Training psychiatry residents at correctional facilities.

Abstract

To the Editor: We read the recently published article “General Psychiatric Residents and Corrections: Moving Forensic Education Beyond the Classroom” [1] with great interest. As the author elegantly puts it, there is an epidemic of psychiatric disorders in correctional facilities. These facilities have now become the largest mental health providers in several counties and states in the USA. Given that the prevalence of mental illness is five times greater than general population [1], the shortage of psychiatrists in correctional settings has reached crisis proportions [2]. In our review of the National Health Provider Scarcity Area (HPSA) database in 2011, we identified 457 correctional facilities in the USA that had over 250 inmates and an inmates-per-year-to-full-time-psychiatrist ratio greater than 2,000:1 [3]. Most psychiatry residency programs are located 3–4 miles from the nearest correctional facility [3] and are uniquely situated to serve this vulnerable population. In 2009, the Department of Psychiatry at the University of Texas SouthwesternMedical Center started collaborating with the Dallas County to train residents at the Lew Sterrett Justice Center. During this month-long mandatory rotation, residents work as members of interdisciplinary teams that provide psychiatric care to approximately 7,000 inmates [3]. Our residents deliver this care on different levels ranging from psychiatric evaluation to inpatient-level care to intensive crisis management (continuous behavioral observation) to outpatient-level medication management and consultation with other medical services. In addition to gaining valuable clinicaland systemsbased-learning experiences, residents also have opportunities to observe forensic evaluations and court hearings. In our limited experience, exposure to the correctional setting has led to an increase in the number of residents opting to work with patients in the criminal justice system. In the last 5 years, one chief resident has started working at the Lew Sterrett Justice Center and four residents have joined the maximum security forensic state hospital of Texas. We disagree with the author that most psychiatry residency programs do not provide clinical training in correctional facilities. In 2010, we conducted an online survey (https://www. surveymonkey.com/s/NYFXJPZ) of 201 institutions through the American Association of Psychiatric Residency Training email listserv. Of the 95 respondents among 492 individuals surveyed, 30 % reported having a mandatory rotation and 25 % reported having an elective rotation at a correctional facility [4]. Training directors were mostly positive in their opinion about rotation at correctional settings, and a majority felt that more residents will choose to work at correctional facilities if they rotate there. Free text responses from training directors provided further details about the barriers to training residents in correctional facilities. Some commonly reported barriers were safety/security concerns, lack of funding, poor learning environment at correctional facilities, lack of room in the schedule, distance from the training program, lack of availability of residents, and lack of interest [4]. The use of listserv as compared to direct email to training directors [5] likely resulted in a low response rate. We welcome this growing awareness of inadequate mental health services for patients in the criminal justice system and fully agree with the author that more training programs should train their residents in correctional settings. The collaboration between academic institutions and correctional facilities will increase the opportunities for scholarly work and lead to the development of innovative strategies to address this urgent public health concern. M. K. Jha (*) : C. S. North :A. M. Brenner (*) University of Texas Southwestern Medical Center, Dallas, TX, USA e-mail: manishjha2201@yahoo.com e-mail: adam.brenner@utsouthwestern.edu