The 2018 Special Session I Acts of Assembly, Chapter 2, Item 391, P., directs the Department of Corrections (DOC) to report on potential options to reduce the number of serious mentally ill state responsible (SR) offender population who serve their sentences in local or regional jails.

The Department of Corrections shall evaluate potential options to reduce the number of state-responsible inmates with serious mental illness who serve the entirety of their state-responsible sentences in, and are released directly from, local and regional jails. In its evaluation, and using the definition of serious mental illness in accordance with the American Correctional Association, the Department shall give consideration to (i) the number of state-responsible inmates identified by jail staff with serious mental illness held in regional jails, the jails in which they are held, their diagnostic category as delineated in the DSM-V, the length of their state-responsible sentence and the type of their offense, and whether they were assigned to a DBHDS facility from the jail for evaluation; (ii) which among these offenders should be prioritized for transfer to a state correctional facility; (iii) the current inmate population with serious mental illness held in state correctional facilities, their diagnosis and the acuity of their symptoms, and the length of their sentence and the type of their offenses; (iv) the facilities and services currently provided for the treatment of inmates with serious mental illness held in state correctional facilities; and, (v) what additional capital and operating resources would be needed by the Department to facilitate a reduction in the number of state-responsible inmates with serious mental illness serving the entirety of their sentence in local and regional jails. The Department shall provide the results of its evaluation to the Chairmen of the House Appropriations and Senate Finance Committees no later than October 15, 2018.

A comprehensive review of available Department of Corrections’ (DOC) data and data collected from local and regional jails in Virginia, as part of the State Compensation Board’s (SCB) 2018 Mental Illness in Jails Survey, revealed information that could be utilized to determine the length of state-responsible sentence, the type of offense, and whether the state-responsible (SR) offender with mental health diagnoses (MH) was assigned to a Department of Behavioral Health and Developmental Services (DBHDS) facility from the jail for evaluation. Based on the lack of consistent sourcing of data and variety of clinical services available across Virginia’s jails, data to support identification of which among these offenders should be prioritized for transfer to a state correctional facility is not readily possible; however, the DOC Jail Intake Unit, based on the request of the jail and with input from DOC Qualified Mental Health Professionals, already expeditiously prioritizes and intakes offenders with MH issues.

The DOC utilizes the American Correctional Associations’ (ACA) definition of SMI, which indicates there are only five diagnoses that qualify as a SMI--bipolar or major depressive disorder, dysthymic disorder, anxiety disorder, post-traumatic stress disorder, schizophrenia or schizoaffective disorder. Utilizing this definition, DOC determined 811 offenders (3%) currently incarcerated in the state prison system were diagnosed with a SMI. The five most prevalent diagnoses were schizophrenia, schizoaffective disorder, major depressive disorder, PTSD, and Bipolar I. Utilizing all available data, DOC determined there are several variables that prevented the Department from providing a true picture of the number of SR offenders with serious mental illness serving the entirety of their state-responsible sentence of two years or less in local and regional jails. Certainly, those with more significant offense histories and longer sentences serve their sentences in DOC facilities. Of the 811 SMI offenders in DOC facilities, 119 offenders were serving Single Life, Multiple Life, or Three Strikes sentences. The remaining 692 SMI offenders were serving a total imposed sentence of an average of 22.7 years and 81% of these offenders were convicted of a violent most serious offense.

Within the DOC, most mental health services are provided on an outpatient basis, and include but are not limited to, crisis management, groups, and brief solution-focused individual treatment sessions. Psychiatric services, including medication management, are also available. There are 548 total DBHDS licensed mental health beds in the DOC system currently, including 112 Acute Care level inpatient beds for offenders who currently meet “commitment status" at Fluvanna Correctional Center for Women and Marion Correctional Treatment Center.

Offenders who require less structure than Acute Care but more services than are available in general population settings may be referred to one of the 436 beds in six Residential Treatment Mental Health Units in the DOC. The DOC does not have sufficient resources to determine the mental health status of SR offenders in jails. In addition to the lack of standardized screenings, or even the type of personnel conducting the screenings, there is also a sizeable population categorized as “suspected of having a mental illness" in the jail data from the SCB 2018 survey. If DOC does not know about a SR offender’s mental health condition, we cannot provide assistance with helping SR offenders upon release or determining if an offender would be better served, even in the short term, with intake into DOC. We currently have a model to address mental health concerns in the community utilizing District Mental Health Clinicians that can be expanded to include evaluation and services to SR offenders in the jails as a means to ensure a continuum of care.

While identification, diagnosis and treatment of mental health concerns is consistent within the DOC incarcerated populations, there is no common language or protocols between DOC and the individual jails around the Commonwealth. The 28 Regional Jails and 31 Local Jails (jails that run multiple locations were only counted once) assess offenders differently for MH issues. Some have mental health staff, others have Community Services Board (CSB) staff to assess and provide mental health services, while others rely on the completion of a twelve question mental health assessment without dedicated Qualified Mental Health Professional (QMHP) staff to follow-up, but the jails reported that 70% of SR offenders serving the entirety of their sentence in the jails were diagnosed as, were suspected to have or self-reported a SMI.

Lastly, there is a high rate of recidivism for SR offenders with mental health diagnoses who serve their sentences completely in jails. Without the DOC having knowledge of which SR offenders in jails is diagnosed with a SMI, the DOC works with jails to bring offenders needing specialized treatment into facilities at a more expedited rate to ensure they receive necessary care.

In order to address the inconsistencies surrounding the collection of data, assessment of SR offenders in jails diagnosed with a SMI and treatment, DOC offers the following recommendations:

• Increase the number of District Mental Health Clinicians within the DOC, which will allow for better assessment, diagnoses, treatment and continuity of care regardless of whether the SR offender with a SMI is transferring to a DOC facility, discharging directly from the jail, or continuing with DOC Probation and Parole supervision.

• Implement electronic health records that can “talk" across the continuum of care, and (including the jails, prisons, CSBs, probation offices, state hospitals and Veteran’s Administration) could streamline diagnosis and treatment options, greatly boosting efficacy of the system as a whole.

• Allow additional resources to be available for individuals with MH issues upon release from jails and prisons. For example, Discharge Assistance Planning (DAP) funds are used for housing, mental health care, medication, and transportation but can only be accessed by psychiatric hospitalization at DBHDS. Governor’s Assistance Program (GAP) is only available after CSB screening. It has been very beneficial to have DOC offenders prioritized for Supplemental Security Income (SSI) benefits screenings, but this is not available to the jails. Lastly, if Medicaid were suspended instead of revoked, less high risk-high need offenders would be back in communities with few or no visible means of self-support.

• Standardize the application and utilization of mental health services within jails, to include trauma informed care strategies and practices, and focus on case management.

• Standardize the methods for the MH assessment for all local jails, regional jails and the DOC to reduce reliance on self-reporting and determine which offenders have been or should be diagnosed with a SMI in a consistent manner.

• Determine criteria as to which offenders should be prioritized for treatment or movement, such as amount of time remaining to serve, severity of SMI, and treatment options available at the jail.