SOP_NUMBER: 508.23
TITLE: Specialized Mental Health Treatment Units
DIVISION: Health Services Division
TOPIC_AREA: 508 Policy-MH Suicide Prevention/ACU/CSU/BTU
EFFECTIVE_DATE: 2018-04-27
WORD_COUNT: 3775
POWERDMS_URL: https://public.powerdms.com/GADOC/documents/196628
URL: https://gps.press/sop-data/508.23/

SUMMARY:
This policy establishes secure, therapeutic treatment units within GDC facilities that provide specialized mental health programs to incarcerated individuals with serious mental illness, severe personality disorders, brain injuries, impulse control disorders, and violent behavior. The SMHTU program uses evidence-based, incentive-based interventions delivered by multidisciplinary teams and aims to develop pro-social behaviors and prepare individuals for reintegration into the general prison population and society. Admission is based on clinical need and mental health referral, with multi-level approval required from the Warden, Statewide Mental Health Director, and Facilities Division Director.

KEY_TOPICS: specialized mental health treatment units, SMHTU, serious and persistent mental illness, severe personality disorders, traumatic brain injury, impulse control disorders, mental health programming, incentive-based treatment, therapeutic modules, behavior management, offender reentry, multidisciplinary treatment team, evidence-based mental health services, secure treatment units

ATTACHMENTS:
  1. Specialized Mental Health Treatment Unit Recommendation Form
     URL: https://gps.press/sop-data/508.23-att-1/
  2. Consent to Receive Specialized Mental Health Treatment
     URL: https://gps.press/sop-data/508.23-att-2/
  3. Specialized Mental Health Treatment Unit Admission Form
     URL: https://gps.press/sop-data/508.23-att-3/
  4. Activity Therapy Assessment – for Specialized Mental Health Treatment Program
     URL: https://gps.press/sop-data/508.23-att-4/
  5. Specialized Mental Health Treatment Unit (SMHTU) – Orientation to the Program
     URL: https://gps.press/sop-data/508.23-att-5/
  6. Specialized Mental Health Treatment Unit Comprehensive Treatment Plan
     URL: https://gps.press/sop-data/508.23-att-6/
  7. Specialized Mental Health Treatment Unit (SMHTU) Discharge Summary
     URL: https://gps.press/sop-data/508.23-att-7/
  8. Specialized Mental Health Treatment Unit Monthly Report (Monthly Utilization Review)
     URL: https://gps.press/sop-data/508.23-att-8/

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|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|
|**Policy Number:** 508.23|**Effective Date:** 4/27/2018|**Page Number:** 1 of 12|
|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|


**I.** **Introduction and Summary:**







It is the policy of the Georgia Department of Corrections (GDC) to offer specialized
programs to offenders with severe and persistent mental illness who have a significant
history of assaultive behavior or difficulty effectively managing their behavior within
the general prison population. These programs provide therapeutic multidisciplinary
interventions that are incentive-based, with the function of developing pro-social
behaviors, meeting individualized treatment goals, and preparing for re-entry into the
general prison population and/or society.

**II.** **Authority:**

ACA Standard: 4-4374.


**III.** **Definitions:**

A. **Specialized Mental Health Treatment Units (SMHTU)**    - Secure units where

evidence-based treatment programs are provided to specialized clinical
populations who have functional impairments that may result in exhibiting
dangerous behaviors. Each of the six (6) SMHTUs will house one of the following
clinical populations, those identified with:

1. Serious and persistent mental illness;

2. Severe personality disorders;

3. Dementia and/or traumatic brain injuries;

4. Severe impulse control disorders;

5. Cognitive delays/deficits; and

6. Violent behavior and mental illness.


a. In addition to the six (6) clinical populations, another SMHTU provides re
entry services for offenders who complete one of the other six (6) SMHTU
programs and may need additional support to transition back into the general
prison population and/or society.


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|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|



B. **Specialized Mental Health Treatment Unit (SMHTU) Treatment Team**    - The

specialized team consists of a clinical director/ psychologist (team lead), a
psychiatrist/ advanced practice registered nurse (APRN), licensed mental health
counselor(s), activity therapist(s), mental health nurse(s) and assigned
multifunctional correctional officer(s). Other facility staff may be included as needed.

