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Am J Psychiatry 1957;114:481-487.
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Director, psychiatric clinic, State Prison of Southern Michigan, Jackson, Mich.

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On the basis of this survey in 1954, only 43 psychiatrists were working full-time and 39 part-time in the 167 prisons and reformatories of the United States and possessions. In addition to this small group, there were 51 working in a consultant capacity. However, some of these rendered only token services to the prisons by making visits less frequently than once a month. Twenty-four states plus the Territory of Hawaii had no psychiatric facilities in their prisons, or else had no services except for occasional visits by psychiatric consultants.It is obvious that the psychiatric study of the criminal offender is still a largely neglected field. Despite the increasing recognition that many repetitive offenders are mentally ill and that criminal behavior stems from unconscious conflicts, very few criminals actually receive thorough psychiatric study or treatment. The level of care rendered to the mentally ill person in the prisons of many states is still at no higher a level than was common in the average asylum of 100 years ago. From the humanitarian standpoint alone, the level of care provided to the mentally ill in prison should be made to approximate that given in the average state hospital. There is no less a need for additional research in this field, inasmuch as the average state now has to allow as much in its budget for the care of criminal offenders as for the maintenance of its mental institutions.Settle(7) feels that the best way to better treatment for the abnormal offender is through the expansion of psychiatric services in the correctional system rather than through changing concepts of criminal responsibiilty. This is the most that can be hoped for at present, since it will certainly be some time before there is any widespread change in the concept of criminal responsibility which would permit a sizeable proportion of such offenders to be screened out in the courts and sent to hospitals for psychiatric treatment( 7, 8).

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