Correctional systems in the United States house inmate populations with high rates of mental health conditions. The high need for mental health services is coupled with a shortage of correctional psychiatrists, which limits access to services. This gap is set against the backdrop of the Eighth Amendment of the US Constitution, which requires providing healthcare services for inmates. In addition, healthcare provision in correctional systems is shaped by complex legal and regulatory frameworks, as well as risk mitigation measures, that influence the development of healthcare initiatives, guidelines and best practices. Therefore, such systems have responded in different manners to enhance access to care and to ensure the quality of the care being provided, at a clinical level and system’s level. This session discusses interventions that some correctional systems have employed to expand access to mental health care, improve the quality of care provided and enhance patient safety. We start with a discussion on the misuse, abuse, and diversion of psychotropic medications that can occur in correctional systems, as well as interventions aimed at mitigating such risks, including policy and administrative interventions, as well as prescriber and correctional officer interventions. Next, we discuss the incorporation of telepsychiatry into correctional systems, as a means to enhance access to care, and we discuss the advantages and challenges associated with providing high quality care remotely in these settings. We discuss certain limitations associated with telepsychiatry, including bureaucracy, misperceptions, lack of electronic health records, limited broadband connectivity and infrastructure. We will also argue that providing robust and widely available behavioral programs, in addition to quality telepsychiatry services, is essential for optimization of care. To that end, we argue that tele-medicine can offer increased access to standardized behavioral interventions, ranging from individual and group psychotherapy to app-based programs. After every presentation, the audience will be invited to ask questions and share their own experience with challenges, concerns and successes within correctional health programs.

**This content was captured for the 2020 APA OnDemand product and may reference information from various sources and terminology from previous editions of the DSM.

Course References

• AAPL Practice Resource for Prescribing in Corrections, Journal of the American Academy of Psychiatry and the Law Online June 2018, 46 (2 Supplement) S2-S50

• Scott, Charles. (2010) Handbook of Correctional Mental Health, Second Edition. Washington DC: American Psychiatric Publishing, Inc. Deslich S et al, Telepsychiatry in Correctional Facilities: Using Technology to Improve Access and Decrease Costs of Mental Health Care in Underserved Populations. The Permanente Journal, 2013; 17

• (Summer;):3 Chakrabarti, S. (2015). Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World journal of psychiatry, 5(3), 286-304.

• H. Mahmoud et al, “Overcoming Barriers to Larger-Scale Adoption of Telepsychiatry.” Psychiatric Annals, 2019;49(2):82-88 https://doi.org/10.3928/00485713-20181228-02

Learning Objectives

• Discuss the status of mental health care access in correctional systems.
• Appreciate the initiatives undertaken by correctional systems to improve access and quality of mental health care.
• Recognize the benefits and challenges associated with implementing telepsychiatry in correctional systems.
• Discuss the potential for telehealth to provide standardized behavioral interventions in combination with telepsychiatry services.

Target Audience

Psychiatrists, Residents/Fellows

Estimated Time to Complete

Estimated Duration: 60 minutes
Begin Date: June 1, 2021
End Date: June 1, 2024

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The APA designates this enduring CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Program Presenters

• Hossam Mahmoud, M.D.; M.P.H. Reports no financial relationships with commercial interests
• Abdi Tinwalla, M.D. Reports no financial relationships with commercial interests
• Irene Epshteyn, M.D. Reports no financial relationships with commercial interests

Program Planners

• Tristan Gorrindo, M.D., Director of Education, American Psychiatric Association. Reports no financial relationships with commercial interests.
• Katie Putnam, Membership Development Specialist, American Psychiatric Association. Reports no financial relationships with commercial interests.
• Ally Brown, Associate Director, Online Learning, American Psychiatric Association. Reports no financial relationships with commercial interests.

Accessibility for Participants with Disabilities

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Technical Requirements

This internet-based CME activity is best experienced using any of the following:

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
• Internet Explorer 11+

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
• Internet Connection: 1 Mbps or higher

Minimum Requirements:

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance