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MENTAL HEALTH G-130 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH EFFECTIVE DATE: 12-25-94 REVISED: 05-05-95, 05-01-98, 06-15-18, 01-24-23 AUTHORITY: Sheriff J. Zanoni APPROVED BY: Assistant Sheriff S. McComas REFERENCE: Penal Code Sections 4011, 4011.6, 4011.8 and 4023. Welfare and Institutions Code Section 5150; California Code of Regulations, Title 15, Sections 1052, 1203, 1205, 1207, 1207.5, 1208, 1209, 1210, 1211, and 1216; 45 CFR 164.512; Prison Rape Elimination Act of 2003 (42 USC 15601) 28 CFR 115; and Hall v. County of Fresno, E.D. Cal. No: 1:11-CV-02047-LJO-BAM (2015). PURPOSE: The purpose of this policy is to establish guidelines for the mental health care of incarcerated people housed in the Fresno County Sheriff's Office Detention Facilities. POLICY: It is the policy of the Fresno County Sheriffs Office Jail Division that adequate and timely mental health care shall be provided to any incarcerated person in custody who demonstrates the need, or is determined to need, mental health care. This care shall be in a manner consistent with all applicable standards of mental health care and in compliance with all applicable Federal, State, and local laws, codes, regulations, directives, and all applicable State and Federal court orders. The Fresno Sheriff's Office is responsible for the on-site and off-site mental health care services for the incarcerated people at the Fresno County Jail. With the approval of the Fresno County Board of Supervisors, such services may be contracted to a private service provider. The service provider shall operate a mental health care program that meets the local community standards of care, and supply all services under the terms of the negotiated contract. PROCEDURES: I. MENTAL HEALTH STAFF A. Clinical decisions, diagnoses, and treatment plans shall only be made by licensed mental health clinicians (psychiatrists, psychologists, Page 1 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH therapists, clinical social workers, psychiatric nurses). Licensed mental health clinicians shall review and cosign record entries made by Licensed Psychiatric Technicians (LPTs) and Licensed Vocational Nurses (LVNs) when LVNs and LPTs are providing behavioral health services. B. Mental health staff shall be appropriately credentialed according to the licensure, certification, and registration requirements for the State of California. C. Mental health staff shall be assigned to work in the jail and to evaluate, monitor, and treat incarcerated people who show signs of mental, rather than physical problems. Mental health staff shall assist correctional officers in dealing with incarcerated people who show signs of emotional or mental problems. II. MENTAL HEALTH SERVICES A. Mental health staff shall be responsible to provide the following services- 1. Mental health evaluations and assessment of treatment needs of incarcerated people who require (or appear to require) mental health services (e.g., incarcerated people with suicidal ideations, incarcerated people in behavioral crisis, incarcerated people who currently participate in a methadone treatment program, incarcerated people who reported alcohol and drug abuse, or who disclosed prior sexual victimization, etc.). 2. Mental health treatment programs provided by qualified staff, including the use of telehealth. 3. Crisis intervention services. 4. Basic mental health services as clinically indicated. 5. Psychiatric medication support services (e.g., access to medications, monitoring the effects of the medications prescribed by the psychiatrist, etc.). 6. Suicide prevention services (completing suicide risk assessments and monitoring incarcerated people assessed to be low, moderate, and high risk). Page 2 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH 7. Safety cell checks, evaluations, and follow-up. 8. Short-term individual and/or psycho-educational or psychotherapy group sessions. 9. Monitoring of SMI incarcerated people housed in administrative separation lockdown and disciplinary housing. Development and implementation of individualized treatment plans (e.g., Behavioral Management Plans [BMP's] to modify problematic behaviors). 10. Evaluations for and documentation of the need for involuntary acute hospitalization pursuant to Welfare and Institutions Code 5150. 