Basic Mental Health Services

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In today’s economy, some correctional administrators are facing tough decisions that threaten to downsize or even eliminate mental health services. With the number of inmates in need of mental health care on the rise, finding ways to provide adequate mental health services on a limited budget is a common challenge.

NCCHC defines mental health services as the use of a variety of psychosocial and pharmacological therapies, either individual or group, including biological, psychological and social, to alleviate symptoms, attain appropriate functioning and prevent relapse. The Basic Mental Health Services standard (G-04 in the 2008 manuals for jails and prisons) is meant to ensure that inmates with mental health problems are able to maintain their best level of functioning. The immediate goal of treatment is to alleviate symptoms of serious mental disorders and to prevent relapse.

Group counseling should be available to patients who need such service. Groups could be offered by on-site mental health staff, program staff, or community volunteers or mental health agencies. Topics might address parenting, trauma, loss and grief, communication, stress management, wellness for patients with a specific disorder or many other subjects. Many patients can benefit from the support offered in groups; the realization that one is not alone can be instrumental in treatment. Group therapy encourages emotional development, personal responsibility and leadership skills. Note that the G-04 standard requires group counseling and psychosocial/ psychoeducational programs in addition to individual counseling; treatment documentation and follow-up; crisis intervention services; psychotropic medication management, when indicated; and identification and referral of inmates with mental health needs (Compliance Indicator 2). These on-site outpatient services should be in place regardless of the facility type or size.

The standard’s discussion section provides additional guidance: Facilities housing significant numbers of mental health patients with longer lengths of stay are expected to offer more extensive programming, and facilities that provide for patients who require psychiatric hospitalization levels of care are expected to mirror treatment provided in community inpatient settings. This section also discusses acute mental health residential units for facilities that provide this level of care on site for patients who are psychotic, mentally unstable or seriously suicidal. Crisis intervention and provision of appropriate psychotropic medications are also expected for inmates with short lengths of stay and in facilities that transfer inmates with serious mental health problems to other facilities.

When commitment or transfer to an inpatient psychiatric setting is clinically indicated, required procedures should be followed and the transfer should be timely. Until the transfer, the patient should be safely housed and adequately monitored (Compliance Indicator 2).

Additional Standards
Other standards address mental health care, as well. Standard G-01 Chronic Disease Services includes major mental illnesses; therefore, the responsible physician should establish and annually approve clinical protocols consistent with national clinical practice guidelines for management of major mental illnesses (Compliance Indicator 1h). Also, standard G-02 Patients With Special Health Needs applies to patients with serious mental health needs such as psychotic disorders or mood disorders (e.g., manic-depressives), self-mutilators, the aggressive mentally ill, those with post-traumatic stress disorders and suicidal inmates.

Mental health treatment is more than prescribing medication: We want to give patients treatment goals with clear steps to achieve them. Treatment goals may include developing self-understanding, self-improvement and gaining skills to cope with and overcome disabilities associated with various mental disorders. Treatment plans should include the frequency of follow-up for medical evaluation; adjustment of treatment modality as clinically indicated; the type and frequency of diagnostic testing and therapeutic regimens; instructions for diet, exercise, adaptation to the correctional environment and medication; and clinical justifications for any deviation from the protocol (see G-01, Compliance Indicator 2). Treatment plans may also incorporate ways to address patients’ problems and enhance their strengths, involve patients in their development and include relapse prevention risk management strategies. Such strategies should describe signs and symptoms associated with relapse or recurring difficulties (e.g., auditory hallucinations), how the patient thinks a relapse can be averted and how best to help the patient manage crises.

The G-04 standard also requires that outpatients receiving basic mental health services should be seen as clinically indicated, but not less than every 90 days. Those with a chronic mental illness should be seen as prescribed in their individual treatment plans (Compliance Indicator 4).

Coordination of medical, mental health and substance abuse services remains an important component of the standard on basic mental health services. Communication among providers is critical to ensure that comorbid conditions are adequately addressed.

Despite the economy and competing priorities, mental health services must be available for all inmates who require them. But our responsibilities do not end there: Inmates with critical mental health needs must also receive discharge planning (see E-13). They need arrangements or referrals for follow-up services in the community and arrangements for a sufficient supply of medications upon discharge to last until they can be seen in the community.

[This article first appeared in the Summer 2010 issue of CorrectCare.]

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