SOP 508.16: Mental Health Levels of Care

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 1 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

I. Introduction and Summary:

Offenders requiring mental health services will be assigned to levels of care based on
a continuum of treatment needs. This procedure is applicable to all Georgia
Department of Corrections (GDC) facilities with a mental health mission.

II. Authority:

A. GDC Standard Operating Procedures (SOPs): 508.10 Confidentiality of Mental

Health Records, 508.15 Mental Health Evaluations, 508.19 MH Referral and
Triage, 508.23 Specialized Mental Health Treatment Unit (SMHTU), 508.24
Psychotropic Medication Use Management, and 508.25 Psychiatric
Hospitalization, and;

B. American Correctional Association (ACA) Standards: 4-4350, 4-4368

(MANDATORY), 4-4370 (MANDATORY), 4-4374, and 4-4399; and

C. National Commission on Correctional Health Care (NCCHC): Standards for

Mental Health Services in Correctional Facilities.

III. Definitions:

A. Mental Health Treatment Team - May consist of, but not limited to the mental

health unit manager, mental health counselors, behavior specialists,
psychiatrists/advanced practice registered nurses (APRNs), psychologists, mental
health nurses, activity therapists, teachers, chaplains, multifunctional correctional
officers, designated security staff, and other staff as needed.

B. Individualized Treatment Plan - A guide for each offender that has a definition

of problem(s), goal(s), and intervention(s) with scheduled updates.

C. Qualified Mental Health Professional - Mental health unit managers,

psychiatrists, psychologists, APRNs, licensed nurses, licensed professional
counselors, licensed master or clinical social workers, licensed marriage and
family therapists, mental health counselors, and mental health behavior
specialists.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 2 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

D. Serious Mental Illness/Serious and Persistent Mental Illness - A substantial

disorder of thought or mood that significantly impairs judgment, behavior,
capacity to recognize reality or cope with the ordinary demands of life within the
correctional environment and is manifested by substantial pain or disability.
Serious mental illness requires a mental health diagnosis and treatment in
accordance with an Individualized Treatment Plan (ITP).

E. Mental Health Outpatient - Services that are provided to offenders in the

general population or any other non-clinical setting at any GDC facility to assist
the offender in overall adjustment in the correctional environment and provide
treatment for specific needs as identified in an Individualized Treatment Plan.

F. Supportive Living Unit (SLU) - Special intermediate care mental health

housing designed to serve the needs of the Seriously Mentally Ill offender who is
unable to live and function effectively in the general prison population due to the
nature of their mental illness. The offender may:

1. Exhibit active symptoms of mental illness and tend to remain Seriously

Mentally Ill over time; or

2. Be relatively stable but fragile and tend to decompensate in stressful

environments such as that of a general prison population.

3. These units are separate housing units from general population. Interaction

with general population and movement within the institution is based on
individual mental health treatment needs and functional level. Reintegration,
when appropriate, with the general population is important. These units offer
a therapeutic milieu with a spectrum of programming designed to support and
treat the mentally ill offender based on an Individualized Treatment Plan.

G. Crisis Stabilization Placement - Offenders who are in crisis will be placed in an

Acute Care Unit (ACU) or Crisis Stabilization Unit (CSU) cell. At facilities
without ACU or CSU cells, the offenders will be placed in an observation cell
until a transfer can take place to a facility with ACU/CSU cells. Offenders with
repeated severe crises who cannot be stabilized in an ACU/CSU may be

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 3 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

considered for transfer to a forensic psychiatric hospital or prison psychiatric
facility for placement.

IV. Statement of Policy and Applicable Procedures:

The level of care of the mental health offender will determine availability and types
of mental health services, frequency of therapeutic contacts, and mode of discharge
planning. It is the responsibility of the assigned mental health counselor to meet with
Level II offenders within fourteen (14) days and with Level III and IV offenders
within seven (5) days of being placed on the mental health caseload. This includes
but is not limited to transfers from other facilities, a counselor change, or level
change, etc. When an offender returns from court they must be seen by a mental
health counselor within 24 hours or the next working day.

