Jail Triage

1. Jail Triage

2. Duty to Protect

3. Program Goals • Lessen the likelihood of custodial suicide • Help Jails manage mental health crises

4. Triage Objectives • Identify inmates at risk for suicide • Identify inmates with serious mental Illness

5. Operational Objectives • Proper restraint and housing • Timely observation and documentation • Timely and reasonable provision of suicide risk management

6. Operational Failures • Knowledge of a behavioral health risk • Understanding the consequences of the risk • Wanton or intentional failure to reasonably avoid the risk • Resulting harm from the failure

7. How Jail Triage Works

8. Free to Participating Jails • Inmates at risk for Suicide or Mental Health Crisis Call 877-266-2602

9. Triage Assessment Once a risk has been Identified a call to the Jail Triage line will begin the assessment process to determine: • Level of risk: Critical, High, Moderate, Low • Recommended jail protocols • Follow-up requirements

10. Identifying Jail Risk

11. When to Triage • Any time suicide or mental health concerns arise

12. At Intake When arresting or transporting officer responds to Jail Intake Assessment questions • arrestee makes statements of self harm • family or friends warn of statements or actions indicating self harm • arrestee’s reaction to arrest suggests risk of self harm • arrestee’s behaviors suggest mental illness

13. At Booking /Screening • Arrestee reports prior suicide attempts • Arrestee reports current suicide ideation • Arrestee reports hospitalization for mental illness in the past year • Arrestee reportsa serious mental health condition

14. Institutional ALERTS • Prior critical or high risk for suicide or self harm • Prior critical or high risk for serious mental illness

15. Event-Driven Risk • In response to a disciplinary action • In response to severity of charge or length of sentence • In response to upsetting court appearance or news about case • In response to a bad phone call or visit • In response to the death of a loved one

16. Observation of Risk • Another inmate expresses concern for self harm • Staff observe indices of suicidal intent or actions • Inmate presents overt signs of depression, psychosis or other acute distress • Family or another third party contacts the jail to express concern

17. Overt Symptoms of Distress • Making instruments of suicide: noose, shank, hoarding medication • Engaging in self injury: Self mutilation, head banging • Refusing meals, medication • Terminating communication: letters, phone calls, visits • Declining showers, recreation, commissary • Saying goodbye, giving away property, preparing will • Exhibiting significant emotional distress, agitation, or withdrawal includingrequests for segregation

18. The Jail Triage Process Jail staff will be asked to provide Triage with basic information from all available sources such as: • Name, SSN, DOB, charges noting felonies, booking date, known substances in use, withdrawal potential, any flags they had at booking. • The concern that prompted the call to Triage • Any past institutional ALERTS • Current inmate presentation

19. Risk Leveling • Critical • High • Moderate • Low

20. Critical Risk Critical • Active suicide attempts • Other self injurious behavior

21. High Risk High • Active suicidal thoughts • History of suicide attempts less than 2 years old • Concern related to charge related risk • Agitated psychosis • Lower level risk compounded by such things as substance use that jeopardizes inmate's immediate safety

22. Moderate Risk Moderate • Suicidal history between 2and 10 years old • Family history of completed suicide • Significant MH treatment history • Psychiatric hospitalization in last year • Active emotional distress without suicide ideation • Lower level risk compounded by added risk factors

23. Low Risk Low • Suicide history of attempts older than 10 years • Minor mental health history • Absence of other compounding risk factors

24. Recommended Jail Protocol

25. Kingsley v. Hendrickson Any force used to prevent suicide or other injury must be objectively reasonable. For example: • Using a safety chair to prevent an active suicide attempt is preferable to forced clothing removal for subsequent placement in a suicide smock. • It is reasoned that the safety chair is less traumatic than a forced clothing removal • Placement in a safety chair after clothing removal in a smock further traumatizes the inmate as the smock often fails to cover genitals and is often recorded

26. Clinician Recommendations • Maintain risk level pending contact with mental health within a specified time frame • Maintain risk level for a specified timeframe and then call Jail Triage again to retriage • Maintain the risk level for a specified period of time and then reduce to the next lower level if no concerns arise

27. Fail Safe • Regardless of recommendation, when in doubt call: JAIL TRIAGE 877-266-2602

28. Mental Health Follow-Up • Jail Triage may recommend contact with local mental health for further suicide assessment. • Jail staff will be responsible for making the inmate available once mental health contacts the jail to speak to the inmate. • In the event of inmate refusal or safety concerns regarding this contact, the risk level will be maintained pending a follow-up call to Jail Triage • In addition to leveling recommendations, mental health may suggest such things as involuntary hospitalization, use of inmate watchers, or referrals to medical, the chaplain, internal mental health staff, or ongoing treatment options. • Using Jail Triage does not preclude contracting with local mental health for additional services as jail administration sees fit.

29. Retriage If a retriage is recommended, jail staff initiates this by calling Jail Triage after the recommended timeframe. • Jail staff should be prepared with all documentation to date on inmate, including recommendations made after any contact with local mental health. • Jail staff will also be asked if inmate continues to report any thoughts of suicide or other distress, about inmate’s current presentation and any other changes in status since the last triage or contact with mental health. • Triage staff will use this information to reassess inmate’s risk level and make recommendations accordingly.

30. 202a Commitments • 202a assessments for involuntary psychiatric hospitalizations are provided by the local mental health agency serving that judicial district • Jail Triage cannot initiate a 202a petition or perform the assessment but can provide Jail Triage information to the local MH provider if requested • If the jail receives a 202a petition or initiates paperwork for a 202a assessment, the appropriate contact is the local mental health provider.

31. Jail Triage Limitations • The legal jurisdiction of Jail Triage begins when custody is accepted and ends upon legal release or custody transfer from the holding jail • Risk leveling by JailTriage applies to in-custody assessments and not to community release • Any inmate being released from the jail that was on a high or critical risk leveling status will be advised to seek community MH services • In the case where a critical or high risk inmate is being released from custody the jail should consider providing: • A 202a referral • A call to the inmate's emergency contact number • Business card with community mental healthcontact information or number for the community mental health crisis line

32. Community MH Crisis Line Numbers • Adanta - 800-633-5599 • Bluegrass –800-928-8000 • Centerstone- 800-221-0446 • Communicare – 800-641-4673 • Comprehend- 877-852-1523 • Cumberland River- 606-864-2104/ 800-273-8255 (after hours) • Four Rivers- 800-592-3980 • Kentucky River- 800-262-7491 • LifeSkills- 800-223-8913 • Mountain Comp- 800-422-1060 • NorthKey- 877-331-3292 • Pathways- 800-562-8909 • Pennyroyal- 877-473-7766 • River Valley – 800-433-7291

33. Community Engagement • As the jail assumes a duty to protect inmates from suicide, it is prudent to engage an inmate’s family, friends and professional associates in suicide prevention. Signage and phone messaging should advise significant others as to their responsibility to notify the jail staff of any inmate action or communication that threatens the safety of an inmate. We all share the responsibility to prevent harm to those in custody.

34. MH Jail Training • 4 hours of MH training required during the first year of service • 1 hour of mental health training required each year thereafter • Jail Triage is willing to provide that training for a fee • Jail Triage online training materials available at www.bluegrass.org.Click the Jail Triage link at the bottom of the home page.