For the past decade, the first edition of this unique book has lighted the way for those seeking to navigate the perilous shoals of providing mental health services in jails and prisons. These guidelines have been used and cited extensively in many contexts: educational, planning, and legal. They also have been used by surveyors and monitors of correctional facilities. Since the publication of the first edition, American jails and prisons have seen many changes, including considerable litigation, the development of consumer groups, and the creation of some exemplary programs. However, there has also been a dramatic increase in the population of U.S. jails and prisons. In September 1989, when the first edition of these guidelines was published, our nation's jails and prisons held an estimated 1.2 million men and women. This number is now 1.8 million. Many studies have consistently demonstrated that about 20% of these inmates have serious mental illnesses, and as many as 5% are actively psychotic. With upward of 700,000 men and women entering the U.S criminal justice system each year with active symptoms of serious mental disorders, with 75% of these people having co-occurring substance abuse disorders, and with these persons likely to stay incarcerated four or five times longer than similarly charged people without mental disorders, what are our duties and responsibilities? How do we live up to our personal moral principles, our professional ethics, and our public service obligations in the face of these overwhelming numbers? This is the question to which this book is addressed. This book is intended both to prod to action and to provide comprehensive guidance on how to fulfill these responsibilities to ourselves, our profession, and these badly underserved patients. We have the technologies for treatment and the knowledge and the skills, yet limited resources and public and professional resistance often impede appropriate response. We believe that these guidelines can help overcome many of these sources of resistance through informed action. More active involvement of our profession, as described in these guidelines, is needed, is possible, and will make a difference.

The 15 years since publication of the second edition of the American Psychiatric Association’s task force report on psychiatric services in correctional facilities have seen increasing rates of incarceration of mentally ill individuals, continuing criminalization of substance use disorders, and a lack of accessible and appropriate care in the community. The purpose of the new edition, Psychiatric Services in Correctional Facilities, and the aim of the work group that authored it over many years of research, dialogue, and development, is to provide leadership in addressing the needs of the often disenfranchised population of the incarcerated and to provide guidance to mental health clinicians working in correctional settings. Urging an expanded role in leadership and advocacy, the work group members present the foundational principles that apply to providing care in correctional facilities, outline the basic types of services that should be provided, and apply the principles and guidelines previously established to specific disorders, patient populations, treatment modalities, and special needs. Working with these patients and in these settings presents particular challenges that clinicians are unlikely to have encountered elsewhere in practice, such as the use of seclusion and restraint and administrative issues. Psychiatric Services in Correctional Facilities provides critical guidance and support for mental health professionals operating in this often frustrating environment, enabling them to provide both effective treatment and informed advocacy for their patients.