Corrections- Changes Implemented within our Mental Health System - PowerPoint PPT Presentation

South Carolina Department of Corrections- Changes Implemented within our Mental Health System Presented by Director Bryan Stirling December 7, 2017

Goal and Intent The goal is for SCDC to: • diagnose and treat mentally ill inmates • to work with inmates in developing plans of care designed to minimize symptoms and reduce adverse effects of mental illness, maximize wellness, and promote recovery. 2

Number of MI Inmates at SCDC- As of 11/27/17 • Mentally ill inmates at SCDC make up 18% of the total population (N=3,582).

Mental Health Update • Caseload Information (11/27/17) • 3,582 inmates are on the mental health caseload out of a population of 19,929 • 18% of the population is represented on the caseload • This is an increase from 2014 which was averaging 15%

Who we served as of June 30, 2017 South Carolina Department of Corrections' Inmates with Behavioral Health Illnesses Based on June 30, 2017 Custody Population Male Population Female Population Total Population Total Population 18,538 1,451 19,989 Number Percent Number Percent Number Percent Mentally Ill* 2,668 14% 710 49% 3,378 17% Chemically Dependent 6,173 33% 753 52% 6,926 35% Mentally Ill* and Chemically Dependent 1,236 7% 411 28% 1,647 8% *Includes Developmentally Disabled.

Screening/Evaluation/Treatment All inmates identified as mentally ill (Mental Health Classification L1, L2, L3, L4, or L5) must be monitored by mental health staff, regardless of whether or not psychotropic medication is prescribed, or whether or not the inmate is compliant with his/her prescription medication. 6

Mental Health staff at the following Institutions: • Kirkland Reception and Evaluation (L2, L3, • Manning Correctional Institution (L4, L5) L4) • Lee Correctional Institution (L3, L4) • Broad River Correctional Institution (L4) • Evans Correctional Institution (L4) • Camille Graham Correctional Institution (L2, L3, L4) • Kershaw Correctional Institution (L4) • Perry Correctional Institution (L3, L4) • Turbeville Correctional Institution (L3, L4) • Tyger River Correctional Institution (L4) • Ridgeland Correctional Institution (L4) • McCormick Correctional Institution (L4) • Lieber Correctional Institution (L3, L4) • Leath Correctional Institution (L4) • • Allendale Correctional Institution (L4) MacDougall Correctional Institution (L4) • Gilliam Psychiatric Hospital (L1) • Contract Hospital Facility/females (L1) 7

Clinical Administration • SCDC mental health staff is comprised of a diverse group of licensed, credentialed, and qualified mental health professionals that include Psychiatrists, Clinical Supervisors, QMHPs, Mental Health Technicians, Activity Therapist, and others who offer on-site mental health care and case management on a daily basis to all SCDC inmates as needed. 8

MENTAL HEALTH STAFF COMPARISON 2014 2017 Title # of Staff # of Staff Masters Licensed Masters Licensed Total Filled Vacant Total Filled Vacant ADMINISTRATION 5 5 0 4 3 9 9 0 4 3 TOTALS PSYCHIATRY 5.89 16 11.62 4.38 TOTALS PSYCHOLOGY 0.34 3.74 1.74 2 TOTALS QUALITY ASSURANCE 1 1 0 1 6 6 0 TOTALS COUNSELORS 78 72 6 3 2 112.5 95 17.5 TOTALS MENTAL HEALTH TECHS 0 0 0 30 30 0 TOTALS ACTIVITY THERAPY 0 0 0 3 2 1 TOTALS ADMINISTRATIVE SUPPORT 9 9 0 9 9 0 TOTALS DIVISION TOTALS 99.23 87 6 8 11 189.24 164.36 24.88 4 3

Staffing/Salaries • Completion of local/salary comparisons for clinicians which resulted in raising compensation for psychiatrists, psychologists, and QMHPs; • Psychiatry - $250,000 • Psychologist- $120,000 • QMHPS- $52,000 (based on licensure level) • Psychiatry Staffing • 9.12 FTEs for psychiatry coverage • 1.64 FTEs for psychiatry nurse practitioners • Approximately 102.50 hours per week of tele-psych

Serious Mental Illness • Serious mental illness can include diagnoses such as schizophrenia spectrum and other psychotic disorders, bipolar disorders, depressive disorders, and anxiety disorders, trauma and stress related disorders, neurodevelopmental disorders, neurocognitive disorders, and severe personality disorders that result in significant dysfunction and the inability to function in the general population. Inmates who experience significant functional impairment involving acts of self-harm or other behaviors that have a serious adverse effect on life may also fall into this category. • Inmates falling into this category must remain on the Mental Health Caseload.

