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| Managing The Mentally Ill And Suicidal Inmate |
| By Lt. Pete Brothers |
| Published: 03/01/2002 |
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Growing evidence points toward an inescapable conclusion: Jails and prisons may soon displace mental institutions as the dominant short and long term treatment facilities for the mentally ill. While local jails have traditionally served as pre-trial detention/short sentence housing and prisons as long term punishment facilities, increasing awareness of the mentally ill inmate raises many issues of their custody and care. Additionally, large monetary judgements and orders for injunctive relief have caused many local, state and federal governments to look at treatment of the mentally ill in criminal institutions. As the boundaries between the mental health and criminal justice systems disintegrate, policies and procedures for handling the mentally ill while incarcerated must be carefully scrutinized to reflect an adequate level of care. Additionally, we must look at our own internal resources to ensure quality care. The treatment of the mentally ill in the correctional setting begins at the intake facility. According to And Darkness Closes In... A National Study of Jail Suicides by the National Center on Institutions and Alternatives, (for the National Institute of Corrections), 29% of all jail suicides occur during the first 3 hours. Also according to the same study, over 50% of all jail suicides occur during the first 24 hours of incarceration. At the intake facility a careful screening by medical/mental health staff should occur to assess suicide risk and the inmate's mental health status. Individuals exhibiting mental illness or suicide potential should be housed in an area of close, documented observation. As time progresses and before the inmate is transferred to a more permanent housing area, staff should continue similar housing and supervision. As many offenders are substance abusers, it is important for custody staff to observe behavior for signs of detoxification in addition to abnormal behavior. Management of the mentally ill inmate should involve custody staff as well as medical and mental health professionals. While it is custody staff's responsibility to provide the basics such as meals and showers, custody staff also has the responsibility to document and report unusual behavior to the appropriate mental health or medical staff. This is where correctional officer training is crucial. Correctional staff must receive adequate training to appropriately manage and document behavior. The Orange County Jail in Orlando, Florida provides all custody staff and supervisors assigned to the 'high liability' areas, training in suicide prevention. Staff are also instructed in mental health issues with an emphasis on the signs of depression, bi-polar, borderline personality and anti-social behavior. An overview of medications and treatment is also presented to staff giving them a more global perspective. This training is given above and beyond mandatory annual instruction. Many custody staff appreciate and enjoy the training once they realize that it is practical and relevant. This instruction is provided by mental health professionals employed by the Jail. Providing this type of training to custody staff demonstrates that jail administration is taking a proactive approach in handling the mentally ill inmate. Standard operating procedures should be developed and implemented with input from custody, medical and mental health professionals. Individual case management by representatives from the three groups has been found to be extremely invaluable in many acute and sub-acute cases. This 'joint management' approach differs from the traditional jail environment. The traditional jail environment leaves treatment to the mental health and medical professionals while the correctional officer plays a less significant role. The benefits of the 'joint management' approach are numerous. Regular meetings between the three groups provide the best information possible. These regular meetings provide valuable insight to the treatment professionals that may often go undocumented. The more information the medical and mental health professionals have, the better the treatment can be. Who has been 'cheeking' their medications? Who is allowed a blanket? What observable behavior constitutes an immediate response? What are the side effects of certain medications? When these questions are answered in such meetings the level of care is improved, removing much of the mystery to line staff. These meetings are called for by policy and documentation of minutes is always provided to jail administration. In addition to case management, a custody supervisor, mental health professional and nurse make documented rounds three times a week of all acute mental health housing areas. These joint rounds ensure communication and is standard operating procedure as well as agency policy. This practice is unique and as a matter of policy, perhaps makes the Jail's care and treatment of the mentally ill more defendable in court. In managing acute cases often custody, mental health and medical formulate treatment plans that must be implemented immediately. For example, when Orange County staff were recently faced with an inmate who slit his arms and wrists with a razor only to return from the hospital to open up his wounds again, a joint treatment plan was constructed and implemented. Specifically, this inmate was restrained with humane restraints and subsequently 'weaned off' them progressively. Rather than face the traditional risk of leaving him totally restrained, staff incrementally removed an appendage at a time from the leathers over a period of time until the inmate was completely unrestrained. Basic behavior modification and reward with medical supervision gave staff success. This plan worked and in fact had to work as the designated mental health facility could not accept the inmate due to medical problems and the psychiatric hospital did not have bed space. As we continue to face the challenge of the mentally ill inmate, now more than ever we must use our existing resources in different ways to provide the best possible service to the community. Our best resources are well-trained staff who communicates with each other providing a multi-faceted approach to an ever growing problem. Lt. Pete Brothers supervises and manages sections of the Orange County Jail that includes psychiatric housing. He has a BA from Buffalo State College and is a certified law enforcement instructor with a wide variety of experience in various capacities. E-mail address is jai7@aol.com. |
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