The emergence of clinical evidence demonstrating the benefits of widespread access to appropriate psychoactive medications has increased pressure on corrections systems to ensure availability of these medications to those who need them. New, atypical antipsychotic medications (e.g., Clozaril (clozapine), Risperdal, Zyprexa, Seroquel, Geodon, and Abilify) and selective serotonin reuptake inhibitors (SSRIs), new antidepressant medications ( e.g., Prozac, Zoloft, Celexa, and Paxil) have been shown to reduce unwanted side effects, increase medication compliance, and result in outcomes that are significantly improved over the outcomes of older medications.

The increased use of antipsychotic and antidepressant medication in jails and prisons in recent years has, however, added considerably to the medication budgets of most corrections systems, leading to more costly options being kept off formularies. The temptation to keep the more costly atypical antipsychotics and SSRIs off prison and jail formularies should be resisted. Ensuring that those who need them have access to these medications will produce benefits that may appear in other budget categories; failure to make them available will raise costs associated with prisoner and corrections officer injury, increased use of segregated housing, hospitalization, and recidivism. Indeed, individuals taking these newer medications may ultimately become more productive, more likely to enter the workforce, and less dependent on a wide array of social services. The newer, more expensive medications are not the most appropriate medications for every inmate with a mental illness, but their availability will help jails and prisons to provide effective treatment to a large number of inmates who would otherwise continue to suffer and display the symptoms of their illness.

If drug formularies are used, it is important that they be developed with input from a variety of sources. Certainly, physicians with experience in prescribing antipsychotic medications in correctional and community settings should be involved. People with mental illness who have taken psychotropic medications can also offer valuable insights into effectiveness, side effects, and other factors that might be considered in regulating drug availability. Finally, data on the costs, benefits, and cost-effectiveness of different medications continues to be collected in different venues. No decision on the availability of medications should be made without an attempt to gain an understanding of these complex factors.

Example: Texas Medication Algorithm Project, Texas Department of Mental Health and Mental Retardation

Texas Medication Algorithm Project (TMAP) was a collaborative effort involving public sector and academic partners, parent and family representatives, mental health advocacy groups, and the Texas Department of Mental Health and Mental Retardation (TDMHMD). TMAP developed, tested, evaluated, and instituted a set of algorithms to illustrate the order and method for using various psychotropic medications. The TMAP algorithms have been adopted by the Texas Department of Criminal Justice for use in the state's prisons. TDMHMD ceased operations on September 1, 2004.