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The Latest Column
Questions are from the latest Standards Q&A column, posted in March 2018.
Mental Health Screening
If the psychiatrist trains the nurses who do health assessments to do mental health screenings, would this be an acceptable way to meet standard E-05 Mental Health Screening and Evaluation?
This standard is essential for both jails and prisons and its intent is to “ensure that the inmate’s serious mental health needs, including those related to developmental disability and/or addictions, are identified.” To answer your question, we must distinguish between the “screening” portion of the standard and the “evaluation” portion.
Mental health screening: Within 14 days, all inmates must receive the initial mental health screening that addresses the issues listed in compliance indicator 2. This screening may be done by qualified mental health professionals or by mental health staff, defined as qualified health care professionals who have received instruction and supervision in identifying and interacting with individuals in need of mental health services. The training you describe by the psychiatrist would meet the intent of this part of the standard.
Mental health evaluation: Regardless of who does the initial screening, when the results are positive for mental health problems, the inmate must be referred to qualified mental health professionals (e.g., psychiatrist, psychologist, psychiatric nurse, psychiatric social worker) for further evaluation as stated in compliance indicator 4.
Juveniles in Adult Facilities
We are a large state prison for male adults but now have four juveniles. They were adjudicated as adults and are serving their time with us. Chronologically, however, they are adolescents. Which NCCHC standards do we follow for them?
You should follow the standards for health services in prisons. You are not required to meet NCCHC’s standards for juvenile facilities in addition to the prison standards just because you house a handful of adolescents. However, standard P-G-02 Patients With Special Health Needs encompasses juveniles and requires the development of a treatment plan and special attention to diet, exercise and nutrition. The juveniles in your facility should be on your list of special needs patients.
Medical Autonomy or Access to Care?
We have been holding sick call in the afternoons. The warden now wants sick call held at 5 a.m. so that inmates can be screened before the workday starts. Isn’t it a violation of the standard on medical autonomy for the warden to tell us to change our sick call time when the existing schedule is preferred by the health professionals?
The standard on medical autonomy (A-03) addresses clinical decisions and actions regarding health care provided to inmates. However, the time that sick call is held is not a clinical issue. The scenario you describe best fits under A-01 Access to Care. This standard requires the responsible health authority to identify and eliminate any barriers to inmates receiving health care. As mentioned in the discussion section of that standard, an unreasonable barrier includes deterring inmates from seeking care for their serious health needs, such as holding sick call at 2 a.m., when this practice is not reasonably related to the needs of the institution. It would be important to explore the reason for the proposed change during administrative meetings and that the decision be made jointly by the corrections administration and the responsible health authority.