Dr Jeffrey Metzner's brief article, "Evolving Issues in Correctional Psychiatry" (Psychiatric Times, September 2007) related many of the difficulties and complexities of the corrections world; however, it did not mention the greatest problem of all—"deinstitutionalization," which, over the past half century, has resulted in the wholesale diversion of patients with chronic mental illnesses—many of whom cannot be managed as outpatients—from hospitals to jails and prisons.
There seems to be relatively little concern about the matter in the field of psychiatry. Rather, we are involved in implementing the trend touched on by Dr Metzner: "In general, treatment of inmates with serious mental illness should be similar to that available to persons who are not incarcerated." I believe that such an expectation is unrealistic for most jails and prisons, and I believe that corrections facilities are systematically exploited. For example, to achieve "bed reduction," commitment of psychotic and dangerous chronic "consumers" is eschewed and criminal charges are placed by psychiatric facilities. Further, nothing could be more common than the arrest of a patient who has a chronic mental illness within a week of his or her release from a psychiatric hospital.