County Affairs Presentation on Mental Health July 30, 2015
2009-Sunset Review As part of Sunset, Commission is given two major duties Enforcement of Code of Criminal Procedure 16.22 Investigate number & nature of inmate deaths As part of a set of risk factors to determine county jails at risk for noncompliance. Prior to 2009, Commission did not have the authority to investigate jail deaths. Two new duties forced the Commission to look more closely at how jailers were completing the intake screening form.
CCP 16.22 requires a sheriff to notify a magistrate if the sheriff has credible information that an inmate in the sheriff s custody is suspected of having a mental illness. Commission modified the Assessment for Suicide, Medical and Mental Impairments intake form to enforce CCP 16.22 Form is to be completed immediately upon intake of all county jail inmates.
September 2009-Commission begins enforcement of CCP 16.22 Sept. 2010-Oct.2012 The Commission becomes increasingly aware that jailers were misinterpreting CCP 16.22. During custodial death investigations, jailers frequently told Commission staff that they did not notify a magistrate though there were red-flag indicators on the intake screening form. Jailers believed that the inmate had to be in crisis or suicidal before they could or should notify a magistrate.
October 2012 Commission staff approached TCOOMMI about solutions for jailers to recognize when they should notify a magistrate. It was decided that Commission staff would develop a training module to train jailers how to properly assess for mental illness and suicide. It was further decided that Local Mental Health Authority staff should assist with teaching the course in the hope that better relationships between LMHAs and county jail staff would develop. In addition, TCOOMMI staff volunteered to develop a notification guide of when to notify a magistrate and/or a Local Mental Health Authority.
March 2013 In its monthly newsletter, Commission staff included an article about using a CCQ match as a source of credible information to notify a magistrate in compliance with CCP 16.22. April 2013 Commission staff completed the first draft of the assessment training module and sent it to TCOOMMI staff for comment. Commission staff also sent it to TCOLE and UTMB for collaboration and comment. In addition, the Commission sent the training module to selected sheriffs and jail administrators for comment. Based on all the comments received, the Commission revised the training module. The Commission requested that TCOLE issue a course number so that jailers may receive TCOLE credit, which TCOLE did.
July 2013-The training course goes live with 211 participants receiving training by the end of FY 2013. The Commission also created a resource guide for completing the intake screening form. The course is offered for free. August 2013-Commission staff presented the assessment training course at TCOOMMI s meeting of all LMHA program directors. During the presentation, Commission and TCOOMMI staff requested that LMHA personnel assist Commission trainers when the course was scheduled in the LMHA s area. To date, almost every LMHA has sent staff to assist with the assessment training course when requested.
November 2013 Though not related to CCP 16.22, TCOOMMI, DSHS-state hospital division, and the Commission began a monthly conference call after the death of two county jail inmates. The circumstances of one of the deaths required the involvement of all three agencies. Upon completion of the death investigations, all agencies agreed to a monthly collaborative conference call to troubleshoot problems involving special needs offenders of each agency and discuss other mental health issues. The monthly collaborative call continues to date.
August 2014- In FY 2014, 824 participants received training in assessing for suicide, medical, and mental impairments. July 2015-In FY 2015, 88 participants have received training in assessing for suicide. medical, and mental impairments
1. Revision of intake screening form in collaboration with TCOOMMI and DSHS. Justification-Current intake screening was created circa 2000 with TCOOMMI advisory group. Since then, better screening tools are now available. 2. Non-crisis inmates suspected of having a mental illness shall be assessed by a medical professional with mental health training or a mental health professional within 8 hours of intake. Justification-Current administrative rules require a one-hour response by an LMHA if an inmate is in crisis or suicidal. However, for inmates not in crisis, the wait time can be a few hours to days for an evaluation if there is suspected mental illness. The inmate should be assessed by a mental health professional and collaborate with security/medical staff regarding supervision level, medications, and
3. Appropriations for CCP 16.22 Magistrate-ordered assessments Justification-The state mandates that magistrates order an assessment of persons suspected of having a mental illness, yet provides little to no funding for these assessments. The state should contribute a percentage along with counties and LMHAs. 4. Mandatory mental health training with focus on Code of Criminal Procedure 16.22, 17.032 and 46B training for peace officers, jail staff, magistrates, county and district judges, defense attorneys, prosecutors. Justification-County jails often receive resistance from magistrates regarding CCP 16.22 referrals because magistrates are unsure of their role and responsibilities. Approximately 60 inmates 46B inmates with dementia have been sent to state hospitals for restoration when there is no hope of restoration. Many of these inmates are utilizing limited resources when they may be better served in a nursing home. SB 1507, 84 th Legislature, requires DSHS to provide mental health training to judicial personnel. Training is currently in development.
5. Require the Texas Uniform Health Status Update (TUHS) form between county jails, prisons, and state hospitals. Justification-The form is currently utilized between county jails and prisons; however, many inmates are arriving at state hospitals with severe medical needs that the hospital was not prepared for. 6. Require minimum of 72-hour notice of sending entity to receiving entity of a special needs inmate/client, including severe medical issues. Justification-The Commission was notified that county jails were sending inmates to TDCJ and State Hospitals with severe medical and mental health issues without notifying the receiving entity. This requirement would be reciprocal among all entities.
7. Require compilation and publication of mental health formulary of all criminal justice and mental health entities Justification-Often, inmates/clients are prescribed medications that are not on receiving entities formulary. If entities are aware of each other s formulary, medication stabilization may be better achieved. 8. State Appropriations for jail case managers with all 39 Community Centers (Example-Bluebonnet Trails Model-Williamson County LMHA) Justification-The Bluebonnet Trails Jail Division Specialist coordinates the mental health care of jail inmates. This individual provides collaboration and guidance from intake through release intended to coordinate an effective plan between the criminal justice system, court system and mental health care. These individuals provide vital information to prosecutors, defense attorneys, and the courts in the proper placement and adjudication of special needs offenders. Supporting the courts and justice system in this way enables timely consideration of appropriateness of diversion; offers immediate access to counseling and case management; and engages key persons determining conditions for release and upon release.
9. Increase of maximum security mental health beds. Justification-Currently, there is a 4-6 month wait for a 46B inmate to get into a maximum security mental health bed. Maximum security inmates are inmates that have committed felony offenses and have been determined to be manifestly dangerous.
County Jail Death and Suicide Total Deaths Suicides 90 74 72 101 78 26 19 23 25 23 2010 2011 2012 2013 2014 County Jail Population Population 69999 64984 64302 66807 64587 2010 2011 2012 2013 2014
Intake Screening Form Liberty County Wise County Code of Criminal Procedure 16.22 Bosque Gillespie Hill Sutton Upton Supervision Checks Karnes Cherokee Hemphill *Liberty Maverick Medina *Smith Tarrant *Waller *Custodial Death