1.1 Referrals

1.1.1 Each Facility Health Administrator shall:

1.1.1.1 Ensure that referrals to the SPU/SPA are limited to those inmates who have demonstrated behavior associated with a mental disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders, or have a syndrome associated with an organic brain dysfunction, or have a developmental disability.

1.1.1.2 Ensure that a mental health professional conducts a mental health examination of each inmate prior to referral to the SPU/SPA.

1.1.1.3 Submit to the SPU/SPA Mental Health Program Coordinator a completed Referral to the SPU/SPA for Evaluation, Form 1103-14P.

1.1.2 The SPU/SPA Mental Health Program Coordinator shall:

1.1.2.1 Review all referrals.

1.1.2.2 Coordinate all activities related to scheduling evaluations at the SPU/SPA.

1.1.2.3 Arrange for inmates to be evaluated by the Mental Health Admission/Discharge Board.

1.1.3 Each Facility Health Administrator shall ensure that the inmate's mental health examination results, medical file and institutional file are provided to the Mental Health Admission/Discharge Board prior to the Board's evaluation of the inmate.

1.2 Evaluation of Referred Inmates - Within 72 hours of an inmate's evaluation, the Mental Health Admission/Discharge Board shall:

1.2.1 Review all available information, including the inmate's institutional and medical records, and determine if the inmate meets the admission criteria outlined in 1103.01, 1.3 through 1.3.2.5.

1.2.2 Assess the factors outlined in 1103.01, 1.3 through 1.3.2.5, and determine if the inmate would compromise the safe and secure operation of the SPU/SPA.

1.2.3 Interview the inmate and complete a Mental Health Evaluation, Form 1103-9P.

1.2.4 Complete a SPU/SPA Evaluation and Admission Determination, Form 1103-10P, which shall include the Board's recommendation to approve or deny the inmate's admission to the SPU/SPA.

1.2.5 Submit the completed SPU/SPA Evaluation and Admission Determination to the SPU/SPA Mental Health Program Coordinator.

1.3 Admission Criteria

1.3.1 Inmates may be admitted to the SPU/SPA if they meet all of the criteria listed below in 1.3.1.1 through 1.3.1.3.

1.3.1.1 The inmate has one of the following:

1.3.1.1.1 A mental disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders and supported by the inmate's medical/psychiatric history, family/social history and psychological testing.

1.3.1.1.2 Limited functional ability as a result of a mental disorder, developmental disability, organic brain dysfunction or personality disorder.

1.3.1.2 The inmate accepts placement and treatment voluntarily.

1.3.1.3 The inmate's public risk factor and institutional risk factor scores are compatible with the security designation of the facility.

1.3.2 The SPU/SPA Mental Health Admission/Discharge Board may deny an inmate admission to the SPU/SPA if the inmate has a history of:

1.3.2.1 Assaultive or violent behavior.

1.3.2.2 Escape/escape attempts.

1.3.2.3 Acute self-mutilation or suicidal behavior.

1.3.2.4 Gang affiliation.

1.3.2.5 Protective or Administrative Segregation status.

1.4 Admission

1.4.1 Within five workdays of receipt of the SPU/SPA Mental Health Admission/ Discharge Board's recommendations, the SPU/SPA Mental Health Program Coordinator shall:

1.4.1.1 Review the recommendation and either approve or disapprove the admission.

1.4.1.2 Submit the recommendation to the Deputy Warden of the SPU/ SPA.

1.4.1.3 Provide the Offender Services Bureau Administrator with a written list of inmates approved for admission.

1.4.2 The Associate Deputy Warden may deny admission to the SPU/SPA if the inmate's admission would jeopardize the secure and orderly operation of the unit/area.

1.4.3 The Offender Services Bureau Administrator shall ensure that:

1.4.3.1 A current list of inmates evaluated and approved for admission to the SPU/SPA is maintained.

1.4.3.2 Inmates are transferred to the SPU/SPA on a first-come, first-served basis as bed space becomes available.

1.5 Discharge

1.5.1 The SPU/SPA Mental Health Admission/Discharge Board shall initiate the discharge process when an inmate meets any of the following criteria:

1.5.1.1 Inmate has a pending release date.

1.5.1.2 Inmate has completed the mental health treatment plan established by the SPU/SPA and is able to function in a general institutional environment.

1.5.1.3 Inmate has exhibited behavior that threatens the safe and secure operation of the unit/area, the inmate's own personal safety or the safety of others.

1.5.1.4 Inmate has been interviewed by the Institutional Classification Committee (ICC) during the 180-day Reclassification Review and the ICC has determined that the SPU/SPA is no longer an appropriate placement.

1.5.2 When an inmate has met the discharge criterion outlined in 1103.01, 1.5.1.1 through 1.5.1.4, the Mental Health Admission/Discharge Board shall review the inmate's progress and present the appropriate discharge recommendations to the ICC approximately 90 days prior to the inmate's actual release date.

1.5.2.1 Based on the SPU/SPA Mental Health Admission/Discharge Board's recommendations, the inmate's assigned mental health caseworker shall complete a program summary report reflecting the inmate's progress and further treatment needs.

1.5.3 When an inmate has met one of the discharge criteria outlined in 1103.01, 1.5.1.1 through 1.5.1.4, the following shall occur:

1.5.3.1 The SPU/SPA Mental Health Admission/Discharge Board shall review the inmate's progress and make clinical and program recommendations to the ICC 30 days prior to the expected transfer date.

1.5.3.1.1 The ICC shall review the Board's recommendations, interview the inmate and forward their recommendation to the SPU/SPA Mental Health Program Coordinator for review and approval/ disapproval.

1.5.3.2 The SPU/SPA Mental Health Program Coordinator shall submit the recommendations to the Deputy Warden for review and final approval/disapproval of the transfer.

1.5.3.3 The SPU/SPA Mental Health Program Coordinator shall notify the Offender Services Bureau Administrator of any inmates approved for discharge so they can be transferred to an appropriate prison.

1.1.1.1 Examining the inmate and diagnosing or confirming any previous diagnosis.

1.1.1.2 Reviewing the inmate's medical/behavioral health record, and determining if the inmate's disorder and treatment history are consistent with the SMI criteria.

1.1.1.3 Completion and signing of the Checklist for Seriously Mentally Ill Determination, Form 1103-13P, as published by the Arizona Department of Health Services, and the filing of that checklist in the appropriate section of the inmate's health record.

1.1.2 In the event there is a question about the SMI status of an inmate soon to be released, a psychiatrist or licensed clinical psychologist shall:

1.1.2.1 Examine the inmate, and diagnose or confirm the previous diagnosis.

1.1.2.2 Review the inmate's medical/behavioral health record, and determine if the inmate's disorders and treatment history are consistent with the SMI criteria.

1.1.2.3 Complete and sign the Checklist for Seriously Mentally Ill Determination, and assure its' inclusion in the inmate's health record.

1.2 Referral of an Inmate to a Regional Behavioral Health Authority (RBHA)

1.2.1 When an inmate has been designated SMI, and is scheduled to be released within ninety days, the Licensed Clinical Psychologist III or designee shall:

1.2.1.1 Review the Checklist for Seriously Mentally Ill Determination and confirm that the inmate is SMI.

1.2.1.2 Ensure that the Mental Health professional assigned to the case prepares a referral packet, obtains the inmates signature on the applicable forms, and returns the completed packet to the Licensed Clinical Psychologist III or designee.

1.2.1.2.1 Inmates who decline the services of a case manager and other specified services shall be asked to sign a Refusal To Submit To Treatment, Form 1101-4P, and shall be informed by the preparer of the packet that he/she may apply for these services at any subsequent time. The inmate shall be provided with the information needed to reapply for the services.

1.2.1.3 Refer the inmate to the RBHA in the county where he or she will reside.

1.2.1.4 Forward the referral packet to the RBHA.

1.2.1.5 Notify the Correctional Officer IV of the inmate's post-release mental health services plan, to include the name and phone number of the Regional Behavioral Health Authority to which the release referral packet has been sent.

1.2.1.5.1 The Correctional Officer IV shall ensure that this information is included in the inmate's release packet.

1.2.1.6 Notify the RBHA of the need to assign a case manager within three work days after referral.

1.2.1.7 Coordinate a meeting or teleconference between the RBHA's assigned case manager, institutional health staff, Community Corrections Division staff (if reasonably available to attend the meeting) and the inmate at the facility where the inmate is located.

