CDCR’s Answer to Mental Issues and Suicide

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.

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