PURPOSE OF ORDER:
Upon arrival to TTCF, Mental Observation inmates are identified and interviewed by a Mental Health professional so they may be properly housed. Past practice has revealed when a Mental Observation inmate is moved with the approval of a Mental Health staff member, the inmate can generally be safely moved and appropriately housed for his level of mental illness. This Unit Order establishes policy and procedure governing the housing and movement of mental observation inmates.
SCOPE OF ORDER:
This order shall apply to all personnel assigned to and/or working in any capacity at Twin Towers Correctional Facility.
ORDER:
The mental health services provided in the mental observation units are considered to be an “outpatient level of care.” An outpatient level of care is equivalent to the type of treatment these individuals would receive in the community. Those inmates who are housed in the mental observation units are assigned to a primary therapist who manages their case. These inmates are provided with individual, group and recreation therapy, as well as crisis intervention when necessary. Their medications are prescribed by a jail mental health psychiatrist. These medications are delivered by Sheriff’s Department medical staff. The focus of treatment is on keeping the inmates stable while they are in custody and to assist them in obtaining mental health services following release from jail.
The Mental Observation Units consist of three categories of inmates:
· Suicidal (danger to self)
· Potentially violent (dangerous to others)
· In need of medical/psychological monitoring
Transfers of Inmates to Mental Health Housing (JMET Referrals)
In some cases, The Jail Mental Evaluation Team (JMET) may determine an inmate is not suitable to remain in a general population setting and requires mental health observation, treatment, and housing. JMET referrals are brought to the originating facility’s clinic for clearance prior to transfer to determine if they are appropriate for transfer to mental health housing at TTCF. In such cases, a Behavioral Observation and Mental Health Referral (BOMHR) form shall be completed and arrangements made to transfer the inmate to the Inmate Reception Center (IRC) for a more intensive medical health evaluation, and placement in an appropriate level of mental health housing. The IRC clinician will then assign the inmate to an appropriate level of mental health housing. Transfer of an inmate to IRC and TTCF mental health housing shall be provided by the facility from which the inmate is being transferred. The Watch Commander, in conjunction with Medical Services personnel, shall make the final determination for immediate or routine transfer of the inmate.
The Inmate Reception Center medical staff shall conduct a medical screening if requested by the Mental Health psychiatric staff. Upon completion of the medical and mental health screening, the inmate shall be transferred to TTCF Tower I Transfer Center with the required documentation:
· Completed Behavioral Observation and Mental Health Referral form (SH-J-407),
· Jail Record Card (JRC),
· Blue wristband coded with an “S” (Suicidal) and/or “M” (Mental)
In cases where JMET personnel determine an inmate does not meet the criteria for acute mental observation housing at TTCF, Tower 1, 7th floor, a transfer referral may be made for Direct Admission to a designated service area on the 3rd, 4th, 5th, or 6th floor in Tower I, pending further evaluation by TTCF mental health staff. The medical section of the BOMHR form shall be completed by the clinic at the originating facility and identified as a JMET referral. The words “JMET Referral” shall be stamped or written across the top in red ink with the recommended housing location clearly visible in the upper right hand corner. No Direct Admission to FIP will be allowed unless ordered by a psychiatrist. TTCF Tower I Transfer Center will receive the inmate and house him based on the recommendation annotated on the JMET Transfer Sheet. Direct Admission inmates shall be transferred to TTCF with the following documentation:
· Completed Behavioral Observation and Mental Health Referral form (SH-J-407),
· JMET Transfer Sheet,
· Jail Record Card (JRC),
· Copy of the IC12 (Special Handle) screen indicating the inmate has been re-classified as “S” and/or “M”,
· Blue wristband coded with an “S” and/or “M”
Tower I houses inmates requiring mental health interaction on a daily basis. As such, a Tower I on-call mental health clinician is available at all times via portable radio. Tower II houses general population inmates, and/or inmates not requiring regularly prescribed mental health treatment. Consequently, Tower II does not have an on-call mental health clinician. In the instance a Tower II general population inmate displays unusual and/or bizarre behavior requiring mental health intervention, personnel shall determine whether the situation is non-emergent or emergent and the following procedures shall apply:
NON-EMERGENT(request for medication, psychological evaluation, etc.)
· Custody personnel shall contact the Tower II Transfer Center and report the inmate’s information (i.e., name, booking number, location, behavior observed and reporting personnel)
· Tower II Transfer Center personnel will record all of the information on the JMET Referral Sheet
· JMET staff will retrieve the information daily and respond to the location to evaluate the inmate
EMERGENT (suicidal, danger to others, gravely disabled, extreme bizarre behavior, etc.)
