BOP Program Statement 5310.16 § 14

The Bureau is committed to helping inmates prepare for reintegration into their communities by

transferring inmates with mental illness through RRCs or home confinement placements.

However, each inmate should first be reviewed for suitability for community placement and

continuity of care needs.

Each Warden is strongly encouraged to approve inmates who successfully complete Mental

Health PTPs for RRC/Home Confinement placement, consistent with the recommendations of

PTP staff.

a. Assessment of Psychological Suitability. The CCARE team considers community

placement for all inmates with mental illness on an individual basis. However, some inmates

may not be suitable for community placements. Others may be suitable, but may not benefit

from community placements due to their mental health conditions, or may need special

consideration given to the type of community placement. The following conditions indicate an

inmate is potentially unsuitable for RRC or home confinement placement:

■ Ongoing inpatient psychiatric treatment.

■ Uncontrolled mental health symptoms (e.g., psychosis with no insight, non-adherent with

medication).

■ Acute suicidal ideation with accompanying plans or recent attempts of moderate to high

lethality.

■ Inability to perform routine activities of daily living (bathing, dressing, eating, toileting,

general hygiene, and mobility).

Continuity of care is also a primary consideration in placement decisions. For inmates who are

particularly vulnerable to environmental changes or stressors, the following situations indicate

caution should be taken regarding the inmate’s placement and the inmate’s needs, strengths, and

weaknesses should be considered as part of the CCARE team planning process:

■ There is no RRC in the inmate’s community, causing him/her to have to relocate for RRC

placement and again to return to his/her community.

■ The inmate has a history of struggling to adapt to new environments.

■ Community supports or mental health services are limited in the area to which the inmate is

transferring.

At a minimum, the institution’s CCARE Team assesses all CARE2-MH, CARE3-MH, and

CARE4-MH inmates for suitability at the time of the RRC Referral Process and when the Mental

Health Transfer Summary is prepared (30 to 60 days before RRC placement). If there are any

concerns regarding the inmate’s ability to be successful in a community placement, the team

consults with CTS and Residential Reentry Management Branch staff.

PS5310.16 05/01/2014 25

PS5310.16 05/01/2014 26

Clinically manageable in the community is defined as having mental health symptoms that can

be treated on an outpatient basis through pre-arranged linkages to family/community support,

counseling, and psychiatric medications as needed.

When the CCARE Team determines the disposition for an inmate having one or more of the

above-listed conditions, the team takes the actions below consistent with their decision:

■ Clinically manageable. If an inmate’s mental health needs are determined to be

manageable in the community, the institution CCARE Team continues to monitor his/her

status at intervals set by the team. If no complications arise, RRC or home confinement

referral proceeds as planned by the Unit Team. If symptoms increase significantly, a

reassessment occurs.

■ Clinically unmanageable. If an inmate’s mental health needs are determined to be

unmanageable in the community, the Unit Manager will submit a request to Residential

Reentry Management Branch staff to revoke or retard the RRC date. Clinically

unmanageable in the community is defined as not having the requisite family/social network,

health care facility, clinical or specialty services, or access to prescribed medications to

maintain or improve an inmate’s mental health status as assessed at the time of release to

RRC or home confinement placement. The institution CCARE Team continues to monitor

the inmate’s mental health at intervals set by the team and changes his/her status if his/her

mental health improves such that he/she has clinically manageable needs.

If the inmate is releasing to supervision under the United States Probation Office (USPO) or

Court Services Offender Supervision Agency (CSOSA), and his/her mental health needs remain

unmanageable in the community up to the point of release from custody, the treating

psychologist must ensure contact is made with USPO or CSOSA. The treating psychologist

ensures they are informed of the inmate’s status and provides the Mental Health Transfer

Summary as documented in PDS. The treating psychologist then makes a referral to the social

worker, who will develop a comprehensive release plan, as detailed below. If the inmate is

releasing directly to the community with no supervision requirement, a Bureau social worker

takes responsibility for coordinating a release plan, as detailed below.

If an inmate with mental illness is releasing from a CARE1-MH institution with no CCARE

team, the Mental Health Treatment Coordinator coordinates with staff from other disciplines, as

needed, and ensures continuity of care during the inmate’s release is consistent with the practices

described in this policy.

b. Community Treatment Services. CTS staff determine which inmates with moderate,

serious, or acute mental health needs releasing to community placements are appropriate for

community treatment services by consulting with institution CCARE teams and running rosters

of CARE2-MH, CARE3-MH, and CARE4-MH and Psychology Alert assignments. CTS staff

review inmate PDS files, including the Mental Health Transfer Summary, which recommend

follow-up treatment in the community. They arrange appropriate services to support inmates

with mental illness who are placed in RRCs or in home confinement.

c. Social Workers. Social workers, in collaboration with the inmate and the institution

CCARE Team, create comprehensive release plans for inmates who are releasing from Bureau

custody with no community placement. The release plan identifies community tre atment

providers in the areas of psychiatry, mental health treatment, family counseling, substance abuse,

and sex offender treatment, as recommended by the treating psychologist and as available in the

PS5310.16 05/01/2014 27

community. Some institutions have locally based socia l workers; those that do not rely on

Regional Social Workers. Social workers may consult with CTS staff regarding resources

available in the community to which the inmate is releasing.

d. Continuity of Care to Community Placements. Procedures for transfer to community

placements are detailed below.

