Lewis County Sheriff’s Office
Request for Proposal
Jail Mental Health Services
The mission for every member of the Lewis County Jail is to support the feeling of community safety and security in Lewis County by consistently contributing toward a secure custody environment in a professional, ethical, and competent manner.
Increasingly meeting this mission requires our facility respond to inmates living with mental illness. Each year the impact of this population grows, as does the complex custody issues which arise as a result. In order to effectively address this population, we enlist the services of mental health professionals who can help us identify, engage, and manage these inmates. This report explains how our mental health programming has arrived where it is today, and provides a plan to more effectively address this population, and in doing so, better meet our mission.
Mental Health Services in the Jail
For as long as any of our administration can remember, we have received an annual budget of $34,000, derived from millage dollars, to provide mental health services inside the jail. This money has provided for one part-time employee which we have contracted through a variety of providers. In April of last year, we began contracting with Cascade Mental Health to provide these services in the form of one 28-hour per week position titled Jail Liaison.
The second mental health position in our facility, the Criminal Justice Transition Specialist, is the most recent iteration of funding allocated by House Bill 1290 (2005). This legislation provides funding to community mental health agencies to provide Medicaid re-enrollment services. Using these funds, Cascade first hired a part-time employee in 2005; however, this position was never able to make the impact on Medicaid re-enrollment, or our jail population, as intended due to the very restrictive processes mandated by the Department of Social and Health Services (DSHS). In 2012, Cascade Mental Health approached the Timberlands RSN and requested they allow these funds to be spent less restrictively. The RSN approved of some changes and allowed the funds to be spent on mental health services beyond Medicaid enrollment inside the facility. Using this money, Cascade hired a Criminal Justice Transition Specialist, who has now been working in our facility full-time for two years.
In late 2013, we were advised by Cascade the funding for this Criminal Justice Transition Specialist position had been restricted by the legislature and future funding was in jeopardy. While the RSN has reported they can likely continue to fund this 1290 position through June of 2015, there is no guarantee of funding beyond that time. This is very concerning to our facility as we depend on these professional contract staff to ensure we are able to address our mentally ill inmates.
Late last year, Cascade agreed to also provide six hours of service by their Engagement Specialist. This position has been working in our facility one day a week, providing services to inmates who have been or are hoping to enroll in services with Cascade.
Our current jail mental health programming consists of 1.75 FTE’s, with six additional hours per week of engagement services. While this level of staffing is higher than we have seen in years past, there seems to be no end to the number of inmates entering our facility showing signs of acute mental illness, requesting to meet with a counselor, and needing help getting connected with resources in our community upon release.
Statement of Need and Gaps in Service
While we knew the mental health needs of our inmate population continued to outpace our capacity to address them, we were unsure how to best highlight this issue. In the beginning of this year, we asked Cascade’s jail mental health staff to closely track their work in an attempt to document how our current programming was working, and how we might improve going forward. We also supported our mental health staff’s efforts in conducting a mental health survey in conjunction with the Lewis County Public’s Health “Point in Time” homeless count. While we always thought these studies would support our belief the jail population was in need of increased mental health services, the findings were more dramatic than we ever expected. Attached is a copy of that report. Highlights include:
· Almost half the inmates had unmet mental health needs, despite our existing mental health program.
· Almost half the inmates had unmet chemical dependency needs.
· More than two-thirds of the inmates surveyed were homeless.
· Almost two-thirds of the inmates surveyed lacked health insurance and would be Medicaid eligible upon release.
· There is a 2-3 week wait for an inmate to speak to a counselor for non-emergent mental health needs.
· For ongoing mental health treatment, inmates with non-emergent mental health needs wait approximately 4-6 weeks between visits.
Our jail has always been difficult to serve time in, and it’s my intention to keep it that way. However, improving our ability to address mental illness and other related problems such as homelessness and chemical dependency better enables us to have an impact on community safety and better meet our mission. I believe these goals are in line with the Tax Advisory Boards’ mission statement, which is why I am requesting an additional $100,000 from the .1 Sales Tax to establish sufficient mental health programming in our facility and meet the gaps in service highlighted above, and detailed in the attached report.