· Custody personnel shall complete the appropriate sections of the BOMHR form, including the reference number. This includes Sections 1 through 6, note that Section 5 shall be completed by the watch commander when Option 4 is circled
· Sworn supervisory personnel shall complete Section 8 of the BOMHR form and assist custodial personnel with escorting the inmate to the IRC Main Clinic (located in TTCF Tower II, Module 231) for a mental health evaluation. If the inmate is deemed suicidal, the watch commander shall complete Section 5 of the BOMHR form
· If the inmate is deemed suicidal, custodial personnel shall complete an “Inmate Special Handling Request” card (SH-J-181) requesting an “S”. Once the updated information is input into the computer and verified, they shall replace the inmates’ wristband and identification card
· When IRC’s mental health clinician confirms that the inmate needs to be rehoused, the inmate will be left at IRC and IRC personnel will continue with the rehousing process
Interview and Routine Movement of Mental Observation Inmates
All inmates need to be interviewed by mental health staff prior to their being housed in the Mental Observation units and when an inmate is to be released from custody.
Any housing movement or the declassification of an inmate from mental observation status requires the concurrence of a mental health staff member. If a conflict arises regarding whether the inmate should be moved or not, the Watch Commander shall make the final decision.
A movement sheet shall be completed by mental health staff when there is movement of inmates on mental observation floors to another module in TTCF, another facility, or release from custody.
NOTE: Movement from the intake pods to other pods on the 7th floor may be done without mental health’s approval if the move is to prevent mattress sleepers. Mental health staff shall be notified of the movement as soon as possible.
The following procedures shall be adhered to regarding movement sheets:
· Module personnel shall retain and file movement sheets for a period of no less than 30 days from the date of issuance.
· Module personnel shall advise floor nursing staff of inmate movement to ensure continual delivery of prescribed medication.
· Tower I module personnel shall ensure movement sheets for de-classed inmates are provided to the Transfer Center and the charge nurse in the Tower I main clinic.
A Mental Observation inmate shall not be moved without the concurrence of a Mental Health staff member unless an inmate is being transferred to the Discipline Module in the manner described below.
NOTE: Refer to TTCF Unit Order #3-02-300, Contact with Insubordinate Inmates.
Discipline Movement
Mental health observation inmates must be evaluated and approved prior to placement in disciplinary segregation/isolation. If the mental health staff does not recommend the patient is appropriate to be moved to a discipline module, the patient can be locked in his cell to serve his discipline time.
NOTE: While the entire movement policy must be adhered to, it is not all encompassing. Each and every situation regarding movement of Mental Observation inmates cannot be anticipated. Therefore sound judgement, based on our Core Values -- and simultaneously balancing the need to provide a secure environment and the welfare of the inmate(s) -- must be exercised. Decisions in these instances shall be made by the on duty Watch Commander.
Mental Health Observation Discipline
Inmates housed in Tower I on the 3rd, 4th, and 5th floors, are in a general population type setting and require a lower level of observation and care. They may be transferred to the Discipline Module under the conditions mentioned under Discipline Movement, unless the inmate is displaying bizarre behavior, articulates suicidal ideation or a need to see a Mental Health Counselor. In such situations, a Mental Health Counselor shall aid staff in deciding the proper housing location for the inmate. Tower I inmates are under active Mental Health observation.
When inmates housed in Tower I, on the 7th floor are to be disciplined, they shall remain on the 7th floor under active mental health observation. If the inmate’s mental health clinician determines he is suitable for disciplinary housing in Tower I Module 121, the inmate may be transferred to this module with a transfer request approved and signed by the clinician.
NOTE: All jail rule violations shall be documented on an Inmate Incident Report (SH-J-213), even if the inmate will obviously not be able to serve any disciplinary time. Refer to TTCF Unit Order 5-22-010, Inmate Discipline Procedures.
When inmates housed in Tower I, on the 6th floor are to be disciplined, the assigned or “on-call” clinician shall be consulted prior to transfer. The clinician shall determine if the inmate is appropriate for the Discipline Module, or to be moved to the 7th floor for observation.
NOTE: Most inmates placed in Discipline from the 6th floor will return there, so a movement order to G.P. is often not appropriate.
The Inmate Reports Tracking System (IRTS) has no provision for recording the concurrence or opinion of the Mental Health clinician. To provide the necessary record, deputies shall document the consult in the assigned Module “Red Book” Log, referencing the report number(s), and have the clinician sign (with employee number) adjacent to the entry. The clinician may list recommendations, if any, or indicate “consulted.”
NOTE: The Mental Health clinician is not making a judgement of whether the inmate should be disciplined or not. He is merely determining if the inmate can withstand being housed in a disciplinary setting.