Management of the Mentally Disordered Offender in Prisons

Possibly no area of human endeavour poses a greater ethical challenge to a free society than the safe control of mentally disordered persons who represent a significant social danger. Managing mentally disordered offenders (MDOs) is a major challenge for the clinician because they have multiple problems and diagnoses and the cost of a "mistake" can be very high. Despite these complexities, until now there have been few guidelines for dealing with MDOs. Drawing on extensive case studies and his experience as director of psychiatric services at the Regional Treatment Centre in Ontario, Neil Conacher traces the MDO management process from initial assessment, through secure stabilization, to preparation for release and subsequent community supervision. He outlines the difficulties of managing a population of serious offenders and highlights elements of treatment that are essential if the MDO is to be reintegrated into the community. Conacher also considers dangerousness, issues of treatment, and forensic aspects of mental disorder, as well as psychiatric concerns that are particular to the prison context, such as ethical issues, predatory sexual behaviour, self-mutilation, suicide, the "inadequate offender", and the predictably dangerous mentally disordered offender. The Management of the Mentally Disordered Offender in Prisons makes an important addition to existing psychiatric literature by bringing to the fore a neglected area of tremendous social concern.