POLICY STATEMENT
The Behavioral Observation and Mental Health Referral (BOMHR) (SH-J-407) report was created to refer inmates exhibiting symptoms of mental illness for assessment and treatment by mental health staff. Personnel shall utilize the electronic Behavioral Observation and Mental Health Referral (e-BOMHR), available through the Custody Automated Reporting and Tracking System (CARTS), in place of the printed BOMHR form, absent circumstances in which use of the e-BOMHR is not possible (e.g. system failure, an emergency that significantly affects facility operations, etc.), in accordance with CDM section 4-05/005.00, "Electronic Behavioral Observation and Mental Health Referral Report (e-BOMHR)."
INITIATION OF A BOMHR
All custody personnel who through observation, information received from another person (i.e. relative, clergy, etc.), intake screening, or exhibited behavior, identify an inmate who has a potential need for mental health care or who threatens or exhibits self-injurious behavior, shall complete the first five (5) sections of the BOMHR report or the corresponding sections in the e-BOMHR, as soon as reasonably practicable, but no later than the end of the shift. Custody personnel shall include the BOMHR report, the date and time the report was initiated, and the names of any witnesses.
The e-BOMHR system automatically directs the form to the appropriate queues after reporting personnel have completed the necessary fields. In cases where a printed BOMHR was initiated, the BOMHR report and the Special Handling Request (SH-J-181), if applicable, shall accompany the inmate from initial observation to final housing, including the medical assessment, any transportation, and the mental health assessment. When possible, the medical assessment shall be completed prior to the mental health assessment.
The BOMHR shall include the date and time of the event. Unless otherwise provided in an Incident Report (SH-R-49) or an Inmate Injury/Illness Report, the BOMHR shall include the names of any known material witnesses to the event. If there were no witnesses to the event, this shall be indicated.
A BOMHR does not need to be completed by custody personnel when the identification of an inmate’s potential self-injurious behavior or need for mental health care is initiated by a Correctional Health Services (CHS) mental health clinician. In these cases, the BOMHR will be completed by the respective mental health clinician.
The original printed BOMHR report shall have a reference number from the originating facility. Originating facilities shall retain a copy of the original printed BOMHR.
If an inmate is being booked at any Los Angeles County jail, and the Arrestee Medical Screening Form (SH-R-422) requires a BOMHR, custody personnel shall not accept the booking until sections one (1) through five (5) of the BOMHR or equivalent fields in the e-BOMHR have been completed by the arresting or transporting deputy.
In case of suicidal, dangerous or mentally ill inmates, an electronic Special Handling Request Form shall also be completed; refer to Custody Division Manual (CDM), section 5-01/050.00, "Handling of Suicidal Inmates," section 5-01/040.00, “Inmate Classification and Handling Requests," and 5-01/030.00, “Inmate Classification and Identification.”
Outside agency personnel booking/transferring an arrestee who threatens or exhibits self-injurious behavior to a Sheriff's Department jail must submit a BOMHR form with sections one (1) through six (6) completed. A Sheriff's Department supervisor may sign section 6, "Originating Agency Sworn Supervisor Review" in the absence of a supervisor signature from the arresting agency, to ensure that all applicable fields were completed.
Upon electronically signing an e-BOMHR form, the approving supervisor shall ensure a telephonic and email notification is made to the on-duty nursing supervisor, advising that the form is ready for CHS review.
A Department supervisor at the receiving facility shall ensure the printed form is completed correctly and the inmate is escorted to CHS personnel for assessment.
CORRECTIONAL HEALTH SERVICES PERSONNEL RESPONSIBILITIES
CHS personnel are responsible for completing section 7, "Jail Medical Staff Assessment," of the BOMHR report, or the "Medical Assessment" and "Mental Health Assessment" sections of the e-BOMHR.
