Unit 15 Monitoring Psych and Physical Health
UNIT 15.0 LESSON PLAN
Monitoring Psychological and Physical Health
Module 15.1
Legal Issues
0:30
J.K. Test #4
5 Test Items
UNIT OUTLINE AND PRESENTATION: NOTES:
Performance Objective: Identify Title 15 mandates regarding the medical and 5 test items
15.1.1 psychological treatment of prisoners, and potential liability
for non-compliance.
1. Review the Title 15 mandated regarding medical and psychological
treatment for offender. Review potential for liabilities. (Article 10)
a. 1200--Fixes responsibility for health care services. Medical decisions are
the sole province of responsible physician. Security measures apply
to medical staff.
b. 1202--Provides for a written plan for treatment, transfer or referral.
c. 1203--Certificates for health workers.
d. 1204--Must develop written protocol.
e. 1205--Maintenance of medical/mental health records.
1
UNIT OUTLINE AND PRESENTATION: NOTES:
f. 1206--The health authority to develop written policy and procedure
that conform to applicable state and federal law.
g. 1206.5--Management of communicable diseases in a custody setting.
h. 1207--Review and screening at intake.
i. 1207.5--Special Mental Disorder Assessment--Additional mental health
screening on women who have given birth within the past year and are
charged with murder or attempted murder of their infants.
j. 1208--Inmates must have access to treatment.
k. 1209—Mental health director and the facility administrator shall establish policy and
procedure to provide mental health services. Additionally it provides for mentally
disordered inmates to be transferred to hospital (P.C. 4011.6 or W.&I. 5150).
l. 1210--Individualized Treatment Plans--As necessary custody staff are to be
notified of ongoing care of an individual being treated for mental health
problems or medical problems.
m. 1211--Daily sick call.
n. 1212--Each facility must have a plan to treat and control vermin.
o. 1213--Written plan for treatment of those requiring detoxification treatment.
p. 1215-Informed consent. Any competent inmate may refuse treatment in writing
both emergency and non-emergency medical and mental health care.
q. 1215--Provisions for adequate dental care.
r. 1216--Written plan for the secure storage, controlled administration
and disposal of all legally obtained drugs.
s. 1217 Psychotropic Medications--written plan for governing the use of psychotropic
medications.
t. 1218-Inmate deaths--medical review of every in custody inmate death.
u. 1219--Suicide Prevention Program--written plan for suicide prevention program.
2
v. 1220--First Aid Kit(s)--available in all facilities.
w. 1230--Food Handler's--written plan for the medical screening of inmate
food workers prior to working in the kitchen.
2.. Failure to comply of mandates and law can result in civil and legal liability.
Writs, grievances, law suits can be filed by inmates claiming inadequate medical
care. Infirmary can lose its accreditation by the AMA.
a. Deliberate indifference-discuss
b. One of areas most vulnerable for jail administrators is medical care.
3
Module 15.2
Mental Health Issues
2:30
J.K. Test #4
W.S. Test #9
10 Test Items
Performance Objective: Identify the following potential signs of mental 10 test items
15.2.1 health issues in inmates.
Withdrawal
Bizarre behavior
Excessive fear
Loss of appetite
A noticeable change in established behavior
Mentally disordered
Use of psychotropic drugs
Expressing personal/familial problems
Suicide statements
Performance Objective: Presented with a simulated interview or interaction Written Skills
15.2.2 between an inmate and a corrections officer, generate Test #9
a written description of the inmate’s behavior and
appearance.
1. Mental illness is a disorder of the functioning of the mind.
2. Mental deficiency is characterized by inadequate coping with life problems due
to a below average intellectual ability.
3. Review the various types of behaviors exhibited by inmates in custody who may
be suffering from some type of mental illness.
a. Inmates general appearance
b. Speech patterns
UNIT OUTLINE AND PRESENTATION: NOTES:
c. Mood and affect
d. Thought process
4
e. Cognition
4. Common types of mental illness found in institutions
a. Suicide
b. Paranoia--reluctant to trust or get along with others.
c. Schizophrenia--multiple personalities.
d. Manic Depressive--BI-polar.
e. Depression.
5
UNIT OUTLINE AND PRESENTATION: NOTES:
5. Discuss the factors that may indicate signs of psychological disturbances
in an inmate.
a. Withdrawal from others.
b. Bizarre behavior
c. Excessive fear.
d. Loss of appetite.
e. Does not sleep.
f. Always sleeping.
g. Noticeable change in established behavior.
h. Mentally handicapped.
i. Use of psychotropic drugs.
j. Suicidal statements, threats, behavior.
k. Expressing personal/family problems.
