The author evaluated psychiatric care in three U.S. prison systems.
Major problems included limitations imposed by prison architecture,
inadequate staff, medication prescription and distribution by unlicensed,
untrained personnel, and a punitive rather than therapeutic attitude.
Following the standards of care recommended by American Correctional
Association would correct most of these problems. Psychiatrists should
guard against prescribing unnecessary medications, particularly minor
tranquilizers and sedatives, and should be concerned with prison conditions
conductive to mental illness, particularly overcrowding, abuses of solitary
confinement, and inadequate programs for inmates who are mentally disturbed
but not overtly psychotic. The author recommends minimum staffing standards
and suggests considering the transfer of mentally ill inmates to
appropriate psychiatric hospitals outside the prison system.