Urgent Attention Needed: Mental Health Crisis within TDCJ Must Be Addressed Immediately

Recent incidents within TDCJ Connally Unit raise concerns about the state's approach to mental healthcare within the correctional system. It's time for our elected officials to take action!

HAS BEEN ON THE RISE SINCE 2021 AND BEYOND WHEN WILL ENOUGH BE ENOUGH?

https://www.themarshallproject.org/2021/08/12/they-should-have-been-watching-suicides-rise-in-texas-prisons-during-pandemic

Dear Governor and Elected Officials,

We are deeply concerned about the recent reports of suicide within TDCJ Connally Unit. It has come to our attention that not only were there two tragic deaths, but also one attempt within the span of just two weeks. This alarming situation demands your immediate attention, as it highlights the urgent need for a comprehensive approach to addressing mental health within our correctional facilities.

It is disheartening to learn that similar reports have emerged from McConnel and Beto Units, yet these incidents remain largely unknown to the public. We must emphasize that this lack of transparency is both unacceptable and concerning. The mental well-being of our incarcerated population should not be disregarded or kept hidden from the public eye.

We urge you to take immediate action to rectify the mental health crisis within TDCJ. Inmates entrusted with the oversight of their fellow prisoners' mental health is an inadequate and unsustainable solution. The administration must prioritize obtaining professional help and resources for those in need.

As concerned citizens, we call upon you, Governor, and all elected officials, to fulfill your responsibilities by proactively addressing this issue. It is your duty to ensure the safety and well-being of all individuals within the Texas Department of Criminal Justice.

We understand that managing the mental health needs of a large incarcerated population is a complex task. However, it is not an excuse for inaction. We implore you to swiftly implement comprehensive strategies to address the mental health crisis within TDCJ.

By investing in professional mental healthcare services, training correctional staff in recognizing and responding to mental health issues, and improving the availability of counseling and therapy for inmates, we can begin to make significant progress in preventing further tragedies.

The time for putting a band-aid on this issue has long passed. We demand a proactive and systematic approach to mental health within TDCJ. Our incarcerated citizens deserve the opportunity for rehabilitation and support, and it is crucial that we provide them with the necessary resources to address their mental health needs.

If you, Governor, and the elected officials responsible for overseeing the state's correctional system, fail to take swift and decisive action, we will have no choice but to demand your removal from office. We believe in our democracy and in the power of the people to hold their leaders accountable.

In conclusion, we urge you to prioritize the mental health crisis within TDCJ and take immediate steps to address the concerning incidents at Connally Unit, as well as any other facilities experiencing similar issues. The well-being and safety of both inmates and staff depend on your decisive action.

We, the concerned citizens of Texas, will closely monitor the progress of this matter and expect timely updates regarding the steps being taken to rectify the mental health crisis within TDCJ.

Together, let us ensure that our correctional system upholds the principles of justice, compassion, and effective rehabilitation.

#MentalHealthMatters #JusticeReform #TakeActionNow

BELOW IS THE SUPPOSED PLAN OF ACTION 
(NOT BY INMATES BUT QUALIFIED MENTAL HEALTH PROFESSIONAL)

PURPOSE: To provide policy, defined procedures, and a program for identifying and responding to suicidal individuals. Prevention of suicide is the responsibility of Health Services staff as well as security and other correctional personnel. POLICY: A program exists to provide specialized programming, intervention, training and tracking for the prevention of inmate suicide. 

I. DEFINITIONS: A. Mental Health Observation (MH Obs): If the unit is designated or authorized for MH observation cells, then MH observation is a status authorized by a Qualified Mental Health Professional (QMHP) for an inmate who is determined to be at risk of self-injury but is not acutely suicidal or an imminent risk to do significant medical harm. The inmate is to be placed in a specially prepared and approved cell. Inmates in MH Obs are observed for psychiatric symptoms at least every thirty minutes by medical/mental health staff. B. Crisis Management: A status ordered by a QMHP for an inmate at imminent risk of significant self-injury, suicide, or their mental health needs cannot be managed at their assigned unit. The inmate is to be placed in a specially prepared and approved cell. Inmates in Crisis Management are observed for psychiatric symptoms at least every fifteen minutes by medical/mental health staff or a correctional officer with special training at a Behavioral Health Facility (BHF). C. Constant and Direct Observation (CDO): A status in which an inmate who is determined to require movement to Crisis Management is pending transport. In CDO the inmate is constantly observed by an officer who is close enough and has the means to intervene to prevent selfinjury. Note: this status is not ordered by providers but is a function that security provides upon providers issuing an order for Crisis Management until the inmate can be delivered to Crisis Management. D. Safety Garments: When standard issued clothing presents a security or medical risk (for example, suicide observation), provisions are made to supply the inmate with a safety garment that will promote inmate safety in a way that is designed to prevent humiliation and degradation. Safety garments may include smocks and/or suicide blankets. II. Training A. All staff receives training in suicide prevention during pre-service and/or new employee orientation and at least annually thereafter. B. Suicide prevention training includes, but is not limited to the following areas: 1. Identifying warning signs and risk factors of suicide 2. Demographic and cultural parameters of suicide 3. Responding to suicidal and/or depressed inmates 4. Referral procedures 5. Communication between correctional and health care personnel 6. Monitoring and observation procedures, including follow-up 7. Critical incident debriefing and staff support following completed or near-completed inmate suicides. 