1.2.1.8 Assist the assigned case manager to assess the inmate's needs and to develop a transition/discharge plan.

1.2.1.9 Coordinate with the case manager/clinical team to ensure that they provide necessary linkage of services, i.e., linkage with the psychiatrist so that inmates have adequate medication during the transition, and linkage with the case manager/clinical team so that the discharge plan is implemented.

1.2.1.10 Coordinate with the Community Corrections Division to determine if they have an approved placement plan to accommodate SMI inmates who are ready for release but for whom no approved plans have been developed.

1.2.2 The Medical Records/Investigations Program Manager or designee shall, when requested, and when provided a signed waiver for release of medical records, release the medical records to the RBHA for offender and ex-offender clients.

1.2.2.1 Community Corrections Division staff who identify an offender pending release whose behavior appears to meet the SMI criteria, but for whom no release packet was prepared, shall immediately contact the appropriate Facility Health Administrator.

1.2.3 When contacted by Community Corrections staff, the Facility Health Administrator shall ensure assigned mental health staff:

1.2.3.1 Conduct an initial mental status examination and determine if the offender meets the SMI criteria.

1.2.3.2 Arrange for the RBHA's case management team to interview the offender if the offender appears to meet the SMI criteria.

1.1.1 Advise the inmate of the date and time of the hearing.

1.1.2 Explain the Department's requirement for continuity of care for offenders and ex-offenders who are SMI, and how it may apply to the inmate.

1.1.3 Ask the inmate whether he or she would like staff representation at the hearing to report on the inmate's progress or lack of progress in the Department's mental health treatment program.

1.1.4 Advise the inmate, if the inmate agrees to staff representation, to identify who he or she would like to be represented by.

1.1.5 Determine, if the inmate does not agree to accept staff representation at the hearing, if the inmate misunderstood the question that was asked or if the inmate's mental health condition made it doubtful that the inmate understood.

1.1.6 Clarify, if the inmate misunderstood the question, the Department's requirement for continuity of care for offenders and ex-offenders who are SMI, and how it may apply to the inmate, and again ask the inmate whether he or she would like staff representation at the hearing.

1.1.7 Advise the Board of Executive Clemency, as authorized by the inmate, if the inmate knowingly refused the representation, or if the inmate was not able to make a viable decision due to a mental impairment.

1.1.8 Ask the inmate to sign the Waiver of Confidentiality, Form 1104-1P, if the inmate agrees to staff representation at the hearing, and forward the orginal page of the Waiver of Confidentiality for filing in the inmate's medical record.

1.1.9 Attend the hearing, if the inmate agrees to staff representation and signs the waiver of confidentiality.

1.1.1 In the absence of a mental health professional, staff shall notify a health professional.

1.2 Upon the notification listed in 1.1 and 1.1.1 above, the mental health or health professional shall arrange for an evaluation of the inmate by mental health staff.

1.2.1 If the mental health staff member evaluating the inmate determines the inmate may be mentally disturbed and that psychiatric hospitalization may be in order, they shall request a further evaluation by a psychiatrist.

1.2.2 If no psychiatrist is available, then the evaluation shall be by a physician in consultation with a mental health professional.

1.3 Upon determining the need for psychiatric hospitalization of the inmate, the psychiatrist/ physician shall further determine if the inmate is willing to be hospitalized voluntarily.

1.3.1 If the inmate is willing to be hospitalized voluntarily and indicates so by signing a Conditions to Admission, Form 1101-7P, the psychiatrist shall proceed as outlined in 1103.04, 1.6 through 1.6.5.1.

1.3.2 If the inmate is not willing to be hospitalized voluntarily, the psychiatrist/ physician shall proceed as outlined in 1103.04, 1.7 through 1.8.1.6.

1.4 Upon determining the need for a course of mental health treatment other than psychiatric hospitalization, the psychiatrist/physician shall proceed accordingly in concert with other members of the mental health team, and shall document the proposed course of action in the inmate's health record.

1.5 Mentally Disturbed Releasees/Parolees Under Community Supervision

1.5.1 Releasees/parolees who exhibit symptoms of a mental disorder shall be referred by their assigned Parole Officer to a contracted psychiatrist, physician, hospital or mental health facility for psychiatric evaluation.

1.5.2 When a releasee/parolee refuses the referral, the assigned Parole Officer may request that a warrant for the revocation of parole or administrative release be issued by the Parole Bureau Administrator.

1.5.2.1 If the request is approved, the warrant shall be issued.

1.5.3 If the psychiatrist/physician determines that the releasee/parolee needs inpatient psychiatric treatment, the releasee/parolee may be voluntarily admitted or involuntarily committed.

1.5.4 The assigned Parole Officer shall notify the Board of Executive Clemency of the action taken.

1.6 Voluntary Admissions - Any inmate who is committed to a Department prison or Correctional Release Center may be voluntarily admitted to the appropriate mental health facility, upon referral by a psychiatrist or physician. The psychiatrist/physician shall:

1.6.1 Determine the inmate's need for treatment and request that the inmate sign a Conditions to Admission.

1.6.2 Contact the appropriate mental health facility admitting psychiatrist and provide a briefing of the case.

1.6.3 Contact the admissions officer of the appropriate mental health facility to arrange for the transfer/admission of the inmate/releasee/parolee.

1.6.4 Forward, in the case of all males and females being transferred to Flamenco "G" Ward, the inmate's health record file to the treatment unit's admitting officer.

1.6.4.1 The health record file shall include a written summary documenting the inmate's condition and behavior, and a copy of the completed Conditions of Admission.

1.6.5 Forward, in the case of all females and minor males being considered for transfer to the Arizona State Hospital, a written summary documenting the inmate's condition and behavior, and a copy of the completed Conditions of Admission to the treatment unit's admitting officer, upon first securing authorization from the Deputy Director, Inmate Health Services.

1.6.5.1 The female or minor male inmate's health record file shall be retained at the sending facility.

1.7 Involuntary Hospitalization (Involuntary Non-Emergency Admissions)

1.7.1 When an inmate is found to be mentally disordered, but not a current danger to himself or others, by a psychiatrist/physician, and is unwilling to commit himself voluntarily to a mental health facility, the following procedure shall be followed:

1.7.1.1 A psychiatrist, or a physician when no psychiatrist is immediately available, shall examine the inmate/releasee/parolee and submit a notarized affidavit to the Director, or designee, describing the inmate's condition, including a recommendation for the involuntary hospitalization of the inmate.

1.7.1.2 Upon receipt of the written report, the Director, or designee, shall review the affidavit and, if approved, send a copy to the Department's Attorney General Liaison for filing with the appropriate Court, and notify the petitioning psychiatrist of the approval.

1.7.2 At least 10 days prior to the court hearing on the petition for involuntary hospitalization, the Office of the Attorney General is to provide the inmate the following:

1.7.2.1 A copy of the petition.

1.7.2.2 A written notice of the hearing.

1.7.2.3 A copy of the inmate's rights at the hearing.

1.7.3 When the court orders that the inmate be committed involuntarily, the security staff assigned to transport the inmate to court shall obtain a copy of the court order from the Court and transport the inmate and a copy of the court order to the hospital or the mental health facility designated by the court.

1.7.4 When the court does not order the inmate committed involuntarily, the security staff assigned to transport the inmate shall return the inmate to the sending facility and notify the Facility Health Administrator of the inmate's return, who shall notify the appropriate mental health staff to assure continuity of care.

1.8 Involuntary Emergency Transfer to a Mental Health Facility

1.8.1 When an inmate is found by a psychiatrist/physician to be mentally disordered and to pose a current danger to themself or others, and the inmate is unwilling to commit him/herself voluntarily to a mental health facility, the psychiatrist/physician shall:

1.8.1.1 Contact the appropriate mental health facility admitting psychiatrist and provide a briefing of the case.

1.8.1.2 Contact the admissions officer of the appropriate mental health facility to arrange for the emergency transfer/admission of the inmate/releasee/parolee.

1.8.1.3 Ensure, when a male inmate is transferred to a mental health facility, that the inmate's institutional file and medical record, including all relevant documentation, is sent to the receiving facility with the inmate.

1.8.1.4 Forward, in the case of female and minor male inmates, a written summary documenting the inmate's condition and behavior to the Arizona State Hospital's treatment unit admitting officer.

1.8.1.4.1 The female and minor male inmate's health record file shall be retained at the sending facility.

1.8.1.4.2 Female inmates who constitute a danger to themselves or others shall not be committed to Flamenco "G" Ward.

1.8.1.5 Notify the Deputy Director, Inmate Health Services, that an emergency transfer has occurred.

1.8.1.6 Be available to the Department's Attorney General Liaison, as necessary, to testify in Court as to his/her findings.

