CMHS believes in a multidisciplinary approach to care, and although we recognize that all who we treat are “detainees,” we treat them as “patients.”  Complete assessments, appropriate treatment, safe management, coordinated aftercare and training for correctional officers are all are believed to be an integral part of an effective Mental and Behavioral Health Service.

Program Goals
CMHS’ goal is to provide comprehensive mental and behavioral health services that are tailored to meet each Facility’s individual needs.  In order to achieve this goal, our service includes:

• 24-hour, 7 days a week, 365 days a year on-call availability
  
  
• Initial screening assessments
  
  
• Accurate diagnosis
  
  
• Ongoing evaluation and treatment
  
  
• Appropriate use of medication
  
  
• Crisis intervention
  
  
• Suicide risk identification
  
  
• Group counseling on a variety of relevant topics
  
  
• Administration and monitoring of psychotropic medications 

Our provision of care is strongly connected to the transition and disposition portion of management and encourages a smooth transition to the community, with case management and supportive services available to all inmates receiving services. All of our mental and behavioral health services comply with the American Psychiatric Association’s Jail Standards, and our policies and procedures are based on ACA and NCCHC Standards and guidelines. All services provided are of high quality, responsive to identified needs, and available to all inmates regardless of diagnosis or legal status.

We are aware of the challenges treatment of the mentally ill can present within these settings, including the balancing of treatment needs with security concerns, costs, and liability issues. CMHS provides clinical services stressing management of mental and behavioral disorders.  Our programs and policies and procedures focus on early detection and appropriate intervention of mental disorders, thus reducing the impact on security, duration of symptoms, disruptive behaviors, and consequences of mental disorders.

Reaching out to those who do not/can not ask for treatment is essential.  However, we also realize that not all who present themselves for treatment require medication.  Missed diagnoses of truly ill individuals, over medication for manipulative behaviors, risk of injuries to both staff and inmates, use of force and restraint, increased costs, and unacceptable liability can all occur without an effective and well established management strategy.

Quality Assurance
CMHS is extremely proud of its record of passing every audit.  This is an accomplishment that does not happen without meticulous attention to detail on quality.  From the moment we are awarded the contract, we begin the quality assurance process examining records, and policies and procedures.  We thoughtfully and with the cooperation of the administration accept the best current policies, enhance existing policies, and bring well proven new policies and procedures where deficits exist. 

CMHS utilizes a multi-faceted Quality Assurance Program (QAP) to ensure the delivery of high-quality healthcare services to inmates. Our QAP includes:

• Employee Training. Employees receive initial orientation and training as a new hire and throughout the year.  Ongoing training is provided on topics such as risk management, de-escalation techniques, and suicide prevention. 

• Written Policies and Procedures. CMHS has created “blue prints” for policies and procedures based on the National Commission on Correctional Health Care’s (NCCHC) Standards that are modified to the specific needs of each of the institutions we serve.

• Cost Containment. We employ several strategies for cost containment, such as early diagnosis and treatment of emerging illnesses, availability of telemental health, use of licensed personnel to make triage decisions, managing a jail’s entire mental health population, and the use of a standardized pharmaceutical formulary.

• Service Analysis. The level of mental and behavioral health services provided to inmates is evaluated monthly for quality, appropriateness, and continuity of care.

• Cost Analysis. The cost of delivering mental and behavioral healthcare is examined each month – not only staffing and pharmaceutical costs, but also the use of force, psychiatric hospitalization and specific classifications of illness.  We work to identify and address cost overruns as early and aggressively as possible.

Policies and Procedures
The Facility’s Health Services Unit will have a comprehensive Quality Improvement Plan (QIP) covering mental and behavioral health practices that is based upon continuous, systematic quality improvement.  Approximately five to ten percent (5% to 10%) of the medical records are reviewed monthly using pre-established criteria; the reviews evaluate the quality and appropriateness of diagnostic and treatment procedures, the content, completeness and quality of medical record entries, the use of medication, and for cases of inmates who require off-site services, the appropriateness of the referral.

CMHS monitors the quality and appropriateness of the important aspects of care and organizes the data collected for each such indicator to facilitate the identification of situations in need of more detailed evaluations of the quality or appropriateness of care delivered.  When problems are identified, CMHS takes action to correct the problem or improve the quality of care.  Such information includes a mental health risk assessment “Risk List” which is shared with correctional personnel at regularly scheduled meetings. An examination of high risk/high volume activities and special management procedures, including but not limited to the use of emergency medications, mechanical restraints and court ordered treatment, is included in the quality improvement/assurance program.

CMHS develops and implements policies that identify the types of mental health information that is communicated between mental health teams and correctional personnel within the Facility.  These policies maximize information related to safety and facilitation of treatment while protecting confidentiality and privacy.

CMHS has developed and implements policies, education and training programs that increase awareness of mental health symptoms and behavioral signs that warrant intervention and mental health services.  These programs target both correctional and medical staff.

Management Plans
A Management Plan is a tool utilized to provide a coordinated approach to managing chronically ill or difficult to manage individuals. It is initiated when an inmate is expected to be maintained in the Facility for an extended period of time, or when clinically indicated to assist in managing a complicated behaviorally disturbed or symptomatic individual. This Management Plan includes, but is not limited to, the following information:

• The inmate's needs, strengths and skills required to be safely managed within the Facility
  
  
• Clearly defined staff responsibilities and assignments for implementing the Management Plan
  
  
• Safety issues and responses to identified risk factors
  
  
• The signatures of the staff involved in the review or revision of the Management Plan, that is to include at least one senior representative from medical and one representative from security staff

The Management Plan is periodically reevaluated consistent with changes in the inmate's status.  At a minimum, the Management Plan is reviewed at major key points in the inmate's management, classification, program, or housing changes.

All Management Plans are reviewed and signed off by the Mental Health Coordinator and are reviewed after implementation for effectiveness and modification, if indicated.  The Mental Health Coordinator may also convene Special Case Conferences to review the status of inmates who present unique behavioral problems, to include participation of all necessary medical, program and security staff.

Case Management Services
CMHS can offer case management services to those inmates who are preparing for release and are in need of assistance connecting to external providers, entitlements and resources. All those who receive services are offered assistance in obtaining aftercare and, at a minimum, a Resource List of community services that include community mental health providers, substance abuse programs, somatic care, shelters and transportation options. CMHS provides this Resource List at the time of Initial Assessment in the event that an inmate leaves unexpectedly, as they often do.

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