11. Continuity of care from admission to transfer or discharge from the facility, including referral to community-based providers, when indicated. B. Mental health staff may make recommendations to Population Management staff regarding incarcerated person housing assignment locations and/or changes, as appropriate. Mental health staff will provide a reason for such recommendation. C. Mental health staff will coordinate with medical staff to ensure that care is appropriately integrated, medical and mental health needs are met, and the impact of any condition on each other is adequately addressed. D. Mental health staff will collaborate with the Department of Behavioral Health (DBH) to provide continuity of care with psychiatric medications and referrals to DBH services. Mental health staff shall have access to the DBH computerized information database to facilitate such care. III. INITIAL HEALTH CARE SCREENING FOR ARRESTEES A. All arrestees shall be screened by the Booking Nurse (i.e., registered nurse or nurse practioner) prior to acceptance for booking. B. Health care intake screening shall include, but not be limited to, medical and mental health problems, developmental disabilities, tuberculosis and other communicable diseases. Page 3 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH 1. The Intake/Receiving Screening Form includes questions regarding history of mental health problems or treatment, hospitalizations, and/or current or previous thoughts of self-harm. 2. Incarcerated people identified as having developmental disabilities, mental retardation, and/or learning disabilities will be referred to mental health staff for assessment. Mental health staff shall contact the Central Valley Regional Center for the purposes of diagnosis and/or treatment within 24 hours of such determination, excluding holidays and weekends. 3. Incarcerated people displaying signs of suicide risk at intake screening will be referred for an immediate mental health evaluation. C. The Booking Nurse may recommend that any arrestee who is in need of obvious acute medical attention not be accepted into custody. (The screening shall be fully completed, so that all detectable medical needs can be addressed prior to acceptance.) 1. The recommendation will be reviewed and approved by the Watch Commander. 2. The arresting/transporting officer shall be responsible to transport the arrestee to Community Regional Medical Center (CRMC) or other medical facility so that his or her medical needs can be addressed prior to booking into the Jail. The transporting officer will be required to provide a copy of the CRMC medical clearance paperwork, upon return. 3. If the Booking Nurse again finds the arrestee not fit for confinement, the nurse shall consult with the on-duty (or on-call) physician (or psychiatrist, as applicable). 4. If the physician/psychiatrist concurs with the Booking Nurse and rejects the arrestee, the Watch Commander will "override" the decision and accept the arrestee into custody. 5. The Watch Commander will coordinate with Medical/Mental Health to transport the incarcerated person back to CRMC via the site Emergency Room transfer process to address the incarcerated person's medical care and fitness for confinement needs. Page 4 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH 6. The contracted medical provider will be responsible to coordinate with CRMC regarding subsequent care of the incarcerated person, to ensure their fitness for confinement upon discharge from the Emergency Room, as necessary. [See flowchart on Addendum A.] D. If the arrestee is found fit for incarceration but requires further medical attention, he/she shall be treated by jail medical staff. If the arrestee requires psychiatric treatment, he/she shall be provided a mental health evaluation by health services stafft, who shall consult with Population Management staff regarding appropriate housing for the incarcerated person. IV. SPECIAL MENTAL DISORDER ASSESSMENT An additional mental health screening will be performed on women who have given birth within the past year and are charged with murder or attempted murder of their infants. Such screening will be performed at intake and, if the assessment indicates postpartum psychosis, a referral for further evaluation will be made. V. ACCESS TO MENTAL HEALTH TREATMENT A. Mental health service requests are to be made in writing, utilizing a Health Services Request Form. Incarcerated people are to place the completed forms in the locked boxes located inside each pod. Health Services Request Forms will be collected by health care staff during medication passes at least twice a day. Health care staff will pick up completed health service request forms directly from incarcerated people in Iockdown units during medication passes twice a day. The Charge Nurse will review and triage each request prior to placement of the incarcerated person's name on the sick call list and/or scheduling an appointment. B. Mental health staff may receive referrals for mental health evaluations from correctional and medical staff. 1. Population Management Unit staff may refer incarcerated people with documented mental health history (e.g., safety cell placements), incarcerated people who report prior sexual victimization, incarcerated people who are exhibiting mental impairments during classification interviews, and incarcerated people returning from State Hospitals. 