Jack-to answer the question as to why generically giving any one group of medication-requiring prisoners the same medication or type of med from a class of similarly acting meds (E.g antipsychotics, antidepressants of various types etc.) without regard to the prisoner's individual response then yes, it could. Antipsychotics in particular are very unpleasant drugs, and are pretty toxic, in the short term capable of causing very unpleasant side effects, severe akathisia, dystonic reactions and other extrapyramidal reactions, and are mentally dulling, and stulting, plenty of people taking them would rather be dead than stuck on the neuroleptics.
Chronically they can cause tardive reactions, such as tardive dyskinesia or dystonias, which are PERMANENT, and from everything I've ever read, agonizing, and a fate worse than death. Also, in the acute timeframe, some people, who are extremely sensitive to D2 dopamine receptor antagonists (the primary mechanism of action for most antipsychotics) can develop a condition called malignant hyperthermia, which can resut in rhabdomyolysis (breakdown of muscle tissue, the byproducts of the destroyed muscle tissue then flood the kidneys and cause kidney failure, in addition to potential for brain damage due to the severe hyperthermia. Untreated (and it requires hospital treatment, and rapidly. If it occurs, the prisoner would be incapacitated and unable themseves to request assistance. And if they did they probably would just be dismissed as malingering and fucked off. Or assumed to be trying to get to a hospital, and escape under lesser security.)
Untreated, malignant hyperthermia has a death rate of about 75 percent. Treated in hospital the fatality rate is reduced to just 5% or so. It requires, usually a drug called dantrolene, hospitals have to carry it, but it is not a drug which would be stocked in a prison, its a specialist treatment for malignant hyperthermia and used in serotonin syndrome to prevent rhabdomyolysis, being a directly acting skeletal muscle relaxant, acting directy on muscle tissue via ryanodine receptors, even if prisons did have access to dantrolene they wouldn't know how to use it. And its injection only.
And just the side effects in general would make a lot of people suffer, and those who are misdiagnosed by halfarsed prison doctors that are more concerned with avoiding any prisoner getting anything potentially recreational than they are with actually treating disease (this is true, I've seen it, I've been a victim of it. They'd rather leave me having repeated grand-mal seizures for months and nearly starve to death as a result, in a near delirious state, than allow me a benzodiazepine, or chlormethiazole as I was already prescribed before being nicked, and at the same time, aggravating the problem and leaving me in a living breathing hell by forcing me cold-turkey from my GP-prescribed oxycontin (80mg OCs several times daily) and fobbing me off with a completely, utterly useless 8/500 codeine/paracetamol. Which needless to say to a longterm chronic pain patient is absolutely without action. They even had the cheek to tell me they were being generous in giving me TWO of those per day!. They almost did kill me. I'm pretty surprised they didn't.
And they tried putting me on mirtazepine, another time, because I've always had trouble sleeping, after I rejected an antipsychotic for use as a sedative (I was lucky in that I already knew I cannot take them, because I'm hypersensitive to D2 antagonists, I can't even take domperidone, the antiemetic, which is a weak D2 antagonist that isn't meant to cross the blood-brain barrier. And I've had the misfortune, after being hospitalized due to a real nasty ass bout of food poisoning to be treated with trifluoroperazine, to which I reacted very badly indeed. I was cautious, as I'd never taken it before, with the mirtazepine, and took just a small portion of the lowest dose tablets available, took just 2.5mg to start with. Its primarily a sedating antihistamine, and tetracyclic antidepressant, in fact it is, if I am not mistaken the antihistamine with the lowest Ki in medical use (lower Ki values mean higher potency), but its also an alpha2 adrenergic autoreceptor antagonist, like for example, yohimbine, and causes release of noradrenaline. I also cannot tolerate most adrenergic drugs, at least unless adrenergic release is a side-trait when accompanied by dopamine release, and even then in small quantities (low dose amphetamines for example, or with stimulants that can be dosed at high levels and tolerated, they MUST, for me, be highly selective DA-releasers or DA-reuptake inhibitors, with the Ki for DAT vastly lower than that for NET (noradrenaline transporter) or NA release. For example, the selective NA releasers ephedrine or pseudoephedrine are poison to me and make me feel like hell. Yet with the additional dopaminergic activity of amphetamine or methamphetamine/ethamphetamine, even racemic amphetamines (the laevo-isomers having primarily just noradrenergic activity) I can tolerate low doses. With pure dextro-isomers I can tolerate more, and with those psychostimulants which act as extremely selective dopamine reuptake inhibitors or releasers I'm fine (plenty have some serotonergic activity too, which doesn't really act badly with me, although SSRIs don't agree with me)
But the mirtazepine, causing the unmitigated noradrenaline release, that reacted so badly that I felt so horrible that I would have thrown myself out of a window, if only it would make it stop. It was that bad. Words cannot even describe the absolute utter misery that even that tiny test dose caused me. The remainder went straight down the toilet.