C. **Specialized Mental Health Treatment Unit (SMHTU) Incentive Program**    - A

treatment program designed to increase prosocial behaviors through the use of
privileges and contingency reinforcers i.e., special visits, store calls, additional
phone calls, toiletries, television time, extra recreation, edible items, electronic
devices, etc., (as available per facility).

D. **Therapeutic Modules/Programming Chairs**    - Individual modules/chairs that

limit freedom of movement and facilitate the ability to participate in activities and
treatment while providing a secure environment for staff and offenders.

**IV.** **Statement of Policy and Applicable Procedures:**

A. Overview of the SMHTU program: This procedure applies to any prison that is

designated to house a Specialized Mental Health Treatment Unit. The Specialized
Mental Health Treatment Unit, hereafter referred to as the “SMHTU program”
utilizes evidence-based interventions, focused on the clinical needs of identified
offenders, with security procedures to protect staff and offenders. The SMHTU is
restrictive in that offenders may be escorted and handcuffed when they are out of
their cells for unit-specific programming.

The SMHTU program’s primary mission is security and programming essential to
the daily improvement of the behavior of identified offenders. All SMHTU assigned
staff shall be permanently assigned to the SMHTU program. The SMHTU staff may
not be reassigned to other duties unless a replacement is found to ensure continuity
of care. The SMHTU program will establish incentives and privileges for
demonstrating appropriate behavior and program compliance. The ultimate goal is to
prepare the offenders for reintegration into the general prison population and/or reentry into society. A significant period of stability, acquisition of acceptable skills
and adherence to rules will result in more privileges and a less restrictive
environment.


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|
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|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|



B. Criteria for Admission:


1. Offenders must be receiving mental health services.

2. Offenders will be identified based on their clinical need, to include serious and

persistent mental illness, severe personality disorders, dementia and/or
traumatic brain injuries, severe impulse control disorders, cognitive
delays/deficits, and violent behavior and mental illness.

3. Offenders may be actively psychotic, experience acute symptoms of serious

mental illness, or may be an imminent danger to self or others.

C. Process for Assignment to one of the SMHTU Programs:


1. The mental health (MH) staff at the offender’s currently assigned facility will

make the referral to one of the SMHTU programs based on clinical/treatment
needs and evidence of chronic or severe antisocial, undesirable behavior. The
mental health treatment team will make the recommendation to the Warden
using Attachment 1, Specialized Mental Health Treatment Unit
Recommendation Form. Upon approval by the Warden, the Statewide Mental
Health Director/designee in the Office of Health Services (Central Office) will
review the recommendation within seven (7) days of receiving the
recommendation by the Warden. If approved, Central Office will forward the
second page of Attachment 1, Specialized Mental Health Treatment Unit
Recommendation Form to the facilities division director/designee to approve
or deny the offender’s placement into one of the SMHTU programs within
seven (7) days. If the statewide mental health director/designee denies the
recommendation, there shall be justification of why the denial occurred and
recommendations for other placement options. If the facilities division
director/designee denies placement, justification should be provided and
recommendations for placement shall be made on the form and returned to the
statewide mental health director/designee’s office. In turn, the statewide
mental health director/designee will contact the mental health unit
manager/designee to discuss the denial and placement and/or treatment
options.


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|
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|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|



2.  Reasons for denying entry into an SMHTU:


a. Remainder of time on sentence is too short (less than six (6) months); and

b. Clinically determined to de-stabilize the offender since there may be

contra- indications to any clinical intervention; the contra-indications are
documented.

3. If approved, secure placement in the designated SMHTU program can occur if

there is available bed space. wardens/designees, mental health unit
managers/designees, and clinical directors/designees from the referring and
receiving facilities should collaborate to have identified offenders moved,
transported or enter into the specific program. A wait-list may be maintained
if the need is greater than the available bed space. The wait-list will be
maintained by a designated MH staff member at the facility with the SMHTU
program.

4. Offenders on a wait-list will receive individual treatment at their assigned

facility until a bed is available at the desired SMHTU program. Consultation
between the current MH counselor and the SMHTU program MH counselor
should occur to provide direction and provide relevant material to the offender
on an individual basis.

5.  Scribe will be updated within forty-eight (48) hours or two (2) business days

once an offender has been assigned and transferred into a SMHTU program.

