Jail Triage is a voluntary program available to Kentuckys county jails that screens for suicide risk recommends interventions and arranges followup assessments with local mental health as needed ID: 917941
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Slide1
Jail Triage
Slide2Jail Triage Program Goals
Jail Triage is a voluntary program available to Kentucky’s county jails that screens for suicide risk, recommends interventions and arranges follow-up assessments with local mental health as needed.
Its goals focus on:
Lessening the likelihood of custodial suicide.
Helping jails manage mental health crises.
Slide3Jail Triage Objectives
Identify inmates at risk for suicide.
Identify inmates with serious mental illness.
Make recommendations to the jail for managing these risks.
Slide4Jails’ Operational Objectives
Proper restraint and housing
Timely observation and documentation
Timely and reasonable provision of suicide risk management
Slide5Operational 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
Slide6How Jail Triage Works
Slide7Identifying Risk
Jail staff identify possible risk through:
Inmate responses to screening questions at booking.
Institutional alerts from past incarcerations.
Observations of behavior at the jail.
Information provided by arresting or transporting officers, or transferring agencies.
Information provided by third parties: friends, family, hospitals, attorneys, court staff, other inmates, etc.
Slide8Free to Participating Jails
Once a potential risk for suicide or mental health crisis has been identified, the jail calls:
877-266-2602
Slide9Triage Assessment
A Jail Triage clinician will return the jail’s call to gather further information and determine:
Level of risk: Critical, High, Moderate, Low
Recommended jail protocols
Follow-up requirements
Slide10When to Triage
Any time suicide or mental health concerns arise:
At intake
At booking/screening
When there are institutional alerts
When there is event-driven risk
When there is observation of risk
Slide11At Intake
When the arresting or transporting officer responds to Jail Intake Assessment questions and reports:
Arrestee made statements of self harm
Family or friends warned of statements or actions indicating self harm
Arrestee’s reaction to arrest suggested risk of self harm
Arrestee’s behaviors suggested mental illness
Slide12At Booking/Screening
Arrestee reports prior suicide attempts
Arrestee reports current suicidal ideation
Arrestee reports hospitalization for mental illness in the past year
Arrestee reports a serious mental health condition
Slide13Institutional Alerts
Arrestee was triaged at critical or high risk level during a past incarceration for:
Suicide risk or self harm
Acute symptoms of mental illness
Substance-induced risk factors
Behavioral risk factors
Arrestee was designated during a past incarceration as having an intellectual or developmental disability, serious mental illness or brain injury.
Slide14Event-Driven Risk
Severity of charge or length of sentence
Upsetting court appearance or news about case
Response to disciplinary action
Bad phone call or visit
Death of loved one
Slide15Observation of Risk
Another inmate expresses concern about self-harm or mental instability
Jail staff observe overt signs of depression, psychosis or other acute distress
Jail staff discover preparations for self-harm or observe active efforts to harm self
Family or another third party contacts the jail to express concern
Slide16Overt Indications of Distress
Making instruments of suicide: noose, shank, hoarding medication
Engaging in self-injury: cutting, scratching, 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 upset, physical agitation, or withdrawal including requests for segregation
Slide17Substance-related Concerns
Substance use can heighten suicide risk factors by
Decreasing inhibitions
Increasing psychological distress
Increasing aggressiveness
Constricting cognition so the person can’t see beyond their current despair
The Substance Abuse & Mental Health Services Administration reports that
Suicide is the leading cause of death among people who misuse alcohol and drugs.
A large percentage of suicides had substances in their system at time of death: 22% alcohol, 20% opiates, 10.2% marijuana, 4.6% cocaine, and 3.4% amphetamines.
The presentation of someone impaired or withdrawing from substances can be easily confused with mental health problems and not be recognized as a potential medical emergency.
Slide18Withdrawal Symptoms
Always refer arrestees to medical staff if there is any indication of substance use. Medical clearance at the local hospital before taking custody may guard against overdose, but withdrawal can also be deadly. It may be days before serious symptoms appear.
Be particularly mindful of inmates withdrawing from these substances:
Alcohol
Benzodiazepines
Opiates
Even if the inmate did not disclose withdrawal risk, symptoms listed on the following pages can indicate need for immediate medical attention.
Slide19Alcohol Withdrawal
Seizures and delirium tremens (DTs) are the most serious alcohol withdrawal symptoms and can result in death.
Watch for these symptoms: shaking, shivering, irregular/
fast heartbeat
, high blood pressure, heavy sweating, hallucinations, very high fever, nightmares, global confusion, and seizures.
Can occur up to 3 days into withdrawal.
More likely among inmates who have had a high intake of alcohol for more than one month (7-8 pints of beer daily or 1 pint of liquor daily).
History of seizures/DTs predicts future withdrawal episodes.
Slide20Benzodiazepine Withdrawal
Catatonia, convulsions/seizures, delirium tremens (DTs) similar to alcohol withdrawal and increased suicidal ideation are the most serious benzodiazepine withdrawal symptoms and can result in death.
Watch for these symptoms: psychosis, confusion, fever, mania, aggression, and psychomotor rigidity or severe psychomotor agitation.
Can occur within 6-8 hours for short-acting benzodiazepines.
Can occur within 24-48 hours for long-acting benzodiazepines.
Closely monitor on days 3 and 4. Fatal symptoms often manifest during this window for heavy benzodiazepine users.