A. Level I – No need for Mental Health Services: Mental health services are not

indicated when an offender's ability to adjust and function in general population
is not significantly impaired due to the presence of a mental illness.

B. Level II – Outpatient Services:

1. Mental Health Outpatient services are indicated when an offender’s ability to

function in general population is (1) mildly impaired due to mental illness, or
(2) is not currently impaired but needs monitoring due to:

a. Medication maintenance or a recent discontinuation of psychotropic

medication.

b. A recent discharge from either a SLU or Crisis Stabilization Placement.

c. A recent history of significant self-injurious behavior or suicidal ideation.

2. Admission Criteria: The decision to provide an offender with mental health

outpatient services is based on an evaluation made by a psychiatrist/APRN
and/or psychologist. (Reference SOP 508.19, MH Referral and Triage)

3. Services Provided: Outpatient services may include but are not be limited to:

a. Development of an Individualized Treatment Plan;

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 4 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

b. Psychopharmacological treatment;

c. Psychological testing;

d. Individual counseling/group counseling;

e. Individual therapy/group therapy;

f. All groups, programs and services available to general population

offenders, to include assisting with re-entry efforts; and

g. Crisis intervention.

4. Frequency of Contact: Offenders placed on Level II will be seen at least once

a month by their mental health counselor unless the Treatment Team
determines another timeframe and the frequency of contact is documented in
the offender’s Individualized Treatment Plan. Each session will be
documented in a progress note using the Mental Health Progress Note (M2002-02).

5. Mental Health Outpatient services are provided in the following settings:

a. At all facilities with a Mental Health Treatment Team; and

b. At facilities with a mental health satellite program for isolation
segregation rounds and evaluation of services.

6. Mental Health Outpatient Staffing Organization:

a. Treatment for Mental Health Outpatient programs will be based on an

interdisciplinary approach to the treatment of mental illness. The
following disciplines may be involved in providing services:

1) Mental health unit manager;

2) Clinical psychologist;

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 5 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

3) Psychiatrist/Advanced practice registered nurse (APRN);

4) Mental health counselors;

5) Mental health nurses;

6) Mental health behavior specialist (in diagnostic facilities);

7) Multifunctional correctional officers;

8) Clinical chaplain;

9) Teacher;

10) Activity therapists; and

11) Medication clinic coordinator.

b. Clinical consultant services for offenders receiving Outpatient Mental

Health services will be coordinated by the mental health unit manager.
Psychiatric, psychological, and other clinical consultants will provide onsite or tele-mental health services at scheduled times at designated
facilities with Outpatient Mental Health services.

7. Discharge Planning: The Treatment Team, led by the clinical
director/psychologist, to include the treating psychiatrist/APRN, mental
health unit manager and the assigned mental health counselor will decide to
discharge an offender. This decision should be documented on a Treatment
Team note, Diagnosis List, Individualized Comprehensive Treatment
Plan/Review and Utilization Review (on the front of the Comprehensive
Treatment Plan). This decision is based on the Treatment Plan goals having
been met and maintained without the utilization of psychotropic medication
for a time frame judged to be sufficient (a minimum of 60 days) for the
offender being treated. (See SOP 508.24, Psychotropic Medication Use
Management). The Counselor Discharge Summary Note (M32-01-01).
which is Attachment 1, will be placed, along with the mental health record, in

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 6 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

section five (5) of the medical record. The mental health unit manager will
ensure that appropriate staff utilizes the current computer systems (Scribe) to
reflect level I status.

8. Offenders released from a forensic psychiatric hospital or prison psychiatric

facility cannot be returned to a level I facility. Offenders released from a
Crisis Stabilization Unit (CSU), or an Acute Care Unit (ACU), cannot be
returned to a level I facility until the offender has been evaluated by a
psychiatrist/APRN and/or a psychologist and with concurrence from the
Treatment Team it is determined this offender can return to a level I facility.
Documentation justifying the decision should be placed in section five of the
medical record. Contact should be made by the mental health unit manager
(via email or phone call) to the receiving facility’s deputy warden of care and
treatment at the level 1 facility regarding the decision. This communication
shall be made by the next business day after the Treatment Team meeting to
coordinate transportation of the offender back to the level 1 facility.

