BOP Program Statement 5335.02 § 5

PROCEDURES

SMHU Psychology Services staff enter applicable Bureau inmate management system codes to

track program participation. Reference the PSB page of the Bureau’s intranet site for guidance

regarding current program codes.

a. Authority for Admission to an SMHU.

Secure PTPs/Secure PTUs. The PSB, in collaboration with the Specialty Program Coordinator,

determines designation/admission. In cases where a Specialty Program Coordinator and PSB

disagree about a Secure PTP admission, the Assistant Director, RSD will have final decision-making authority.

MRCs. Once an inmate with an SMI arrives at an MRC, they will be evaluated for placement in

an appropriate housing unit within the MRC by a psychologist or psychiatrist. In cases where an

inmate with an SMI is already at an MRC and requires placement in an SMHU, only

psychologists and psychiatrists may admit inmates with an SMI to SMHUs. In cases where there

is disagreement between psychology and psychiatry, the institution will consult with the RSD

who will also consult with the HSD. Recommendations will be made to the Warden. The

Warden will have the final decision-making authority.

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b. Criteria for Admission to an SMHU.

Secure PTPs/Secure PTUs. Criteria for admission to Secure PTPs/PTUs are specific to the

mission of each program and are determined when the unit is established. These criteria are

established by an activation memo published by RSD and Correctional Programs Division

(CPD). Changes to the Institution Supplements or updated program handbooks need approval

from PSB.

MRCs. Inmates may be admitted to an SMHU if the inmate has an SMI or is deemed to be at

heightened risk for suicide and under one or more of the following circumstances:

■ The inmate poses an imminent threat to the safety of others;

■ The inmate poses an imminent threat to the security of the institution;

■ The inmate poses an imminent threat to the safety of themself (i.e., requires suicide

watch);

■ The inmate requests secure housing because of safety concerns (i.e., is requesting

protective custody);

■ The inmate requests secure housing as a temporary means of self-management;

■ The inmate is gravely disabled and requires assistance with activities of daily living; or,

■ The inmate has been designated to an SMHU by the DSCC or Office of Medical

Designations and Transfers (OMDT) through consultation with PSB.

If an inmate is accused of violating an institutional rule in the 100- or 200-series and is pending a

disciplinary hearing or the inmate has been sanctioned to Disciplinary Segregation (DS), a

psychologist or psychiatrist will determine if placement in the SMHU is appropriate.

c. Admission Restrictions for SMHUs. Some inmates are precluded from placement in an

SMHU.

SMHUs do not house inmates whose current medical condition(s) cannot be managed in the

proposed SMHU. Medical conditions that preclude admission to the SMHU are determined by

the Clinical Director or designee. If an inmate cannot be housed in an SMHU given medical

conditions, the services needed to meet their mental health needs will adhere to requirements

outlined in this program statement except as their medical condition prohibits.

If an inmate is pregnant or up to 12 weeks postpartum (i.e., live birth, miscarriage, or pregnancy

termination) and is admitted to an SMHU, the Warden will reference the Program Statement

Female Offender Manual and will notify the PSB Administrator and the Women and Special

Populations Branch Administrator for further guidance and continuation of care.

Ordinarily, inmates with an SMI who are new to an MRC will not be immediately placed in the

SMHU upon arrival. Inmates with an SMI who are new to an institution will meet with a

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psychologist to determine appropriate housing placement and will only be admitted to an SMHU

with approval from the Chief Psychologist or designee, or Chief Psychiatrist or designee.

d. Admission Procedures for SMHUs. Prior to admission to a Secure Administrative Unit (SAU),

inmates must be provided the opportunity to engage in an SAU hearing with a hearing officer who

will be a PSB psychologist. Forms utilized in this process include the BP-A1185, Notice of Referral to

the Secure Administrative Unit and BP-A1186, Secure Administrative Unit Referral Report. Current

SAU hearing procedures are located on the PSB page of the Bureau’s intranet site.

Upon admission to any SMHU, either at an MRC or a Secure PTP/PTU, a psychologist will

generate an SMHU Admission Note describing:

■ The date and time of SMHU admission;

■ The reason for SMHU admission;

■ Less restrictive alternatives considered or attempted prior to SMHU admission;

■ The inmate’s mental status at the time of admission;

■ Criteria that must be met for discharge from the SMHU or completion of the Secure PTP;

and

■ Interventions planned to support discharge from the SMHU or completion of the Secure

PTP.

e. SMHU Transition. Inmates leave SMHUs for a variety of reasons.

MRCs and Secure PTUs. At MRCs and Secure PTUs, the Secure Treatment Team will

collaboratively decide when an inmate has met criteria for transition from the SMHU and is

ready for placement in a less restrictive setting. Ideally, inmates leave SMHUs at MRCs or

Secure PTUs when:

■ The inmate demonstrates the ability to be safe around staff and other inmates;

■ The inmate does not interfere with the safety and security of the institution;

■ The inmate demonstrates the ability to keep themself safe; and

■ The inmate is no longer considered gravely disabled.

