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| Jail Mental Health Programs - Linking with Community Resources |
| By Robert W. May, M.S. |
| Published: 04/29/2002 |
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The management and treatment of inmates with mental disorders is a growing problem for jail operators. With jail populations already above capacity, the increasing percentage of inmates entering jails with mental illness presents additional management challenges in regards to housing and meeting the basic treatment needs of these inmates. Though jails are not typically designed as treatment centers for persons with mental illness, today they comprise the largest mental health institutions in the United States. A variety of factors contribute to this dynamic, including the reduction of community based inpatient and residential programs for the chronically mentally ill, 'get tough on crime' legislation and changing social attitudes towards the care and treatment of persons with mental illness. With fewer placement and treatment options available in the public mental health care system, jails have become the de facto primary mental health institutions. All of these factors are beyond the control of the jail administrator, but what is clear is that jails must provide certain basic internal levels of mental health care and treatment to inmates with mental illness. Additionally, as jails are now a part of the overall community mental health system, they must also participate externally with various agencies and providers that make up the community continuum of care. With operating budgets already stressed to the limit, jail administrators are often perplexed about how best to address the mental health needs of the inmate population. In recent years, many jails have discovered the hard way how best to provide mental health services, having undergone serious and expensive litigation as a result of insufficient mental health services. Such litigation often results in court ordered levels of service designed to ensure inmates with mental illness are properly identified and receive appropriate housing and treatment from qualified professionals. A well managed jail facility will take a proactive approach to meeting the mental health needs of its inmate population and stave-off expensive litigation by ensuring certain basic services are provided. Since providing mental health services to inmates is often viewed as a necessary evil, jail systems are wise to acknowledge and embrace their responsibilities towards serving the mentally ill and develop official policies and procedures related to this service. At a minimum, all jails, regardless of size, should provide the following basic internal mental health services: *Screening and evaluation: Jails must proactively screen and evaluate inmates for mental illness as part of the intake process as well as on an ongoing basis during incarceration. Additionally, jails must provide a means for inmates to make their needs known to the medical staff through a formalized process of self-referral. *Access to Treatment: Inmates must have access to modern treatment provided by qualified mental health professionals. Services should be available and provided in a timely fashion. *Medication: Appropriate prescription and management of psychotropic medications by qualified professionals. *Crisis Intervention: Formal procedures for responding to inmates in crisis as a result of their mental condition (i.e. self-injurious behavior) *Suicide Prevention Program: An ongoing facility-wide program to maintain a high level of awareness of the potential for suicide and appropriate interventions. *Records: Formal system of record keeping regarding mental health services and responses to treatment. Depending on size, jails should ensure sufficient staff to provide for mental health services, including designation of management staff to assume responsibility for the adequate coordination and provision of mental health services. Large jails often have designated positions for mental health program directors. Smaller jails may not be able to afford such positions in their budgets, but should ensure the sufficiency of their services by seeking external guidance and periodic review. Additionally, and of equal importance to the services listed above, jails should provide an external Community Liaison service, which involves linkage with various community mental health and social service agencies to provide for a continuum of care. This linkage will improve the consistency of services inmates receive and help reduce recidivism rates of inmates with mental illness. Many jail administrators may not realize that there may be numerous services available in the community. By coordinating with the community mental health system, jail administrators may be able to tap into services and resources for inmates at no additional cost to the jail. To preserve precious resources, and to improve the continuum of care, jails should identify and take advantage of available community programs and services. Jails are an integral part of the community mental health system and should therefore actively integrate their services with the other community mental health agencies in their catchment area. In some communities, the linkage between jails, hospitals, law enforcement and community mental health centers works well, but in many locales, there is much discord amongst these agencies when it comes to the placement and management of persons with mental illness. Routinely, communities see the same handful of repeat offenders being shuffled between hospital emergency rooms, mental health centers and jails, often tying up significant law enforcement officer hours running circuit between facilities trying to find a placement. Unfortunately, jails often bear the brunt of closed doors and lack of bed space at other facilities and end up providing overnight or short-term shelter to inmates followed by quick release to the community to repeat the cycle again. This lack of coordination between agencies is not just a jail concern - it is a community concern - and should involve multiple agencies committed to working together to ensure the most efficient use of community resources. Community mental health varies among states and jurisdictions, but typically, there is some form of public community mental health as well as a variety of private providers in proximity to a jail facility. Jail administrators should identify and understand the scope of mental health services available in their communities as well as the local regulations and procedures related to commitment of persons with mental illness. Further, jails should establish formal working relationships with involved agencies and meet regularly with them to develop and maintain a seamless continuum of care. Ideally, a consortium of agencies and community providers can be developed to hold regular meetings and establish effective lines of communication regarding the care and management of inmates with mental illness. This level of communication on the front-end will help to ensure the appropriate placement of individuals prior to formal arrest. For the provision of mental health services to inmates in the facility, often jails may be able to draw upon the resources of community mental health centers and other local providers to provide services on-site at the jail facility. Arguably, inmates come from the community and return there after incarceration, thus, community mental health resources should be targeted for these individuals while incarcerated. Many community mental health centers view their services as being limited to the confines of the community mental health center facilities, while others are more willing to branch out and take the services where they are most needed, which includes jail settings. Jail administrators should contact the leadership of their local community mental health centers and explore methods to better coordinate services to the mutual population served. Given the fact that many inmates with mental illness who enter jails have a history of involvement with community mental health providers, jail mental health staff should establish working relationships with community providers in order to coordinate treatment services and share information. This level of communication not only saves time in the treatment process, but it also increases the level of consistency of treatment. Community mental health providers and jail mental health providers should view the mental health services provided during incarceration as a component of a larger continuum of care within a seamless community system. In addition to basic community mental health services, jails may also have access to a variety of other specialty services provided in the community. These services include programs for substance abusing offenders (i.e. Alcoholics Anonymous, Narcotics Anonymous), female offenders and youthful offenders. Obviously, easier said than done, this level of coordination requires ongoing proactive communication among community agencies with members from each involved agency taking the time to meet with and tour the facilities of the other agencies. If not currently underway, jail administrators should take the initiative to create such working relationships in their communities. Over the long term, such coordinated community efforts will result in increased services to the jail, fewer inappropriate admissions of persons with mental illness, and reduced recidivism of inmates with mental illness. Robert W. May, M.S, is President of Behavioral Health Management, Inc., a management and development consulting firm specializing in correctional mental health. May can be reached by telephone at (404) 583-0197 or by e-mail at rwmay3@aol.com. |
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