1.8.2 The receiving/admitting psychiatrist shall:

1.8.2.1 Examine and admit the inmate on an emergency or voluntary basis.

1.8.2.2 Complete, if the inmate is not willing to be admitted on a voluntary basis and continues to appear mentally disordered and dangerous to self or others, a notarized affidavit/ petition for emergency transfer and provide it forthwith to the Department's Attorney General Liaison for filing with the appropriate court.

1.8.2.2.1 The affidavit/petition shall be completed within 48 hours of admission (excluding weekends and holidays).

1.8.2.3 Notify the Deputy Director, Inmate Health Services, that an emergency admission has occurred, and provide him with a copy of the affidavit/petition.

1.8.3 The clinical director of the admitting facility shall:

1.8.3.1 Provide the court and the Deputy Director, Inmate Health Services, or designee, as long as the court order for involuntary hospitalization is in effect, with quarterly reports detailing the inmates mental health status and proposed plan of treatment for the next 90 days.

1.8.3.2 Notify the State Attorney General and the Deputy Director, Inmate Health Services, when the inmate's involuntary hospitalization is terminated by discharge from the hospital.

1.9 Release or Commitment of SMI Inmates

1.9.1 Inmates who have been determined by a psychiatrist or clinical psychologist to be SMI shall not be released from the custody of the Department without every effort being made to assure continuity of care and a smooth transition to mental health services in the community.

1.9.2 Prior to the expiration of sentence, if the inmate is determined to pose a threat to themselves or others by reason of a mental disorder, an involuntary commitment shall be sought in accordance with Civil Commitment Procedures.

1.1.1 The inmate has a history of sexual offenses or the committing offense is a sexual offense.

1.1.2 The inmate has no more than 36 months until their earliest release date.

1.1.3 The inmate's public risk factor and institutional risk factor are compatible with the custody level at ASPC-Tucson.

1.1.4 The inmate agrees to participate fully in the SOTP.

1.1.4.1 Should an inmate arrive at ASPC-Tucson, after being approved/ transferred for program participation and subsequently refuse to participate, he shall be returned to his prior institution as soon as possible.

1.2 Application - Inmates who meet the eligibility requirements shall complete a Participation/Non-Participation Agreement, Form 1103-5P, after discussing the SOTP with their assigned caseworker or the Initial/Institutional Classification Committee.

1.3 Referrals

1.3.1 Inmates may initiate a referral by submitting an application for the SOTP to their caseworker.

1.3.2 Caseworkers shall refer inmates to the SOTP by completing a SOTP Referral, Form 1103-6P.

1.3.3 The caseworker shall submit completed referral forms to the ICC to review and to recommend approval or denial of referrals.

1.3.4 The ICC shall forward their recommendations to the Warden, Deputy Warden or Administrator for approval or denial.

1.3.5 The Warden, Deputy Warden or Administrator shall:

1.3.5.1 Return denied referrals, through the chain of command, to the initiator with an explanation of the denial.

1.3.5.2 Forward approved referrals to the SOTP Coordinator for review by the SOTP Committee.

1.3.6 The SOTP Coordinator shall:

1.3.6.1 Review all referrals for accuracy.

1.3.6.2 Submit the referrals to the SOTP Committee.

1.3.6.3 Coordinate meetings and all activities related to the SOTP.

1.3.6.4 Monitor the inmate waiting list for the SOTP and assure that the Program enrollment is maintained within the contracted and funded parameters.

1.4 Admission

1.4.1 Upon receipt of referrals from the SOTP Coordinator, the SOTP Committee shall:

1.4.1.1 Review the referral and determine if the inmate meets the SOTP eligibility requirements.

1.4.1.2 Complete and sign the lower portion of the referral and return the form to the SOTP Coordinator.

1.4.2 The SOTP Coordinator shall:

1.4.2.1 Provide the Offender Services Bureau Administrator with a written list of inmates approved for the SOTP.

1.4.2.2 Advise the inmate's assigned caseworker, via the chain of command, that the inmate has been approved for admission to the SOTP.

1.4.2.2.1 The decision of the SOTP Coordinator to approve or deny an inmate's admission into the SOTP shall be final.

1.4.3 The Offender Services Bureau Administrator shall:

1.5.1 Measurable program goals and objectives.

1.5.2 Types of treatment to be provided sex offenders.

1.5.3 Behavioral guidelines for participants.

1.5.4 Individual, group and family counseling.

1.5.5 Self-help programs such as Alcoholics Anonymous, Narcotics Anonymous and physical education.

1.5.6 Additional programs such as Human Sexuality, Sexuality of Women and Child Development.

1.5.7 A process to evaluate and monitor an inmate's progress in the program, to include identification of data to be collected and analyzed.

1.6 Plethysmographic Instruments and Assessments - The SOTP Provider is authorized to provide for the use of a plethysmography in the voluntary assessment and treatment of male inmates in the SOTP by a qualified operator, on the order of a physician, under the following limitations and conditions:

1.6.1 The ASPC-Tucson Warden shall designate a laboratory site that has restricted access and is located in a secure area.

1.6.1.1 Due to the sensitive nature of the mechanical instrumentation, testing, stimulus materials and treatment files used, entry to the laboratory shall be restricted to the health, mental health, and program administration staff, and inmates by appointment.

1.6.1.2 In an emergency, security staff may enter the laboratory.

1.6.3.1 Ensure the development of a catalog system to identify each picture and tape proposed for use as stimulus material.

1.6.3.2 Approve each picture and tape prior to use as stimulus material.

1.6.3.3 Inventory stimulus materials monthly to ensure proper control.

1.6.4 Standardized stimulus materials shall be:

1.6.4.1 Approved, identified and cataloged by the program administrator prior to use in the plethysmographic program.

1.6.4.2 Secured and accessed only by the program administrator, therapists and operators.

1.6.5 The plethysmographic operator shall:

1.6.5.1 Operate the plethysmography instrumentation.

1.6.5.2 Follow instrumentation guidelines and specifications ensuring inmate safety and accurate results.

1.6.5.3 Maintain inmate and program confidentiality.

1.6.5.4 Follow Departmental written instructions related to employee conduct.

1.6.5.5 Comply with A.R.S. 32-3301, Certified Counselor.

1.6.5.6 At a minimum, be trained in the following areas:

1.6.5.6.1 Measurement theory.

1.6.5.6.2 Plethysmography operation and calibration.

1.6.5.6.3 Stimulus material selection.

1.6.5.6.4 Data Analysis.

1.6.5.6.5 Legal status of data.

1.6.5.6.6 Therapy techniques.

1.6.5.6.7 Behavior analysis.

1.6.5.6.8 Safety considerations

1.6.5.6.9 Ethical responsibilities.

1.6.6 A program counselor or operator shall explain to all potential inmate participants, in a one-on-one session, the complete details of the plethysmographic program, how the program will relate individually to the inmate and any potential negative impact on the inmate.

1.6.6.1 Inmates shall voluntarily sign a Plethysmography Consent, Form 1103-11P, prior to participation in the plethysmographic program.

1.6.7 All communications between an inmate-participant and the operator shall be private.

1.6.7.1 When security staff shall be present to provide appropriate security, auditory privacy shall be maintained.

1.6.7.2 All staff shall maintain confidentiality of identity of inmate participants.

1.6.8 The SOTP Committee may initiate the discharge process when an inmate meets any of the following criteria:

1.6.8.1 The inmate has completed the established SOTP.

1.6.8.2 The inmate has a pending release date.

1.6.8.3 The inmate has been interviewed by the ICC during the 180 day reclassification review and have determined that the inmate no longer meets the criteria for placement in the SOTP.

1.6.8.4 The inmate has exhibited behavior that violates program behavior guidelines or threatens the safe and secure operation of the unit, the inmate's personal safety or the safety of others.

1.6.9 When an inmate meets the discharge criteria outlined in 1103.05, 1.6.8.1 through 1.6.8.4, the SOTP Committee shall review the inmate's progress and present the appropriate discharge recommendations to the ICC approximately 90 calendar days prior to the inmate's actual release date.

1.6.9.1 Based on the SOTP Committee's recommendations, contract staff shall complete a program summary report indicating the inmate's progress and further treatment needs.