2. Correctional and medical staff may refer incarcerated people who Page 5 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH display signs of suicide risk or require other crisis intervention services. (Refer to policies D-260/Suicide Prevention [FILE: SUICIDE] and D-360/ Sexual Misconduct and Abuse[FILE: SEXUAL ABUSE].) 3. If at any time, medical or custody staff is made aware of a mental condition that was not conveyed or detected at the time of booking/screening, the discovering staff member should report that information to the appropriate mental health staff. VI. PSYCHIATRIC MEDICATIONS A. Psychiatric medications, including but not limited to antipsychotic medications, shall be prescribed to incarcerated people with mental illness in accord with nationally accepted professional standards for the treatment of serious mental illness. Prescription medications shall only be prescribed by licensed physicians, physician's assistants, psychiatrists, or nurse practitioners, within the scope of their licensures. B. Physicians shall "bridge" all verified, valid prescriptions for incarcerated people who enter the facility currently on psychiatric medications. 1. Incarcerated people who receive such bridge medications shall receive a face-to-face evaluation with a psychiatrist within seven (7) days of initiation of the medication. 2. Follow-up face-to-face evaluations shall occur as needed, but within thirty (30) days following the initial visit. 3. Subsequent face-to-face evaluations by the psychiatrist shall occur as needed, but at intervals of no more than ninety (90) days. C. Incarcerated people who are prescribed psychiatric medications by the psychiatrist (i.e., not"bridge" medications) shall receive follow-up face- to-face evaluations with a psychiatrist as needed depending on their clinical status, but no later than thirty (30) days following the initial visit. Subsequent visits shall occur as needed, but at intervals of no more than ninety (90) days. D. Medication shall be distributed to the incarcerated people each day at designated times by designated medical staff. Psychotropic medications are excluded from self-administration. Page 6 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH E. Some psychotropic medications can pose a serious health risk during times of extreme heat by impairing the body's ability to regulate temperature. Temperatures in all jail facilities are monitored for the purpose of ensuring that incarcerated people prescribed psychotropic medications are not at risk of heat-related illness from extremely hot conditions (i.e., when the heat index reaches or exceeds 900). Conversely, incarcerated people are provided with extra blankets and/or thermal underclothing as needed in extremely cold conditions (i.e., when the temperature of a housing unit drops below 630F). (Refer to policy B-190/Air Pollutants, Extreme Temperatures and Heat-Risk Medications [FILE: WEATHER RISKS].) VI I. SEXUAL ABUSE VICTIMS A. If an incarcerated person indicates during intake screening that they have experienced prior sexual victimization, whether it occurred in an institutional setting or in the community, the incarcerated person shall be offered a follow-up meeting with a medical or mental health practitioner within fourteen (14) days of the intake screening. B. If an incarcerated person is a victim of sexual assault that occurs while in-custody, the incarcerated person/victim must be provided with appropriate mental health services, confidentially, and at no cost, in a manner consistent with the level of care in the community. 1. The incarcerated person will be referred for an urgent suicide risk assessment, and shall be evaluated within one (1) hour of referral. 2. The incarcerated person shall be monitored for suicidal impulses, post-traumatic stress disorder, depression, and other mental health consequences. 3. The incarcerated person shall be offered crisis intervention counseling, appropriate to the needs of the victim. c. The ongoing evaluation and treatment of such victims shall include, as appropriate, follow-up services, treatment plans, and when necessary, referrals for continued care. (Refer to Section xVl/continuity of care.) Vill. SUICIDE PREVENTION AND RISK ASSESSMENT A. All arrestees and incarcerated people shall be medically screened at the time of intake by a medical staff member for possible signs and Page 7 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH symptoms of suicidal behavior. B. Incarcerated people displaying signs of suicide risk shall be referred to a mental health clinician for an evaluation. C. Incarcerated people who have been sexually assaulted while in- custody shall be referred for an urgent suicide risk assessment. D. Mental health clinicians shall complete a comprehensive suicide risk assessment form for all incarcerated people who display signs of suicide risk to determine if the incarcerated person presents a low, moderate, or high risk of suicide. Mental health clinicians shall complete a new form if there are indications of any modification of risk factors, including but not limited to any suicide attempts or expressions of suicidal ideation. A comprehensive suicide risk assessment form will also be completed for incarcerated people who appear to be a danger to themselves or others and/or incarcerated people who may be in behavioral crisis. 