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. This second series of Dr. Belavich’s answers pertain to custody and the prison culture. In future editions the topics will be Suicide and Use of Force, and Transgender Special Needs.
Custody and Prison Culture:
Overall, what policies/procedures have been implemented to impact the prison culture, particularly with respect to the custodial aspects?
CDCR has implemented several changes that are designed to affect the prison culture. Several years ago, a Custody and Mental Health Collaboration Training was developed and delivered to all custody, nursing and mental health staff at selected institutions, including San Quentin. CDCR is currently developing a training that focuses on techniques that custody staff can use when interacting with patients with mental illness.
Significant changes have been made that impact ASU. Inmates who have been placed in ASU for safety concerns now have greater access to property and privileges. A memorandum in December of 2013 was issued enforcing timeframes for releasing non-disciplinary MHSDS inmates from ASU within timeframes of 30 or 60 days depending on their mental health assigned level of care. Further, a policy was enacted requiring the transfer of MHSDS inmates who are housed in ASU for non-disciplinary reasons to occur within 72 hours of the committee determination.
In the past year, the Rules Violation Report (RVR, i.e., CDCR 115) process was changed significantly for participants in the MHSDS and the Developmental Disabilities Program (DDP) who receives a mental health evaluation related to the RVR. Some processes were newly added and existing processes were more clearly outlined. The inclusion of patients in the DDP is a new component of this process. Clinicians may now recommend that, in certain cases, some rules violations be documented in an alternative manner. This may occur when the behavior was influenced by mental health symptoms, developmental disability or impairments in memory or thinking. Clinicians have always been able to indicate when certain penalties may negatively affect a patient’s mental health. This process has been enhanced by the provision of training for mental health clinicians so that they can better understand what penalties might apply.
In addition, RVRs may not be issued if the patient’s behavior:
occurred in connection with a cell extraction for the administration of involuntary medication; (Involuntary medication occurs in those situations when a patient suffers from a severe mental illness and may present as a danger to him or herself or others, or, he or she is gravely disabled and cannot care for him or herself appropriately);
occurred in connection with a cell extraction for transfer of the inmate to a mental health inpatient facility or between mental health inpatient units;
occurred in connection with being placed in mental health restraints and/or seclusion;
if the behavior is determined to be an act of self-mutilation or attempted suicide.
Custody and mental health staff received new training on the process.
In order to ensure that patients at the Correctional Clinical Case Management System (CCCMS) level of care have equal access to programs, they are now being evaluated for placement at Minimum Support Facilities, from which MHSDS patients were previously excluded.
Over the past year we have created alternatives to ASU for our CCCMS population, with the activation of Short and Long Term Restricted Housing units. These units provide more frequent mental health monitoring, more treatment activities and increased out of cell time.
New policies have been implemented that provide patients at the Enhanced Outpatient Program (EOP) level of care similar opportunities as non-MHSDS or CCCMS inmates in areas such as education and vocation. Eligible EOP patients now have the opportunity to earn Milestone credits. EOP patients are no longer required to undergo unclothed body searches upon returning from treatment activities if they have been under constant staff supervision while out of the cell.