Slide21Opiate Withdrawal
Complications from persistent vomiting and diarrhea are the most serious opiate withdrawal symptoms and can result in death.
Dehydration and elevated sodium levels may result in heart failure.
Inadvertently breathing vomited material into the lungs may result in suffocation.
Watch for these dehydration symptoms: dizziness/fainting, rapid heartbeat and breathing, confusion/irritability, decreased urine output/dark colored urine, fatigue/sleepiness
, and low
blood pressure.
Symptoms for short-acting opiates (heroin) peak at around 2-3 days.
Symptoms can continue for up to 10 days.
Slide22Withdrawal Emergencies
The withdrawal symptoms listed on the previous slides indicate a medical emergency. Seek immediate help from a medical professional, whether that be the jail’s own medical staff or an ambulance.
Even if the inmate didn’t acknowledge using these substances, the symptoms are just as life-threatening. Trust observable symptoms over self-report. Remember:
People struggling with addiction routinely downplay the extent of their use.
Inmates may be reluctant to acknowledge use that they believe could impact their case.
Drugs are often cut with substances unknown to the user.
Slide23The Jail Triage Process
When the arrestee is triaged, jail staff will be asked to provide 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 a booking
The concern that prompted the call to Jail Triage
Any past institutional alerts
Current inmate presentation
Slide24Risk Leveling
Critical
High
Moderate
Low
Slide25Critical Risk Level
Active suicide attempts
Other active self-injurious behaviors
Slide26High Risk Level
Active suicidal thoughts
History of suicide attempts less than 2 years ago
Concern related to charge-related risk
Agitated psychosis
Lower level risk compounded by such things as substance use that jeopardizes inmate’s immediate safety
Slide27Moderate Risk Level
History of suicide attempts between 2 and 10 years ago
Family history of completed suicide
Significant mental health treatment history or potential medication issues at the jail
Psychiatric hospitalization in the last year
Active emotional distress without suicide ideation
Lower level risk compounded by added risk factors
Slide28Low Risk Level
Suicide history of attempts more than 10 years ago
Minor mental health history
Absence of other compounding risk factors
Slide29Recommended Jail Protocol
Critical
High
Moderate
Low
Housing
Restraint Chair
Single or Safe Cell
General Population
General Population
Observation
Constant
Slide30Kingsley v. Hendrickson
Any force used to prevent suicide or 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.
Slide31Clinician Recommendations
Once a risk level has been assigned, it will be accompanied by one of these three recommendations:
Maintain risk level pending contact with mental health within a specified timeframe.
Maintain risk level for a specified timeframe and then call Jail Triage to
retriage
.
Maintain the risk level for a specified period of time and then reduce to the next lower level if no concerns arise.
Slide32Fail Safe
Regardless of Triage recommendation, when in doubt or if you have any questions call:
Jail Triage 877-266-2602
Slide33Mental Health Follow-Up
Jail Triage may recommend contact with local mental health for further suicide assessment. This follow-up may be conducted by phone, by video or in person depending on your local provider’s procedures for this.
Jail staff will be responsible for making the inmate available once mental health contacts the jail to assess inmate.
In the event of inmate refusal or safety concerns regarding this contact, the risk level will be maintained and a
retriage
will be recommended for a later time.
In addition to leveling recommendations, mental health may suggest such things as involuntary hospitalization, use of inmate watchers, referrals to jail medical staff or EMT, the chaplain, internal mental health staff or ongoing mental health treatment options.
Using Jail Triage does not preclude contracting with another mental health provider for additional services as jail administration sees fit.
Slide34Retriage
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 assessments by local mental health.
Jail staff will also be asked if inmate is reporting thoughts of suicide or other distress, about inmate’s current presentation, and about any changes in status since the last triage or assessment.
Jail Triage staff will use this information to reassess inmate’s risk level and make recommendations accordingly.
Slide35202a Commitments
202a assessments for involuntary psychiatric hospitalizations are provided through state contracts with the local mental health agency serving that judicial district.
Jail Triage cannot initiate a 202a petition or perform the assessment but can provide collateral Jail Triage information to the local mental health 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.
Slide36Jail 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 on a high or critical risk leveling status should be advised to seek community mental health services. The jail should also consider providing:
A 202a referral
A call to the inmate’s emergency contact number
A business card with the community mental health contact information or number for the community mental health crisis line.
Slide37Community MH Crisis Line Numbers
Adanta
– 800-633-5599
Centerstone – 800-221-0446
Communicare
– 800-641-4673
Comprehend – 877-852-1523
Cumberland River –
(day) 606-864-2104
(afterhours) 800-273-8255
Four Rivers – 800-592-3980
Kentucky River – 800-262-7491
LifeSkills
– 800-223-8913
Mountain Comp – 800-422-1060
New Vista – 800-928-8000
NorthKey
– 877-331-3292
Pathways – 800-562-8909
Pennyroyal – 877-473-7766
River Valley – 800-433-7291
Slide38Community Engagement
As the jail assumes a duty to protect inmates from suicide, it is prudent to engage an inmate’s family, friends and professional associates in suicide prevention. Signage and phone messaging should advise significant others of 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.
Slide39Mental Health Jail Training
The state requires 4 hours of mental health training for jail personnel during the first year of service.
One hour of mental health training is required for each year thereafter.
Jail Triage is willing to provide this training for a fee.
Jail Triage online training materials are available at
www.newvista.org
. Click the Jail Triage link at the bottom of the home page.