Costs, control or just good clinical practice? The use of antipsychotic medications and formulary decision-making in large U.S. prisons and jails

Medications are central to the psychiatric armamentorium in U.S. jails and prisons. Psychiatric medications are used both to stabilize acute symptoms as well as maintain mental health once symptoms are reduced. Both jails and prisons rely heavily on traditional antipsychotics, but both have a full array of atypical medications in their formularies. The heavy reliance on cheaper traditional medications when alternatives are present suggests that cost remains a factor. The fact that psychiatrists prescribe off the formulary and are more influenced by demonstrated efficacy in formulary decision-making, in contrast, supports the notion that they are indeed concerned with good practice.