Appropriate Treatment for Incarcerated People with Schizophrenia - Episode 12
Peter L. Salgo, MD: Is treatment within the correctional facility reliable, from the perspective of a clinician in an institution? Does it require an enormous change in the way this whole system works to administer it?
Nneka Jones Tapia, PsyD: In correctional institutions that have nursing care, it is certainly the choice treatment. It is more reliable for patients to get their injection than a daily pill. There are court hearings and programs that inmates can go to, but for the correctional system, it’s much less cumbersome to get the inmate to the nurses and psychiatrists every 1 to 3 months.
Peter L. Salgo, MD: Does every correctional facility have a health care professional, a nurse, or a physician—someone who can do this?
Nneka Jones Tapia, PsyD: Not daily, unfortunately; that’s where money comes in again.
Steven Leifman: In rural communities it’s very difficult.
Nneka Jones Tapia, PsyD: It’s difficult to find medical professionals who go there on a daily basis, especially when we’re talking about the need to monitor side effects. It can be impactful to have a long-acting injection without monitoring.
Steven Leifman: Telepsychiatry is important in this arena.
Mauricio Tohen, MD, DPH, MBA: Sometimes the availability of medical services is better in the correctional system than out in the community. In many cases we see that patients received long-lasting treatments while incarcerated. When they are discharged, their medical coverage for long-lasting antipsychotics diminishes.
Peter L. Salgo, MD: This again weighs in favor of long-lasting injections as opposed to the daily pill.
Richard S. Jackson, MD: We know when they’re treated effectively. People say, “Give it to them on their way out,” but that’s incorrect: We need to start while they’re in the facility; they function better and maintain the ability to follow the rules better. They’re additionally more likely to get parole or early release; it’s an obvious win-win for everybody.
Steven Leifman: But there’s another complication: When we do send people off to a competency-restoration facility, they’re usually using a new, long-lasting medication; however, when they return to the jail, there is a different formulary because it’s a federal system. The people decompensate, and we start all over again.
Peter L. Salgo, MD: Does the left hand ever know what the right hand is doing?
Steven Leifman: It is so frustrating.
Mauricio Tohen, MD, DPH, MBA: Remember: Seamless collaboration.
Steven Leifman: Right, it’s a mess.
Nneka Jones Tapia, PsyD: If you have one of those smaller facilities that do not have daily nursing care, it’s important to educate the correctional staff on what side effects look like.
Peter L. Salgo, MD: Good luck with that too, because of the staff turnover.
Nneka Jones Tapia, PsyD: It does, but it’s because, in the smaller rural areas, a correctional institution is usually the primary place of employment; it doesn’t turn over as much. What I found is that, when you engage the correctional staff, they’re well attuned to what those side effects look like. We also need to educate them on engagement.
Richard S. Jackson, MD: Unfortunately, the correctional officers are not often trained to deal with the mentally ill. You can tell how the day will go on depending who your officers are. Namely, those who are trained and able to deal with the mentally ill.
Transcript edited for clarity.