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The over-representation of individuals with behavioral health challenges in the criminal justice system is not a new problem or a problem isolated to the Commonwealth of Virginia. Rather, for many years most states have reported having more individuals with behavioral health challenges incarcerated than are reported in national community prevalence rates. While the Department of Behavioral Health & Developmental Services (DBHDS) continues to encourage and support the development of criminal justice diversion programs for individuals with serious mental illness who can be more effectively treated in the community (without significantly increasing community risk), it remains likely that individuals with behavioral health challenges will continue to be incarcerated as not all cases can or should be diverted. To that end, it became evident that there was a need for the development of recommendations for minimum standards for behavioral healthcare in jails.
During the Spring/Summer of 201 8 DBHDS formed a workgroup comprised of criminal justice professionals, behavioral health professionals, advocates, and other stakeholders to aid in the development of recommended minimum standards for behavioral healthcare in local/regional jails. The workgroup used existing, published best practice standards to guide its work. In the end the workgroup identified 14 standards for behavioral healthcare which should be available to all individuals incarcerated in jails within the Commonwealth. Thirteen of the standards were identified as essential and one was identified as a best practice (but not necessarily essential). The workgroup identified compliance indictors, explored the degree to which jails were already meeting the recommended standards, barriers to implementation, and what, if any resources would be required for full adoption. The workgroup also made recommendations regarding compliance monitoring and enforcement of the standards. Finally, the workgroup offered some insights about the benefits and challenges of having Community Service Boards (CSBs) serve as the primary provider of jail based mental health services. The 14 recommended minimum standards for behavioral health/mental health presented in this report include:
- Access to Care - Inmates have access to care to meet their mental health needs.
- Policies & Procedures - The facility has a manual or compilation of policies and defined procedures regarding mental health care services which may be part of larger health care manual.
- Communication of Patient Needs - Communication occurs between the facility administration and treating mental health care professionals regarding inmates' significant mental health needs.
- Mental Health Training for Correctional Officers - A training program established or approved by the responsible health authority in cooperation with the facility administration guides the mental health related training of all correctional officers who work with inmates.
- Mental Health Care Liaison - A designated, trained mental health care liaison coordinates the health services delivery in the facility on those days when no qualified health care professionals available for 24 hours.
- Medication Services - Medication services are clinically appropriate and provided in a timely, safe and sufficient manner.
- Mental Health Screening - Mental health screening is performed on all inmates on arrival at the intake facility to ensure that emergent and urgent mental health needs are met.
- Mental Health Assessment - All inmates receive mental health screening; inmates with positive screens receive a mental health assessment.
- Emergency Services - The facility provides 24 hour emergency mental health services.
- Restrictive Housing - When an inmate is held in restrictive housing, staff monitor his or her mental health.
- Continuity & Coordination of Health Care During Incarceration - All aspects of health care are coordinated and monitored from admission to discharge.
- Discharge Planning - Discharge planning is provided for inmates with mental health needs whose release is imminent.
- Basic Mental Health Services - Mental health services are available for all inmates who need services.
- Suicide Prevention Program - The facility identifies suicidal inmates and intervenes appropriately.