1.6.9.2 The SOTP Coordinator shall notify the Offender Services Bureau Administrator of any inmates approved for discharge so they can be transferred to an appropriate facility.

1.6.9.3 The SOTP Committee shall review the inmate's progress and make program recommendations to the ICC 30 days prior to the expected transfer date.

1.6.10 All actions involving the referral unit's recommendations, admission or discharge of an inmate to the SOTP shall be entered by the individual who initiates the action on the appropriate AIMS screen.

1.6.11 The SOTP Team Coordinator shall report annually to the Deputy Director, Inmate Health Services, the following:

1.6.11.1 Program services delivered.

1.6.11.2 Progress toward goals and objectives.

1.6.11.3 Recommendations for the following year's program.

1.6.12 The Deputy Director, Inmate Health Services, or designee, shall evaluate the SOTP at the end of each fiscal year to determine the following:

1.6.12.1 The success of the program as a whole.

1.6.12.2 Identification of additional data which needs to be collected and analyzed in the future.

1.6.12.3 Goals and objectives for the next year.

1.2 The Deputy Director, Inmate Health Services, and the ASPC-Phoenix Facility Health Administrator shall ensure the licensed mental health facilities are provided with comprehensive treatment programs, clinical services and personnel and administrative support.

1.3 The Clinical Director for the licensed mental health facilities shall:

1.1.1 Attempts to commit suicide and/or verbally threatens to commit suicide, and/or talks about suicide as an option.

1.1.2 Demonstrates and/or verbally threatens self-destructive behavior.

1.1.3 Causes self-inflicted wounds.

1.1.4 Demonstrates bizarre and/or unusual behavior.

1.2 Staff shall document the observed inmate behavior and verbal and/or situational warnings indicating a need for a suicide or mental health watch on an Information Report.

1.3 The shift commander shall immediately notify the prison's mental health/health care staff for purposes of evaluating the inmate.

1.3.1 When mental health/health care staff are not available, the shift commander shall ensure the inmate is referred to them by no later than the next workday.

1.3.2 When mental/health care staff are not available and there is an emergency situation (i.e., suicide risk), the shift commander shall contact the on-call staff member.

1.4 If a written order for a suicide or mental health watch is issued, the shift commander shall ensure an Observation Record is generated.

1.4.1 The staff member ordering the suicide or mental health watch, or designee, shall initiate the Observation Record.

1.4.2 Completed Observation Records shall be collected by the shift commander at the end of each shift for his/her signature.

1.6 To authorize a suicide or mental health watch, mental health/health care staff or, in their absence the shift commander, shall issue a written order to place an inmate on a suicide or mental health watch when:

1.6.1 The inmate's behavior is self-destructive.

1.6.2 The inmate is displaying suicidal behavior.

1.6.3 The inmate attempts suicide and/or has a documented history of attempting suicide, and there are situational warnings indicating an impending suicide attempt.

1.6.4 The inmate verbally threatens to commit suicide and/or to cause self-inflicted wounds.

1.6.5 The inmate demonstrates acute signs or symptoms of a significant mental disorder.

1.7 Suicide Watch

1.7.1 A suicide watch shall be authorized when the inmate is acting self-destructively, attempting suicide, verbally threatening to commit suicide and/or to cause self-harm, or when there are situational warnings indicating an impending suicide attempt.

1.7.2 The shift commander shall ensure completion of a Suicide Prevention Referral, Form 1103-8P, prior to the end of the shift, and document the authorization in the unit log book and on the initial Observation Record.

1.7.3 Mental health staff shall complete a suicide assessment no later than the next workday after the date of the suicide watch order.

1.7.4 Inmates placed on a suicide watch shall be placed in their own cell, a seclusion cell or another appropriate and secure location.

1.7.4.1 Staff shall search the placement area and remove all objects which could be used as a weapon or for self-harm prior to the inmate's confinement.

1.7.4.2 At a minimum, the inmate shall be provided with a seclusion blanket and a small supply of toilet paper (minus the cardboard roll).

1.7.4.2.1 Any additional property provided to the inmate shall be approved by Mental Health staff.

1.7.5 In the event the placement area contains fixtures, appliances or bars which could be used with the inmate's clothing in a self-harm attempt, security staff shall, in consideration of the inmate's health and medical status, overall well-being and the encompassing temperature, do the following:

1.7.5.1 Strip search the inmate.

1.7.5.2 Remove all objects that may be used as a weapon for self-harm.

1.7.5.3 Visually check the inmate for his/her welfare at ten minute intervals, or as otherwise specified.

1.7.5.4 Record the check on the Observation Record and in the unit log.

1.7.6 Mental health/health care staff shall visit the inmate every four hours.

1.8 Mental Health Watch

1.8.1 If the inmate is demonstrating acute signs or symptoms of significant mental disorder but is not acting in a manner indicating considerable suicide risk as indicated in 1.7.1, the inmate may be placed on a mental health watch.

1.8.2 The shift commander shall ensure notification of Mental Health care staff, including the on-call staff member, prior to the end of the shift, and document the authorization in the unit log book and on the initial Observation Record.

1.8.3 Mental health staff staff shall complete a mental health assessment no later than the next workday after the date of the mental health watch order.

1.8.4 An inmate placed on a mental health watch shall be placed in either his/her own cell, a seclusion cell, or another appropriate and secure location.

1.8.4.1 An inmate on a mental health watch shall be allowed one set of personal clothing, personal hygiene items (excluding sharps if so directed by Mental Health care staff), and reading material.

1.8.4.2 Any additional property provided to the inmate shall be approved by Mental Health staff.

1.8.5 Security staff shall visually check the inmate for his/her welfare at thirty minute intervals, or as otherwise specified, and log the check on the Observation Record and in the unit log.

1.8.6 Mental health/health care staff shall visit the inmate each day the inmate is on the mental health watch.

1.8.7 Security staff monitoring the mental health watch shall notify Mental Health care staff, through the shift commander, of any significant changes in an inmate's behavior while on the mental health watch.

1.9 Security staff shall ensure an inmate on a suicide or mental health watch is provided the opportunity, on a daily basis, to practice personal hygiene and to maintain sanitary conditions.

1.9.1 Security staff shall ensure an inmate on a suicide or mental health watch is provided the following health care necessities:

1.9.1.1 Toilet use, upon request.

1.9.1.2 Fluid intake, once each hour, while awake.

1.9.1.3 Three meals a day, including special medical or religious diets, provided at the standard breakfast, lunch and supper hour, and in the same quality and quantity as meals served to the general population.

1.9.1.4 Sack lunches or finger food may be provided to inmates on suicide watch, if necessary.

1.9.1.5 Prescribed medication, in unit dosage, and by watch swallow.

1.9.2 Mental health/health care staff shall document in the inmate's health record file:

1.9.2.1 The suicide or mental health watch order.

1.9.2.2 Circumstances that necessitated the order.

1.9.2.3 The inmate's statements as to why he or she made the suicidal threat and/or displayed self-destructive behavior or mentally disordered behavior.

1.9.2.4 A Subjective, Objective, Assessment Plan (SOAP) entry for every observation/evaluation reflective of the current situation, staff observations, assessment, and plan of action.

1.9.3 Each security or mental health/health care staff who checks an inmate placed on a suicide watch shall record the date, time and observations on the Observation Record and shall sign the entry.

1.9.4 To authorize the removal of a suicide or mental health watch, or a change in watch, a licensed mental health staff or an unlicensed mental health staff, in consultation with a licensed mental health staff, shall:

1.9.4.1 Issue written authorization to end the suicide or mental health watch when it is no longer warranted.

1.9.4.2 Document this on the Observation Record, the unit log, and in the inmate's health record.

1.9.4.3 Initiate a new Observation Record when a mental health watch is changed to a suicide watch, or when a suicide watch is changed to a mental health watch.

1.9.5 Suicide or mental health watches shall not be used as a disciplinary sanction against an inmate.

1.9.6 Any deviation from the procedures outlined in this Department Order shall be pre-approved by the Mental Health Program Manager.

1.1.1 Complete the Informed Consent for Psychotropic Medication, Form 1103-12P, and allow the inmate to sign it.

1.1.1.1 This form is to be used at any facility where psychotropic medication is administered for treatment of mental disorders.

1.1.1.2 In the event the inmate refuses to sign the form, the attending staff shall write "refused to sign" on the inmate signature line.

1.1.2 Document, on the Physician's Progress Notes in the inmate's health record file, the reason for prescribing psychotropic medication for an inmate with a mental disorder and whether or not the inmate consented to the treatment and signed the Informed Consent for Psychotropic Medication.