CORRECTIONAL MANAGED HEALTH CARE POLICY MANUAL Effective Date: 7/13/2023 NUMBER: G-53.1 Replaces: 9/8/2022 Formulated: 5/95 Page 2 of 5 Reviewed: 07/2023 SUICIDE PREVENTION PLAN 8. Population specific factors, pertaining to suicide risk in the facility. C. Health Services staff who provide training will maintain copies of lesson plans and rosters of all participants in a secure file for at least three years. III. Identification, Evaluation, Intervention and Referral A. Inmates may be identified as at risk for suicide or self-injury through self-referral or by referral from any other party. B. Inmates who are identified as for suicide or self-injury will be evaluated immediately by a mental health or medical clinician. In the event there are no medical or mental health staff at the facility, the ranking security officer will contact the on-call psychiatrist/mid-level practitioner (MLP) for disposition. Suicidal inmates will be moved immediately to an environment in which inmate safety is ensured, and constant and direct observation (CDO) can be maintained. C. A Qualified Mental Health Professional, when available, will assess the patient for suicide risk to determine if placement in Mental Health Observation or referral to Crisis Management is indicated. When no qualified mental health professional is available, nursing will contact the on-call psychiatrist/MLP for disposition. D. An inmate is appropriate for outpatient Mental Health Observation if: 1. She/he has made no act of self-injury requiring ongoing medical attention 2. Behavior and/or mental status do not necessitate the use of physical restraint 3. Behavior and/or mental status do not necessitate enforced medication 4. The inmate/patient is not acutely psychotic, acutely suicidal, severely depressed or otherwise seriously mentally ill. Those inmates who do not meet the above criteria are inappropriate for Mental Health Observation and should be transferred immediately to a crisis management or Behavioral Health Facility. Inmates awaiting transfer to a crisis management facility must be held in a safe environment under constant and direct observation (CDO) until departure from the facility. E. An inmate is appropriate for Crisis Management if he/she exceeds the criteria for Mental Health Observation or is being transferred to inpatient care due to mental illness that cannot be managed on an outpatient basis. The procedure for referral to Crisis Management is detailed in Correctional Managed Health Care Policy G-51.6. F. Documentation: 1. Documentation of all referrals, assessments and intervention of suicidal inmates are made in the health record. Assessment forms, if used, will be documented in the health record. Nursing staff will utilize a nursing protocol to assess all patients. 2. The unit QMHP will describe or document each incident of inmate self-injurious behavior and/or suicide attempt by completing the Electronic Health Record (EHR) template, MH Self-Injurious Report, appropriate for the facility where the incident occurred no later than the next working day following the incident. 3. A completed HSM-14 (99) will be included in the health record before transfer of an inmate to Crisis Management.

CORRECTIONAL MANAGED HEALTH CARE POLICY MANUAL Effective Date: 7/13/2023 NUMBER: G-53.1 Replaces: 9/8/2022 Formulated: 5/95 Page 3 of 5 Reviewed: 07/2023 SUICIDE PREVENTION PLAN IV. Constant and Direct Observation (CDO) A. Security officers will provide constant and direct observation according to Security Procedures. B. All inmates with authorization for Crisis Management will be placed on CDO until transferred. C. A licensed healthcare worker will make rounds once per day. D. A QMHP, when available, will assess all inmates in CDO at least once per working day. V. Mental Health Observation and Crisis Management documentation are to be included in the inmate’s EHR at the time of admission. A. All admissions to Mental Health Observation and Crisis Management require the authorization of a Psychiatrist, Advanced Practice Provider (APP) or QMHP based on the documented assessment of risk for self-harm. The entry will include: 1. The time and date of admission 2. Reason for admission 3. Description of behavior which has resulted in the admission and the inmate’s mental status 4. Authorization for Crisis Management will not exceed three (3) working days, but may be extended one (1) time for an additional three (3) working days with documented clinical justification 5. Items which the inmate may possess are appropriate clothing and serving ware for meals 6. Information given to the patient about reason for admission B. Crisis Management admissions will also include pertinent physical findings and current medications if any. C. The Mental Health Observation Checklist (HSP-5) will be initiated by medical and/or mental health services staff upon the inmate’s admission to Mental Health Observation or Crisis Management and completed in accordance with instructions. VI. Housing Criteria for Mental Health Observation/Crisis Management A. Any room or cell used for Mental Health Observation/Crisis Management must have the following: 1. Adequate lighting 2. No exposed electrical outlets 3. Ability for the observer to see the entire room without entering 4. No fixtures which the inmate may use to harm him/herself 5. Adequate ventilation during warm weather and adequate heat during cold weather B. Immediate availability of items that would be necessary to save life if a suicide attempt is made, including (but not limited to) 1. Emergency response equipment 

