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PRAMS: A Systematic Method for Evaluating Penal Institutions Under Litigation

Dr. Wills is Clinical Assistant Professor of Psychiatry, Tulane University School of Medicine, New Orleans, LA. Address correspondence to: Cheryl D. Wills, MD, 141 Robert E. Lee Boulevard, PMB 178, New Orleans, LA 70124. E-mail: cwforensic{at}earthlink.net

Forensic psychiatrists serve as expert witnesses in litigation involving the impact of conditions of confinement, including mental health care delivery, on the emotional well-being of institutionalized persons. Experts review volumes of data before formulating opinions and preparing reports. The author has developed PRAMS, a method for systematically reviewing and presenting data during mental health litigation involving detention and corrections facilities. The PRAMS method divides the examination process into five stages: paper review, real-world view, aggravating circumstances, mitigating circumstances, and supplemental information. PRAMS provides the scaffolding on which a compelling picture of an institution's system of care may be constructed and disseminated in reports and during courtroom testimony. Also, PRAMS enhances the organization, analysis, publication, and presentation of salient findings, thereby coordinating the forensic psychiatrist's efforts to provide expert opinions regarding complex systems of mental health care.