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DMS psychiatry joins forces with state prison system

"There are more psychiatric patients in prisons in our country than there are in mental hospitals," says Peter Silberfarb, M.D., chair of psychiatry at DMS. "It's a national disgrace."

Dartmouth Medical School has stepped in to help with this growing national problem, and under a contract with the state will provide psychiatric services to inmates in the New Hampshire prison system.

"Our prisons have become the mental hospitals of the '90s," Silberfarb continues. "Up to 25% of inmates have a significant psychiatric disorder and have spent overnight in a mental hospital at some point in their lives. The amazing thing was that almost 40% of white women prisoners 24 and under have been identified as having mental illness."

Prevalence: According to the National Alliance for the Mentally Ill, there are four times more mentally ill people in prisons than in mental hospitals. Individuals may enter the criminal justice system with severe psychiatric disorders or may develop psychiatric symptoms while incarcerated. The prevalence of schizophrenia and major affective disorders is estimated to be two to three times higher among inmates than in the general population. And prison life can intensify mental illnesses, since corrections officers are often unable to distinguish between mental problems and simple unruliness. Mentally ill inmates serve, on average, about 15 months longer than other inmates, often because they are disciplined for behavior such as fights.

The agreement between the Medical School and the prison system is an amendment to DMS's longtime contract to provide psychiatric services at the New Hampshire Hospital, the state's psychiatric facility.

"This is incredibly exciting," says Linda Flynn, A.R.N.P., M.S., the administrative director of medical and psychiatric services for the New Hampshire Department of Corrections. Flynn, coincidentally, was at the New Hampshire Hospital in the late 1980s when its contract with DMS was initially signed. At the time, such a partnership—under which a nonstate entity took responsibility for the medical care for residents of a state-run mental health facility—was the first of its kind in the nation.

Flynn has been pleased with that collaboration and looks forward to the new relationship with the Department of Corrections. DMS brings with it a whole system of information, she says, an awareness of current trends, and knowledge that has been researched and validated.

First: DMS is, as far as Silberfarb knows, the first nonpublic medical school to provide psychiatric services to a prison system. He does know of a few public schools engaged in such efforts, including the University of Connecticut and the University of Massachusetts at Worcester. DMS will be providing psychiatric services to the Secure Psychiatric Unit—a 60-bed, freestanding facility in Concord—as well as to the men's prison in Concord, the women's prison in Goffstown, the Northern New Hampshire Correctional Facility in Berlin, and the Lakes Region Facility in Laconia.

The Medical School will hire four psychiatrists, including a medical director to oversee the design and implementation of the program and to supervise DMS residents and medical students. The medical director will report to Flynn on administrative matters and on medical matters to Silberfarb, through the state hospital's medical director —Robert Vidaver, M.D., vice chair of psychiatry at DMS.

"I see this as a tremendous opportunity for training medical students and residents," says Silberfarb. In addition to its longstanding psychiatry residency program, the department just this year started a forensic psychiatry fellowship program.

Aging: The collaboration also offers a chance to determine the kinds of services that the aging prison population needs. America's prison population is growing as well as getting older—due, in part, to increases in mandatory sentencing, in the age of firsttime offenders, and in the age of the general population.

"What I hope to do is make this a national model," Silberfarb says. "Our state hospital has become a gem. It's really the gold standard now for state hospitals across the nation. We hope to do the same for the prisons."

Laura Stephenson Carter

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