Proposed Program Approach
This money, along with our millage funds, would provide us with a yearly total of $134,000. This would enable us to contract for a minimum of two full-time mental health staff. These positions would ensure our facility had adequate staffing to improve our screening processes, decrease wait times for mental health visits, and make appropriate referrals for chemical dependency treatment. In doing this, we would be substantially growing our program from 1.75 FTEs to three FTEs (including position funded by RSN). At least one of the positions would be for a Mental Health Professional (Masters Degree in counseling or related field + 2 years experience). This would enable the positions to function with a more independent nature as the MHP staff could conduct evaluations to determine the presence of a mental health disorder, while coordinating the other workers to ensure inmate contacts and coordination efforts were adequately addressed.
This funding would also have a dramatic impact on the work of our Criminal Justice Transition Specialist. As of today, this position spends an average of 30-hours of each week addressing requests for services from our inmates and ensuring our most critical mental health cases are sufficiently staffed. The addition of two mental health staff would free this position to develop the type of transition programming we would all like to see; including increased collaboration with the courts, an improved screening process for inmates entering jail, and a streamlined Medicaid enrollment strategy.
This funding will:
· Ensure we have adequate mental health staffing, regardless of RSN funding.
· Increase our ability to enroll inmates into mental health treatment upon release.
· Improve our ability to identify and address high utilizing citizens.
· Increase our ability to coordinate with Lewis County Shelter.
· Increase our ability to coordinate with area Veterans’ benefits specialists.
· Increase our ability to partner with local courts.
· Increase our ability to work with Prosecuting Attorneys and “follow-up” on Judgment and Sentences requiring mental health follow up.
· Protect the County from potential liability by ensuring mentally ill inmates are receiving timely and effective services. (The average length of stay in the Lewis County Jail is nine days. Often, non-emergent requests for mental health services are not being provided due to the minimal mental health staffing).
· Assist in alleviating the burden placed on Corrections Officers who deal with severely mentally ill inmates. This will assist in maintaining a safe atmosphere for both the inmates and the Corrections Officers.
Staff and Organizational Experience
The positions will be staffed by clinicians working for Cascade Mental Health under the supervision of the Crisis Services Manager, Sarah Hockett, LMHC. JP Anderson, MSW, will act as team lead and on-site supervisor. Hiring for the new positions will be conducted by Cascade Mental Health, with consultation and confirmation by the Lewis County Sheriff’s Office.
Evaluation
Using the same information gathering processes used for the attached report (Cascade’s Chrystal reports and annual inmate census data), we will evaluate new programming annually on its ability to:
1. Provide direct visits to inmates.
2. Respond in a timely manner to inmate requests for mental health counseling.
3. Respond in a timely manner to officer referrals.
Inmate visits and direct service information will be gathered each month by Cascade staff and delivered to Captain Jim Pea. Average inmate wait times will be calculated by Cascade staff and delivered when requested by Jail administration. Qualitative data will also be gathered from Corrections Sergeants and Corrections Officers on a regular basis.
We intend to use the results of these evaluations to improve our approach to addressing this population. This ongoing self-evaluation will continue to take place during our quarterly management and administrative team meetings. As always, we believe these objectives can best be accomplished using a collaborative and outcome-oriented approach.
Thank you for considering this additional financial support of our mental health programming. I believe this request satisfies the intent of the .1 % tax money and I’m confident this funding will make an impact in our facility and our community.
Respectfully,
Kevin Hanson, Corrections Chief
Lewis County Sheriff’s Office
Budget for Services Contracted through Cascade Mental Health
Spending Category / Cost (per year)Salary/FTE / $42,000
(Master’s level clinician)
Benefits / $14,700
Overhead (supervision, materials, etc.) / $5,000
Miscellaneous (travel, training, group/counseling materials, etc.) / $5,000
Spending Category / Cost (per year)
Salary/Part-time / $21,312
Benefits / $7,326
Overhead (supervision, materials, etc.) / $2,331
Miscellaneous (travel, training, group/counseling materials, etc.) / $2,331
TOTAL: $100,000
Jail Mental Health Services:
Inmate Census Results
Renee Strode, M.A.T., A.A.C.