9. Offenders diagnosed with a Serious and Persistent Mental Illness (SPMI)

cannot be removed from the caseload. They must be placed in the least
restrictive environment given their adaptive level of functioning and they
should be followed by a mental health counselor and a psychiatrist/APRN or
psychologist. An offender can be taken off the caseload if a
psychiatrist/APRN or psychologist concludes that the diagnosis of Serious
and Persistent Mental Illness was incorrect and then proceeds to make a
diagnosis in collaboration with the Treatment Team, correcting the previous
diagnostic impression.

10. The scope of services offered by mental health staff to the RSAT program

mental health detainees will be restricted to:

a. Medication management;

b. Crisis intervention;

c. Reentry;

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 7 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

d. Maintenance (maintenance detainees can be seen once a month in groups.

The mental health counselor, psychiatrist/APRN or psychologist will
determine who is appropriate for a maintenance group); and

e. Limited individual/therapeutic counseling.

C. Level III – Supportive Living Unit Services:

1. Level III Supportive Living Unit (SLU) services are indicated when an

offender's ability to function in general population is moderately impaired
due to mental illness. This designation reflects a tenuous mental status that is
easily overwhelmed by everyday pressures, demands, and frustrations
resulting in the following: disorganization, impulsive behavior, poor
judgment, a deterioration of emotional controls, loosening of associations,
delusional thinking, and/or hallucinations. The decision on whether to allow
these offenders to participate in general population activities, such as a work
detail, a psycho-educational group, school, gym call, and library call is based
on their mental status and Individualized Treatment Plan goals.

2. Admission Criteria for Supportive Living Unit Placement:

a. The offender has a moderate mental illness as defined above and as a

result of the moderate mental illness has experienced significant
impairment in their ability to adjust and function satisfactorily within the
general prison population, as determined by the number, intensity, and
frequency of mental health services needed, or the offender has stabilized
at a higher level of care and can now function within the Supportive
Living Unit.

b. The offender must also meet the following criteria:

1) Absence of acute psychotic and/or affective symptomatology

requiring a higher level of care (i.e. Crisis Stabilization care or
hospitalization).

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 8 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

2) Absence of acute or chronic medical conditions that require intensive

or prolonged skilled nursing care or hospitalization.

3) Ability to participate in their treatment and attend treatment

appointments.

c. The offender has been recommended for Supportive Living Unit

placement by the Mental Health Treatment Team as part of the offender's
Individualized Treatment Plan or has been recommended for placement
pending the outcome of a mental health evaluation.

3. Level III Supportive Living Unit Program Description:

a. The Supportive Living Unit will provide a structured therapeutic milieu

designed to assist moderately mentally ill offenders in functioning
psycho-socially and vocationally at the highest possible level within the
correctional environment. A broad spectrum of therapeutic activities and
groups will be available and utilized as needed based on the specific
treatment needs of each offender as identified in the Individualized
Treatment Plan.

b. General Operating Principles of the Supportive Living Unit.

1) Offenders housed in the Supportive Living Unit will have daily access

to mental health staff. To ensure access to staff and to provide a
mechanism for regular monitoring of the Supportive Living Unit
population, the mental health counselor(s) assigned to the Supportive
Living Unit will conduct daily rounds. Rounds will be conducted at a
designated time each day. Problems identified during rounds will be
discussed with the clinical director/psychologist responsible for
overseeing the therapeutic program.

2) Offenders placed on level III or level IV care will be seen at least

twice a month by their mental health counselor. Each session will be
documented in a progress note.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 9 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

3) Offenders released from a forensic psychiatric hospital or prison

psychiatric facility, Crisis Stabilization Unit or Acute Care Unit must
be followed more closely by their mental health counselor than other
level IV, level III, or level II offenders.

4) Offenders should be engaged in therapeutic programming a minimum

of two (2) to four (4) hours a day. Based on the needs of the offender,
scheduled structured recreation or therapeutic activities may include:
work, education, structured therapeutic activities or programs,
individual, or group therapy, and/or psychological/psychiatric
appointments.