1. Upon completion of the suicide risk assessment form, mental health staff shall create a corresponding Alert in Offendertrak indicating the suicide risk level (i.e., L-Suicide, M-Suicide, or H- Suicide). 2. Low-risk (L-Suicide) incarcerated people shall be monitored at least monthly by mental health staff and shall be housed with other incarcerated people or, if they cannot be housed with other incarcerated people, in housing where they can be frequently monitored by correctional staff. 3. Moderate-risk (M-Suicide) incarcerated people shall be monitored at least weekly by mental health staff and shall be housed with other incarcerated people unless they pose a safety and security threat to other incarcerated people. Moderate-risk incarcerated people shall be housed in locations that allow custody staff to observe and communicate with these incarcerated people on a daily basis. 4. High-risk (H-Suicide) incarcerated people shall be monitored at least every twenty-four (24) hours by mental health staff. 5. Incarcerated people who are determined to be "low low-risk" do not require follow-up (unless determined necessary based on a subsequent assessment). Page 8 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH E. If an incarcerated person is at moderate risk of attempting self- injurious behavior, but is not in immediate danger, a mental health clinician may recommend that the incarcerated person be placed on Suicide Precaution/"no sharps." 1. The clinician will also complete a Crisis Management Plan that documents their recommendation, and indicates the possessions and clothing items that should be removed or kept. 2. The clinician will be responsible to create an Alert ("Restriction - Mental Health") in Offendertrak. F. Sentenced incarcerated people who have been identified as a moderate or high level of suicide risk shall receive an evaluation by a mental health clinician prior to their release. (Refer to section xvl/Continuity of Care for the complete/detailed requirement.) IX. SERIOUS MENTAL ILLNESS or SEVERE MENTAL ILLNESS (SMI) Serious mental illness is defined as any mental disorder that results in comparatively severe impairment in major areas of functioning, such as cognitive capabilities or disruption in normal developmental processes and requires significant mental health treatment. The term is synonymous with "severe mental illness." A. Mental health staff shall create an "SMI" Alert in Offendertrak for all SMI incarcerated people. B. Mental health staff, with the assistance of correctional staff, shall develop and implement Behavior Management Plans for incarcerated people with serious mental illness who engage in repeated acts of misconduct with the goal of reducing their placements, or shortening the length of time they spend in Iockdown administrative separation housing. 1. Correctional staff assigned to Population Management who are familiar with the housing of incarcerated people with serious mental illness shall be included in administrative meetings where Behavior Management Plans are developed and reviewed. 2. Behavior Management Plan forms shall be scanned into the Incarcerated person Management Plans folder (G/RefM at/Custody/I nm ate Management Plans) by the designated Population Management Sergeant. Page 9 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH C. SMI incarcerated people may be assigned to all levels of classification. Population Management works in conjunction with mental health staff to assess the best housing environment that will aid the SMI incarcerated person in maintaining optimum mental health without compromising the safety and security of other incarcerated people and jail staff. D. Incarcerated people with serious mental illness are not housed in any locked down administrative separation or discipline housing unit in the jail system unless those incarcerated people demonstrate a current threat to jail security, incarcerated person and/or officer safety, as documented by correctional staff, that prevents them from being safely housed in less restrictive locations. E. In the event any SMI incarcerated person must be housed in a locked down administrative separation or discipline housing unit, correctional and mental health staff shall ensure those incarcerated people are offered mental health treatments three (3) times per week. 1. SMI incarcerated people who are housed in any lockdown cell for more than 48 hours are to have their cases reviewed by a multidisciplinary team consisting of corrections and mental health staff every two (2) weeks. Decisions for an individual's continued housing in a single cell includes input from a licensed mental health clinician. 