■ Transfers to RRCs and Home Confinement. When CARE2-MH, CARE3-MH, and

CARE4-MH inmates are between 30 and 60 days from an RRC date, the Mental Health

Transfer Summary is completed by the treating psychologist and entered in PDS. If CTS

staff determine this form is not present in PDS 30 days prior to the RRC date, they notify the

Chief Psychologist of the discrepancy. The Chief Psychologist ensures the summary is

completed before the inmate’s transfer. If there is sufficient concern regarding the inmate’s

mental health condition, CTS staff also consult with the Residential Reentry Manager

(RRM), who may retard the RRC date until adequate information is available to ensure

continuity of care.

■ Release to the Community with Supervision. When a CARE2 -MH, CARE3-MH, or

CARE4-MH inmate releases directly to the community under the supervision of the USPO or

CSOSA, the treating psychologist completes the Mental Health Transfer Summary in PDS

and ensures the supervising USPO or CSOSA receives a copy. The treating psychologist

completes this summary 30-60 days before the inmate’s release. If the inmate requires

mental health aftercare services, the treating psychologist will make a referral to the

institution Social Worker or Regional Social Worker, who will assist with reentry planning.

■ Release to the Community without Supervision. When a CARE2 -MH, CARE3-MH, or

CARE4-MH inmate releases directly to the community with no supervision requirement, the

treating psychologist completes the Mental Health Transfer Summary in PDS 30-60 days

before the inmate’s release. If the inmate requests, the treating psychologist forwards it to a

community treatment provider, following completion of the release of information. Such a

request can also be made by the inmate following his/her release. If the inmate is on

psychiatric medication and needs linkage to community resources, the psychologist should

make a referral to the institution Social Worker or Regional Social Worker to enhance

continuity of care.

e. Return to Custody Due to Mental Illness. Sometimes inmates experience mental health

crises or behavioral problems in an RRC setting and are no longer able to be managed in the

community. When this occurs:

■ The RRM staff must immediately notify and consult with CTS regarding any CARE2-MH,

CARE3-MH, or CARE4-MH inmate or any CARE1-MH inmate exhibiting symptoms of

mental illness, for whom the RRC placement or home confinement may be terminated.

■ CTS staff in turn consult with Psychology Services Branch mental health staff and document

the consultation in PDS.

PS5310.16 05/01/2014 28

■ Psychology Services Branch mental health staff adjust the care level assignment, if

necessary, by entering a mental health assignment that better approximates the inmate’s need

for services.

■ Psychology Services Branch mental health staff make a recommendation regarding whether

the inmate should be transferred to an MRC for treatment of acute mental illness, returned to

a mainline institution, continued in the current placement with additional supports, or housed

in a contract facility until the end of his/her sentence.

■ The RRM staff work with the OMDT or the DSCC to identify and return the inmate to the

parent institution or, if necessary, identify an alternate institution. If the inmate needs

emergency psychiatric care at a Psychiatric Referral Center, RRM staff prepare the BP-A0770 in consultation with CTS and the Psychology Services Branch.

If the inmate is returned to an institution, release planning begins again immediately upon his/her

arrival.

15. AGENCY ACA ACCREDITATION PROVISIONS

■ American Correctional Association Standards for Adult Correctional Institutions, 4th

Edition: 4-4142, 4-4143, 4-4144, 4-4305, 4-4368, 4-4370, 4-4371, 4-4372, 4-4373, 4-4374,

4-4399, 4-4429, 4-4429-1.

■ American Correctional Association Performance Based Standards for Adult Local Detention

Facilities, 4th Edition: 4 -ALDF-2A-32, 4-ALDF-4C-8, 4-ALDF-4C-19, 4-ALDF-4C-27,

4-ALDF-4C-28, 4-ALDF-4C-29, 4-ALDF-4C-30, 4-ALDF-4C-31, 4-ALDF-4C-32, 4-

ALDF-4C-34, 4-ALDF-4C-40, 4-ALDF-6B-05, 4-ALDF-6B-06, 4-ALDF-6B-07, 4-ALDF-

6B-08.

■ American Correctional Association Standards for Administration of Correctional Agencies,

2nd Edition: 2-CO-4B-04.

REFERENCES

Program Statements

P5070.12 Forensic and Other Mental Health Evaluations (4/16/08)

P5100.08 Inmate Security Designation and Custody Classification (9/12/06)

P5212.07 Control Unit Programs (2/20/01)

P5270.09 Inmate Discipline Program (7/8/11)

P5270.10 Special Housing Units (7/29/11)

P5290.14 Admission and Orientation Program (4/3/03)

P5310.12 Psychology Services Manual (8/13/93)

P5324.08 Suicide Prevention Program (3/15/07)

P5330.11 Psychology Treatment Programs (3/16/09)

P5370.11 Inmate Recreation Programs (6/25/08)

P6031.03 Patient Care (8/23/12)

P6340.04 Psychiatric Services (1/15/05)

Other References

President’s New Freedom Commission on Mental Health, 2003

National Consensus Statement on Mental Health, 2004

Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition, 2013

BOP Forms

BP-A0770 Medical/Surgical and Psychiatric Referral Request

BP-A1055 Notice of Psychological Evaluation – ADX Control Unit

BP-A1056 Notice of Psychological Evaluation – ADX General Population

BP-A1057 Restrictive Housing Mental Health Evaluation – Initial Review

BP-A1058 Restrictive Housing Mental Health Evaluation – Follow-Up Review

Records Retention Requirements

Requirements and retention guidance for records and information applicable to this program are

available in the Records and Information Disposition Schedule (RIDS) on Sallyport.

PS5310.16 05/01/2014 29