SOP 508.31: Mental Health Crisis Stabilization Unit

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|
|Policy Number: 508.31|Effective Date: 12/9/2019|Page Number 1 of 7|
|Authority:
Commissioner
|Originating Division:
Health Services Division
(Mental Health)|Access Listing:
Level I: All Access|

I. Introduction and Summary: Crisis Stabilization is a level of care (Level V) requiring

intensive mental health services. Crisis Stabilization Unit mental health services will
only be provided in designated Georgia Department Corrections’ (GDC) prison
infirmaries located at facilities with a mental health mission.

II. Authority:

A. ACA Standards: 4-4410 and 4-4411;

B. NCCHC Standards for Health Services in Prisons;

C. NCCHC Standards for Health Services in Juvenile Detention and Confinement

Facilities; and

D. GDC Standard Operating Procedures (SOPs): 209.04, Use of Force and Restraint for

Offender Control; 209.05, Stripped Cells and Temporary Confiscation of Personal
Property; 507.04.42, Infirmary Care; 508.04, Credentialing Verification and
Privileging; 508.20, Mental Health Rounds in Isolation/Administrative Segregation
Units; 508.27, Time Out and Physical Restraints; 508.28, Managing Potentially
Suicidal, Self-Injurious, and Assaultive Behavior; and 508.29, Suicide Precautions.

III. Definitions:

A. Crisis Stabilization Unit (CSU) - A designated infirmary area expressly set-up and

operated for the purpose of treating mental health offenders who are in crisis and
need 24-hour health care presence while being in a safe environment.

B. CSU Nurse - A nurse, Registered Nurse (RN), or Licensed Practical Nurse (LPN),

who is qualified as a mental health nurse due to training and/or experience, and who
will coordinate and provide care during all shifts.

C. Stabilization Team - The staff members making up the treatment team for offenders

housed in CSU. Team members include, but are not limited to, a
psychiatrist/Advanced Practice Registered Nurse (APRN), a CSU nurse, and the
CSU counselor.

IV. Statement of Policy and Applicable Procedures:

A. The Crisis Stabilization Unit will provide intensive inpatient mental health services

for offenders who require 24-hour monitoring by professional staff. Crisis
Stabilization Unit (CSU) services will be based in infirmaries throughout the state as
designated by the State MH Program Supervisor in coordination with the GDC

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|
|Policy Number: 508.31|Effective Date: 12/9/2019|Page Number 2 of 7|
|Authority:
Commissioner
|Originating Division:
Health Services Division
(Mental Health)|Access Listing:
Level I: All Access|

Medical Director. Male juveniles will be sent to Augusta State Medical Prison
(ASMP) for CSU services. Female juveniles will be sent to Lee Arrendale State
Prison for CSU services. Wardens will be informed of all incidents, measures of
restraint, and movements associated with CSU at their respective facilities.

B. The number of CSU beds per infirmary area will be specific, but there will be

flexibility to expand or reduce the number of beds according to need and in
coordination with medical staff. CSU will be recognized as a temporary stay unit
with an average length of stay to be approximately five days. Length of stay may
vary based on clinical justification and may be shorter or longer than the average five
day stay.

C. The psychiatrist/APRN will be the attending provider for the offender while he or

she is admitted to the CSU. A psychiatrist will be on-call 24 hours per day. The
Medical Director has ultimate authority over medical services in the infirmary. The
Mental Health Unit Manager is responsible for ensuring that CSU activities are
coordinated with the multidisciplinary team. CSU Nurses cover the CSU seven days
per week on all shifts. The Director of Nursing, in coordination with the Mental
Health Nurse Coordinator, must ensure that there is adequate nursing coverage for
the CSU. A Mental Health Counselor, approved by the Clinical Director pursuant to
SOP 508.04, will be on call 24 hours per day (acting as a duty officer). A mental
health duty officer "on-call" roster and a psychiatrist "on-call" roster will be posted
in the infirmary.

D. All offenders transferred from another institution for CSU services may be held on

sleeper status. Reassignments may also be considered if appropriate.