1.1.3 Prepare a prescription to dispense psychotropic medication.

1.1.4 Ensure, in conjunction with Pharmacy and Nursing staff, that the inmate receives the psychotropic medication within a medically appropriate time frame, as determined by the Psychiatrist.

1.2 When voluntarily administering psychotropic medication, the health care professionals or pharmacy staff responsible for administering the psychotropic medication and documenting compliance with the psychiatrist's prescription for psychotropic medication shall:

1.2.1 Only dispense psychotropic medication that has been ordered in a current prescription by a psychiatrist and are so labeled.

1.2.2 Copy each medication order, exactly as written onto the medication sheet.

1.2.3 Complete a laboratory requisition, if indicated.

1.2.4 Bracket, after transcribing the orders, all orders in RED and write "noted," followed by the date, time, the health care professional's legal name and professional title.

1.2.5 Document, on the medication sheet, all psychotropic medication that is administered.

1.2.6 Inform the psychiatrist and the pharmacist of any adverse reactions to the psychotropic medication, and document the information on the medication sheet.

1.2.7 Keep all psychotropic medication in containers bearing the pharmacist's original label and store it in a securely locked medicine cabinet where the institution's prescription medications are stored and dispensed, as prescribed, to inmates.

1.2.8 Administer psychotropic medication to inmates as determined by reviewing the prescription, by one of the following methods:

1.2.8.1 By unit dose.

1.2.8.2 By watch swallow.

1.2.8.2.1 A health care professional may place an inmate on watch swallow if he or she suspects that the inmate may abuse the medication, but may not take an inmate off watch swallow without written orders from the psychiatrist.

1.3 Psychiatrists may prescribe psychotropic medication and administer it voluntarily to inmates who are inpatients at the Alhambra Behavioral Treatment Facility if, in their opinion, the medication is necessary for the treatment of a mental disorder.

1.4 A Department psychiatrist (or another attending physician if a psychiatrist is unavailable) may order psychotropic medication for and administer it involuntarily to an inmate with a mental disorder if, after evaluating the severity of the inmate's symptoms and the likely effects of the particular drug to be used, the psychiatrist determines that:

1.4.1 An emergency exists.

1.4.2 Alternative methods of restraint are inadequate.

1.4.3 Forced medication is required, as a last resort, to address the emergency.

1.5 An inmate may be medicated involuntarily with psychotropic medication, for a maximum of six months, if the following conditions have been met:

1.5.1 The inmate suffers from a diagnosed mental disorder.

1.5.2 The treating psychiatrist has determined that, due to a mental disorder, the inmate is either severely impaired or the inmate's conduct presents a likelihood of serious harm.

1.5.3 The psychiatrist has concluded that there is a substantial likelihood that psychotropic medication will ameliorate the inmate's condition and has prescribed them in the medical interest of the inmate as an integral part of the treatment plan.

1.5.4 The inmate has been offered and has refused the opportunity to voluntarily participate in the treatment plan, including the medication component.

1.5.5 The Psychotropic Medication Review Board (PMRB) has reviewed the matter and determined that:

1.5.5.1 The inmate suffers from a mental disorder.

1.5.5.2 The inmate is severely impaired or his conduct presents a likelihood of serious harm.

1.5.5.3 The proposed medication is in the inmate's medical interest.

1.6 Refusal of Treatment with Psychotropic Medication (Non-Emergency Situations):

1.6.1 The treating psychiatrist shall give the inmate at least 24 hours, written notice of his/her intent to convene an involuntary medication hearing (Form 70400195) before the PMRB, during which time the inmate may not be involuntarily medicated in the absence of an emergency situation as defined in this Order.

1.6.1.1 The notification is to include the treating Psychiatrist's tentative diagnosis of the inmate, the factual basis for the diagnosis, and a statement as to why the psychiatrist believes medication is necessary and in the inmate's medical interest.

1.6.2 Upon receipt of the copy of the psychiatrist's notice to the inmate, the Facility Health Administrator shall:

1.6.2.1 Schedule a meeting of the PMRB, to be held no earlier than 24 hours and no later than 72 hours after the FHA's receipt of the psychiatrist's notification.

1.6.2.2 Notify the inmate and the Correctional Officer III using Psychotropic Medication Review Board Notification of Hearing and Inmate's Rights, Form 1103-1P.

1.6.2.3 Notify the treating psychiatrist of the hearing date and time.

1.6.3 At the hearing the inmate has the right:

1.6.3.1 To attend or refuse to attend.

1.6.3.2 At the discretion of the PMRB panel, to present evidence, and to cross-examine staff witnesses.

1.6.3.3 To the assistance and presence of a lay advisor in the form of his/her Correctional Officer III or the unit Correctional Officer IV.

1.6.4 A summary of the PMRB findings and a list of the attendees shall be prepared by the PMRB chair or designee, using the Findings of Psychotropic Medication Review Board, Form 1103-2P, at the conclusion of the hearing, and copies distributed to:

1.6.4.1 The inmate and the inmate's Correctional Officer III, within 8 hours of the conclusion of the hearing.

1.6.4.2 The FHA, the treating psychiatrist, the Warden, the Deputy Director for Inmate Health Services or his designee, and the inmate's medical record (section 4, behind the "legal/administrative" tab).

1.6.5 If the committee determines, by a majority vote, that the inmate suffers from a mental disorder and is severely impaired or poses a likelihood of serious harm to self, others, or property, the inmate may be medicated against his/her will, provided the PMRB psychiatrist is in the majority.

1.6.6 The inmate has the right to appeal the Board's decision to the Deputy Director for Inmate Health Services of the Department of Corrections, or his designee, by notification of the FHA, via an inmate letter, within 24 hours of receipt of the PMRB's decision.

1.6.6.1 The FHA shall fax the inmate letter to the Deputy Director for Inmate Health Services, along with copies of the psychiatrist's request (Form 70400195) and the Findings of Psychotropic Medication Review Board form.

1.6.6.2 The Deputy Director for Inmate Health Services, or his designee, shall decide the appeal and notify the inmate through the FHA of the decision, via fax, within 24 hours of receipt (excluding weekends and holidays).

1.6.6.3 Within four hours of receipt of the Deputy Director's decision (excluding weekends and holidays), the FHA shall provide copies of the decision to the inmate, the inmate's Correctional Officer III, the treating Psychiatrist, and the PMRB chair.

1.6.6.4 During the appeal period, in the absence of an emergency as defined in this Order, the inmate shall not be involuntarily medicated.

1.6.6.5 In the event that the appeal is upheld, the inmate shall not be involuntarily medicated in the essence of an emergency as defined in this Order or in a Court order.

1.6.7 The treating psychiatrist may request a new involuntary medication hearing no sooner than fourteen working days after the appeal is upheld.

1.6.8 If the PMRB approves the involuntary administration of psychotropic medication of an inmate, and there is no upheld appeal, the PMRB shall review the inmate's case within three months and approve or disapprove, by use of the criteria cited in this Order, the continuance of involuntary medication for an additional three months.

1.6.8.1 The PMRB's decision is final and not subject to appeal.

1.6.9 If involuntary medication is re-approved, the PMRB shall again review and approve or disapprove, by the criteria cited herein, the continuance of involuntary medication for an additional three months.

1.6.10 At any time that the inmate becomes compliant with his medication and agrees to voluntarily take them, the treating psychiatrist shall so note in the inmate's medical record, though the PMRB order shall remain in effect unless rescinded by the PMRB or it expires.

1.6.11 Whenever the PMRB meets to review an inmate's case, the FHA or designee shall provide the PMRB with a copy of all mental health records, laboratory results received, and any HNRs received from the inmate, since the last PMRB hearing.

1.6.12 At the end of the six month involuntary medication period, the PMRB order for involuntary medication shall expire.

1.6.13 The treating psychiatrist may, pursuant to the criteria above, again seek authorization to involuntarily medicate the inmate with psychotropic medication.

1.7 Nothing in this order shall relieve the treating psychiatrist from responsibility for adhering to Department written instructions.

1.8 Psychiatrists may also prescribe psychotropic medication and administer it involuntarily to inmates who are involuntarily-committed patients at the Alhambra Behavioral Treatment Facility if one of the following apply:

1.8.1 The conditions in 1103.08, 1.4 through 1.4.3 exist.

1.8.2 In a non-emergency, a review and consent is obtained from a committee composed of staff physicians and psychiatrists/licensed psychologists.