Inmates may also transition from Secure PTUs if they are recommended for and volunteer to

participate in a Psychology Treatment Program.

Only psychologists and psychiatrists may discharge inmates from SMHUs at MRCs and Secure

PTUs. In cases of disagreement between psychology and psychiatry, the institution will consult

with RSD who will also consult with HSD. Recommendations will be made to the Warden. The

Warden will have final decision-making authority.

Secure PTPs. Given the voluntary nature of admission, inmates may leave Secure PTPs for a

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variety of reasons.

■ Secure PTP Completion. As soon as Secure PTP participants demonstrate a consistent

ability to be safe around staff and other inmates, do not interfere with the safety and

security of the institution, keep themselves safe, and are no longer considered gravely

disabled, they must be considered for transfer to a less restrictive setting. The Secure

Treatment Team determines when the inmate has completed treatment in the Secure PTP.

■ Voluntary Program Withdrawals. Secure PTP participants may choose to voluntarily

withdraw. At a minimum:

 The inmate makes a formal request to withdraw, and it is documented;

 Psychologists/treatment specialists/psychology trainees in the Secure PTP document

at least three different clinical interventions spread throughout at least a 30-day period

to increase motivation for treatment;

 Following the 30-day period, the inmate’s final decision is documented in the

Electronic Health Record (EHR);

 The Specialty Program Coordinator discusses placement options with PSB and local

staff will then initiate transition; and

 A Treatment Summary is finalized in the EHR prior to transfer, and ordinarily

completed by the inmate’s Secure PTP primary provider.

■ Program Incompletion. Secure PTP participants may be moved to incomplete status for

various reasons. Examples include an unforeseen designation or removal from the

institution for a federal writ or medical treatment. The Specialty Program Coordinator

will consult with PSB about whether to fill the inmate’s vacant program bed.

■ Program Expulsion. If a Secure PTP participant refuses to participate in treatment

despite extended and significant efforts to engage them, the inmate may be better served

in a different setting. Inmates who have refused to participate in treatment or negatively

impact the treatment milieu in the Secure PTP must receive at least three psychological

interventions intended to increase motivation for treatment. These three interventions are

documented in the EHR. Ordinarily, the third intervention will be provided by the

Specialty Program Coordinator.

There may be some behaviors so egregious in nature (e.g., behavior equivalent to a

prohibited act of greatest severity) that continued placement in the Secure PTP would be

disruptive to the treatment program. In these cases, the Secure PTP participant may be

expelled using the following process:

The Specialty Program Coordinator consults with the Chief Psychologist, Captain,

Warden, Consolidated Legal Center (CLC) responsible for the institution, the Regional

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Psychology Administrator (RPA), and PSB about the recommendation for expulsion.

If expulsion is recommended or the team cannot come to a consensus, this issue is

referred to the Difficult to Place Committee for review and a final decision on expulsion

and future placement.

The Warden, in consultation with the Specialty Program Coordinator, will make any

immediate decisions with regard to the inmate’s placement until the Difficult to Place

Committee makes their final decision.

f. SMHU Transition Documentation. Careful discharge planning is a key component in

reducing readmission to SMHUs and increases the ability of inmates with an SMI to succeed in

less restrictive settings. For those inmates participating in a Secure PTP, a Treatment Summary is

prepared, whereas inmates residing in a Secure PTU require an SMHU Discharge Note. The

following is a list of requirements for SMHU Discharge Notes/Treatment Summaries, both for

MRC SMHUs and Secure PTPs/PTUs:

■ Date and time of SMHU discharge;

■ Number of days, weeks, or months the inmate was living in the SMHU;

■ How the inmate was included in discharge planning;

■ How the inmate meets criteria for SMHU discharge;

■ A brief description of the inmate’s next housing assignment; and

■ Continuity of care planning between the SMHU mental health provider and the inmate’s

next mental health provider. There is no need for a Treatment Summary when there is not

a change in provider (i.e., when moved from secure to a less secure setting but the same

provider is seeing them).

g. Release from SMHU to Community. The Bureau will make every attempt to transition an

inmate with an SMI into a less restrictive environment than an SMHU prior to release to the

community. However, in rare cases, if an inmate requires secure housing up to their release date,

the mental health provider primarily responsible for the inmate’s care will collaborate with

institution or regional social workers, Unit Management staff, and community treatment staff to

develop a plan for safe transition. The SMHU mental health provider with primary responsibility

for the inmate’s care will write a Mental Health Transfer Summary and document it in the EHR.

Please refer to the Program Statement Treatment and Care of Inmates With Mental Illness

for more guidance about Community Treatment Services and Reentry Planning Services.