E. The decision to admit an offender to the CSU may be based on any of the following

criteria:

1. Extreme agitation as evidenced by self-harm or harm to others;

2. Need for mental health observation due to abrupt behavioral change with

diagnostic questions of possible underlying medical problem(s);

3. Suicidal preoccupation/actively self-injurious and has history of particularly

lethal acts;

4. Need for restraints as a last resort due to the imminent threat or self-harm or

harm to others; and/or

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|
|Policy Number: 508.31|Effective Date: 12/9/2019|Page Number 3 of 7|
|Authority:
Commissioner
|Originating Division:
Health Services Division
(Mental Health)|Access Listing:
Level I: All Access|

5. Need for intensive psychopharmacological treatment.

F. Admission Process:

1. Offenders may refuse mental health treatment, but they may not refuse crisis

stabilization placement. All offenders admitted to the infirmary will be within
sight or sound of a licensed health care provider 24 hours per day.

2. Once a decision is made that an offender may need CSU services, the CSU nurse

must be notified. The CSU nurse must contact the psychiatrist/APRN within an
hour of placement in the infirmary to discuss the case with the
psychiatrist/APRN and obtain admission orders.

3. The admitting order will include:

a. Reason for admission and diagnosis;

b. Frequency of vital signs;

c. Type of diet required (consider medical condition and safety concerns);

d. Frequency of observation;

e. Diagnostic or treatment measures to be taken during the infirmary stay;

f. Restraint as needed per SOP 508.27; and

g. Laboratory tests as clinically indicated.

4. Property and clothing for those cells where suicide precautions occur will be

suicide-resistant garments, booties and suicide-resistant bedding (and appropriate
resources for females during menses). Provisions are made to supply the offender
with a security garment that will promote offender safety in a way that is
designed to prevent humiliation and degradation. The person will have no other
property unless modification (i.e. additional items) is allowed based on the
documented direction of a psychiatrist/APRN/psychologist. This is to be
determined on an individual basis.

G. CSU Treatment:

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|
|Policy Number: 508.31|Effective Date: 12/9/2019|Page Number 4 of 7|
|Authority:
Commissioner
|Originating Division:
Health Services Division
(Mental Health)|Access Listing:
Level I: All Access|

1. The CSU nurse will perform a Nursing Assessment (Form M70-02-01).

2. Nursing documentation will require an admission note that includes, at a

minimum, chief complaint, vital signs, relevant history, relevant observations.

3. Psychiatry/APRN will evaluate the offender and complete the Psychiatric

Admission Form (Form M70-02-02). If the offender is being readmitted within
30 days, the Abbreviated Psychiatric Admission Form (Form M70-02-03) may
be used. The evaluation will occur within 24 hours or the next business day
unless an emergency condition exists.

4. Vital signs will be taken daily or as ordered by the provider.

5. The CSU counselor will initiate a CSU Treatment Plan (Form M70-02-04) for

cases in which the offender is in CSU, not on Suicide Precautions (SP) status. [In
cases of SP status, a Suicide Precautions Treatment Plan (Form M69-01-02) must
be completed.] The CSU Treatment Plan will be mental health-oriented and will
include problems, goals and interventions. The Mental Health Counselor and
Psychiatrist/APRN may specify interventions to be included. The plan should
focus on the primary reason for admission and any psychological or social
factors that may have contributed to the crisis. It should include information on
present mental status and history of mental illness.

6. The CSU Nurse will coordinate with a non-psychiatric physician or Physician’s

Assistant (PA) to perform a history and physical (Form P30-0012.01) within 24
hours of admission.

7. The CSU nurse will work with the offender throughout the CSU admission

period. The assigned Mental Health Counselor will spend time with the offender
daily, Monday-Friday. The Psychiatrist/APRN will evaluate the offender daily,
Monday-Friday. These clinicians will be considered the Stabilization Team.

8. Phone rounds are conducted Saturday, Sunday, and on holidays between the

mental health duty officer, CSU Nurse and Psychiatrist/APRN.
9. During each 8-hour shift, the CSU Nurse will complete a Nursing Assessment

and Database (M70-02-01) including a mental status exam. The Mental Health
Counselor and Psychiatrist/APRN will document daily rounds, Monday through
Friday.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|
|Policy Number: 508.31|Effective Date: 12/9/2019|Page Number 5 of 7|
|Authority:
Commissioner
|Originating Division:
Health Services Division
(Mental Health)|Access Listing:
Level I: All Access|

10. The CSU Counselor or the on-call duty officer will write a progress note

addressing the primary reason for admission and the clinical status of the
offender daily.

11. The CSU Counselor, in accordance with the Stabilization Team’s deliberations,

will utilize available resources such as Chaplaincy, Education, Library Services,
Activity Therapy, etc. to supplement care. The Stabilization Team should be
consulted and will approve any activity outside of the CSU cell.