1.9 Medication shall not be discontinued or allowed to expire without a face-to-face interview with the psychiatrist or mental health professional in consultation with the psychiatrist.

1.9.1 Discontinuation of medication at the inmate's request shall be done in a face-to-face interview with the psychiatrist or mental health professional in consultation with the psychiatrist, and both the interview and the refusal shall be documented in the mental health section of the inmate's medical record.

1.9.2 Non-compliance with medication regimen by an inmate shall be followed by a face-to-face interview with a mental health professional, in consultation with the psychiatrist, prior to the psychiatrist authorizing discontinuation of the medication.

1.9.2.1 Non-compliance shall be documented in the mental health section of the medical record.

1.10 Staff who discover any psychotropic medication in an inmate's possession shall consider the medication to be illegal contraband.

1.11.1 The report shall include the number of prescriptions for psychotropic medication dispensed during the preceding month.

1.11.2 The Facility Health Administrator shall forward copies of the report to the Medical Program Manager, Pharmacy Program Manager, and the Mental Health Program Manager.

1.12 Each Facility Health Administrator shall submit a monthly report to the Mental Health Program Manager, with copies to their respective Warden and the Deputy Director, Inmate Health Services, by the twentieth work day of each month. The report shall include:

1.12.1 The number of inmates, and percentage of the inmate population, who voluntarily received psychotropic medication during the preceding month.

1.12.2 The number of inmates, and percentage of the inmate population, who involuntarily received psychotropic medication during the preceding month.

1.2 Indicators may include but are not limited to:

1.2.1 Inability to comprehend verbal instructions.

1.2.2 Inability to comprehend written instructions.

1.2.3 Childlike behavior.

1.2.4 Atypical physical characteristics.

1.2.5 Inappropriate emotional responses.

1.3 When indicated, a clinical psychologist or designee shall test and/or evaluate the inmate to determine the inmate's intellectual and adaptive function level.

1.4 If it is determined the inmate is developmentally disabled/retarded, the psychologist or designee shall develop a service or treatment plan and make recommendations to the Deputy Warden regarding the inmate's:

1.4.1 Classification.

1.4.2 Placement.

1.4.3 Work assignments.

1.4.4 Educational training.

 

1.4.5 Vocational training.

1.4.6 Other services or treatment that may be needed.

1.5 The Warden, Deputy Warden or Administrator shall ensure that inmates who have been determined to be developmentally disabled/retarded receive the services and treatment which the psychology staff have recommended.

1.6 Developmentally disabled/retarded inmates shall be reevaluated annually by the psychology staff to determine if a change of placement, assignment or treatment is necessary.

1.7 Psychological evaluations shall be retained in the inmate's health record in accordance with the Medical Records Technical Manual.

1.1.1 The inmate is assigned to a single bed cell in a high custody setting, the inmate has been isolated in that cell, and the inmate exhibits symptoms of serious mental illness that require ongoing treatment in a secure setting beyond 48 hours, but not of an acuity requiring immediate placement in a licensed psychiatric facility.

1.1.2 The inmate has been transferred, on an emergency basis, from their regular housing assignment to an isolation cell in a non-treatment facility, and is exhibiting symptoms of serious mental illness requiring ongoing treatment in a protective and isolated setting that is not available at that complex/facility for more than 48 hours, and whose acuity does not require immediate placement in a licensed psychiatric facility.

1.1.3 The inmate has been hospitalized in a licensed psychiatric facility, no longer requiring that level of care, and who, because of their assaultive behavior or other behavior problems, requires ongoing treatment for mental illness in a high security, structured treatment environment.

1.2 The Facility Health Administrator shall ensure that:

1.2.1 In an emergency, inmates exhibiting symptoms of serious mental illness and placed in an isolation cell of a non-treatment facility are seen face-to-face each workday by a mental health professional, and by a health professional in consultation with a mental health professional on weekends and holidays.

1.2.2 Within 48 hours of the placement of a seriously mentally ill inmate into the isolation cell of a non-treatment facility, a Psychiatrist or licensed Psychologist (or a mental health professional on weekends and holidays) initiates the expedited transfer of the inmate to an appropriate treatment setting/facility.

1.2.2.1 The transfer shall be completed within 72 hours of the placement of the seriously mentally ill inmate into the isolation cell of a non-treatment facility.

1.3 The Clinical Psychologist III, or designee, shall:

1.3.1 Review all referrals or actual placements of inmates into the SMTU/SMTA.

1.3.2 Ensure a mental health professional conducts a Mental Health Evaluation of each inmate within one work day of transfer to the SMTU/SMTA.

1.3.3 Coordinate all activity related to scheduling the evaluations of inmates referred/ assigned to the SMTU/SMTA.

1.3.4 Convene Mental Health Team members to evaluate all inmates placed in the SMTU/SMTA.

1.3.5 Coordinate the Mental Health Team and supporting staff to provide appropriate program activities to remediate assessed deficits, and to provide the necessary habilitation activities.

1.3.6 Ensure that an individualized Program/Treatment Plan is formulated, maintained and updated at least every 90 days.

1.4 The inmate shall be evaluated by a Mental Health Professional, who shall assess the inmate's treatment needs and SMI status within three work days of entrance to the SMTU/SMTA.

1.4.1 The Mental Health Professional shall make the necessary referrals to members of the Mental Health Treatment Team.

1.4.1.1 The Mental Health Treatment Team shall initiate the assessment of the inmate's program needs.

1.4.2 The Mental Health Services Coordinator, or designee, shall ensure that an initial individual inmate treatment plan, based upon the results of the needs assessment, is formulated, documented and initiated within ten work days of the inmate's admission to the program.

1.4.3 Mental Health services available to inmates in the SMTU/SMTA shall be based on the individual inmate's treatment needs as identified in the individual inmate treatment plan and may include, but need not be limited to:

1.4.3.1 Individual treatment.

1.4.3.2 Group participation.

1.4.3.3 Socialization activities.

1.4.3.4 Daily living skills.

1.4.3.5 Recreation/physical activities.

1.4.3.6 Behavior management/modification.

1.5 The Mental Health Treatment Team shall initiate the discharge process when an inmate meets any one of the following criteria:

1.5.1 The inmate has a pending release date.

1.5.2 The inmate's propensity for assaultive behavior or other behavior problems have diminished such that their classification provides for placement at a lower custody level, and a Psychiatrist or licensed Psychologist has determined that the inmate's mental health treatment needs can be met in a less structured setting.

1.6 The Mental Health Treatment Team shall determine the level of ongoing mental health care required by the inmate, and shall establish the placement restrictions necessary to accommodate that need.

1.7 When an inmate meets the discharge criterion outlined in 1103.10, 1.5.1 through 1.5.2, the Mental Health Treatment Team shall review the inmate's progress and present the appropriate discharge recommendation to the ICC approximately 60 days prior to the inmate's scheduled release date.

1.7.1 Based on the Mental Health Team's recommendations, the inmate's assigned therapist shall complete a program summary report indicating the inmate's progress and further treatment needs.

1.8 When an inmate has a diagnosed mental disorder and level of acuity requiring admission to a licensed Behavioral Health Treatment Facility, the staff Psychiatrist or other physician in consultation with a mental health professional, shall initiate an emergency or non-emergency transfer pursuant to the provisions of Department written instructions.