2. Out-of-cell structured behavioral health services for SMI incarcerated people housed in any lockdown cell will be offered: a. A minimum of three (3) out-of-cell mental health contacts per week consisting of structured individual or group therapeutic/ educational treatment and programming, each lasting approximately one (1) hour with appropriate duration to be determined by a mental health clinician (or incarcerated person, if the incarcerated person ends the session before the hour is up). b. At a minimum, one (1) one-to-one structured therapeutic contact session will be offered by a mental health clinician. The remaining two (2) contacts per week may either be additional one-to-one structured therapeutic contacts or group therapeutic/ educational contact sessions. Page 10 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH F. Mental health contacts shall be documented indicating type and duration of activity. G. The Sheriff's Office shall review the status of incarcerated people with serious mental illness housed in administrative separation lockdown cells at least once every 30 days to determine if the incarcerated person can be moved to less restrictive housing. Jail mental health staff shall assess SMI incarcerated people' housing requirements, which shall be discussed at monthly administrative meetings with custody and health care staff. H. Sentenced SMI incarcerated people will receive discharge planning from health care staff(i.e., an LMFT or RN) prior to their release to the community. (Refer to SectionXVI/Continuity of Care.) X. SAFETY CELLS A. A mental health opinion/consultation with responsible health care staff on placement and retention shall be secured within two (2) hours of placement in a safety cell to determine the incarcerated person's need for mental health services and suitability for retention in the safety cell. This evaluation may be performed by any qualified, licensed health care staff. Licensed mental health staff will evaluate the incarcerated person and perform a clinical assessment within the first twelve (12) hours of placement. (Refer to policy D-210/Safety Cell[FILE: SAFETY CELL].) B. Mental health clinicians shall complete a comprehensive suicide risk assessment form for all incarcerated people who display signs of suicide risk to determine if the incarcerated person presents a low, moderate, or high risk of suicide. This assessment will be indicated on the Crisis Management Plan form. The clinician will be responsible to create a corresponding Alert in Offendertrak. C. The incarcerated person must be reviewed for continued retention in the safety cell a minimum of every four (4) hours by the on-duty Watch Commander. However, nothing shall preclude correctional, medical, or mental health staff from recommending removal prior to that time. D. Whenever health care staff members wish to recommend either the placement of an incarcerated person into a safety cell, or the removal of an incarcerated person from a safety cell, they shall contact the Page 11 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH Watch Commander. Health care staff utilize Crisis Management Plan forms (commonly referred to as "Restriction forms") to document incarcerated person safety cell placement and removal and to indicate their recommendation that an incarcerated person be placed on any restrictions (e.g., "no sharps"). 1. The Crisis Management Plan form is submitted to the Watch Commander for approval and signature. The Watch Commander will then approve or deny safety cell placement, removal, or restrictions, and ensure all subsequent custody notifications are made. 2. The signed form is delivered to Population Management staff by the health care staff member. E. Whenever an incarcerated person's placement in a safety cell is to exceed thirty-six (36) hours, mental health staff shall submit written justification (i.e., a Crisis Management Plan) to the Watch Commander, to recommend one of the following actions: 1. The reasonable extension and temporary continuance of the safety cell housing. 