If no on-site mental health clinician is available, CHS personnel may (in conjunction with the facility watch commander) arrange the inmate's transfer to Inmate Reception Center (IRC) or Century Regional Detention Facility (CRDF) for a mental health evaluation, or if it is determined that the inmate’s condition is non-emergent, may arrange for the inmate's return to the appropriate housing location pending the availability of Jail Mental Evaluation Team (JMET) personnel or a mental health clinician.
A BOMHR report for movement to a lower level of mental health housing does not require a medical assessment unless a medical condition is claimed.
WATCH COMMANDER'S RESPONSIBILITIES - INMATE TRANSPORTATION FOR MENTAL HEALTH EVALUATION
The watch commander shall be notified in the event an inmate requires transportation to IRC or CRDF for a mental health evaluation. The watch commander, or their designee, shall arrange for the inmate's transportation. Alternate transportation shall be arranged if the inmate's condition warrants any urgency as determined by CHS personnel. The watch commander, or their designee, shall ensure that inmates requiring transportation for evaluation by mental health staff are placed on a separate transmittal.
The watch commander in the originating facility shall ensure the BOMHR report has been completed, including section 6, "Originating Agency Sworn Supervisor Review" of the printed form or the "Sworn Supervisor" section of the e-BOMHR, and that an Inmate Special Handling Request (SH-J-181), if required, accompanies the inmate.
INMATE RECEPTION CENTER AND CENTURY REGIONAL DETENTION FACILITY RESPONSIBILITIES
Personnel at IRC and CRDF shall be responsible for ensuring the partially completed original BOMHR report, the appropriate arrestee screening document or medical/mental health transfer summary, and a Special Handling Request form (if applicable) are received with the inmate. IRC and CRDF shall expedite the transfer of the inmate and the accompanying paperwork to CHS medical personnel. The inmate shall then be assessed, and upon completion of the assessment, expedited to CHS mental health staff for evaluation and completion of the respective sections of the BOMHR.
If the inmate does not require placement in mental health housing, the printed BOMHR shall accompany the inmate to his or her designated facility, where the watch commander shall review the form, ensure that section 9, "Final Housing Information" is completed, and shall sign section 10, "Final Housing Location - Watch Commander's Review." The e-BOMHR system will automatically direct electronic forms to the originating facility upon approval by CHS personnel and completion of the "Inmate Housing" section, after which the final review of the report shall be conducted by the Access to Care Bureau (ACB) lieutenant or a designee of the minimum rank of sergeant.
MENTAL HEALTH OBSERVATION RECEIVING AREA RESPONSIBILITIES
If the inmate requires placement in mental health housing, the housing officer shall be responsible for the following:
CORRECTIONAL HEALTH SERVICES MENTAL HEALTH REVIEW - MOVEMENT WITHIN MENTAL HEALTH AREAS
A BOMHR report shall be completed for any inmate currently housed in a mental health housing area who attempts suicide, or who threatens or exhibits self-injurious behavior. The inmate shall be re-evaluated by mental health staff. Mental health staff will complete section 8, "Jail Mental Health Services Recommendation," of the printed BOMHR report or the "Mental Health Assessment" section of the e-BOMHR.
In the event that an inmate threatens or exhibits self-injurious behavior witnessed by or directed at mental health staff, mental health staff will initiate an e-BOHMR.
DISTRIBUTION OF THE BEHAVIORAL OBSERVATION AND MENTAL HEALTH REFERRAL REPORT
The final review and approval of an e-BOMHR report shall be conducted by the originating facility's ACB lieutenant or a designee of the minimum rank of sergeant.
The completed printed BOMHR report shall be forwarded to the housing facility's Operations staff, who shall scan and append the form to the respective record in the e-BOMHR system. Refer to CDM sections 4-05/005.00, "Electronic Behavioral Observation and Mental Health Referral Report (e-BOMHR)," and 4-13/00.000, "Retention of Records."
A printed copy of the BOMHR report shall be maintained for the duration of the inmate's stay in the designated housing location, and accompany the inmate to any subsequent housing areas. The printed copy shall be destroyed upon the inmate's release.