Forensic and legal issues

Abstract This chapter focuses on common forensic issues that a psychiatrist working in a correctional setting may have to address. In many states, there are inadequate inpatient resources to meet the rising demand for the management of criminal defendants found to be incompetent to stand trial, with some states expanding community or institutionally based competency restoration programs. Correctional psychiatrists may face allegations and investigations in addition to the more usual cases alleging professional negligence or malpractice found in other settings. They are exposed to risk, not only from medical malpractice, but also through civil rights actions under the standard of deliberate indifference. Suicide is the most common cause of action against a psychiatrist practicing in a jail or prison. Correctional psychiatrists may also be named in class action suits. Psychiatrists working in these settings should be cautious about limitations of confidentiality, formulary restrictions, avoiding dual agency, and providing adequate care. The forensic and legal context of jails and prisons, including class action litigation, external review and investigations, and other formative law (such as the Civil Rights of Institutionalized Persons Act and the Prison Rape Elimination Act), shapes the work correctional psychiatrists do and is important to understand.