Basic Mental Health Services

G-04 Basic Mental Health Services (essential)

Mental health services are available for all inmates who require them. – 2008 Standards for Health Services for jails and prisons

Mental health is an overwhelming issue in today’s correctional institutions. With limited community resources, mental health care in jails and prisons may be an individual’s only opportunity for treatment. Providing appropriate care reduces risk, improves safety, and reduces recidivism.

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 (F-03 in the 2018 manuals for jails and prisons) is meant to ensure that individuals 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 F-03 standard requires group counseling and/or 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 individuals 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. 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 individuals with short lengths of stay and in facilities that transfer those 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 3).

Additional Standards

Other standards address mental health care, as well. Standard F-01 Patients with Chronic Disease Services and Other Special Needs 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 Indicators 2 and 3). This standard also encompassess special needs patients, defined below in F-01 as:

a. Chronic diseases (see F-01 Patients With Chronic Disease and Other Special Needs)
b. Dialysis
c. Communicable diseases
d. Physical disability
e. Pregnancy
f. Frailty or old age
g. Terminal illness
h. Mental illness
i. Suicidal intent
j. Developmental disability
k. Intellectual disability
l. Physical or sexual abuse
m. Physical or mental contraindications to restraint or seclusion
n. Gender dysphoria, transgender

Mental health treatment is more than prescribing medication: We need 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 F-01, Compliance Indicator 6). 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 F-03 standard also requires that outpatients receiving basic mental health services should be seen as clinically indicated.

Coordination of medical, mental health and substance abuse services remains an important component of the standard on basic mental health services (F-03, Compliance Indicator 5). Communication among providers is critical to ensure that comorbid conditions are adequately addressed.

Despite competing priorities, mental health services must be available for all individuals who require them. But our responsibilities do not end there: Patients with critical mental health needs must also receive discharge planning (see E-10). They need arrangements or referrals for follow-up services in the community and arrangements for a reasonable supply of medications upon discharge to last until they can be seen in the community.