Interviewing

Abstract The psychiatric interview is the foundation for effective diagnosis and treatment in any setting. Conducting a psychiatric interview in a jail or prison requires an appreciation of contextual factors including the referral source, the reason for consultation, active stressors affecting the patient, the timing of the interview in relation to these stressors, the setting of the interview, privacy and safety concerns, language and cultural considerations, current and historical symptoms and their relationship with substance use, and the alignment of goals between the interviewer and interviewee, among others. The base rate of mental health disorders in carceral settings, including serious mental illness, substance use disorders, and personality disorders, is high, and comorbidity is the rule. The interview should be thorough, including a history of present illness, past psychiatric history, family history, and psychosocial history, as well as relevant medical and legal histories. Collateral information is particularly helpful in difficult cases. While deception and malingering are important and necessary considerations, effective interviewing may require the management of countertransference. A high-quality psychiatric interview is essential to promoting effective treatment for patients, which will, in turn, promote better outcomes, improve safety, and increase respect for psychiatric services by custody staff.