I am pleased to be joined on JailMedicine by my colleague Dr. Sharen Barboza! Dr. Barboza has been providing correctional mental health care for more than 20 years. Her complete bio can be found in the About The Authors tab (here). Besides her broad experience, intelligence and common sense, Dr. Barboza is simply the best speaker I have heard at any correctional medicine conference. I am honored to have her as my co-editor at JailMedicine! Jeffrey Keller

I am truly honored, grateful and humbled to join Dr. Keller on JailMedicine.com.  I think that now, more than any other time in the past, we are all realizing the impact that our mental health has on our ability to function in the world.  For so many of us, we take the “health” part of our “mental health” for granted.  We trust our thoughts to be based in reality; we rely on our emotions to adequately and appropriately meet the moment; and we have confidence in our ability to cope with what comes our way.  Most days. 

These last few months have challenged our thinking, our emotions and our coping skills.  In big and small ways, many of us have noticed “cracks” in our mental health.  Fears and anxieties have emerged.  We find ourselves ruminating and worrying.  Thoughts creep in that we did not invite and cannot seem to shake.  Feelings overtake us.  We are washing and wiping down, checking and double-checking.  We are not so sure that we can handle what’s happening for very much longer. 

For a number of our incarcerated patients, experiences like this are not new.  Not trusting their own thoughts and having unwanted thoughts are, and have been, a part of their lives for a very long time.  Being overtaken by emotions that cannot be controlled is familiar, not new.  Feeling overwhelmed by life experiences and not trusting in their ability to manage what comes at them happens more than they like. 

Research tells us that approximately 20 percent of inmates in jails and 15 percent of inmates in state prisons have a serious mental illness. Based on the total number of inmates across the country, approximately 356,000 inmates with serious mental illness are incarcerated in jails and state prisons. This is 10 times more than the approximately 35,000 individuals with serious mental illness remaining in state hospitals. (Torrey EF, Zdanowicz MT, Kennard AD et al. The treatment of persons with mental illness in prisons and jails: A state survey. Arlington, VA, Treatment Advocacy Center, April 8, 2014.)

Looking at mental health problems, rather than serious mental illness, the Bureau of Justice Statistics (2006) found that jail inmates had the highest rate of symptoms of a mental health disorder (60%), followed by State (49%), and Federal prisoners (40%).

According to the National Alliance for the Mental Ill (NAMI), in a mental health crisis, people are more likely to encounter police than get medical help. As a result, 2 million people with mental illness are booked into jails each year. Nearly 15% of men and 30% of women booked into jails have a serious mental health condition.

When we feel overwhelmed and unable to cope, we reflect these feelings in our behavior.  Most of us lack the ability to find the words or communicate our needs adequately when we are in crisis.  This is true of our patients as well.  Mental illness and mental health crises can result in people acting in impulsive, “bizarre,” and sometimes dangerous ways to express their fears and needs.  For many of us, assisting individuals experiencing a mental health crisis or even serious mental health symptoms is new territory.  We are not sure what to do or how to help.

As part of Jail Medicine, I hope to share useful insights and best practices to assist in supporting our patients with mental health needs.  I am interested in hearing your thoughts and your questions related to working with individuals who experience mental health problems.  Until then, be well and stay safe.