6. Review behaviors of mental illness with class. Give a description or show video of subject
suffering from mental illness. Have class give a written description of the behavior
and appearance. Written Skills Test #9.
6
Module 15.3
Suicide Issues
4:00
J.K. Test #4
B.S. Test #29
W.S. Test #10
15 Test Items
PERFORMANCE OBJECTIVE: Discuss potential liabilities resulting from a suicide No test item
15.3.1
Agency
Individual
Deliberate indifference
1. Suicide is always a high liability area for persons working in the jail setting. The liabilities include
the line officer through the Facility Commander, the Sheriff or Department Head as well as the
County at Large.
a. Discuss the agencies liabilities:
b. Discuss the individual officers potential liability:
c. Deliberate Indifference—failure to act:
1. Define under Farmer vs. Brennan.
2. Discuss how an officer can be deliberately indifferent.
3. Discuss the agencies role with regards to deliberate indifference.
7
UNIT OUTLINE AND PRESENTATION: NOTES:
PERFORMANCE OBJECTIVE: Describe signs and symptoms of inmates who 5 test items
15.3.2 pose a suicide risk.
Initial period of incarceration
Isolation
Persons potentially at risk
State of intoxication
Environmental precautions
15.3.3
PERFORMANCE OBJECTIVE: Identify officers’ responsibilities when dealing with
suicide risk inmates.
Communication.
Medical staff involvement.
Monitoring.
PERFORMANCE OBJECTIVE: Given a simulated conversation or interaction with a potential
15.3.4 suicidal inmate, demonstrate at least three verbal comments
a correctional officer could make to intervene.
BST #29
PERFORMANCE OBJECTIVE: Identifying Suicide risk factors—Inmate perspective: 3 test items
15.3.5
Fear of the unknown
Authoritarian environment
No apparent control of the future
Isolation from family and significant others
Shame of incarceration
Dehumanizing aspects of incarceration
PERFORMANCE OBJECTIVE: Identifying Suicide risk factors—predisposing 3 Test items
15.3.6 factors:
Recent excessive drinking or use of drugs
Recent loss of stabilizing resources
Severe guilt or shame over the offense
Same sex rape or threat of rape
Current mental illness
Approaching an emotional breaking point
8
UNIT OUTLINE AND PRESENTATION: NOTES:
PERFORMANCE OBJECTIVE: Identifying Suicide risk factors—High suicide 2 test items
15.3.7 risk periods:
First 24 hours of confinement
Intoxication/withdrawal
Trial sentencing hearings
Impending release
Decreased staff supervision
Weekends and holidays
Bad news from home
1. Possibility of suicidal inmate is high in correctional setting.
a. History of nervous or mental disorders.
b. According to Bureau of Prison cases, 90% accomplish by hanging
while in segregation between midnight and 9:00 a.m.
c. Overt signs include but are not limited to:
2. Officers’ responsibilities when dealing with suicide risk inmates:
a. Communication - Remain calm, speak in a relaxed manner and with a relaxed
tone of voice; determine threat of suicide by the inmate.
b. Medical staff involvement – Communicate with medical staff. Inform them of
changes in inmate’s behavior.
c. Monitoring – Observe inmate and their actions if not placed in a safety cell.
If placed in safety cell, monitor inmate per agencies policy and procedure.
UNIT PRESENTATION AND OUTLINE NOTES
3. Correctional officers should be aware and alert to the basic signs and symptoms of a possible
suicide. Additionally they need to be aware of factors that may cause an inmate to contemplate
suicide.
a. Fear of the unknown—unfamiliar with jail surrounding or the criminal
justice process.
b. Jail rules and regulations—unable to cope with the loss of personal freedom
9
and having to follow directions/orders from those in charge.
c. Unsure of the future and no control of their circumstances once incarcerated.
d. Isolation from family and friends.
e. Shame—be aware of other cultures view of incarceration and those that are
at a greater risk.
f. Dehumanizing aspects of incarceration—lack of privacy, searches, etc.
4. Officers need to be aware of some significant factors that may predispose and inmate to threaten
or attempt suicide.
a. Type of charges for this incarceration—
b. Loss of stabilizing resources:
c. Fear of custody environment:
d. Physical or mental health
UNIT PRESENTATION AND OUTLINE NOTES
5. Discuss high-risk periods.
a. The first 24 hours of confinement.
b. If the inmate is intoxicated or withdrawn.
c. Just before or right after sentencing hearings—especially in high profile cases.
d. Just prior to release.
e. When staff supervision is decreased.
f. Weekends, holidays or significant dates in the inmates life
(birthday/anniversary/etc).
g. Bad news from home or a bad visit.
