Dr. Timothy Belavich answered San Quentin News questions last December about the delivery of health care services to prisoners. Dr. Belavich was formerly acting director of the Division of Health Care Services and deputy director of the Statewide Mental Health Program. He is now employed by Los Angeles County. In previous editions San Quentin News reported his views on the Coleman lawsuit and custody and prison culture. This edition focuses on Suicide and Use of Force. Transgender Special Needs will appear next month.
By Dr. Timothy Belavich
Contributing Writer
Q. Tell us specifically about the programs and policies that have been implemented to reduce the suicide rate.
A. Education for staff, patients and families is an important piece of any suicide prevention program. Suicide prevention posters are located in every institution. Custody staff carries pocket cards that identify suicide warning signs and risk factors. We have created workbooks for inmates placed in restricted housing, and we have disseminated informational pamphlets for inmates and their families and friends. In addition, every institution has an assigned suicide prevention coordinator who is required to attend the Men’s Advisory Council and Inmate Family Council in order to provide education about suicide prevention and to answer questions about mental health concerns.
In order to try to reduce the suicide rate in Administrative Segregation Units (ASU), CDCR increased the frequency of welfare checks in all administrative segregation units and initiated the use of intake cells (cells that have been designed to be suicide-resistant) in ASU. CDCR also developed a workbook for all inmates placed in ASU, and purchased hand-cranked radios for inmate’s use while in ASU. The workbooks and radios were distributed because it was recognized that initial placement in ASU can be emotionally difficult, and it is important for inmates to be able to have a diversion in an isolating environment. The workbooks contain some suicide prevention messages and coping strategies.
Training for health care and custody staff has been revised and expanded. In addition, new training modules and methods for enhancing suicide risk evaluations completed by mental health staff have been developed and implemented. Additionally, a system for monitoring compliance with CDCR’s suicide prevention policies was developed and will become part of the department’s regular monitoring.
Statewide suicide prevention video conferences occur monthly and include medical, nursing, custody, legal and mental health representation at all institutions. Every institution has an assigned Suicide Prevention Coordinator.
Q. What changes have been made in the Use of Force policies and procedures?
A. Mental health is now involved in all situations that may require controlled use of force, whether or not the inmate is a participant in the mental health program, also known as the Mental Health Services Delivery System (MHSDS). Specifically, when controlled use of force is considered, a “cool-down period” is required. A mental health clinician must assess the inmate and determine if the inmate 1) understands the order 2) has difficulty complying with the order and/or 3) if the inmate’s mental health symptoms are likely to get worse if force is used. The mental health clinician will work with the inmate if he is suffering from a mental health related condition. Furthermore, nursing staff will review the health care record to ensure that the use of a chemical agent will not adversely affect an existing health condition. Decisions to use force are now a team decision that involves custody, mental health, nursing and medical staff. If the team cannot agree, the decision about whether to use force is elevated to custody and mental health (and medical, as appropriate) management. Mental health is now involved in all institutional reviews of controlled use of force and immediate use of force incidents involving patients in the MHSDS.
New System Designed to Better Monitor Patient Care
In December, Dr. Timothy Belavich answered San Quentin News questions about the delivery of health care services to prisoners. Belavich was formerly acting director of the Division of Health Care Services and deputy director of Statewide Mental Health Program. He is now employed by Los Angeles County. Dr. Belavich’s answers will be published as a series in the next several editions of the San Quentin News under the headings The Coleman Lawsuit, Custody and Prison Culture, Suicide and Use of Force, and Transgender Special Needs.
THE COLEMAN LAWSUIT:
Can you provide a brief history of the Coleman lawsuit?
In 1996, CDCR settled with Coleman plaintiffs regarding the delivery of care for inmates with mental illness. The original order required (1) proper
screening; (2) timely access to adequate mental health care; (3) competent staff in sufficient numbers; (4) an adequate medical record system; (5) proper administration of psychotropic medication; and (6) a basic suicide prevention program.
CDCR has continued to work with the Coleman monitors in a number of areas, including ensuring patients who require inpatient treatment are appropriately identified and referred, ensuring adequate treatment space and housing for patients with mental illness, and developing a system to monitor and ensure the quality of mental health services.
How can we know that the changes that have occurred as a result of the Coleman lawsuit can be sustainable?
The Mental Health Program, in conjunction with the Division of Adult Institutions (DAI) and the Coleman monitors, has developed a comprehensive system to monitor and evaluate the care provided to mental health patients and to ensure adherence to policies. This program is administered by the Quality Management Unit within the Mental Health Program and is implemented by the regional mental health teams. There are four regional mental health teams, each of which has a Regional Mental Health Administrator, several senior psychologists, support staff, and assigned lieutenants. The regional mental health teams ensure that both mental health and custodial components are compliant. In addition, the Quality Management Unit identifies areas that could be improved and ensures these areas area appropriately addressed.
Of the $10 billion CDCR budget, how much of it goes to Mental Health?
Approximately $400 million.
What other changes can we expect to see in the Mental Health Program in Corrections?
We are continuing to develop additional opportunities for patients at the EOP level of care to earn Milestone credits. Furthermore, we are planning toenhance and expand the substance-abuse treatment offered to patients at the Enhanced Outpatient Level of Care. The Mental Health Program is also
working to expand pre-release activities for patients at the EOP level of care. “Conflict Resolution” and “Coping with ASU” programs are currently in development.
What are the classifications of the various clinicians in the Mental Health Program and what are the requirements to obtain jobs in MHSDS?
The Statewide Mental Health Program employs psychiatrists, psychologists, and clinical social workers. All clinicians must meet credentialing guidelines established by California Correctional Health Care Services.
Do custody officers receive any training on how to intervene effectively with inmates who suffer from mental health conditions?
Yes, this is an ongoing process. First, all custody staff receive an eight-hour course at the cadet academy introducing the Mental Health Program.
This class covers issues such as:
Communicating with someone in crisis.
How to intervene with suicidal patients.
Understanding psychological disorders and how they are exacerbated in prison.
How to best communicate and work with individuals suffering from a mental illness.
Custody staff also receives annual training in crisis intervention and suicide prevention.
Additionally, we are in the process of developing a training specific to understanding and working with EOP patients. This training will be taught collaboratively by mental health and custody and will occur for custody and mental health staff at all EOP institutions.