According to the fitness tracker I wear on my wrist, I slept for 7 hours and 13 minutes last night. I was restless eight times and woke up twice. What does that tell me? No idea. The Centers for Disease Control tell us that adults need seven or more hours of sleep each night. But what if I feel refreshed after five hours? Am I unhealthy? What if I slept 10 hours, am I super healthy?
At the risk of oversimplifying, many incarcerated patients come to us with some manifestation of the following (or a combination of these):
It is important to work with the patient to understand which of these issues is experienced by the patient as most distressing and in need of change. I think back to a patient I once saw who was diagnosed with schizophrenia. She had significant trouble with tangential and disorganized thinking but what she wanted more than anything was having cigarettes at the end of the month. (This was back when inmates could still smoke in the prison.) She often smoked all her cigarettes prior to the end of the month and then had to borrow cigarettes “2-for-1” for the remainder of the month, putting her at a deficit at the start of the next month…you see the cycle. She did not have any interest in meeting with me to improve her thinking. She wanted her cigarettes.
This morning, inmate Gibbs had a visit. The nurse passing medications in the housing unit noticed that he was not ready when his name was called. Unusual. Mr. Gibbs is typically aware of his visits and is up and ready at least five minutes before it’s time to go. The nurse asked Mr. Gibbs if he was feeling ok. Mr. Gibbs just shrugged and left the unit for his visit. Later that day, the nurse noticed that Mr. Gibbs was not out in the day room playing cards with others, like he usually is. The nurse walked by Mr. Gibbs’ cell and noticed he was just lying on his bunk looking at the ceiling. The nurse asked again if everything was ok and Mr. Gibbs stated, “Just not my day. Things aren’t working out for me. That’s the problem with hope, you always get disappointed.” “Anything I can do?” the nurse asked. “No, man. Thanks. Just gotta do what I gotta do.”
Every individual who works in a correctional setting has unique experiences with inmates. Based on your role, your personality, your style of interaction and how others perceive you, you are likely to see and hear things that others do not see and hear. In the above example, the nurse has a unique perspective on what’s happening with Mr. Gibbs.
Do not underestimate the value and importance of what you see and hear.
When you notice things are out of the ordinary, ask questions. If the answers leave you feeling unsure, make a referral.
It was a holiday weekend in the middle of the night. The booking area of the jail was a big, open, noisy pit with people sitting in plastic chairs, watching TV or on phones and the officers either behind desks or circling the perimeter. It was filling up. A staff member was completing initial mental health screenings in a corner of the open room, up on a platform and behind a computer. She had the electronic health record open to the mental health screening form and she was going through each “yes/no” question, reading from the computer screen and not looking at the recently arrested individual, a young man picked up on a possession charge.
“Are you currently taking any medications for mental health problems?” “No.”
“Have you ever been hospitalized for mental health reasons?” “No.”
“Are you currently thinking about hurting or killing yourself?” Pause. Swallow. “No.”
“Have you ever been treated for withdrawal from drugs or alcohol?” “No.”
She missed it. She missed the pause; she missed the swallow.
Matt, Correctional Pharmacist. Everyone Needs One!
In my last post on this subject (found here), I mentioned three medications that I think should rarely, if ever, be allowed in correctional institutions. I would like to expand this list today.
In my personal protocol on this subject, I break problem medications into four categories, depending on three criteria:
1. The risk of abuse the medication has in a correctional setting.
2. How much potential benefit the medication has.
3. Whether there is ready availability of other, less problematic, substitute medications. Continue reading