1.1.1 The primary counselor shall develop an initial treatment plan within 72 hours of the inmate's arrival.

1.1.2 The treatment plan shall be based on the initial assessment of the following:

1.1.2.1 Presenting problem.

1.1.2.2 Physical health.

1.1.2.3 Mental/emotional status.

1.1.2.4 Behavioral status.

1.2 The Mental Health Team at the facility shall:

1.2.1 Develop a master treatment plan based on a comprehensive assessment of the inmate's needs within 30 days.

1.2.2 Allow the inmate to participate in the development of their treatment plan when appropriate.

1.3 The master treatment plan shall include, but is not limited to, the following:

1.3.1 Diagnosis.

1.3.2 Specific goals and objectives.

1.3.3 Methods for achieving goals and objectives.

1.3.4 Target achievement dates.

1.3.5 Specific activities.

1.3.6 Specific staff members assigned to inmate.

1.3.7 Frequency of treatment procedures.

1.4 The treatment plan shall be documented and maintained in the mental health section of the inmate's medical record.

1.5 The Mental Health Team shall review and update the treatment plan every 90 days, or more frequently if needed.

FORMS LIST

1101-4P, Refusal To Submit To Treatment

1101-4PS, Refusal To Submit To Treatment (Spanish)

1101-5P, Patient Care Plan

1101-6P, Physician's Orders

1101-7P, Conditions To Admission

1101-16P, Observation Record

1102-2P, Long-Term/Continuous Medication and Treatment Record

1102-3P, Disclosure Statement

1103-1P, Psychotropic Medication Review Board Notification of Hearing and Inmate's Rights

1103-2P, Findings of Psychotropic Medication Review Board

1103-5P, Participation/Non-Participation Agreement

1103-6P, Sex Offender Treatment Program Referral

1103-7P, Treatment Plan (3 pages)

1103-8P, Suicide Prevention Referral

1103-9P, Mental Health Evaluation

1103-10P, Special Programs Unit - Evaluation and Admission Determination

1103-11P, Plethysmography Consent

1103-12P, Informed Consent for Psychotropic Medication

1103-13P, Checklist for Seriously Mentally Ill Determination (2 pages)

1103-14P, Referral To The Special Programs Unit For Evaluation

1103-15P, Notification of Intent to Request Approval to Involuntarily Administer Psychotropic Medication

1104-1P, Waiver Of Confidentiality

1104-2P, Authorization To Release Medical Records (Parole Use)

1104-3P, Authorization To Disclose Copies Of Medical Records

1104-5P, Authorization To Request Copies Of Medical Records

ADULT INTELLIGENCE QUOTIENT TEST - A test which classifies a person's retardation level based on test scores, as indicated below:

BEHAVIOR MANAGEMENT/MODIFICATION - Services based on the principles of reward and reinforcement designed to modify/improve the inmate's ability to socialize, maintain acceptable hygiene, and develop general coping and living skills.

DEVELOPMENTALLY DISABLED/RETARDATION - A congenital abnormality, traumatic injury or disease that impairs normal intellectual functioning and prevents a person from participating normally in activities appropriate for the person's particular age group. This disorder is characterized by deficient intellectual functions which impair the ability of the individual to learn and adapt socially.

DSM-IV - The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, a taxonomy of mental disorders published by the American Psychiatric Association, is used by psychiatrists and certified psychologists to diagnose mental disorders.

EMERGENCY - For the purposes of this Department Order, administering psychotropic medication, the inmate's current mental disorder or condition that involves a clear threat of death or physical injury to the inmate, other inmates or staff.

HEALTH CARE STAFF - Department/contract physicians, correctional registered nurses, physician's assistants, nurse practitioners and/or correctional medical assistants.

INVOLUNTARY ADMINISTRATION OF PSYCHOTROPIC MEDICATION - Administering any psychotropic medication to an inmate without the inmate's agreement to take the medication, following an explanation by the psychiatrist, in terms and language the inmate can understand, of material facts regarding the consequences of taking and not taking the medication, and any risk to the inmate's health status.

INVOLUNTARY ADMISSION - The court-ordered commitment of an inmate/ releasee/parolee to a Departmental mental health inpatient treatment facility, or to the Arizona State Hospital for females whose behavior constitutes a danger to themselves or others.

LICENSED MENTAL HEALTH FACILITY - For adult male inmates/releasees/parolees, the Alhambra Behavioral Health Treatment Facility (licensed as a Level 1 Behavioral Health Treatment Facility by the Arizona Department of Health Services) which includes B Ward and Flamenco; for adult female inmates/releasees/parolees, the Arizona State Hospital or the Alhambra Behavioral Health Treatment Facility, and for all juvenile inmates/releasees/parolees, the Arizona State Hospital.

LIKELIHOOD OF SERIOUS HARM - For the purposes of this order, a substantial risk that physical harm will be inflicted by an inmate upon the occurrence of at least one of the following:

• His or her own person, as evidenced by threats or attempts to commit suicide or inflict physical harm to one's self.

• Another, as evidenced by behavior which has caused such harm or places another person or persons in reasonable fear of sustaining such harm.

• The property of others, as evidenced by behavior which has caused substantial loss or damage to the property of others.

MENTAL AGE - The age level at which a person functions intellectually, as determined by standardized psychological and intelligence tests which interpret functional abilities as the age at which that level of function is normally achieved.

MENTAL DISORDER - A substantial disorder of an individual's emotional processes, thought, cognition or memory.

MENTAL HEALTH PROFESSIONAL - A staff member who is a certified clinical psychologist, a psychiatrist, a psychiatric social worker, a psychology associate, a psychiatric nurse or a psychotherapist.

MENTAL HEALTH STAFF - Department/contract psychiatrists, psychologists, psychology associates and/or psychiatric nurses.

MENTAL ILLNESS - A substantial disorder of a person's emotional processes, thought, cognition or memory. More specifically, for the purposes of this Department Order, a diagnosis by a licensed psychiatrist or psychologist that is consistent with one or more classes of mental disorders in axes I of the DSM-IV (or the most current edition). Includes schizophrenic disorders; delusional disorders; psychotic disorders not elsewhere classified; mood disorder (bipolar disorder and/or depressive disorder); anxiety disorders (excluding social phobia or simple phobia); organic mental disorders or syndromes; and others disorders listed in the DSM-IV, with the exception of psychosexual disorders. (Includes organic mood disorders; organic delusional disorders; organic anxiety disorders; organic personality disorders; organic hallucinoses not caused by psychoactive substance use; and organic mental disorders not otherwise specified. Also includes maladaptive [self-destructive and/or suicidal] behaviors when caused by a mental illness as defined axes I of the DSM-IV.)

MODALITY - A method of therapy, e.g., treatment as an inpatient in a long-term care facility, or partial hospitalization.

OBSERVATION RECORD - A documented record of all visual health and welfare checks conducted by staff during a suicide watch on a specific inmate.

PAROLEE - An adult offender who has been granted a parole and is under community supervision.

PATIENT - For the purposes of this Department Order, an inmate receiving mental health treatment services from a psychiatrist or health care professional.

PLETHYSMOGRAPHY - Mechanical instrumentation that measures penile response to standardized stimulus material. This stimulus material elicits data related to sexual preference and arousal patterns.

PLETHYSMOGRAPHIC PROGRAM - A program designed to assess adult male sex offenders through the use of psychophysiological instrumentation. The program, which facilitates individual treatment, is a part of the total therapeutic treatment for sex offenders.

PLETHYSMOGRAPHY OPERATOR - A contract employee who has a masters degree in psychology/ counseling and is formally trained in the operation of a plethysmography.

PRESCRIPTION - A psychiatrist's specific written order, following a face-to-face encounter with an inmate patient:

• To dispense psychotropic medication to that inmate for 30 calendar days, or up to 60calendar days if that inmate's current condition is noted as stable by the psychiatrist.

• That may be renewed or changed only after another face-to-face encounter with the inmate.

• That includes but is not limited to:

• The exact dosage to be given.

• The method by which the medication is to be given.

• The exact number of times per day the medication is to be given.

• The exact number of days or doses to be given.

• Any laboratory examinations required to monitor the inmate's reaction to the medication.

PSYCHIATRIST - For the purposes of this Department Order, a psychiatrist licensed pursuant to A.R.S. 32-1401 to diagnose and treat mental illness and prescribe psychotropic medication.

PSYCHOLOGIST - For the purposes of this Department Order, a psychologist licensed pursuant to A.R.S. 32-2062 to diagnose and treat mental illness.

PSYCHOTROPIC MEDICATION - Any medication that affects the functioning of the brain and is used in the treatment of psychiatric disorders.

PSYCHOTROPIC MEDICATION REVIEW BOARD (PMRB) - For the purposes of this order, a committee designated by the Facility Health Administrator (FHA) composed of one Psychiatrist, one Psychologist, and one Deputy Warden or Associate Deputy Warden.

• No PMRB member shall currently be involved directly in the treatment or diagnosis of an inmate being reviewed by the board. If any PMRB member is so involved, he or she shall excuse himself or herself from that hearing and an alternate member of the same discipline shall be designated by the Facility Health Administrator.

• The psychiatrist shall chair PMRB meetings and shall be responsible for assuring the notification of all parties as to the location, date, and time of same.

REFERRAL PACKET - The following information about an inmate, which is forwarded to the Regional Behavioral Health Authority to which the soon-to-be-released inmate is referred:

• Psychiatric or psychological evaluation (performed during the preceding six months).

• Social history.

• Physical examination.

• Needs assessment/evaluation.

• Checklist for Seriously Mentally Ill Determination, Form 1103-13P.

• Authorization to Request Copies of Medical Records, Form 1104-5P.

