Jail Triage - BLUEGRASS

Jail Triage - BLUEGRASS

Jail Triage Duty to Protect Program Goals Lessen the likelihood of custodial suicide Help Jails manage mental health crises Triage Objectives Identify inmates at risk for suicide

Identify inmates with serious mental Illness Operational Objectives Proper restraint and housing Timely observation and documentation Timely and reasonable provision of suicide risk management

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

How Jail Triage Works Free to Participating Jails Inmates at risk for Suicide or Mental Health Crisis Call 877-266-2602 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 Identifying Jail Risk When to Triage Any time suicide or mental health concerns arise 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 arrestees reaction to arrest suggests risk of self harm arrestees behaviors suggest mental illness At Booking / Screening

Arrestee reports prior suicide attempts Arrestee reports current suicide ideation Arrestee reports hospitalization for mental illness in the past year Arrestee reports a serious mental health condition Institutional ALERTS

Prior critical or high risk for suicide or self harm Prior critical or high risk for serious mental illness 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 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 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 including requests for segregation 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 Risk Leveling Critical High

Moderate Low Critical Risk Critical Active suicide attempts Other self injurious behavior

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 Moderate Risk Moderate Suicidal history between 2 and 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 Low Risk Low Suicide history of attempts older than 10 years

Minor mental health history Absence of other compounding risk factors Recommended Jail Protocol Critical High Moderate Low Housing

Restraint Chair Single or Safe Cell General Population General Population Observation Constant Frequent and Staggered Individualized Normal

Property None None or Suicide Blanket Full Full Clothing Regular Suicide Smock Jump Suit

Jump Suit Food Finger Finger Regular Regular 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 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 Fail Safe Regardless of recommendation, when in doubt call: JAIL TRIAGE 877-266-2602

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. 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 inmates 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 inmates risk level and make recommendations accordingly. 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. 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 Jail Triage 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 health contact information or number for the community mental health crisis line 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 Community MH Crisis Line Numbers Community Engagement As the jail assumes a duty to protect inmates from suicide, it is prudent to engage an inmates 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. 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.

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