12. CSU admissions will be discussed daily in Rounds. All members of the

Stabilization Team should participate in the Rounds.

H. Discharge Process:

1. The CSU Discharge Summary (Form M70-02-06) will be utilized for

documentation by the Attending Psychiatrist/APRN and will clearly reflect the
offender's discharge diagnosis(es) and discharge plan. The nursing portion of the
Discharge Summary will be completed upon discharge.

2. A Psychiatrist/APRN is required to review and sign all infirmary discharges with

the appropriate date, time, and signature.

3. All non-mental health offenders admitted to the CSU will have a complete

mental health evaluation using form M31-01-01 before being discharged from
CSU.

4. The completed Crisis Stabilization documentation package will be filed in the

medical record behind the Infirmary Admission divider.

5. The Mental Health Counselor will complete a discharge summary note (in lieu of

a progress note, on the day of discharge) to include information pertinent to the
CSU stay and the time period of admission using form M70-02-09. A copy of
the CSU Discharge Summary (M70-02-06) will be filed in section 1 of the
mental health record.
6. Once the offender is permanently assigned to an institution upon discharge from

CSU, the newly assigned treatment team will decide the most appropriate
housing according to treatment needs and coordinate with security for the move
and placement.

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|
|Policy Number: 508.31|Effective Date: 12/9/2019|Page Number 6 of 7|
|Authority:
Commissioner
|Originating Division:
Health Services Division
(Mental Health)|Access Listing:
Level I: All Access|

7. The CSU Stabilization Team will determine the level of services needed upon

discharge from the CSU. The MH Unit Manager will ensure placement at an
institution with the appropriate level of care by coordinating with local and
Central Office classification personnel.

8. Discharge from the CSU on weekends is discouraged unless it is to an ACU at

the same facility.

9. If an offender is placed in Isolation/Segregation after release from Acute Care

Unit/Crisis Stabilization Unit, a mental health assessment will be conducted by
the Qualified Mental Health Professional on that offender within the first 10 - 12
hours of placement in Isolation/Segregation.

I. Data Collection:

1. A CSU Admission Log (Form M70-02-07) will be maintained and will include

the following data:

a. Offender's Name and ID number;

b. Date of admission;

c. Admitting diagnosis(es);

d. Discharge diagnosis(es);

e. Discharge placement;

f. Referral source; and

g. Date of discharge.

J. Readmission: If an offender is readmitted within 30 days for the same condition, the

CSU nurse will coordinate with the non-psychiatric medical providers to update the
previous history and physical. A complete history will not be necessary unless
clinically indicated. All other documents must be completed for a new admission.

V. Attachments:

Attachment 1: Crisis Stabilization Unit Nursing Assessment and Database (M70-02-01)
Attachment 2: Crisis Stabilization Unit Psychiatric Admission Form (M70-02-02)

|GEORGIA DEPARTMENT OF CORRECTIONS
Standard Operating Procedures|Col2|Col3|
|---|---|---|
|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|Policy Name:Mental Health Crisis Stabilization Unit|
|Policy Number: 508.31|Effective Date: 12/9/2019|Page Number 7 of 7|
|Authority:
Commissioner
|Originating Division:
Health Services Division
(Mental Health)|Access Listing:
Level I: All Access|

Attachment 3: Abbreviated Psychiatric Admission for Crisis Stabilization
Unit (M70-02-03)
Attachment 4: Crisis Stabilization Unit Treatment Plan (M70-02-04)
Attachment 6: Crisis Stabilization Unit Discharge Summary (M70-02-06)
Attachment 7: Crisis Stabilization Unit Admission Log (M70-02-07)
Attachment 8: Crisis Stabilization Unit Referral Report (M70-02-08)
Attachment 9: Crisis Stabilization Unit Summary Discharge Note (M70-02-09)
Attachment 10: Crisis Stabilization Unit Admission Cover Page (M70-02-10)

VI. Record Retention of Forms Relevant to this Policy:

Upon completion, Attachments 1, 2, 3, 4, and 8 shall be placed in the offender’s medical
file (Infirmary Section with CSU/ACU packets) and retained for ten (10) years.
Attachments 6, 9, and 10 shall be placed in the offender’s medical file (Infirmary
Section on the top of the CSU packet) and a copy in the mental health file (section 1). 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.
Attachment 7 shall be maintained for four (4) years in the mental health area.