6. The mental health unit manager or the clinical director of the SMHTU program

will notify the statewide mental health director/designee of each admission into
the program. Data from the SMHTU program, (to include discharges,
disciplinary reports, Acute Care Unit and/or Crisis Stabilization Unit
admissions and discharges, program development, programmatic changes,
programmatic challenges, and other information deemed relevant to the
SMHTU program) will be provided to statewide mental health
director/designee on at least a monthly basis, or more frequently as needed.
Attachment 8, Specialized Mental Health Treatment Unit Monthly Report
( Monthly Utilization Review), will be used for routine data collection. Other
forms of communication, such as phone call, email, etc., are acceptable for
emergency situations or unusual circumstances. This monthly report should be


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|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|



independently generated and submitted. Some of the data will be replicated in
the official facility monthly report.

D. Offender Orientation within the SMHTU Program:


1. Within 24 - 48 hours (or next business day whichever is earlier) of arrival in

the SMHTU program, a member of the SMHTU Treatment Team will meet
with the offender and provide Attachment 2, Consent for Placement in the
Specialized Mental Health Treatment Unit for the offender’s signature. In
addition, Attachment 3, Specialized Mental Health Treatment Unit Admission
Form will be completed by the SMHTU Treatment team and placed in the
offender’s mental health file.


a. Within seven (7) days of arrival in the SMHTU, a member of the SMHTU

Treatment Team will provide the offender with an orientation to the
program. The orientation will include expectations, rules, schedule,
privileges and incentives and Attachment 5, Program Orientation which
will be given to the offender; and

b. Attachment 4, Activity Therapy Assessment will be completed during the

orientation phase.

2.  Planning goals for the Treatment Plan will be discussed during the orientation

phase and Attachment 6, SMHTU Comprehensive Treatment Plan will be
completed within 14 days of admission into the program.

3.  The basic restrictions for each level will be explained to the offender during

the orientation phase. Criteria for moving from level to level must be clearly
stated.

E. Conditions and Privileges: As deemed necessary by the warden/designee, all the

following conditions and/or privileges are subject to modification due to
extenuating operational circumstances.


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|



1. At a minimum, the following standards will apply to offenders assigned to a

SMHTU:

a. Cells should be single occupancy. Double bunking may be considered in

the SMHTU – Transition Unit if offenders are the same mental health level,
to facilitate re-entry or socialization, or if there are physical health
challenges. The SMHTU Treatment Team, in collaboration with security
staff, shall document and justify its double-bunking recommendation;

b. Cells must be equipped and furnished in a way consistent with cells in the

general population;

c. The offender may be handcuffed when out of the cell. Progression through

the SMHTU levels may decrease the need for being handcuffed when out
of the cell. The SMHTU Comprehensive Treatment Plan will list the lack
of need for being handcuffed as a goal when meeting certain objectives;

d. Offenders must have an opportunity to shower at least three (3) times per

week;

e. Food provided to the offender must be of the same quality and quantity as

that provided in the general population;

f. Laundry services and frequency will occur as in the general population;

g. Offenders must be provided the same bedding supplies as are provided for

offenders in the general population;

h. Security will provide the offender with exercise periods (in addition to

SMHTU unstructured recreational time) totaling no less than one (1) hour
per day and five (5) days per week. This exercise must be outside the cells,
unless security or safety considerations dictate otherwise;

i. All telephone calls will be in accordance with limitations outlined by the

SMHTU levels and earned incentives (See Attachment 5);


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|
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|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|



j.  The deputy warden of security’s designee or security unit manager,

chaplain, SMHTU counselor, and the multifunctional correctional officer
will handle emergency telephone calls on a case-by-case basis;

k. Offenders must be allowed attorney visits and legal access;

l. Offenders must be allowed Chaplaincy visits; and

m. A consent for treatment within the SMHTU program will be signed by the

offender and SMHTU assigned counselor.