2. Discontinuance of the safety cell placement, and/or: a. Evaluate for a transfer to a medical or behavioral health facility for 72-hour treatment and evaluation pursuant to Section 5150 of the Welfare and Institutions Code. b. Recommend direct supervision (managed within the Jail facility). F. Any confinement lasting more than thirty-six (36) hours shall require the written approval of a Bureau Commander or their designee. No incarcerated person shall remain in a safety cell for more than forty- eight (48) continuous hours. G. Within twenty-four (24) hours of safety cell removal, the incarcerated person will be evaluated by mental health staff. The evaluation will be documented via a "24-hr Safety Cell Follow Up" event in Offendertrak. The incarcerated person will receive subsequent mental health evaluations at designated intervals (e.g., 7-days, 14-days, etc.). All Page 12 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH events will be documented via the appropriate entries in Offendertrak (e.g., 7-Day Safety Cell Follow Up," 14-Day Safety Cell Follow Up," etc.). XI. OBSERVATION CELL The observation cell is to be used to separate and protect those incarcerated people who display behavior that indicates they are in a crisis or a danger to themselves or others and require close observation. (Refer to policy D-375/Safety Cell[FILE: OBSERVATION CELL].) A. Placement into an observation cell requires recommendation from a licensed mental health clinician (or in their absence, a registered nurse who has been trained in mental health issues) and approval of the Watch Commander. If an RN performed the initial evaluation, licensed Mental Health staff shall evaluate the incarcerated person and perform a clinical assessment within the first twelve (12) hours of placement B. Any deprivation of rights or privileges withheld from an incarcerated person in an observation cell shall require written documentation by a licensed mental health clinician and the prior approval of the Watch Commander. C. The incarcerated person shall be medically cleared by qualified Medical staff(i.e., RN or provider) for retention every twenty-four (24) hours thereafter. D. The incarcerated person shall be reevaluated for removal or continued retention in the observation cell a minimum of every twenty- four (24) hours by a licensed mental health clinician and the Watch Commander. However, nothing shall preclude correctional, Medical, or Mental Health staff from recommending removal prior to that time. E. Whenever an incarcerated person's placement in an observation cell is to exceed ten (10) days, a mental health assessment from the facility Psychiatrist or facility Medical Director shall be conducted and a written recommendation shall be forwarded to the Watch Commander for the reasonable extension and temporary continuance of the observation cell housing. No incarcerated person shall remain in an observation cell for more than fourteen (14) continuous days. Page 13 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH XII. INDIVIDUAL MENTAL HEALTH TREATMENT PLANS F. For each incarcerated person treated for mental health conditions, custody staff shall be informed of the treatment plan when necessary, to ensure coordination and cooperation in the ongoing care of the incarcerated person. This treatment plan shall include referral to treatment after release from the facility when recommended by mental health staff. [Refer to Section XVI/Continuity of Care.] G. All Behavior Management Plans are scanned into the Inmate Management Plans folder in the G-drive (G/RefMat/Custody/Inmate Management Plans) by a designated Population Management Sergeant. Crisis Management Plans are also accessible in the Inmate Management Plans folder. H. The Watch Commander will ensure that an email is sent to all Sergeants and Lieutenants, notifying them of any newly effected plan. The affected Facility Sergeant is responsible to- 1. Print all newly enacted Crisis Management Plans, Behavior Management Plans, and Administrative Action Reports, as applicable. Copies of all current/applicable forms are placed into the "Inmate Management Plan" binder located in the security station of the affectecd housing floor. The only exception is the South Annex 2D housing unit, where the plans are immediately accessible outside of each individual cell door. 2. Ensure the affected housing floor officers are notified and aware of any newly effected incarcerated person management plans. 3. Purge the binder of expired forms, as necessary. XIII. TRANSFER TO A MENTAL HEALTH TREATMENT FACILITY A. A mentally disordered incarcerated person who appears to be a danger to himself or others, or to be gravely disabled, and is unable to be cared for adequately within the jail facilities, shall be transferred to an off-site Lanterman Petris Short treatment facility (e.g., Exodus) for diagnosis and treatment of such apparent mental disorder pursuant to Penal Code 4011.6, Penal Code 4011.8, and/or Welfare & Institutions Page 14 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH Code 5150. B. In the event an incarcerated person is housed off-site, but remains in custody, the mental health lead clinician/supervisor will have regular communication with the off-site care provider to assess the incarcerated person's status and ensure continuity of care upon return to the jail facility. The mental health lead clinician/supervisor will also have regular communication with appropriate custody staff regarding the incarcerated person's status. XIV. PRIVATE MENTAL HEALTH TREATMENT If an incarcerated person desires to be