5) A clinical director/psychologist in conjunction with the mental health

counselor(s) assigned to the Supportive Living Unit will be
responsible for developing, implementing, and overseeing the
therapeutic program in the Supportive Living Units.

6) The mental health counselor(s) assigned to the Supportive Living Unit

will generally be the primary mental health care provider(s) for the
offenders living in that Supportive Living Unit. This person will be
responsible for the development (in conjunction with the offender and
the Mental Health Treatment Team), implementation and monitoring
of the offender's Individualized Treatment Plan.

c. Offender’s scheduled activities/programs/treatment will be scheduled

through the computer tracking system (Scribe), where available.
Activities required as part of the treatment plan are part of the offender's
schedule.

d. Program services to include but are not limited to:

1) Structured therapeutic activities to include socialization and reality
orientation programs as well as activity therapy;

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 10 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

2) Individual and group mental health treatment designed to help the

individual change behavior as needed and develop more effective
coping skills;

3) Psychiatric evaluation and psychopharmacology;

4) Psychological testing and assessment;

5) Patient education on mental illness and psychotropic medications;

6) Medication compliance monitoring and counseling;

7) Psycho-educational programs and groups (such as anger management,

mood disorder, stress management, etc.);

8) Activity therapy programs (i.e., pet therapy, horticulture, recreation

therapy, physical fitness, Activities of Daily Living (ADL’s), etc.);

9) Therapy groups (may be considered if not emotionally overwhelming

to the fragile SLU population);

10) Self-help groups include Alcoholics, etc.;

11) Institutional work details;

12) Educational programs;

13) General population counseling programs as clinically indicated to

include substance abuse groups/support groups;

14) All other general population services and activities (i.e., store call and

yard and gym call) will be made available to all mental health
offenders;

15) Community meetings held weekly to include Supportive Living Unit

correctional officers/multifunctional correctional officers. Minutes

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 11 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

should be kept during all community meetings. The minutes should
include documentation regarding whether there is adequate seating.

4. Level III Supportive Living Unit Staffing Composition: Treatment on the

Supportive Living Unit (SLU) will be based on an interdisciplinary approach
to the treatment of mental illness. The following disciplines may be involved
in providing services within the therapeutic milieu:

a. Mental health unit manager;

b. Clinical psychologist;

c. Psychiatrist/APRN;

d. Mental health counselor(s);

e. Mental health behavior specialist (in diagnostic facilities);

f. Correctional officers/multifunctional correctional officers;

g. Activity therapist(s);

h. Mental health nurse or nurse supervisor;

i. Chaplain;

j. Teacher; and

k. Medication clinic coordinator.

5. Discharge Planning:

a. The Treatment Team, led by the clinical director/psychologist, to include

the treating psychiatrist/APRN, mental health unit manager and the
assigned mental health counselor will decide to discharge an offender
from level III services. This decision should be documented on a

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 12 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

Treatment Team note, Mental Health Diagnosis List (Attachment 4, M2001-05, SOP 508.09), Individualized Comprehensive Treatment
Plan/Review, and Utilization Review on the front of the Comprehensive
Treatment Plan.

b. Offenders should generally be stepped down one level of care at a time.

Offenders should remain on a level of care (level IV, level III or level II)
for at least 60 days before having their level of care reduced.

c. When the Treatment Team is considering reducing an offender's level of

care by more than one level and/or reducing it in less than 60 days, then a
psychiatrist/APRN or psychologist must evaluate the offender to
determine whether to follow the Treatment Team’s recommendation.
The evaluation must contain:

1) A review of the offender's mental health history, medication

adherence, diagnosis, and mental status.

2) A statement justifying either agreement or disagreement with the

Treatment Team’s recommendation.

d. When clinically indicated, treatment will be directed toward transitioning

Supportive Living Unit (SLU) offenders into the prison’s general
population.

e. During the transitioning process, mainstreaming the mental health

offenders into general population programs/activities to include work
details education programs, and general population programs should take
place on a gradually increasing basis in accordance with the offender's
Individualized Treatment Plan.

f. Transfer to general population is a clinical decision and will be made

when the Mental Health Treatment Team determines that an offender can
function effectively in general population.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 13 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

g. During the transitioning period, close coordination between the

Supportive Living Unit (SLU) and Mental Health Outpatient staff must
take place to ensure continuity of care.

