One approach CMHS may utilize in the management of a jail’s mentally ill population is the use of “Special Population Tiers.”  We recognize that not all jails are designed/equipped/funded to develop specific psychiatric “units.” In those circumstances, CMHS advocates for the designation of a “psychiatric tier” to house those individuals who are in need of more intensive management and/or protection from victimization.  The day-to-day population of these tiers is tightly controlled by classification with regular input from the Mental Health Service as to who is in need of further stay.  Individuals who are aggressive, intimidate or victimize others are removed from the tier and receive treatment within the general population.  Weekly rounds on the unit themselves, led by Mental Health Professionals and with correctional officer involvement, help to manage this potentially problematic population and identifies issues before they intensify.  These units also utilize slightly different rules (no self-medication, quiet times, limits to access to razors, expectations of peer support, etc.) to foster safety, stability and smooth functioning of the tier.

Segregation is a security initiated event that is out of the realm of mental health decision making.  However, all inmates placed in segregation who have a history of mental health treatment or who exhibit signs and symptoms of a mental illness receive a reassessment. This reassessment is conducted by a qualified health professional, is included in the medical record, and referrals are made to mental health staff when indicated.  A follow-up evaluation may be initiated at any time behaviors warrant concern.

Once referred, a Mental Health Professional assesses the inmate as per protocol.  Any inmate remaining in segregation who has active mental health issues will be regularly assessed for wellness checks and when needed, a more in-depth reassessment.  Mental health staff will respond promptly to referrals from the medical staff conducting daily rounds and will monitor these Inmates in subsequent triage meetings.