SUCCESSFULLY TREATING AGGRESSION IN
MENTALLY ILL PRISON INMATES
Catherine F. Lewis, M.D.
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, per-
sonality 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 in-
mates with aggressive behavior and complex mental health issues. Speciﬁc diag-
noses are discussed as are the general approaches best used to assess new onset
violent behavior in a mentally ill prison inmate.
The population of inmates in the United States prison system is
rapidly rising. In 1984 it was 700, 000 and by 1994 it had risen
to 1.7 million (1). During the years of increasing rates of incarcer-
ation, the complexion of the prison population changed somewhat.
Increasing numbers of women were incarcerated (1). The prison
population aged with a resultant rise in the number of middle
Catherine F. Lewis, M.D., is an Assistant Professor, Department of Psychia-
try, University of Connecticut Health Center, Farmington, Connecticut.
Address correspondence to Catherine Lewis, M.D., University of Connecticut
Health Center, Department of Psychiatry, 10 Talcott Notch Rd., 3rd ﬂoor, Farm-
ington, CT 06030-6410; e-mail: Lewis@psychiatry.uchc.edu.
PSYCHIATRIC QUARTERLY, Vol. 71, No. 4, Winter 2000
0033-2720/00/1200-0331$18.00/0 2000 Human Sciences Press, Inc.