D. Level IV – Supportive Living Unit Services:

1. Level IV Supportive Living Unit services are indicated when an offender's

ability to function in general population is severely impaired due to mental
illness. This level reflects active symptoms of a Severe and Persistent Mental
Illness (SPMI) with impaired reality testing. These offenders are unable to
attend most treatment or recreational groups in traditional settings and may
require ancillary services provided in the residential unit such as special
education, psycho-educational groups, activity therapy, and library services.

2. Admission Criteria for Level IV Supportive Living Unit Placement:

a. As a result of the Severe and Persistent Mental Illness, the offender has

experienced severe functional impairment (e.g., unable to transition to the
cafeteria, a need for an escort to transition within the facility, the need for
assistance for sick call access, or the need for a single cell environment
for activities of daily living).

b. Their ability to adjust satisfactorily within the general prison environment

may be determined by the number, intensity, and frequency of mental
health services needed.

c. The offender's ability to participate in treatment and attend planned

scheduled treatment is limited by their mental illness.

d. The offender has been recommended for Supportive Living Unit

placement by the Mental Health Treatment Team as part of the offender's
Individualized Treatment Plan or has been recommended for placement
pending the outcome of a mental health evaluation.

3. Level IV Supportive Living Unit Staffing Composition and Program

Description:

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 14 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

a. Staffing composition of a level IV Supportive Living Unit will be

interdisciplinary as stated above and more intensive than level III
Supportive Living Unit given the mental health needs of the offender.

b. The general operating principles of a level IV Supportive Living Unit are

identical to those of a level III Supportive Living Unit.

c. Program services in a level IV Supportive Living Unit are identical to

those of a level III Supportive Living Unit with the exception that many
services are offered in the residential unit rather than elsewhere in the
facility.

d. Discharge planning for a level IV offender is similar to a level III

offender in a Supportive Living Unit with the exception that most level
IV offenders are discharged to a level III Supportive Living Unit rather
than to general population.

1) The Treatment Team, led by the clinical director/psychologist, to

include the treating psychiatrist/APRN, mental health unit manager
and the assigned mental health counselor will decide to discharge an
offender from level IV services. This decision should be documented
on a Treatment Team note, Diagnosis List, Individualized
Comprehensive Treatment Plan/Review and Utilization Review on
the front of the Comprehensive Treatment Plan.

2) Offenders should generally be stepped down one level of care at a

time. Offenders should remain on a level of care (level IV, level III
or level II) for at least 60 days before having their level of care
reduced.

3) When the Treatment Team is considering reducing an offender's level

of care by more than one level and/or reducing it in less than 60 days,
then a psychiatrist/APRN or psychologist must evaluate the offender
to determine whether to follow the Treatment Team’s
recommendation or not follow the recommendation. The evaluation
must contain:

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 15 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

a) A review of the offender's mental health history, medication adherence,

diagnosis, and mental status.

b) A statement justifying either agreement or disagreement with the

Treatment Team’s recommendation.

E. Level V – Acute Care Unit (ACU) or Crisis Stabilization Unit (CSU) Placement:

1. Crisis Placement is indicated when:

a. An offender's ability to function is severely impaired due to acute Serious

Mental Illness;

b. It would facilitate diagnostic clarification;

c. There is a need for more intensive psychopharmacological intervention;

d. There is a need for continued observation; and/or

e. There is a need for continued mental health and medical observation or

treatment in the infirmary (CSU).

