Department Operations Manual

91020.1 Policy The Department shall receive, evaluate, house, treat, and/or refer all psychiatrically disturbed inmates who by virtue of their mental illness are unable to appropriately function within the constraints of the usual correctional processing or program assignments. 91020.2

91020.2 Purpose To provide for the detection, diagnosis, treatment, and referral of inmates with mental health problems and to assist each facility's Warden during all stages of each inmate's period of incarceration. 91020.3

91020.3 Plan for Mental Health Programs The Deputy Director, HCSD, shall maintain the delivery of mental health services and programs to inmates and parolees. Such services and programs shall include the following: • Provisions for mental health care to all inmates and parolees with emphasis on identification of need while in reception and prerelease processing. • Provision for diagnosis and treatment of voluntary patients. • Provision for involuntary diagnostic and treatment services with appropriate safeguards against abuse and means for appeal and relief. • POCs shall provide mental health services to parolees, reporting administratively to P&CSD, and reporting professionally to the Deputy Director, HCSD. • An ongoing program to assess the needs of current departmental population. • Priorities for the use of limited resources and plans for improving existing programs or initiating new programs. • Criteria for referring for services within the Department and to other agencies. • A program review and evaluation activity. 91020.4

91020.4 Services Each institution shall provide staff, space, equipment, and supplies for the treatment and/or referral of inmates with mental disorders requiring care. Each institution shall provide 24-hour emergency service. • All departmental staff, by their supervisors, shall apprise institutional management when this procedure and/or professional standards are not being followed or met. 91020.5

91020.5 How Services are Obtained Departmental employees may refer an inmate to an institution's mental health services or the inmate may submit a request for such services. 91020.6

91020.6 On-Site Services Inpatient psychiatric services shall be provided at the: • CMF. • CIM. Outpatient services or arrangements for appropriate referrals shall be provided at all institutions. 91020.7

91020.7 Routine Referrals The treating physician at any facility may initiate a referral to any psychiatric resource by contacting the designated facility Chief Psychiatrist (CP) or equivalent. The referring facility shall arrange transportation. The receiving facility may request further evaluation prior to transfer. Placement and assignment procedures for psychiatric treatment categories, including documentation and CSR endorsement, shall be as outlined in the DOM 62050 and 62080. 91020.8

91020.8 Category "I" A classification of Category "I" for males and "I" or "Psychotic" for females is assigned to inmates who are believed to be: • Acutely psychotic, severely depressed, or suicidal. • Mentally ill inmates who are management problems, providing the psychosis warrants treatment in a hospital setting. 91020.8.1

91020.8.1 Category "I" Transfers Category "I" care is provided at CMF or at the CIW. Category "I" designation shall only be made by CMF or CIW staff. Other institutions with inmates who appear to meet Category "I" criteria shall transfer such cases to CMF or CIW for psychiatric observation. When an inmate believed to be mentally ill is transferred to a psychiatric program and later found not to be mentally ill, they shall be returned to the sending institution without CSR review. The DMH provides inpatient services for inmates transferred from the Department in accordance with PC 2684 and at CMF by interdepartmental contract. 91020.8.2

91020.8.2 Mental Health Evaluations When an inmate is transferred for a comprehensive mental health evaluation by a multiple disciplinary mental health team, it shall take place within 14 days after the date of transfer. The evaluation shall include at least the following: • Review of mental health screening and appraisal data. • Collection and review of additional data from staff observation. • Individual diagnostic interviews and tests assessing intellect and coping abilities. • Compilation of individual's mental health history. • Development and overall treatment/management plan with referrals. 91020.9

91020.9 Off-Site Services The Department maintains interdepartmental agreements to transfer mentally ill or mentally deficient inmates or parolees to DMH or the Department of Developmental Services for treatment. 91020.10

91020.10 Records Records for each inmate housed by DMH shall be maintained by the respective "hub" institution (refer to DOM 62030). The "hub" institution and P&CSD staff shall make all contacts with the designated DMH facility to secure reports, schedule BPT hearings, and to process an inmate's parole or discharge. Any report needed for BPT hearings, Superior Court, or other such proceeding shall be requested of DMH to prepare the report or send the departmental staff person to the hospital to complete the report. 91020.11

91020.11 Inpatient Facility The psychiatric inpatient unit shall treat mentally disordered patients with any psychiatric illness or disease, whether functional or of organic origin, requiring inpatient-level care. 91020.11.1

91020.11.1 Inpatient Facilities Requirements The CP shall: • Administer medical care and services for the unit, including all acts of diagnosis, treatment, prescribing, and ordering of drugs. • Develop a plan for treating and/or referral of patients with emergency medical problems. • Chair a committee to identify and recommend to administration necessary equipment and supplies. 91020.11.2

91020.11.2 Psychiatrists The psychiatrist shall: • Prepare the diagnostic formulation for each inmate. • Develop and implement individual treatment plans. • Determine frequency of medical examinations. Reports of all medical examinations shall be placed in the inmate's medical record file. Only medical staff shall order an inmate removed from general housing status for medical or psychiatric reasons. 91020.11.3

91020.11.3 Clinical Psychologists Psychological services shall be provided by clinical psychologists. Clinical psychologists are members of the medical staff and shall have admitting privileges within departmental medical facilities. 91020.11.4

91020.11.4 Social Worker Services A social worker shall be used for the rendering of social services: • At the request of the patient's attending physician. • At the request of management staff. 91020.11.5

91020.11.5 Psychiatric Nursing A nurse with at least two years experience in psychiatric nursing shall provide the nursing management of the psychiatric unit. Operations Manual Chapter 9 824 There shall be an RN with training and experience in psychiatric nursing on duty at all times in an institution having a psychiatric unit. There shall be sufficient nursing staff including RNs, MTAs, Licensed Vocational Nurses (LVN), and mental health workers to meet the needs of inmates. Nursing activity documentation shall be forwarded to the unit CP. 91020.12

91020.12 Therapeutic Programs Every inpatient unit shall: • Provide and conduct organized programs of therapeutic activities in accordance with the interests, abilities, and personal and custodial needs of the inmate. • Develop and record an individual evaluation and treatment plan which is correlated with the total therapeutic program. Qualified therapists shall be employed to conduct the therapeutic activity program that may include: • Occupational. • Music. • Art. • Dance. • Recreation. 91020.13

91020.13 Inmate Patient Rights Each inmate patient shall have the same rights as all other inmates unless the physician has good cause to deny an inmate any of the rights specified. The denial and reasons shall be entered in the inmate's medical record. 91020.14