• Authorization to Release Medical Information (Parole Use), Form 1104-2P.

• Authorization to Disclose Copies of Medical Records, Form 1104-3P.

• Disclosure Statement, Form 1103-5P.

• Treatment Plan, Form 1103-7P (if applicable).

• Physician's Orders, Form 1101-6P (if applicable).

• Long-Term/Continuous Medication and Treatment Record, Form 1102-2P.

• Patient Ca0re Plan, Form 1101-5P (if applicable).

REGIONAL BEHAVIORAL HEALTH AUTHORITY - Providers of behavioral health services who have contracted with the Arizona Department of Health Services, Division of Behavioral Health Services, to provide treatment to residents of the community who are SMI. RBHA services are available in each county.

RELEASEE - An adult offender who is on release status, e.g. mandatory, temporary, compassionate leave, provisional, under community supervision.

SECLUSION CELL - A secure cell designed and organized to provide for the temporary care and observation of an inmate. The cell provides an environment with minimal stimuli, with security protection and with provisions for either direct or indirect staff observations.

SELF-DESTRUCTIVE BEHAVIOR - A pattern of deliberate behavior likely to result in self-inflicted bodily harm, but not in death.

SERIOUSLY MENTALLY ILL (AS DEFINED BY THE ARIZONA DEPARTMENT OF HEALTH SERVICES, DIVISION OF BEHAVIORAL HEALTH SERVICES) - Persons, including inmates, who meet diagnostic and functional criteria in the "Check List for Seriously Mentally Ill Determination," Form 1103-13P.

SEVERELY IMPAIRED - For the purpose of this order, a condition in which an inmate, as a result of a mental disorder:

• Is in danger of serious physical harm resulting from his or her failure to utilize resources providing essential human needs or health or safety, or

• Manifests severe deterioration in routine functioning, as evidenced by the repeated and escalating loss of cognitive or volitional control over his or her actions and is non-compliant with the taking of psychotropic medication prescribed by the treating psychiatrist in the inmate's medical interest.

SEX OFFENDER - An adult male inmate whose primary or secondary conviction is a sexual offense or who has a history of sex offenses.

SEX OFFENDER TREATMENT PROGRAM - An 18-month program, established at ASPC-Tucson, for treating adult male inmates with a history of sexual offenses.

S.O.A.P. FORMAT - For the purposes of this Department Order, the reporting format for documenting a health professional's encounter with a potentially suicidal inmate.

• Subjective - Refers to the inmate's complaint or explanation of the presenting situation.

• Objective - Refers to the health professional's pertinent findings after examining the inmate and the circumstances which created the need for the assessment and evaluation.

• Assessment - Refers to the health professional's evaluation and opinion of the inmate's general condition and mental status.

• Plan - Refers to the mental health and/or medical treatment provided and specific directions provided to the inmate and others directly involved in the housing and handling of the inmate.

SOTP COMMITTEE - A committee that evaluates and assesses inmates for admission to or discharge from the SOTP. The committee consists of the SOTP Team Coordinator, the Deputy Warden, Programs Administration, ASPC-T or designee, a licensed clinical psychologist and a security staff at the level of sergeant or above.

SOTP PROVIDER - The contract provider responsible for operating the SOTP program.

SOTP TEAM COORDINATOR - A staff member assigned, by the Deputy Director, Inmate Health Services, to coordinate all SOTP admission and discharge activities.

SPECIAL MANAGEMENT TREATMENT UNIT/AREA - A single and double bed cell, isolated area at ASPC-Perryville, Santa Maria, for females, or at ASPC-Eyman, SMU II for male inmates who have been identified as having a mental disorder or a syndrome associated with an organic brain dysfunction, who demonstrate assaultive or other significant enduring behavior problems, and whose mental disorder is not of an acuity requiring placement in a licensed behavioral health facility.

SPECIAL PROGRAMS UNIT/AREA - An open yard, dormitory-style unit for inmates who have been identified as having a mental disorder or a syndrome associated with an organic brain dysfunction.

SPU/SPA MENTAL HEALTH PROGRAM COORDINATOR - A staff member assigned to administer and coordinate all mental health services at the SPU/SPA.

SPU/SPA MENTAL HEALTH ADMISSION/DISCHARGE BOARD - A three-member committee that evaluates and assesses inmates for admission to or discharge from the SPU/SPA. The committee consists of two mental health professionals and one uniformed staff holding the rank of Sergeant or above.

STANDARDIZED STIMULUS MATERIALS - Sexually explicit materials, e.g., pictures and tapes, used for research, assessment and/or treatment purposes.

SUICIDAL BEHAVIOR - Deliberate behavior which is likely to result in one's death.

SUICIDE ASSESSMENT - An evaluation, by mental health staff, or in their absence health care staff, of an inmate's behavior, statements and history for signs that would indicate a suicide risk. The assessment shall include face to face contact with the inmate, a review of the inmate's health record, and an evaluation of the inmate's present life circumstance.

SUICIDE WATCH - Ordered for the immediate prevention of self-destructive or suicidal behavior by an inmate who is considered to be a high risk. Suicide watch is not used as an alternative to ongoing mental health treatment.

TREATMENT - For the purposes of this Department Order, structured programs employing standard therapeutic techniques common in the chemical dependency and recovery fields and led by a professional trained to deliver such programs. Treatment programs have as a basis a written individual treatment plan for each participant, mutually developed by participant and counselor. Treatment programs may be comprised of several elements, including group therapy, didactic instruction, written assignments, crisis intervention, structured residential settings with attendant behavioral expectations, and limited individual (intensive) therapy.

VOLUNTARY ADMISSION - The admission of either a female or male inmate/releasee/parolee to a Departmental mental health inpatient treatment facility or of a female to the Arizona State Hospital with the inmate/releasee/parolee's informed consent.

WATCH SWALLOW - The ingestion of medication by an inmate while being watched by a health care professional until the medication has been swallowed and followed by a mouth-sweep or mouth check to be certain that the medication was actually swallowed.

A.R.S. 31-226, Mentally Disordered Prisoner.

A.R.S. 31-226.01, Emergency Transfer Procedures.

A.R.S. 32-1401 et seq, Board of Medical Examiners.

A.R.S. 32-1602, Board of Nursing.

A.R.S. 32-1904 et seq, Board of Pharmacy.

A.R.S. 32-2062 et seq, Board of Psychologist Examiners.

A.R.S. 32-2501 et seq, Certification of Physician's Assistants.

A.R.S. 32-3301 et seq, Professional Counselors; Certification; Requirements.

A.R.S. 36-501, Definitions (behavioral health providers/agencies).

A.A.C. R4-6-701 et seq, Certification of Professional Counselors.

A.A.C. R4-16-101 et seq, Board of Medical Examiners.

A.A.C. R4-17-101 et seq, Joint Board on the Regulation of Physician's Assistants

A.A.C. R4-19-101 et seq, Board of Nursing.

A.A.C. R4-23-101 et seq, Board of Pharmacy.

A.A.C. R4-26-101 et seq, Board of Psychologist Examiners.

A.A.C. R5-1-1201 et seq, Involuntary Administration of Psychotropic Medication.

SUPERSEDES

Department Order 1103, Inmate Mental Health Care, Treatment and Programs, supersedes Director's Instruction 23, Inmate Mental Health Care, Treatment and Programs, which incorporated the following:

DMO 91-22, Management of Licensed Mental Health Facilities at ASPC-Phoenix (10/28/91)

DMO 92-04, Continuity of Care for Offenders and Ex-Offenders Who Are Seriously Mentally Ill (03/24/92)

DMO 92-09, Prescribing and Dispensing Psychotropic Medication for Psychiatric Disorders (05/13/92)

IMP 301.25, Suicide Prevention Watch (08/23/89)

IMP 306.1, Plethysmographic Program (05/13/92)

IMP 702.5, Services for the Mentally Handicapped/Retarded Inmate (10/22/90)

IMP 702.7, Hospitalization of Mentally Disordered Inmates/Releasees/Parolees (05/27/88)

IMP 704.2, Staff Representation at Hearings Conducted by the Board of Pardons and Paroles for Seriously Mentally Ill Inmates (04/28/93)

IMP 708.0, Special Programs Unit; Referral, Evaluation, Admission, Discharge (09/13/89)

IMP 708.1, Sex Offender Treatment Program (09/19/89)

MO 85, Involuntary Administration of Psychotropic Medication in Non-Emergency Situations (08/01/96)