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Book Reviews   |    
Prison Madness: The Mental Health Crisis Behind Bars and What We Must Do About It
Reviewed by Jeffrey Stovall, M.D.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.3.394-a
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by Terry A. Kupers, M.D.; San Francisco, Jossey-Bass Publishers, 1999, 301 pages, $25

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Terry Kupers has written a compelling description of the current state of affairs for persons with mental illness in prison. Prison Madness introduces the general reader to the extent to which individuals with severe mental illness are disproportionately represented in the prison population and vividly describes the conditions existing in correctional facilities that may exacerbate or precipitate mental illness. As its subtitle implies, the book extends the debate on prison reform with a focus on the identification and treatment of mental illness and offers proposals to lessen the dehumanizing aspects of prison life that may lead to mental illness among inmates.

The author organizes the text into three parts, each introducing the reader to a set of related issues. The three chapters of part 1 summarize studies on the prevalence of mental illness in correctional facilities and provide comparisons with the general public. Unfortunately, readers hoping for an in-depth review of the literature may be disappointed, as the author relies primarily on older studies and personal anecdotes to provide the background for his assertions.

Reflecting the author's many years of experience as a consultant in legal actions concerning the conditions prevailing in correctional facilities and as a consultant to various governmental and human rights organizations, part 2 describes life in prison, again relying heavily on case vignettes. Chapters on racism, women, rape, and suicide highlight the needs and experiences of different populations. Again the style is anecdotal, woven around the author's experiences and observations. While the narrative reveals the author's passion for the subject and may be engaging for some readers, his argument would have been strengthened by use of supporting documentation and literature.

After providing a harsh review of life in prison, the author concludes with a section on potential means of reform. Although he acknowledges the role that litigation has played in pushing some correctional systems to improve access to mental health services, he is pessimistic about the courts' providing the surest avenue to reform. A chapter focusing on recommendations for treatment reform is perhaps the strongest one in the book. The author's experience over years as a community psychiatrist is revealed in his focus on identification, prevention, and rehabilitation through development of comprehensive levels of care with continuity and a full range of services. He highlights the role of peer review, quality assurance principles, and training in improving services and in combining mental health treatment with an overall rehabilitative focus in incarceration.

Prison Madness is an anecdotal, descriptive account of life in prison and its impact on the psychological well-being of prisoners. For the general reader who is not well informed about prisons and mental illness, this is a provocative introduction to the subject.

Dr. Stovall is medical director of outpatient services at Community Healthlink and assistant professor of psychiatry at the University of Massachusetts in Worcester.

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