Performance trends

Why is this measure important?

Suicide and self injurious behavior prevention is part of the DOCR core mission given the number of inmates with significant behavioral health problems. Research indicates the first 72 hours of incarceration is the most critical for risk of self injurious behavior. Maintaining life is a core value of our agency and county.

Factors contributing to current performance

  • Serious and/or persistent mental illness remains a challenge for correctional facilities and our community. The Centers for Disease Control and Prevention reports a significant increase in suicides nationally. In July 2018, they noted it as a public health crisis and a national problem hitting our communities. (Washington Post July 2018).
  • The mentally ill prisoner population continues to grow in Montgomery County as community-based programs receive diminished funding and community options are restricted given ongoing budget and economic challenges.
  • Correctional Officers assigned to booking/intake and HHS - CATS (Clinical Assessment and Transition Services) identify high suicide risk prisoners and save lives on a regular basis.
  • Those entering our facility manifesting the signs and symptoms of intoxication (drugs or alcohol) at the point of initial arrest and processing into CPU is increasing. The first 72 hours of incarceration presents a critical time where suicide ideations may occur due to intoxication and or withdrawal. An increasing percentage of new arrestees are so intoxicated that they must receive emergency medical treatment at a hospital prior to incarceration to stabilize them.
  • Identification and protective factors are increasingly difficult to interpret.
  • Opioid withdrawal contributes to the DOCR challenge of maintaining the health and welfare of those committed to our custody.

Factors restricting performance improvement

  • The volume of ever increasing serious and persistently mentally ill prisoners can lead to near-successful efforts and some actual suicides in virtually any correctional environment. The facility and staff must be trained and prepared to intervene at all times. The national averages are 46:100,000 in jails. DOCR has a significantly lower rate at 2.5:100,000. Zero is our goal.
  • No matter how effective and intensive case intervention, crisis intervention and training might be, some persons may exhibit no visible behavioral signs with no previous mental health history, leading up to a suicide attempt.
  • Jail-based crisis assessment services at booking (CATS) are not 24/7, thus leaving some night time and weekend hours uncovered by trained, professional therapeutic staff which assists in the identification of vulnerable individuals.
  • DOCR does not have an electronic medical record that is networked with community health. This continuity of record would provide alerts and information to further alert staff of problematic behaviors and health conditions. Electronic medical records for DOCR was funded in FY17.

Performance improvement plan

  • New Maryland Law (effective October 1, 2018) requiring those adjudicated to receive mental health treatment must be admitted to a state hospital within 10 days of commitment.
  • DOCR in concert with CATS (Clinical Assessment and Transition Services) will strive to engage every possible incoming prisoner with characteristics suggesting serious mental illness and/or potential suicidal thoughts or actions.
  • DOCR Correctional Officers will continue to complete training to expand our potential to understand and identify those with serious mental illness and suicidal potential.
  • DOCR and HHS will increase advocacy in support of community mental health programs and treatment services to diminish jail admissions of the primarily mentally ill.
  • DOCR will advocate for 24/7 HHS CATS therapist at CPU intake.
  • DOCR will pursue electronic health records via strategic budget planning.
  • DOCR will evaluate any emerging practice for implementation that assists in preserving the health and welfare of those committed to our custody.
  • DOCR will seek external evaluation of best practices in this area of correctional management.