All new inmates with a documented, active psychotropic medication prescription, who have been compliant with that medication immediately prior to entering the Facility, may have those medications continued by the Psychiatrist or mid-level provider. This is done upon verification with the pharmacy, and providing the medication is not used primarily as an aid for sleep, prescribed during active substance abuse, or when there is a clinical rational for delaying its use. Psychotropic medication, once ordered, can only be discontinued by a psychiatrist, the prescribing physician, or clinical nurse practicing in an expanded role under the supervision of a psychiatrist. (Clinical nurses are only utilized when permitted by law and with the expressed approval of the Facility Administration, prior to assignment.)

Each inmate receiving psychotropic medication is seen by the prescribing physician at least every 90 days, and more frequently as clinically required.  The following are recorded in the inmate’s medical record in the form of a progress note:

• The indication for the medication (i.e., target symptoms)
  
  
• Risks of side effects, benefits, and alternatives to treatment
  
  
• A note documenting informed consent
  
  
• Consideration of crushed preparations, liquid or long-acting injectable forms of medications for inmates who do not reliably ingest pills/capsules, or for those who have been caught hoarding

CMHS understands that the cost of psychotropic medications have continued to increase at a rapid pace, placing more fiscal demands on Facilities trying to provide consistent, comprehensive care to the inmate population.  While our overall intent is to provide the best level of care for the inmate, CMHS has developed and utilizes alternative strategies for the control of costs, not the least of which is accurate diagnosis, recognition of drug-seeking behaviors, and avoiding the use of medications typically abused and used for sleep.  Furthermore, the use of practice guidelines to make more evidence-based decisions regarding medication use in the jail settings, the use of algorithms, decision-tree formats and evidence-based formulary, and management alternatives all work towards controlling this ever spiraling cost.