Crisis calls are a common occurrence in correctional settings. Psychiatrists are often called upon to triage and manage such events. Requests for urgent psychiatric evaluations can come from many sources, including security staff, non-psychiatric physicians, mental health staff, courts, attorneys, and family members. Psychiatrists responding to these requests for evaluation may feel tremendous pressure to reach a conclusion that is consistent with the opinions of the requesting party. However, maintaining an independent and therapeutic stance when conducting crisis evaluations is crucial. Some aspects of psychiatric evaluations in crisis situations are unique to the correctional environment: evaluations at cell-side, video recording, and leadership by security staff rather than medical professionals. Nonetheless, correctional psychiatrists should be guided by the same principles of medical ethics that apply to patient care in the community, placing the patient’s well-being above all other concerns. They should strive, when possible, to conduct a thorough assessment in a confidential setting. In considering how best to resolve the crisis and care for the patient, they should err on the side of caution and recommend placement in a safe and therapeutic setting, at least until a multidisciplinary team can consider other options. Finally, they should document the encounter carefully, articulating the rationale for the chosen course of action. This chapter reviews the pragmatics of evaluating and managing many common correctional events that lead to mental health crisis calls and discusses the range of concerns, the typical practices and procedures used in correctional settings, and the types of interventions that are best used.
Coping, mental health, and subjective well-being among mental health staff working in secure forensic psychiatric settings: Results from a workplace health assessment.