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Book Forum: Forensic Issues   |    
Treatment of Offenders With Mental Disorders
C. ROBERT SHOWALTER, M.D.
Am J Psychiatry 2000;157:850-850. doi:10.1176/appi.ajp.157.5.850
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Edited by Robert M. Wettstein. New York, Guilford Publications, 1998, 438 pp., $45.00.

This volume is a welcome addition to the forensic mental health literature. As the title suggests, it focuses on mental health treatments for the mentally ill offender in contrast to the more frequently appearing forensic works addressing the issues involved in the various types of preadjudication or presentencing mental health assessments provided by forensic specialists. The number of convicted offenders in the United States increases each year. The publication of a book devoted to treatment issues involving the mentally disordered offender population is timely inasmuch as the correctional population increased more than two and one-half times from 1980 to 1993. Eight percent to 19% of prisoners have substantial psychiatric or functional disabilities, and another 15% to 20% will require some form of psychiatric intervention during their period of incarceration (1).

This collection of essays is well arranged, beginning with a discussion of the administrative aspects of treatment programs for offenders with mental disorders, a discussion both thoughtful and practical, which carefully counterbalances the dual mandates to provide treatment to the mentally disordered offender while ensuring adequate custodial safeguards to protect the public. This is followed by a succinct summary of the legal aspects of treating mentally disordered offenders, beginning with a survey of the evolution of the law relevant to the treatment of mentally disordered offenders in the time before the civil rights movement and extending through the civil rights movement to the 1980s and 1990s, a period during which fundamental decisions affecting the rights of offenders substantially revised some of the legal mandates of the civil rights era. The survey concludes with a review of the current state of evolving mental health law, which is seen as incorporating subtle but important changes that will have an impact on the mental health treatment of mentally disordered offenders. Three chapters follow that discuss the specific and sometimes unique problems associated with the delivery of mental health services for the mentally disordered offender in the three primary venues where treatment is most likely to be provided: community-based programs, inpatient facilities, and jails and prisons. The volume is completed with discussions of specialized treatment issues and protocols that apply specifically to three groups of emotionally vulnerable offenders who may require mental health interventions and treatment: sexual offenders, mentally retarded offenders, and juvenile offenders.

Although there is no general editorial comment outlining the overall design or any intended unifying themes for each chapter in this volume, several general (and useful) patterns are generally noted as components of each chapter. First, each chapter recognizes, in ways appropriate to the subject matter discussed, the challenges of the unique contexts and constraints within which mental health services are provided to offenders. Also addressed are the unavoidable tensions that are inherent in the dual mandate to provide mental health services to mentally disordered offenders (some of whom are treatment resistant) and at the same time ensure the security and protection that the public demands. Second, each clinically oriented chapter contains a cogent summary of the available research and clinical data pertinent to the subject. Third, the chapters are written in a straightforward and practical manner that facilitates application of the research and clinical data presented to the development and maintenance of good clinical practice and sound professional judgment standards for the treatment of the mentally disordered offender. Fourth, recognizing that the demand for clinical mental health services to the offender population is increasing and that patterns of service delivery generally are in a state of transition and ongoing change—a phenomenon likely to persist for some time to come—most of the clinically oriented discussions include both conceptual and specific clinically applicable materials that administrators and clinicians alike will find useful in ongoing program development. Fifth, the more treatment-oriented chapters all stress the need for more research in the area of linking together treatment methods and treatment outcomes to increase both the credibility and the efficacy of the mental health services provided.

This book (both the text and extensive reference lists at the end of each chapter) can certainly be useful to mental health professionals who provide services to offenders and forensic administrators working in programs in which offenders may require mental health services. It can also be an informative addition to materials developed for use in a wide range of forensic teaching and training programs.

Metzner JL: Guidelines for psychiatric services in prisons. Criminal Behavior and Mental Health 1993: 3:252–267
 
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References

Metzner JL: Guidelines for psychiatric services in prisons. Criminal Behavior and Mental Health 1993: 3:252–267
 
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