Designing for Special-Needs Inmates
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In 2005, an exploratory team was formed at Washington County Jail in Hillsboro, Ore., to develop and evaluate a more effective housing solution for vulnerable or at-risk inmates. Based on the findings of the pilot study of the Special Needs Pod program, the SNP is now a permanent fixture at the jail.
The SNP, which is classified as a general population setting, was established with no additional funding, increases in staffing levels or structural changes to the facility.
In July, the National Commission on Correctional Health recognized the SNP program with the 2009 Program of the Year Award.
Defining Concerns
Mirroring a trend that has impacted jails throughout the United States since the 1980s, the characteristics of the county’s inmate population has undergone a significant shift as the number of offenders with serious mental health conditions increased during the last decade.
Previously, the small percentage of incoming inmates with serious mental health problems did not present major operational difficulties. Offenders with acute mental health issues were transported to one of the area’s dedicated mental health treatment facilities, such as the state psychiatric hospital, which could deliver appropriate treatment in a specialized setting.
The closure of these dedicated facilities and elimination of specialized treatment and services have transformed the local jail into the mental health institution of first and last resort. Ever year, the number of jail bookings of mentally ill offenders and the acuity of mental health conditions continue to increase.
Genesis
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Colpean |
Iverson |
The relatively simple two-part question, “Why does it take so much longer to pass medications, and what can be done to improve efficiency?” was the catalyst for the exploration of special needs inmate management — the jail’s medication pass had increased from a two-hour task for medical staff to one that required several hours per shift to complete.
A working group, headed by a facility sergeant and composed of jail personnel, was created to explore the pros and cons of creating a specialized housing unit.
The group’s findings highlighted the need for a specialized housing plan and management program and the potential that existed to generate operational efficiencies and optimize the management of special needs inmates.
The number of inmates being prescribed psychotropic medications daily had increased from a relatively small number to an average of 70-90 inmates during the last 10 years. In addition, inmates treated with psychotropic medications were dispersed throughout facility housing units.
Inmates identified as at-risk were segregated under more extensive supervision and housed in the intensive-management pod or medical-observation unit. All other inmates on a psychotropic medication regimen or those with unmedicated mental health issues and stable behaviors were housed throughout the general population pods.
Although there were concerns that placing the majority of potentially disruptive inmates in the same housing area could prove disruptive for staff and inmates, the team agreed that by centrally housing inmates on psychotropic medications, they would at the very least reduce the time needed to complete daily medication passes.
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After the plan was initiated, correctional and medical staff members visited a special-needs unit at Hillsborough County Jail in Florida to observe operations and established practices.
Prison Health Services and the SNP team piloted the special needs program for approximately one year before presenting findings to the jail’s command staff, who implemented the final report’s recommendation to formalize the SNP with a dedicated staff as standard operational practice at the jail.
Target Population
The SNP target population comprises offenders with major mental health disorders, developmental disabilities and certain physical limitations, an emotional liability or a history of head trauma or attempted suicide, and extremely young or geriatric inmates.
Inmates with mental health issues who choose not to participate in medication management are also housed in the SNP as long as their behavior remains relatively stable.
SNP inmate identification is initiated by correctional and medical staff during the intake screening process and is based on observation, stated medical/-mental health issues and behavior during previous incarceration. The jail’s classification unit can also make SNP referrals, with classification interviews generally conducted within 48 hours of intake. Mental health staff can identify potential special needs inmates following referral to the daily mental health triage list.
Tailored Management
The SNP is the only area in the jail with a designated pool of correctional officers. Creating a team of exclusive-assignment officers helps staff become familiar with inmate behavioral patterns and issues, and promotes continuity in operational standards that differ from the other general population housing pods.
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Successful management of mental health inmates requires knowledge and understanding of special needs and a flexible approach to supervision. Assignment to the SNP is voluntary, attracting officers with strengths and skill sets better suited to this type of inmate population.
Twice weekly SNP team meetings — with brief training talks about specific mental health and operational issues, strategies and tools — allow staff to discuss specific inmates, operational issues and the management of medical/mental health conditions. The meetings facilitate ongoing communication between correctional and medical staff regarding the care and management of the SNP inmates, and provide open forum to discuss procedures, obstacles and ideas.
Training covers all major DSM Axis I and Axis II diagnoses, psychotropic medications, substance abuse, plus extensive suicide-prevention training and behavioral and symptom management skills.
Operational innovations implemented under the SNP model, such as having a mental health staff member on duty to accompany the medication passer to the pod for afternoon medication pass, allow mental health staff to remain fully aware of compliance issues while creating a consistent staff presence.
The SNP also maintains a staff communication log in which inmate information and observations are recorded. Each day, the mental health staff member can check the log for any updates or events, such as abnormal or symptomatic behaviors, medication and meal refusals and isolating behaviors that may warrant action. This log is instrumental in facilitating early interventions and avoiding potentially problematic situations before any unnecessary escalation occurs.
Medical staff can also identify an inmate for enhanced attention/observation, flagging the inmate and prompting officers to more closely monitor behavior and watch for risk factors that could lead to a change in housing assignment, security classification or mental health treatment approaches.
Observed Outcomes
The SNP allows the medication pass to be completed in half the time required prior to the creation of the housing unit and the number of inmates complying with prescribed psychiatric medication regimens increased 20 percent.
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The program allows medical/mental health staff to have more efficient access to inmates. The number of inmates seen by the mental health team increased 111 percent, while the number of inmates seen by nursing staff increased 45 percent.
Moving mentally ill inmates previously housed in the jail’s impacted medical unit to the special needs unit opened up valuable medical beds more appropriate for the treatment of inmates with medical conditions.
During the first year of SNP operation, the number of inmates on suicide watch decreased 12 percent and the facility reported one attempted suicide. The number of incident and disciplinary reports at the jail decreased 50 percent in the first year and remains low three years later.
Implementation of the SNP established lines of communication and information sharing among various staffs where no regular, formalized communication pathways previously existed.
Centralization of the special needs population has made discharge planning and coordination with outside treatment providers more efficient, and has resulted in reductions in the length of stay.
Positive Externalities
Following the creation of the SNP and centralized housing of special needs inmates, jail personnel have reported a reduction in overall tensions within the general population housing areas. Victimization and intimidation of inmates has declined and the number of grievances filed by inmates has decreased by 50 percent.
The SNP has established a nonthreatening environment of positive understanding, support and socialization for special-needs inmates. General population pods are placed on lockdown less frequently, increasing the amount of time inmates spend out of their cells.
Even though it houses some of the most challenging inmates, monthly command inspections consistently rank the SNP as one of the most organized, well maintained and least disruptive pods in the facility.
Sgt. Todd Iverson, who is the SNP team leader, has been a member of the Washington County Sheriff’s Office for 19 years. Robert Colpean, MSW, is an employee of Prison Health Services and has worked at the Washington County Sheriff’s Office for five years.