So yes, casually fucking about like prison doctors do, they are idiots and they have zero compassion, could easily end up killing a prisoner. It nearly killed ME. By the time I'd stopped seizing as a direct result of them terminating my antiseizure medication cold turkey (which even a student trainee would know never, ever to do, because it can easily be lethal, and will almost certainly cause grand-mal convulsions), by the time it stopped of its own accord (the physical withdrawal) it'd been so long, I had almost fucking starved to death, and was very severely dehydrated. Ever seen the pictures of starved auschwitz victims or other nazi death camp liberated victims? thats what I fucking looked like. I'd gone from my usual nine stone nine to barely able to stand, and barely able physically to eat when I again could see that there was food thrown at me.
I won't go into the worst of it. And what I've just described wasn't. I can't. I just can't. And it took a long time after I got out (after being wrongfully remanded for something I was not responsible for, and ending up, after 8 months or so, just tagged for a short time with an ankle-tag and curfew) and a lot of entactogen/psychedelic catalyzed solitary meditation, in a favourite little quiet woodland grove, that I've always found a peaceful place, and amongst the forests, a favourite spot. Its only small, a few tens of meters, but soft broken down leaflitter, surrounded by large stands of scented basam, with a couple of large beech trees, I've liked this particular spot since I was a kid, so it was there I chose to spend much of my meditation time, using AMT and a low-dose dissociative to help maintain a sort of emotional detachment from the worst of it, so I could stand by and be there at the same time, if that makes sense. (AMT, short for alpha-methytryptamine is both an empathogen/entactogen like MDMA, and a bona-fide 5HT2a agonist psychedelic (its also a rather weak MAOI and a moderatey powerful psychostimulant, although the MAOI effects are weak enough that AMT can be safely taken without serotonin syndrome)
And with its help, I eventually managed, with some intensive self-psychoanalysis, meditation and time spent integrating things, to come to terms with the worst of it, and deal with the resultant PTSD. I don't think I'd have been at all comfortable talking to a therapist about it, any of it, and didn't even try seeking one out. But I dealt with it myself, not without difficulty and much effort put into it. But I did succeed in dealing with it, and for the vast part, curing mysef of the PTSD.
I still can't talk about most of what happened, but I no longer suffer the terrifying nightmares, the waking up screaming and sweating bullets, the shaking like crazy, hand tremors. Used to be in a state of hypervigilance, extreme, constant fight-flight state of stress response. Now I've managed to rid mysef of most of it. I still take an adrenergic blocking agent (two, actually, although one of them is taken as a muscle relaxant due to some nerve damage in my leg after a botched knee surgery) but incidentally works the same way exactly, as the clonidine I take to block the excessive overloading that is still a residue of the trauma (its an alpha2 adrenoreceptor agonist, works in exactly the opposite way to the side-effect of that awful shit mirtazepine that made me just want to fucking well go die in a fire. And it both helps me not overload, but in blocking noradrenaline release helps deal with overstimulation too. The other one is tizanidine, the muscle relaxer, although they both work in a very similar way. There are some side-effects, especially with using the two in combination, mainly a powerful drop in blood pressure, and orthostatic hypotension as a result, which means that when changing from a recumbent position to standing, my heart doesn't compensate with an increase in BP fast enough, and as a result, I have to stand bent double, as if bowing, and then slowly rise to allow for the slower compensatory rise in BP, otherwise it can drop so low on standing too quickly that my legs start twitching and give out, and I pass out, or else stay conscious but just can't maintain any muscle tone and hit the deck, although quickly recover as soon as I do, when I flatten out, and my BP returns to the (albeit lowered) resting rate.
