All Jails and Prisons have their own ideas of what the Mental Health Clinician’s Role is. Some are more like Case Managers, some need Bachelors Degrees and others require a Masters or Ph.D. I want to talk about the roles of the MH clinician and the Why of these roles.
Jails and prisons from State to State vary in the role of the MH practitioner.
A few years ago, I was very overwhelmed and talked to Dr. Keller about how I was getting more business than I could handle. Jeff told me that it was my own fault and I needed to learn how to say “no” to people.
If someone has informed me of a potential risk, I will prioritize that person first.
Discuss Pt.’s needing to be in for 30 days prior to referral to clinic. Also talk about needing to have 2 visits 2 weeks apart to meet DSM criteria prior to doing a provisional diagnosis. Discuss being able to observe Pt.’s in the jail prior to seeing them. Then we know how they have been acting. Ask the deputies questions about the Pt. They will know how they have been acting.
Story of sitting in on visit with the kid that wanted Seroquel. To me he said it was for Psychosis and to the doc he said it was for sleep? Often the stories are different. Communication is key.
Discuss delayed gratification
Discuss: www.getselfhelp.co.uk Importance of giving something to work on. Discuss survey where it shows it helps inmates be more compliant to the rules. Don’t open up a can of worms. Discuss when I got overwhelmed and Dr. Keller told me to learn how to set boundaries/limits and I did so it slowed down. Sometimes it takes an hour.
I don’t like to have people committed until we know what is going to happen to them. Best for them not to go the the hospital then back to jail Just had that happen with Haas and she is much worse off now. Discuss the case of the Jerome County Captain just taking the inmate to the Psych Hospital without involving mental health practitioner. Made it a lot harder.
Correctional CounselingThe Mental Health Clinician Roles And Responsibilities
Inmates/Staff Opinion?• “The counselor is there to listen and spend time with the inmates to help them work through their problems”. Nurse BCJ• “Assessing and determining the true mental deficit of the inmate”. Nurse BCJ.
Roles of the Mental Health Clinician• Risk Management• Mental Health Assessments• Referral to Medical Practitioner• Counseling/Classes• Mental Commitments• Officer Training and Education
Favorite “MH” Complaints10. I need a second mattress and medical would not give me one.9. I would rather be in the hospital.8. I have been having problems for years and I am ready to change now. Change Me!7. I need to be on a bottom bunk in the corner, it would help my mental health.6. I don’t like being around a lot of people, can you give me my own room.5. I have been off meds for 5 years and I need to get back on them.4. People are pissing me off so bad, I need to get on meds or I am going to get a new charge for fighting. It’s your fault if I get in a fight.3. I am having terrible nightmares and PTSD.2. I can’t focus or concentrate1. I can’t sleep!
Risk Management Priorities• Suicide Screenings• Referrals from Deputies• Practitioner/Medical Staff• Family or Friends• Other inmates• Inmates in Special Housing Areas
Mental Health Evaluations• What is the purpose of the evaluation?• “Provisional Diagnosis”• What is "normal" in a jail environment?• What are community standards?• How long the inmate waits prior to evaluation?
Referral to Medical Practitioner• MH Clinician the “Gatekeeper” for Patients to get into medical clinic.• Documentation/Communication are vital for the Practitioner and Mental Health.• COR EMR Rocks!
The Why• Wait for the Pt. to be incarcerated at least 30 days before changing, starting, or assessing for medication. (some exceptions)• Patients should be seen at least 2 times, and 2 weeks apart for the diagnosis.• It is very helpful to spend time monitoring Patients in the Pod during those 2 weeks.• It is helpful to get staff opinion about the Patient.
Group and Individual Counseling • Giving assignments to inmates • Educational material • Groups and Individual Counseling • You must treat the Antisocial first
The Why• I love Cognitive material which will focus on treating the Antisocial.• Don’t open up a can of worms if you can’t put them back in.• Dismissing a Participant from class every once in awhile is very effective for the group.• Have Class Mon, Tues, Wed., Thurs…• Set up boundaries.
Mental Commitments• Process varies State to State, even County to County• Alert the legal system of concerns of Gravely, Danger to self or others, lack ability to make informed decisions.• Consider length of stay prior to starting process?• Other housing issues to consider- Malingering
Lessons Learned• Don’t get into a hurry.• What will they do in a hospital that we can do here? They will keep an eye on them and get them on medication…we can do that.• The truly SPMI Patients are like cream, they always rise to the top.
Officer Training and Education• On the job training in Mental Health.• Emotional Survival and Wellness• Referral to EAP Provider or Admin.
Lessons Learned• Don’t do role plays with correctional officers…they ALWAYS go bad.• There are a lot of “Teaching Moments” in a day if we take the opportunity.• Don’t be afraid to be “brutally honest”.
Team Player• Corrections Staff, Medical and Mental Health Staff must communicate effectively. We are a Team.• “If mental health providers can maintain the perspective that provisions of services in correctional settings is subordinate to the primary missions of safety and security, then it will be easier for them to communicate effectively about therapeutic concepts such as mental illness, voluntary disruptive behavior by antisocial offenders, and least restrictive alternatives for those who are genuinely mentally ill.” (Fagan and Ax, 2003)