A PMHNP begins working in a county jail and is asked to evaluate a 28-year-old man with bipolar I disorder who was stable on lithium before incarceration 3 weeks ago. His lithium was not continued upon intake. He is now hypomanic with pressured speech, decreased sleep, and grandiosity. He requests his lithium be restarted. The PMHNP considers the unique challenges of providing psychiatric care in a correctional setting.