Refusal of Mental Health Treatment • An inmate has the right to refuse any or all proposed mental health treatment. • If an inmate refuses treatment but his/her mental health deteriorates to the point that the inmate is no longer stable, the inmate will be evaluated for involuntary treatment and/or inpatient hospitalization. 12

Confidentiality • Every reasonable effort will be made to ensure that an inmate's Mental Health Treatment/Records remain confidential. • Information regarding an inmate's treatment cannot be released to any outside agency or person to include family members without written consent of the inmate. 13

Electronic Health Record • Camille Graham and Leath piloted the Electronic Health Record (EHR). • SCDC continues to assess and monitor plans for the rollout to all male institutions. • The implementation schedule is as follows: • Level 3 Institutions go live (except Kirkland)- Broad River, Lee, Lieber, McCormick, & Perry by 02/16/18; • Level 2 Institutions go live - Allendale, Evans, Ridgeland, Turbeville by 04/06/18; • All remaining Institutions go live- Catawba, Goodman, Kershaw, Livesay, MacDougall, Manning, Trenton, Tyger River, Wateree by 4/20/18; • Kirkland eZmar goes live by 5/3/18.

Assessments for Inmates in Restrictive Housing Unit (RHU) • All inmates will be assessed/monitored weekly while in RHU. • Mental status rounds will be performed on all inmates housed in RHU weekly. 15

RHU Numbers as of 11/29/17 Inmates in Lockup on November 29, 2017 by Institution and Mentally Ill vs. Non-Mentally Ill Population Non-Mentally Institution Mentally Ill Ill Total ALLENDALE 19 47 66 BROAD RIVER 39 26 65 EVANS 23 91 114 GILLIAM PSY 2 2 GRAHAM 1 1 GRAHAM R&E 27 7 34 GREENVILLE CO 1 1 JUST CARE INC(COLA CARE C 1 1 KERSHAW 39 40 79 KIRKLAND 1 25 26 KIRKLAND MAX 6 2 8 LEATH 17 7 24 LEE 41 26 67 LIEBER 41 28 69 MANNING 1 22 23 MCCORMICK 9 26 35 PERRY 31 105 136 RICHLAND CO 2 2 RIDGELAND 6 23 29 TRENTON 30 30 TURBEVILLE 6 22 28 TYGER RIVER 31 25 56 WATEREE RIVER 5 5 Total 341 560 901

Behavioral Management Units (BMU) • Low Level – Allendale CI Inmates on Lock-Up with a mental health classification who have chronic behavioral problems. These inmates do not have a consistent documented history of being aggressive or assaultive. • High Level – Kirkland R&E Inmates on Lock-Up with a mental health classification who have chronic behavioral problems. These inmates have a consistent documented history of being aggressive or assaultive.

Crisis Stabilization Units (CSU) • Broad River – Males, currently 30 inmates • C. Graham – Females, currently zero inmates • If an inmate is on crisis status for longer than 60 hours, they must be transferred to the centralized Crisis Stabilization Unit. Inmate watchers are trained to help provide assistance in monitoring inmates on suicide precaution.

Behavioral/Mental Health & Substance Abuse Services & Programs • Mission: To identify, assess, and provide substance abuse programming opportunities that are educational and therapeutic. • Screening, Identification & Orientation: Screen and identify all newly admitted male and female offenders for potential behavioral health substance abuse needs. • Screenings are conducted at Reception & Evaluation (R&E) at Kirkland and Camille Griffin Graham.

Female Substance Abuse Programs Camille Graham Addiction Treatment Unit • 80 bed residential program, located in Columbia, SC. • Adult female offenders. • Young offender (17 – 25) female offenders. • 6-9 month gender specific structured programming. • Addresses substance abuse, criminal thinking and other life skills issues.

Adult Male Substance Abuse Programs Horizon ATU Program • 130 bed residential program, located in Turbeville, SC. • Males serving a straight time sentence. • 6-9 month structured program. • Addresses substance abuse, criminal thinking and other life skills issues. • Uses a Therapeutic Community Model treatment approach. • Court ordered and conditionally paroled offenders with identified substance abuse program needs are assigned priority admission status.

Male Youthful Offender Substance Abuse Program Correctional Recovery Academy (CRA) • 136 bed residential program, located in Turbeville, SC. • 6-9 month gender specific structured programming. • Uses a Therapeutic Community Model treatment approach. • Addresses substance abuse, criminal thinking and other life skills issues.