Cascade Mental Health Care
Prepared for
The Lewis County Jail Administration
February 14, 2014
Jail Mental Health Services: Inmate Census Results
A jail-wide inmate census was conducted by Cascade Mental Health employees JP Anderson and Renee Strode on January 21, 2014, with the support of the Lewis County Jail administration and staff. This point-in-time survey assessed unmet inmate needs in the areas of mental health, chemical dependency, health insurance, and housing. Inmates identified as homeless completed additional documentation which was provided to the Department of Public Health as a part of project Homeless Connect 2014. This report discusses the results of the census, the status of the current mental health program in the jail, and program recommendations.
Jail Census
On the day of the census, 260 inmates were housed in the jail. Five inmates declined to participate in the survey and seven survey results were discarded due to interviewer error, resulting in inclusion of data in this report for 248 participants. A graphic representation of the survey results is shown in Figure 1. The largest unmet need identified by inmates was housing, with 69% of all inmates reporting homelessness and 68% of inmates residing in Lewis County reporting homelessness (Fig.2). 63% of all inmates and 66% of inmates residing in Lewis County were without medical insurance prior to incarceration and met the maximum income requirements for Medicaid enrollment. 45% of all inmates and 49% of inmates residing in Lewis County reported unmet mental health needs (Fig. 3), and 40% of all inmates and 42% of inmates residing in Lewis County reported unmet chemical dependency treatment needs (Fig.4).
These results indicate significant gaps in services in all areas of measure:
1) Almost half of inmates surveyed had unmet mental health needs despite an existing mental health program, described further in this report.
2) Almost half of inmates surveyed had unmet chemical dependency needs. Currently there are no chemical dependency services accessible from jail, and there is no designated program to address this need.
3) More than two-thirds of inmates surveyed were homeless. There is no designated program to address this need.
4) Almost two-thirds of inmates surveyed lacked health insurance upon entry and would be Medicaid-eligible upon release. There is no designated program to address this need.
Due to the unique motivational state of offenders in the jail environment, these service gaps likely represent a significant loss in opportunity to reduce recidivism. The National Institute of Corrections (2007) identifies offender motivation to change as the result of internal factors (i.e. offender sees personal benefits) highlighted by external pressure (e.g. legal and financial consequences, possible loss of job or relationship). Studies of motivation and change have found that the best outcomes for change occur when both internal and external pressure are elevated (Prochaska & Levesque, 2002, Ryan & Deci, 2000, Ryan, Plant, & O’Malley, 1995). Jail incarceration increases both of these pressures on an offender, creating a window of higher motivation to change. Motivation is also susceptible to influence and can be effectively raised through trained intervention efforts (NIC, 2007). Thus interaction with professionals in the jail setting is more likely to be successful in promoting change and reducing recidivism.
Jail Mental Health Program
Mental health staff at the Lewis County Jail are employees of Cascade Mental Health Care (CMHC). Service requests are triaged by mental health staff according to emergent need and referral source. Priority is given to inmates identified by corrections officers to be in an immediate mental health crisis. Inmates also interact with mental health staff directly through the electronic kiosk system, allowing counselors to gather information for the triage process and provide ongoing therapeutic contact with inmates. Inmates who identify nonemergent mental health needs are placed on a waiting list to speak with a counselor. Because of the need to prioritize crisis response in the jail environment and the overall volume of requests for mental health services, there is an approximate wait to speak with a counselor of 2-3 weeks for an inmate who has identified a nonemergent mental health need. Due to the dynamic nature of the jail population, inmates placed on the waiting list for a mental health visit may be released or transferred to another facility prior to being seen. For ongoing mental health treatment, inmates with nonemergent mental health needs typically experience waits of approximately 4-6 weeks between counselor visits. At the direction of the jail administration, CMHC staff will soon expand program data collection by recording the triage level and the response time for all mental health interactions.