6. Officers need to take immediate action in accordance with their agencies policies.
a. If signs are observed, follow your agencies policy, but advise the appropriate
Personnel. (supervisor, mental health or medical personnel)
b. If inmate has a history of suicidal gestures place them in an area which can be
closely monitored until the appropriate staff can intervene.
c. If symptoms are observed and officer believes there is immediate danger:
10
UNIT OUTLINE AND PRESENTATION: NOTES:
PERFORMANCE OBJECTIVE: Given a simulated conversation or interaction with a
15.3.3 potentially suicidal inmate, demonstrate at least three
BST #29 verbal comments a corrections officer could make to
intervene.
PERFORMANCE OBJECTIVE: Presented with a scenario of inmate behavior, generate
15.3.8 a written report of the inmate’s behavior and appearance.
WST #10 include the following:
Factors that indicate risk
Statement made by the inmate
Corrections officer actions
1. Discuss what the officer should say to an inmate to de-escalate the situation.
a. Remain calm.
b. Don’t threaten or cause more anxiety.
c. Use a low tone, don’t yell or scream at the inmate.
d. Attempt to determine the immediate threat—access the situation.
e. Don’t demean or embarrass the inmate.
2. Complete Behavioral Skills Test.
11
3. Complete Written Skills Test.
12
MODULE 15.4
INDICATORS OF SUBSTANCE ABUSE
2:30
J.K. TEST NUMBER 5
3 TEST ITEMS
PERFORMANCE OBJECTIVE: Identify the potential indicators of substance 1 test item
15.4.1 abuse among inmates. For example
. Stealing sugar
. Signs of intoxication
. Dilation of pupils
. Speech patterns
. Behavior changes
. Odors
. Unusual movement
. Signs if intravenous drug use
1. Discuss the potential indicators of substance among inmates:
a. Stealing sugar from each other or the kitchen.
b. Signs of Intoxication
c. Dilation of pupils
d. Speech patterns
e. Behavioral changes:
f. Odors--about person or on their breath.
g. Unusual movement:
h. Sign of intravenous drug use:
PERFORMANCE OBJECTIVE: Given recent drug history of an inmate describe
15.4.2 behavior problems the inmate might exhibit in the jail.
13
1 Test item
PCP flashback
Alcohol D.T.’s
Opiate withdrawal
1. Describe behaviors associated with substance abuse and behaviors that the inmate may exhibit.
a. Alcohol
b. Amphetamines and Cocaine
UNIT OUTLINE AND PRESENTATION: NOTES:
c. Hallucinogens
1. PCP
2. LSD and Psilocybin (mushrooms)
d. Marijuana
e. Sedatives
f. Opiates
14
MODULE 15.5
INDICATORS OF PHYSICAL/MEDICAL PROBLEMS
2:00
J.K. TEST NUMBER 5
16 TEST ITEMS
UNIT OUTLINE AND PRESENTATION: NOTES:
PERFORMANCE OBJECTIVE: Identify the following as potential indicators of physical
15.5.1 problems requiring medical attention. For example:
3 Test items
. Unusual request to medical staff
. Unusual reaction to medication
. Loss of appetite
. Injury, blood on clothing
. Nodding, seizures, tremors
. Skin color
. Changes in established behavior
1. Discuss the various points of observation that may indicate a physical problem
requiring medical attention.
a. Bleeding
State of consciousness.
a. Seizure/nodding/tremors.
d. Personality/mental status:
e. Complaints of pain.
f. Skin color.
g. Eye observations.
h. Gait observations.
i. Unusual amount of medical requests.
j. Unusual reaction to medication.
PERFORMANCE OBJECTIVE: Given a list of inmate classifications, identify
15.5.2 those that may indicate physical problems requiring medical
treatment and/or special treatment conditions (e.g., paraplegic,
15
colostomy, pregnant, severe back problems,
surgical recovery).
1. Classification of Special Inmates
a. Paraplegic
b. Pregnant
c. Colostomy
d. Severe back injury or problems
e. Surgical recovery
e. Prosthesis
PERFORMANCE OBJECTIVE: Discuss potential benefits of listening to what other
15.5.3 inmates are saying about a fellow inmate.
No test items
1. Discuss the importance of listening to other inmates about their cellmates with
regards to health problems.
a. Can provide information about sleep habits.
b. Bizarre behavior.
c. Appetite-increased or loss of.
d. Consumption of sugar--especially helpful with diabetics
e. Seizure activity.
f. Mental state.
g. Hygiene.
i. Use of medications.
2. May alert you to a potential problem before it becomes more serious.
PERFORMANCE OBJECTIVE: Identify the infectious diseases most likely to 2 test items
16
15.5.4 show up In a jail. (e.g., AIDS, hepatitis, lice, T.B.)
