Todd Wilcox, MD, MBA, CCHP-A, Medical Director of the Salt Lake County Jail System, joins Lorry to discuss managing some difficult correctional patient situations. He presented the session Intensive Medical Management: How to Handle Prisoners Who Self-Mutilate, Slime, Starve, Spit and Scratch at the National Conference on Correctional Health Care in Dallas, TX, October 17-21, 2015.

Providing health care in the criminal justice system brings with it some interesting and challenging patient situations. Patients present with unusual medical conditions, for sure, but also have some difficult behavioral and psychological profiles that lead to safety issues for both the patient and the staff. Dr. Wilcox shares insights on dealing with these patients and provides treatment recommendations based on best practices and clinical experience.

Often, disruptive inmates who slime, spit, or scratch incur charges, restricted contact, and lost of privileges. Extreme outbursts and violent behavior can lead to physical restraint. However, treating these individuals punitively rarely has a good outcome; and can sometimes end in injury or death. Things can get out of control with escalation on both sides. A measured approach, focusing on de-escalation and crisis intervention is warranted.

Self-injury, whether mutilation or starvation, are two of the most challenging behaviors to manage successfully. An understanding of mental illness is needed by both healthcare and security staff. While policy and procedure are important to set a framework for managing these behaviors, a one-size-fits-all approach will not work. Often interventions for individual patients must be tested out to determine response. For example, some patients respond well to increased stimuli while others need to be taken away from noise and audience.

Crisis Intervention Training (CIT) is recommended for those who deal with behaviorally challenging inmates. Dr. Wilcox initiated the training for staff working in the Salt Lake County Jail System and they have seen a 95% reduction in the use of force to manage behavioral issues.

How do you handle patients who self-mutilate, slime, starve, spit or scratch? Share your tips in the comments section of this post.