Like it or not, jails are finding
themselves responsible for meeting a broad and growing spectrum
of inmate needs. From a public health perspective, this makes
sense. Back at the lockup, it isn’t always so easy.
That’s why it’s so impressive that more
than 10 years ago, the correctional and detention facilities in
Montgomery County, Maryland, decided to take a holistic approach
to inmate health care.
This is one of several noteworthy aspects
of the two-facility jail system that have earned it NCCHC’s 2007
Facility of the
Year Award. The accreditation surveyors who nominated the
system praised the way health, custody, program and community
partners collaborate to provide comprehensive care and services
tailored to each individual.
The system also was a trailblazer in
recognizing the value of national standards for health services:
It has taken part in NCCHC’s accreditation program since 1977,
the year it began.
That is the same year that Arthur
Wallenstein learned about NCCHC accreditation as a rookie warden
in Pennsylvania. A staunch advocate ever since, he is now the
director of the Montgomery County Department of Correction and
Rehabilitation, which operates the jail system.
“Mr.
Wallenstein and our wardens, William Smith and Robert Green,
truly understand the importance of health care,” says health
services administrator Anthony Sturgess, MSN, CRNP, CCHP. “They
recognize that we have a captive audience, so why not take
advantage of this and provide as many opportunities, by way of
programs, as we can. Mr. Green often asks, ‘How would you like
them to return, as better criminals or as better people?’”
Programs Galore
That enlightened thinking is evident in the array of
programs (more than 100) the jail offers, Sturgess says. He
started as the sole nurse practitioner 10 years ago and has been
the HSA for six years.
The jail gets help from the county and the
community, particularly with efforts to facilitate reentry to
the community. “Every two weeks, up to 40 individuals from many
different agencies meet to discuss inmates scheduled to be
released,” Sturgess says. “This collaborative case management
meeting is to identify services they will need and to link them
to these services.”
Agencies represented include the public
defender’s office, the county’s Health and Human Services
department, parole and probation, faith-based organizations and
nonprofit community services. HHS coordinates referrals for
substance abuse and mental health services.
HHS is
intrinsically involved in inmate services in many other ways.
For example, HHS staff screen and assess each new detainee for
mental health and substance abuse needs, with diversion to a
nonjail setting if appropriate. Other HHS employees at the jail
include a tuberculosis control nurse and HIV clinic staff. The
agency also operates programs for addiction treatment and for
housing the homeless.Health Care ... and More
Clearly, Montgomery County is serious about tackling mental
illness and substance abuse, including alcoholism, among
inmates. Sturgess cites those as the top two challenges the jail
faces, followed by patient needs for multiple pharmaceuticals
due to co-occurring medical and mental health conditions.
To address these needs, the jail has a
mental health unit managed by Patricia Sollock, MA, CCHP.
Although it is distinct from health services on the
organizational chart, she and Sturgess, and their staffs, work
seamlessly together.
About 18% of the jail population has a
mental illness that requires medication, according to Sollock,
and yet others receive mental health care without meds. A
hallmark of the mental health unit is dialectic behavioral
therapy, an evidence-based program that involves individual and
group sessions to help the patient improve life functioning
skills. Also notable is a 55-bed crisis intervention unit, the
largest inpatient psychiatric unit in the county.
Inmates bring with them a host of medical
problems, too, including chronic diseases such as diabetes,
hypertension and cardiovascular disease. Chronic pain disorders,
poor dental health and injection-drug-related infections are
also common.
The jail strives to minimize inmate
movement within the facility so it brings contracted specialty
providers on site to provide a full range of services at the
community standard of care (see box above).
Quality
health care doesn’t come cheap, so to keep expenses in check,
Sturgess uses a third-party agent to renegotiate bills, which
has saved the jail tens of thousands of dollars per year. But
with costs continually rising, he has a few other creative ideas
for controlling them. He promises to report back, so stay tuned!—
About the author: Jaime Shimkus is NCCHC’s editor. To contact her, e-mail jaimeshimkus@ncchc.org.
[This article first appeared
in the Fall 2007 issue of CorrectCare.]