F. Program Components:


1. SMHTU Treatment Team:


a. The staff of the SMHTU shall be selected carefully by the mental health

unit manager and clinical director. Because of the unusual and challenging
work to be done in the SMHTU, the warden/designee shall approve of all
security staff assigned to SMHTU;

b. The statewide mental health director/designee and/or the assigned

psychologist to the SMHTU shall ensure that staff receive a special
orientation and training about the function of SMHTU, rules governing its
operation, and the typical needs and problems of offenders in SMHTU.
Attendance at and completion of SMHTU orientation and training must be
documented in a file to be kept and maintained by the mental health clinical
director. Ongoing in-service training will be provided as needed to the staff
members working in the SMHTU; and

c. The SMHTU Treatment Team will have designated staff as follows:


i. Clinical Director/Consulting Psychologist (Team Lead) (.5 - 1 FTE

depending on the mission of the SMHTU);

ii. Psychiatrist/APRN (.5 FTE);

iii. Licensed Mental Health Counselor (LCSW, LMFT or LPC only)

(1:20);


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|
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|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|



iv. Activity Therapist (.5 - 2 FTEs);

v. Mental Health Nurse (1-2 FTEs per shift); and

vi. Multifunctional Correctional Officer (1-2 per shift depending upon the

unit)

2. Mental health will expect the following designated security staff:


a. Correctional Officers (2:25);

b. MH Security Unit Manager (1:200); and

c. SMHTU Sergeant (1:200)


3. Offenders will receive services from the SMHTU Treatment Team. The

SMHTU Treatment Team should meet weekly to review the progress of each
offender. Documentation of the Treatment Team meetings will be maintained
by the clinical director/designee in a separate binder, kept in a secure location
with other mental health logs.

4. Each offender will have a Comprehensive Treatment Plan within (14 days) of

admission into the SMHTU. It will include targeted behaviors, achievable
goals, and interventions.

5. The SMHTU assigned counselor and a subset of the Treatment Team will

regularly review the SMHTU Comprehensive Treatment Plan with the
offender present, if appropriate. The entire Treatment Team should meet with
the offender on at least a quarterly basis.

6. The SMHTU Treatment Team, in collaboration with the mental health unit

manager and clinical director/psychologist, may utilize incentives/positive
reinforcement for the offender’s completion of specific goals within the
Offender’s SMHTU Comprehensive Treatment Plan. (See Attachment 5,
Program Orientation). Incentives are distributed or withheld based on the
offender’s performance and progress toward meeting the goals of the
offender’s Comprehensive Treatment Plan.


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|
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|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|



7. Qualitative and quantitative data will be obtained from SMHTU staff at least

monthly to assist with program analysis and evaluation.


8. The Specialized Mental Health Treatment Unit Program:


a. The SMHTU Treatment Team, led by the clinical director/psychologist and

in consultation with the statewide mental health director/designee, will
develop a Program schedule that will initially include for Level II offenders
at least 2-4 hours per week of out-of-cell structured therapeutic activities
or for Level III – IV offenders at least 10 hours per week of out-of-cell
structured therapeutic activities. In total, all SMHTU offenders (Levels II

    - IV) should receive at least 20 hours per week of out-of-cell time;

b. Behavioral progress in accomplishing the established Treatment Plan goals

shall be monitored and positively reinforced utilizing incentives and
privileges;

c. Progression to an increased number of hours, i.e., 10 – 20 hours per week

of out-of-cell time with at least two of those hours per day being out-ofcell structured therapeutic activities, should be reflected in the SMHTU
schedule;

d. The program will match the offender’s capacity to behave responsibly with

the number and types of privileges the offender will receive, as well as
length of out-of-cell structured and unstructured activities;

e. Offenders who are not able to behave responsibly will be placed in a more

restrictive level of care (i.e., limited movement, privileges, property, etc.).
As the offender’s behavior becomes more responsible, they will be placed
in a less restrictive level of care;

f. The SMHTU levels of care will begin at the Basic Level, progress to the

Intermediate Level, then to the Advanced Level, and finally the Ultimate
Level. The highest achievable level within the SMHTU program is the
Ultimate Level;

g. The level to which the offender is assigned is directly linked to the type

and frequency of privileges they will receive;


