Successfully treating aggression in mentally ill prison inmates.

The population of prison inmates in the United States is rapidly growing; in 1994 it was estimated that 1.7 million Americans were incarcerated. Changes in the complexion of the prison population highlight the need for successful mental health interventions for special populations. Specifically, increasing numbers of women, middle aged inmates, physically ill inmates, and inmates with severe mental illness have challenged an already taxed system. Many inmates have complex pathology in which substance abuse, psychosis, affective disorders, personality disorders and medical illnesses play overlapping roles. One of the most challenging aspects of care involves management of inmates who are aggressive to themselves or others. This article discusses the approach to managing inmates with aggressive behavior and complex mental health issues. Specific diagnoses are discussed as are the general approaches best used to assess new onset violent behavior in a mentally ill prison inmate.