By Peter Taylor, with contributions by Tiffany Arrows

The Treatment Advocacy Center reports over the past decade county jails and prisons have emerged as America’s new asylums housing 10 times more mentally ill persons than hospitals. As many communities struggle to manage this mental health crisis, Bluegrass.org marks 35 years of mental health services to the Fayette County Detention Center.                                                              

The Fayette County Detention Center (FCDC) Mental Health program was created as a partnership between the Lexington-Fayette Urban County Government and Bluegrass.org with the goal of lowering the risk of suicide in county jails and providing care for individuals with mental illness while in custody.

Beginning in 1982, clinicians started screening at-risk inmates as they were booked into the Fayette County Jail and provided services based on assessments. The program began operations with three employees and a part-time psychiatrist working inside the detention center. Since then, the program has continued to grow to keep pace with the increasing inmate population with mental health problems.

In 2005, Bluegrass increased services to provide staff 24 hours a day, seven days a week. Having staff on-site around the clock provides a high level of care for inmates and support to jail administration. FCDC is one of only two county jails in Kentucky with on-site mental health services. The FCDC program served as a catalyst for the development of the Bluegrass.org Jail Triage Program which facilitates community mental health and county jail partnerships throughout the state.

Managing risk and providing psychiatric care have proven to be a highly effective strategy for reducing suicide and self-injury at FCDC. The facility’s suicide rate over the last 35 years is dramatically lower than the rate for incarcerated persons nationally. According to the Bureau of Justice Statistics a jail the size of the Fayette County Detention Center would average 6.75 suicides a year. In the past 10 years, there have been no suicides.

Continuity of Care

Providing continuity of care measurably improves an inmate’s quality of life while incarcerated and the goal is to carry this improvement after release. With discharge planning, Bluegrass.org matches clients to a range of community partners including outpatient services, recovery programs, hospitals, Assertive Community Treatment teams, Adult Protective Services and the Fayette Mental Health Court. This program was created to address the high suicide rate in county jails across the nation and to provide care for persons with mental illness while in custody.

The collaborative approach has significantly reduced the cycle of Fayette County’s most severely mentally ill citizens’ needless involvement in the criminal justice system. Further, facilitating access to treatment promotes functional recovery and has proven to be significantly more cost-effective than repetitively cycling individuals with mental illness through the jail and the court system.

Bluegrass.org’s mental health program at FCDC is an integral part of the jail’s daily operation. In 2016, the staff averaged 38 contacts per day for a total of 14,366 contacts. In addition, Bluegrass.org provides psychotropic medication for 20 percent of the inmate population. In 2016, the Fayette County Detention Center was identified by the Community Oriented Correctional Healthcare Services Organization as one of the safest and best connected jails in the nation in a Pew Foundation report to be published at a future date. The Mental Health Program was noted to be important factor in that success.

The problem created by incarcerating the mentally ill is clearly a tremendous challenge. But mental health programs demonstrate incarceration can create an opportunity to connect under served persons with life-changing services. Providing mental healthcare to the incarcerated population has proven to make jails safer, improved the quality of life for persons living with mental illness and lowered the aggregate cost of mental illness to the community.

Jail Triage Program

Referral: Individuals are routinely screened for mental health and safety issues upon entering the facility. Referrals can also be prompted by arresting or transport officers, medical request or risk alerts indicating a history of mental health or safety issues.

Intake Assessments: Clinical assessments include screening for current or past suicidal thinking or behavior, intentional self- injury, current or past medication, acute distress and current or past symptoms of mental illness or impairment.

Recommendations: Specialized housing or observations due to safety risk or mental status are recommended based on clinical assessments. Clinicians also recommend risk alert flags to be placed in the inmate’s file for continued officer notification when warranted.

Clinical Services Offered

There are a variety of mental health issues occurring within the inmate population. Bluegrass.org has developed an array of services to address the needs of individuals while in custody. Custody staff, medical staff, concerned outside individuals and inmates can request an assessment if they have concerns about risk for self-harm or mental status.

Suicide Observation: When an assessment indicates there is an elevated risk for self-harm, inmates are under continuous direct observation and access to items that could be used for self-harm is controlled. Daily follow-up and plans for on-going assessments and safety are established.

Mental Health: Individuals who exhibit active symptoms of mental illness that could affect safe functioning, such aggressive or threatening behavior, active psychosis, poor reality orientation or pronounced mood instability are assessed for treatment and a weekly follow-up is performed by a case manager.

Medication: Inmates who report they are currently taking medications are referred for verification. Current medications are started the next day when possible and psychiatric follow-up is provided for the duration of their stay in custody. Prescriptions and assistance making outpatient appointments are also provided prior to release.

Therapeutic Services: Bluegrass.org believes therapy should be a solution-focused and person-centered. When interventions are targeted to specific issues, evidence indicates individuals are better able to achieve and sustain recovery. Psychoeducational support and referrals for issues such as domestic violence and abuse, and recovery are also provided.

Mental Status Examinations: Performed by court order, these consist of biographical and psychosocial data, psychiatric history, current mental status and recommendations for competency evaluations, treatment, involuntary hospitalization and treatment over objection as needed.

Prior to Release: Individuals are assessed to determine potential danger to self or others due to either active suicidality or acute mental illness and referred for outpatient appointments, medication and involuntary hospitalization if needed.

— Peter Taylor is Team Leader at the Fayette County Detention Center Program and Tiffany Arrows is an FCDC clinician at Bluegrass.org.