BOP Program Statement 5310.16 § 5

Mental health care levels are used to classify inmates based on their need for mental health

services. The contact frequencies described below refer to contacts where psychosocial

interventions are provided.

a. Definitions

(1) CARE1 -MH: No Significant Mental Health Care. An individual is considered to

meet CARE1-MH criteria if he/she:

■ Shows no significant level of functional impairment associated with a mental illness and

demonstrates no need for regular mental health interventions; and

■ Has no history of serious functional impairment due to mental illness or if a history of mental

illness is present, the inmate has consistently demonstrated appropriate help-seeking behavior

in response to any reemergence of symptoms.

(2) CARE2 -MH: Routine Outpatient Mental Health Care or Crisis-Oriented Mental

Health Care. An individual is considered to meet CARE2- MH criteria if he/she has a mental

illness requiring:

■ Routine outpatient mental health care on an ongoing basis; and/or

■ Brief, crisis-oriented mental health care of significant intensity; e.g., placement on suicide

watch or behavioral observation status.

(3) CARE3 -MH: Enhanced Outpatient Mental Health Care or Residential Ment al

Health Care. An individual is considered to meet the criteria for CARE3- MH if he/she has a

mental illness requiring:

■ Enhanced outpatient mental health care (i.e., weekly mental health interventions); or

■ Residential mental health care (i.e., placement in a residential Psychology Treatment

Program).

(4) CARE4 -MH: Inpatient Psychiatric Care. A mentally ill inmate may meet the criteria

for CARE4-MH and require acute care in a psychiatric hospital if the inmate is gravely disabled

and cannot function in general population in a CARE3-MH environment.

b. Determination of Mental Health Care Levels. All current mental health illnesses should

be diagnosed in a Diagnostic and Care Level Formulation note in PDS, including personality

PS5310.16 05/01/2014 9

disorders and intellectual disabilities. The cumulative impact of the disorders on functioning is

taken into account when assigning a mental health care level.

To assign a care level, staff consider the inmate’s current, recent, and historical need for services.

However, this is not the only indicator, as it must be balanced with the inmate’s diagnosis and

anticipated need for future services. For example:

■ Inmates diagnosed with major mental illnesses and/or currently taking antipsychotic

medications are not ordinarily classified as CARE1-MH due to their risk of relapse and the

lack of resources to address such a relapse at a CARE1-MH facility.

■ Inmates releasing from Medical Referral Centers (MRCs) where they received treatment for

acute mental health problems are ordinarily classified as CARE3-MH, due to the resources

required to assist them in adjusting to a mainline institution.

Discrepancies in the Record. Occasionally there are diagnostic discrepancies between

providers. When this occurs, the Mental Health Treatment Coordinator or treating psychologist

attempts to reconcile these differences. The Mental Health Treatment Coordinator or treating

psychologist reviews the record, consults with other treatment providers (including Health

Services staff), performs a clinical interview, and observes symptoms and behaviors. The

Coordinator or psychologist then integrates the data, noting alternate conceptualizations;

attempts to reach consensus between care providers; enters a diagnosis in the Diagnostic and

Care Level Formulation note in PDS; and provides a rationale for the decision. If the

discrepancy cannot be resolved at this level, the Chief Psychologist and Chief Psychiatrist, if

applicable, will review the case, resolve the discrepancy, and document their findings.

A supplemental Mental Health Care Level Training Guide is available on Sallyport. The guide

is also disseminated during Psychologist Familiarization Training and annual mental health

training events. This gui de is designed to assist psychologists in determining appropriate mental

health care levels.

c. Treatment Requirements for Mental Health Care Levels. The required treatment

detailed below is not necessarily provided exclusively by the Mental Health Treatment

Coordinator; for example, another psychologist may provide this care.

(1) Mental Health Care Level One. Inmates classified as CARE1-MH are not required to

receive any regular mental health services or to have a treatment plan. When mental health

services are provided to these inmates, they are documented in PDS.

(2) Mental Health Care Level Two. Required services include, but are not limited to:

■ A diagnosis and mental health care level for each inmate will be documented in a Diagnostic

and Care Level Formulation note in PDS.

■ A rationale for the diagnosis and assigned care level will also be documented in the

Diagnostic and Care Level Formulation note in PDS.

PS5310.16 05/01/2014 10

■ A collaborative, individualized treatment plan that describes the inmate’s problems and

goals, and the interventions planned to assist with goal attainment will be developed,

reviewed, and updated at least every 12 months.

■ Evidence-based psychosocial interventions on at least a monthly basis (if group treatment is

offered, it should occur at least every other week, to provide continuity of care).

(3) Mental Health Care Level Three. Required services include, but are not limited to:

■ A diagnosis and mental health care level for each inmate will be documented in a Diagnostic

and Care Level Formulation note in PDS.

■ A rationale for the diagnosis and assigned care level will also be documented in the

Diagnostic and Care Level Formulation note in PDS.

■ A collaborative, individualized treatment plan that describes the inmate’s problems and

goals, and the interventions planned to assist with goal attainment, will be developed,

reviewed, and updated at least every 6 months.

■ Evidence-based psychosocial interventions on at least a weekly basis are provided via

enhanced outpatient care or on a scheduled basis consistent with a residential Psychology

Treatment Program.

(4) Mental Health Care Level Four. This treatment takes place only in a Medical Referral

Center. Required services include, but are not limited to:

■ A diagnosis and mental health care level for each inmate will be documented in the

Diagnostic and Care Level Formulation note in PDS.

■ A rationale for the diagnosis and assigned care level will also be documented in the

Diagnostic and Care Level Formulation note in PDS.

■ A collaborative, individualized treatment plan that describes the inmate’s problems and

goals, and the interventions planned to assist with goal attainment will be developed,

reviewed, and updated at least every 90 days.

■ Evidence-based psychosocial interventions and/or individual mental health contacts will

occur on at least a weekly basis.

At CARE4-MH sites, for inmates too cognitively impaired to engage in traditional psychosocial

interventions (i.e., severe neurocognitive disorders), supportive contacts from a broad variety of

providers may be the most appropriate care plan. Frequency and type of care will be determined

on an individual basis for these cases.

d. Treatment Refusal. If an inmate declines treatment consistent with his/her mental health

care level, a treatment plan is developed and implemented to frequently assess the inmate’s

mental status, build rapport, and encourage engagement in a treatment process. Ordinarily, the

treatment plan will include a monthly attempt to engage the inmate. Rapport building strategies

may include: group leisure activities; visits to the inmate’s unit or work site; and “drop-in”

group for informal socialization with peers.

An inmate who refuses mental health treatment consistent with his/her mental health care level

may be considered for involuntary commitment.

PS5310.16 05/01/2014 11