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|
|**Policy Number:** 508.23|**Effective Date:** 4/27/2018|**Page Number:** 10 of 12|
|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|



h. Offenders who do not maintain proper behavior within a less restrictive

level will be placed in a more restrictive level;

i. If an offender has a critical incident, the offender will be appropriately

placed in an Acute Care Unit or a Crisis Stabilization Unit;

j. If the offender receives a Disciplinary Report/sanction while in the

SMHTU, the offender shall initially receive an alternative sanction, such
as homework e.g., writing an essay, writing an apology letter or getting
extra duties, e.g., cleaning, collecting trash, washing items, working dining
hall during chow, etc. There should continue to be evidence in the
offender’s schedule of structured and unstructured out-of-cell activities;

k. As a last resort for disciplinary sanctions, or for a first offense of an

egregious nature (physical assault with injury toward staff or other
offenders and not associated with their mental illness), the offender may be
placed in or assigned to isolation/segregation to serve their time, with
evidence of ongoing SMHTU treatment occurring during structured in-cell
activities, and then returned to the usual SMHTU program; and

l. Offenders may participate in any educational, religious, vocational and re
entry programs that can be provided within the confines of the SMHTU
and are consistent with the security needs of the unit.

9. Incentive Component:


a. The incentive component of the SMHTU awards offenders based on

cumulative ratings by the SMHTU Team;

b. The offender may be rated based on personal hygiene, sanitation, activity

attendance and participation, and overall behavior as outlined in the
SMHTU Comprehensive Treatment Plan;

c. Incentives will be distributed or withheld (with explanation) when the

SMHTU Team meets with the offender to discuss the SMHTU
Comprehensive Treatment Plan and progress;


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|



d. Any institutional accounts that are designated for offender benefit may be

used to fund the incentives. Additional funding must be approved by the
statewide mental health director/designee and the Assistant Commissioner
of Health Services; and

e. The list of SMHTU Incentives (See Attachment 5, Program Orientation,

pgs. 2-3) may be revised or adjusted based on funding resources and with
the approval of the statewide mental health director/designee and the
Assistant Commissioner of Health Services.


10. Documentation: All documentation will be done on standard forms, such as

progress notes, activity therapy notes, treatment plans, etc. if there is not an
identified SMHTU document available.

11. Discharge Process:


a. Program completion will occur when the offender completes the Ultimate

Level;

b. Upon completion of the program, each offender will receive a Certificate

of Completion (generated by the SMHTU Treatment Team or from the
Office of Health Services/statewide mental health director/designee). The
SMHTU assigned counselor or multifunctional correctional officer will
document the offender’s completion in the offender’s mental health file,
and will complete a Work Performance Report for the institutional file and
Attachment 7, Specialized Mental Health Treatment Unit Discharge
Summary; and

c. The offender, after completing one of the six (6) SMHTU programs will

then be referred to the SMHTU Transition Unit. This Unit will provide reentry services for offenders who complete one of the other six SMHTU
programs and may need additional support to transition back into the
general prison population and/or society. Attachment 1, Specialized
Mental Health Treatment Unit Recommendation Form will be used for the
purpose of referring the offender to the SMHTU Transition Unit. Referral
for assignment into the SMHTU Transition Unit will be the same as
previously described in this SOP.


|GEORGIA DEPARTMENT OF CORRECTIONS<br>Standard Operating Procedures|Col2|Col3|
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|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|**Policy Name:**Specialized Mental Health Treatment Units|
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|**Authority:** <br>Commissioner|**Originating Division:** <br>Health Services Division|**Access Listing:**<br>Level I: All Access|


**V.** **Attachments:**







Attachment 1: Specialized Mental Health Treatment Unit Recommendation Form
Attachment 2: Consent for Placement in the Specialized Mental Health Treatment
Unit
Attachment 3: Specialized Mental Health Treatment Unit Admission Form
Attachment 4: Activity Therapy Assessment
Attachment 5: Program Orientation
Attachment 6: Specialized Mental Health Treatment Unit Comprehensive Treatment
Plan
Attachment 7: Specialized Mental Health Treatment Unit Discharge Summary
Attachment 8: Specialized Mental Health Treatment Unit Monthly Report ( Monthly
Utilization Review)


**VI.** **Record Retention of Forms Relevant to this Policy:**

Upon completion, Attachments 1-4 and 6-7 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. Attachment 5 shall be utilized per the SOP until revised or obsolete. A
copy of Attachment 8 shall be sent to Central Office by the 3 [rd] of each month and the
original shall be maintained in the mental health area for 10 years.