!