PERFORMANCE OBJECTIVE: Describe symptoms and treatment conditions 3 test items
15.5.5 related to those diseases most likely to show up in a jail.
PERFORMANCE OBJECTIVE: Identify the modes of transmission of 2 test items
5.5.6 infectious diseases.
1. Symptoms and treatment conditions of diseases commonly found in jails.
a. Hepatitis
b. Scabies
c. Head Lice
d. Sexually transmitted diseases
e. Communicable diseases/chronic infections
f. Plegias
UNIT PRESENTATION AND OUTLINE: NOTES:
g. Drains/dressings
h. Jaw fractures
i. Back problems
j. Medication reactions
k. Substance abuse withdrawals
l. Seizures
m. Ulcers
n. Dental problems
o. Pregnancy
p. Contact dermatitis
17
q. Diabetes
r. Trauma
s. Heart disease
t. Asthma/bronchitis
1. Define the infectious diseased most likely to show up in jail.
a. AIDS/HIV
b. Transmission of AIDS
UNIT PRESENTATION AND OUTLINE: NOTES
c. Hepatitis
d. Transmission of Hepatitis
e. Transmission of Tuberculosis.
f. Childhood diseases with influx of other cultures.
g. Venereal Diseases
h. Lice--Transmitted via bedding, sharing of comb/brush.
PERFORMANCE OBJECTIVE: Identify the "universal safety precautions" 3 test items
15.5.7 and their application to jail environment.
1. Discuss universal safety precautions within the jail environment.
a. Use of safety equipment.
b. Know what you are going into before you react and be prepared.
c. Clothing should be washed separately using water soluble bags.
18
d. Eating utensils should be disposed.
MODULE 15.6
ASSISTING MEDICAL PERSONNEL IN THE DISTRIBUTION
OF MEDICATION
0:30
J.K. TEST NUMBER 5
6 TEST ITEMS
PERFORMANCE OBJECTIVE: Discuss the role of the corrections officer when No Test Item
15.6.1 assisting medical staff.
Verify ID of inmate
Control inmates in line
Monitor interaction between medical staff and
inmates
1. Discuss the proper distribution methods of inmate medications. Remind class each
agency may have their own policies to follow.
a. Insure the identity of the inmate.
b. Insure the inmate understands medication time and dosage he is receiving.
c. Insure inmate takes medications or is responsible to take meds at the proper
time.
d. Maintain control and security measures.
e. Document problems.
PERFORMANCE OBJECTIVE: Identify the reasons that doctors and nurses are to be
15.6.2 informed of the classification of all persons they visit,
1 Test item informed that security takes precedence over treatment, and
are to be accompanied at all times.
1. Discuss with class the importance of security and safety for medical staff and
other inmates.
2. Review why medical staff must know the classification of each inmate and each
each agencies classification process.
19
UNIT PRESENTATION AND OUTLINE: NOTES
PERFORMANCE OBJECTIVE: Identify the consequences of improper control over
15.6.3 medications and their distribution. For example:
2 Test items
. Legal liability
. Control problems
. Hoarding medications may lead
to intoxication or suicide
. Selling medications
1. Discuss the consequences of improper control
of medications and their distribution.
a. Legal liability.
b. Disciplinary action by agency.
c. Inmate control problems.
d. Security problems.
e. Inmates may hoard medication.
f. Selling of medications.
g. Inmate seriously injured or dies.
h. Violation of law--criminal action.
PERFORMANCE OBJECTIVE: Differentiate among the following terms related to 2 test items
15.6.4 medication.
Administer
Dispense
Deliver
1. Review the definitions as outlined in Title 15 Section 1006:
a. Administering Medication—The act by which a single dose of medication is given to a
patient. The single dose of medication may be taken either from stock (undispensed) or
dispensed supplies.
b. Dispense—Interpretation of the prescription order, the preparation, repackaging and
labeling of the drug based upon a prescription from a physician, dentist, or other
prescriber authorized by law.
c. Deliver—Taking the medications to the patient to administer.
20
UNIT PRESENTATION AND OUTLINE: NOTES
PERFORMANCE OBJECTIVE: Identify Inmates' rights to refuse medications 1 test item
15.6.5
1. Discuss the inmates' rights to refuse medication.
a. An inmate may refuse to take the following medications at any time.
b. If an inmate refused medical care of treatment that may be life saving he
can be transferred to another treatment facility under a W & I 5150.
PERFORMANCE OBJECTIVE: Discuss possible communication issues between No test items
15.6.6 medical staff and corrections officers.
1. Discuss the importance of good communication between medical and custody staff.
a. Officer and staff safety.
b. More accurate assessments of inmate behavior.
c. Facility security.
d. Avoidance of liability issues.
21