Hospitalization

Abstract A significant number of people with serious mental illness are found in correctional settings and must be provided with clinical care commensurate with their needs. Many of those needs may be met within the mental health care systems established in jails and prisons. When clinical conditions are more complex and require more intensive management, the availability of hospital-level care becomes important. The interplay between acute psychiatric care in jails and prisons on the one hand and forensic or community hospitals on the other varies by jurisdiction. While the decision to pursue hospitalization for an incarcerated person who is acutely ill is driven chiefly by clinical considerations, it is also influenced by security and safety concerns. These factors need to be considered on an individual basis, weighing the advantages and disadvantages of treatment in an outside hospital versus management in the prison or jail with available resources. Involuntary medication and involuntary hospital transfer implicate important legal rights, the protection of which requires due process established by federal and state laws and case precedents. Clinicians working in correctional and hospital settings where sentenced individuals and pretrial detainees are treated need to be aware of the relevant procedures required for these involuntary treatment modalities. In all jurisdictions, hospital-level care is necessary for a subset of sentenced persons and jail detainees and must therefore be made available when appropriate. This chapter discusses a variety of models linking psychiatric care across institutional boundaries.