attended by their private physician and/or at a hospital other than the one normally utilized by the Fresno County Sheriffs Office Jail Division (i.e., CRMC), they may do so at their own expense. (Refer to policy G-120/Medical Health Services[FILE: MEDICAL]). XV. HEALTH CARE RECORDS A. A confidential record shall be kept on each incarcerated person assessed by mental health staff. The record shall include diagnostic studies, individual treatment plan, and records of services provided by the various mental health staff members in sufficient detail to make possible an evaluation of services, and contain all the data necessary in reporting to the State, including records of incarcerated person interviews and progress notes. Mental health records shall be kept separate from all other Jail Division and Sheriffs Office records. B. Health care record and health information, both oral and documented, is confidential protected health information. The minimum necessary health information is to be disclosed to health care staff providing health care or to jail authorities when necessary for the protection of the welfare of the incarcerated person or others, management of the jail, or maintenance of jail security and order. C. All health care records must comply with State and Federal regulations pertaining to access, disclosure, and/or use of health information. (Refer to policy G-120/Medical Health Services[FILE: MEDICAL].) XVI. CONTINUITY OF CARE Inmates shall be provided with continuity of care from admission to transfer or discharge from the facility, including referral to community-based Page 15 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH providers, when indicated. A. All incarcerated people are provided a Medical Discharge Summary. If the incarcerated person is receiving medications at the time of release, a seven (7) day supply of essential medications (including all psychiatric medications) will be available at a nearby pharmacy. The Medical Discharge Summary provides details concerning the pharmacy, and additional community care services available to the incarcerated person. B. Sentenced incarcerated people who have been identified as a moderate or high level of suicide risk shall receive an evaluation by a mental health clinician prior to their release to the community (or treatment program) for appropriate referrals or initiation of an involuntary psychiatric hold pursuant to Welfare and Institutions Code Section 5150. The same services will be provided to unsentenced incarcerated people provided adequate time is available prior to a legally mandated release. (Refer to policy C-210/Release from Custody [FILE: RELEASES].) C. As appropriate and when necessary, victims of in-custody sexual assaults shall be referred for continued care following their transfer to, or placement in, other facilities, or their release from custody. D. All sentenced SMI incarcerated people shall be provided with discharge planning by health care staff(i.e., LMFT or RN) prior to their release to the community. Discharge planning includes connecting such incarcerated people to community health care providers, community social services, community-based housing, and/or appropriate services per the individual's need. The same services will be provided to unsentenced SMI incarcerated people provided adequate time is available prior to a legally mandated release. (Refer to policy C-210/Release from Custody[FILE: RELEASES].) E. Transportation shall be provided, as necessary, in coordination with outside agencies and applicable community resources for SMI incarcerated people who are released from custody. XVII. TRAINING The training requirements listed below are specific to health care staff working in a jail environment. Refer also to policy A-310/Minimum Training Requirements for Correctional Staff Members[FILE: TRAINING]. Page 16 of 17 FRESNO COUNTY SHERIFF'S OFFICE JAIL DIVISION POLICIES AND PROCEDURES TITLE: MENTAL HEALTH SERVICES NO: G-130 FILE: MENTAL HEALTH A. All health care staff shall receive structured orientation and training specific to providing health services in a correctional setting. B. All health care staff shall receive training regarding suicide prevention during new employee orientation, and updated training annually. The training shall be provided by a licensed clinician having expertise in correctional suicide prevention and the use of a suicide risk assessment form. C. All full- and part-time mental health care staff shall be trained in how to detect and assess signs, preserve physical evidence, respond effectively, and report allegations or suspicions of sexual abuse and sexual harassment. D. Mock fire drills are conducted by the Jail Division at least twice a year to ensure all staff members are familiar with safety procedures and evacuation methods. Health care staff shall participate in one of the fire drills at least once each year. Page 17 of 17