2. Crisis Stabilization will only take place in designated infirmaries. Offenders

in need of acute care or Crisis Stabilization will be placed in an ACU/CSU
cell. In facilities without ACU/CSU cells the offender can be placed in an
Observation cell until transferred to a facility with ACU/CSU stabilization
beds.

a. Any Qualified Mental Health Professional may admit an offender for

Acute Care or Crisis Stabilization.

b. Although offenders may refuse mental health treatment, they may not

refuse Acute Care or Crisis Stabilization Placement if the admitting
provider deems it necessary to observe or house the offender in this
location.

|GEORGIA DEPARTMENT OF CORRECTIONS
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|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 16 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

c. The Qualified Mental Health Professional at the Crisis Stabilization Unit

will contact the psychiatrist/APRN to request an admission order within
one (1) hour of transfer to the infirmary CSU cell.

d. A psychiatrist/APRN will be on call during off-hours, weekends and

holidays for consultation regarding offenders in Acute Care or Crisis
Stabilization Placement.

e. Offenders placed in an Acute Care Unit or Crisis Stabilization Unit will

be seen by a licensed mental health clinician every work day or a
Qualified Mental Health Professional privileged to perform crisis
stabilization or evaluation/treatment. A telephone consultation is required
between the Qualified Mental Health Professional and the treating
psychiatrist/APRN if the psychiatrist/APRN has not interviewed the
patient that day. All clinical encounters will be appropriately documented
in either the medical or clinical file.

f. Only a psychiatrist/APRN can discharge an offender from a Crisis

Stabilization Unit.

g. All non-mental health (level I) offenders admitted to the Crisis

Stabilization Unit will have a complete Mental Health Evaluation using
Attachment 1, Mental Health Evaluation for Services (M31-01-01) from
SOP 508.15 and Attachment 6, Initial Psychiatric/Psychological
Evaluation (M60-01-06) from SOP 508.24, before being discharged from
the Crisis Stabilization Unit.

h. An offender being stabilized in a designated Mental Health Crisis

Stabilization Unit and in restraints longer than 72 hours, may be referred
for placement in a prison psychiatric facility using procedures outlined in
SOP 508.25, Psychiatric Hospitalization.

F. Level VI Prison Psychiatric Facility: A prison psychiatric facility is indicated

when an offender has severely debilitating symptomatology which cannot be
safely and adequately treated within an infirmary or Supportive Living Unit and

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 17 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

thus must be transferred to a prison psychiatric facility. (Refer to SOP 508.25,
Psychiatric Hospitalization.)

G. Mental Health “Housing” Criteria:

1. Level II offenders should not take up valuable Supportive Living Unit space.

They should be placed in general population. If level II detainees are at risk
in general population, they can be briefly placed in a Supportive Living Unit
(SLU-III) dorm assuming they are not predators. Facility administration
should be notified weekly of the Level II detainee's status. The state mental
health program supervisor/designee should be sent a copy of these
notifications.

2. Level III offenders should live in a Supportive Living Unit dorm (SLU-III)

with other level III offenders.

3. Level IV offenders should live in a Supportive Living Unit (SLU-IV) dorm

with other level IV offenders. Level IV units are the most staff-intensive and
most restrictive units with many activities/programs being brought to the
offenders instead of the offenders being brought to the activities/programs.
Placing level III offenders in a level IV dorm would violate the least
restrictive environment principle.

4. Special mental health treatment unit (SMHTU) placement will be primarily

determined by treatment needs. Level of care will be secondary in importance
when determining SMHTU housing.

5. Mental health offenders pending movement should not normally be locked

down. If it is a level IV offender in a level III facility the offender can be
kept in the Supportive Living Unit with close observation, until the transfer
can be facilitated. If the offender is a level III offender in a level II facility
they can be kept in general population with close observation, until the
transfer can be facilitated.

6. The above-recommended criteria are guidelines for mental health placement.

It must be noted that there will be exceptions given security concerns, space

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|Policy Name:Mental Health Levels of Care|
|Policy Number: 508.16|Effective Date: 5/9/2018|Page Number: 18 of 18|
|Authority:
Commissioner
|Originating Division:
Health Services Division|Access Listing:
Level II: Required Offender
Access|

problems, and clinical conditions. It is the responsibility of mental health
staff to ensure that mental health offenders are appropriately housed.

V. Attachment:

Attachment 1: Counselor Discharge Summary Note (M32-01-01)

VI. Record Retention of Forms Relevant to this Policy:

Attachment 1 shall be placed in the offender’s mental health file. At the end of the
offender’s need for mental health services and/or sentence, the mental health file
shall be placed within the offender’s health record and retained for 10 years.