To understand what happens when a patient is incarcerated, it is important to understand the difference between various types of correctional facilities. The main distinction is between detention centers, or jails, and prisons. A detention center is a facility to hold defendants who are awaiting trial. A prison is a facility to house defendants who have been convicted and are serving a sentence. Jails may hold sentenced inmates, if the sentence is for one year or less. Detention centers are generally run by the city or county, while prisons are administered by the state.

Another important distinction to understand is the difference between parole and probation. Both parole and probation are contractual agreements between the inmate and a supervising agency. Inmates are placed on probation by the court as an alternative to serving a sentence. Parole is an agreement between the inmate and the prison system. Parole is granted when the inmate agrees to abide by certain conditions, in order to be released from incarceration before the end of the sentence.

If a clinician becomes aware that a patient has been incarcerated, and wishes to contact the appropriate facility, it can be helpful to know why the patient has been detained. A patient locked up for a new charge or for a violation of probation will go to the local detention center, but one who is incarcerated for violating parole will return to the nearest prison. In Baltimore City, someone with a new charge will first be taken to the Central Booking and Intake Facility. If he is not granted bail, or cannot make bail, he will then be moved to the Baltimore City Detention Center. Those who are brought in for parole violations will be taken to the Maryland Reception Diagnostic and Classification Center, which is the intake facility for the state prison system. By law, all newly received inmates are screened for medical and psychiatric disorders. Prisoners are tested for tuberculosis, syphilis and HIV. The mental health screen includes questions about hospitalization, outpatient treatment, and medication use and suicide attempts. Inmates with a positive mental health screen are referred to the psychology department for an intake evaluation. Mental health services are generally provided under contract with the local health department, or (in prisons) with a private correctional health care agency. Regardless, the inmate may first be seen by a master’s level psychologist prior to referral to a psychiatrist. If the inmate arrives on medication, he or she may be referred directly to the consulting psychiatrist. Referrals may also be generated after intake screenings, by correctional staff who observe a need for assessment, or by the inmate himself. All prisons in Maryland have access to a psychology department and a consulting psychiatrist.

Outside of Baltimore City, pretrial detainees (jail inmates) in need of hospitalization can be transferred to a state hospital. Some larger centers, such as the Baltimore City Detention Center, actually have psychiatric infirmaries where acutely ill or suicidal inmates can be treated. Transfers occur through a civil commitment process, although pretrial detainees who are incompetent to stand trial could be transferred through a criminal commitment instead. Pretrial detainees with very serious charges (murder, arson, or rape), or who pose an escape risk, may be transferred to the state’s secure facility, Clifton T. Perkins Hospital Center. As a rule, the majority of pretrial detainees can be treated within the institution through the facility’s psychology department.

Information from the prisoner’s outside clinician helps to ensure continuity of care. The inmate may or may not be able to identify her medications, or may not wish to disclose his psychiatric condition. Community clinicians should be aware that Maryland law authorizes disclosure of treatment information, without a signed release, for patients detained in correctional facilities. Specifically, Health-General 4-307 states:

“A health care provider may disclose a medical record without the authorization of a person in interest to the medical or mental health director of a juvenile or adult detention or correctional facility if the recipient has been involuntarily committed under State law or a court order to the detention or correctional facility requesting the medical record; and, after a review of the medical record, the health care provider who is the custodian of the record is satisfied that disclosure is necessary for the proper care and treatment of the recipient.”

This is particularly relevant because a written release cannot be obtained easily from inmates who are acutely ill or who are housed in segregation. If the inmate is transferred from an inpatient facility to a correctional facility, Maryland law mandates release of information without signed authorization. In other words, information must be disclosed to the receiving facility.