CORRECTIONAL MANAGED HEALTH CARE POLICY MANUAL Effective Date: 7/13/2023 NUMBER: G-53.1 Replaces: 9/8/2022 Formulated: 5/95 Page 4 of 5 Reviewed: 07/2023 SUICIDE PREVENTION PLAN C. Prior to use, annually, and after any modifications, all cells or rooms intended for use as Mental Health Observation/Crisis Management areas must be visually inspected and approved by the Facility Warden, Supervising Qualified Mental Health Professional, Facility Medical Director and Director of Nurses. Written confirmation of this approval must be maintained as an addendum to this policy in the Facility Health Services Manual. Modifications to cells or rooms used for Mental Health Observation/Crisis Management necessitate a re-inspection and approval. D. Facilities using Mental Health Observation must have onsite nursing coverage whenever an inmate is in observation. If a facility does not have a suitable, approved housing area in which to provide Mental Health Observation, the inmate must be transferred to a Crisis Management Facility. VII. Care and documentation for inmates while in Mental Health Observation or Crisis Management. A. Each inmate in Crisis Management will have a Mental Health Crisis Management Evaluation within one (1) workday of placement that includes the reason for admission. B. Clothing, mattress, blanket, eating utensils and legal material are allowed unless otherwise determined by a QMHP. Inmates who are at risk for self-injury should not be permitted to possess items with which they may injure themselves. Inmates may be provided with agency approved security garment (smock or suicide blanket), in lieu of regular linen. If the QMHP considers the security garment contraindicated or dangerous to the patient, the inmate will be placed on CDO or one to one observation. C. Inmates may not be denied possession of legal materials except under the following circumstances: 1. Items with which the inmate may harm him/herself, such as pencils, pens, paper clips and staples may be denied with written justification in the health record. 2. State furnished legal materials may be restricted or denied when the inmate/patient exhibits behavior, which may result in the destruction of such materials. Justification of any restriction must be documented in the health record. D. Inmates in Mental Health Observation must be visually checked a minimum of once every 30 minutes by mental health, medical staff or by security staff. Inmates in Crisis Management must be visually checked a minimum of once every 15 minutes by mental health staff, medical staff, or by a correctional officer with special training at the Behavioral Health Facility. Behavior is documented on the Mental Health Observation Checklist (HSP-5). E. A QMHP will be notified if the inmate’s mental status significantly deteriorates. F. Inmates in Mental Health Observation or Crisis Management are allowed daily bathing privileges in accordance with established security procedures. G. Inmates in Mental Health Observation or Crisis Management may not engage in routine out of cell activities. H. Previously scheduled routine off-site medical appointments for inmates in Mental Health Observation or Crisis Management should be rescheduled if clinically appropriate. 

CORRECTIONAL MANAGED HEALTH CARE POLICY MANUAL Effective Date: 7/13/2023 NUMBER: G-53.1 Replaces: 9/8/2022 Formulated: 5/95 Page 5 of 5 Reviewed: 07/2023 SUICIDE PREVENTION PLAN VIII. Discharge documentation for Inmates in Mental Health Observation and Crisis Management A. Inmates may be discharged from Mental Health Observation or Crisis Management any time up to the duration specified at admission or upon expiration of the admit authorization. The authorization for discharge may be given by a Psychiatrist, APP or QMHP. B. Upon discharge from Mental Health Observation the inmate must be returned to his/her assigned housing area and referred to mental health staff for further evaluation and treatment as clinically indicated and follow-up or transferred to Crisis Management. C. Upon discharge from Mental Health Observation or Crisis Management a qualified mental health professional will document a Discharge Summary note in the EHR that includes: 1. Reason for admission 2. Presenting symptoms, clinical course of stay, and current level of symptomatology 3. Current Mental Status Exam 4. Diagnosis 5. Orders and recommendations IX. Facilities will maintain a log of Mental Health Observation and Crisis Management admissions which includes at a minimum; patient name, TDCJ#, date of admission, referring unit (if applicable), and date of discharge. X. Completed Suicide A. In cases of completed suicide, the QMHP will notify the appropriate Director of Mental Health Services within 24 hours and will work with the Facility Warden or designee, the Medical Director, Practice Manager, Facility Health Administrator and Nurse Manager/Director of Nurses to schedule and conduct a critical incident debriefing(s). The purpose of the critical incident debriefing is two-fold: 1. To review the circumstances of the incident, including the timeliness and appropriateness of staff response and intervention in order to identify any areas in need of improvement of staff evaluation and training needs. 2. To provide staff and inmates who were directly involved or witness to the suicide with supportive counseling and to offer referrals to individuals in need of further intervention. B. Documentation of the critical incident debriefing(s) is confidential. C. In cases of completed suicide, a Post-Mortem Suicide Review will be conducted as per 

Correctional Managed Health Care Policy (A-11.1). Reference: ACA Standard ACI-6B-08 (Ref. 4-4389) Emergency Response (Mandatory) ACA Standard ACI-6A-35 (Ref. 4-4373) Suicide Prevention and Intervention (Mandatory) ACA Standard ACI-6A-28 (Ref. 4-4368) Mental Health Program (Mandatory)