BOP Program Statement 5335.02 § 6

a. Monthly Security Review. At Secure PTPs and PTUs, escort procedures will be

recommended and addressed every 30 days. This does not limit the ability to change these levels

for appropriate circumstances during the daily or weekly meetings. This meeting will consist of

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the Warden, Associate Warden(s), Captain, SIA and/or Special Investigative Services (SIS),

SMHU Lieutenant, Unit Manager, Specialty Program Coordinator, Chief Psychologist,

psychiatric provider(s), other medical providers, and/or any of their designees. This meeting can

also address any other issues or concerns anyone may have at that time. MRCs review escort

procedures during daily meetings.

b. Secure Treatment Team. All SMHUs are administratively managed by an interdisciplinary

Secure Treatment Team. These teams meet briefly each weekday in MRCs and at least weekly in

PTPs/PTUs. Every effort should be made for representatives including the Specialty Treatment

Coordinator, treatment providers, Captain or designee, Health Service providers, Correctional

Services staff assigned to the unit, Unit Management staff, and Education/Recreation staff to be

present. However, staffing and institution needs can be taken into consideration for daily

attendance at a MRC. If any Correctional Services staff assigned to the SMHU cannot attend,

they may send comments to the Specialty Program Coordinator or Chief Psychologist to be

included in the meeting.

In MRCs these teams are led by the Chief Psychologist, Chief Psychiatrist, or designee. In

Secure PTPs/PTUs, the Specialty Program Coordinator leads the team. The team leader has final

decision-making authority and responsibility for programming, therapeutic release, incentive

awards, and any changes to authorized property. Psychiatric providers retain final decision-making authority regarding psychotropic medication. The Captain retains final decision-making

authority regarding security measures. If there is a disagreement between psychology,

psychiatry, and/or a Captain, the Warden has the final decision-making authority.

c. Secure Treatment Team Responsibilities. Secure Treatment Teams are similar to CCARE

Teams but meet as indicated above. Each Secure Treatment Team meeting is documented to

include the date and time of the meeting, who was in attendance, which inmates were discussed,

and which topics were discussed. However, treatment team notes do not need to be entered into

the EHR daily for the Secure Treatment Team at MRCs or weekly in PTPs. Secure Treatment

Teams discuss and ensure the following during each meeting:

■ Security Procedures. The Secure Treatment Team considers:

 The least restrictive means of escorting SMHU inmates (e.g., whether an inmate

requires the use of restraints for escort); The use of restraints on pregnant and

postpartum individuals is prohibited except in rare instances. The restrictions outlined

in the Program Statement Female Offender Manual will be followed in these cases.

 Out-of-cell programming participation (i.e., whether the inmate requires the use of a

therapeutic enclosure); and

 The structure of socialization opportunities (e.g., how many other people can the

inmate tolerate, is the inmate safe around certain staff, certain inmates, or staff only).

■ Recreation Time. At a minimum, SMHU inmates are offered six hours of weekly

recreation time. The Secure Treatment Team may authorize additional outdoor or indoor

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recreation time beyond the weekly minimum if staffing permits.

■ Therapeutic Release (TR). The Secure Treatment Team may authorize TR and determine

the TR plan.

■ Emergency Psychiatric Medicine. If the Secure Treatment Team determines an inmate

is too dangerous and mentally ill to be escorted out of a cell, the psychiatric provider will

evaluate the need for emergency psychiatric medication or pursuing involuntary

psychiatric medication pursuant to the Program Statements Psychiatric Evaluation and

Treatment, Patient Care, and Psychiatric Services. SMHU inmates will not be

restricted from participating in programming or recreation opportunities secondary to

symptoms of mental illness; if their mental illness makes them dangerous or impairs them

to the extent that staff are concerned about removing them from their cell, this could be

an indicator for grave disability and an evaluation to consider emergency psychiatric

medication should be completed. A medical provider will document the least restrictive

method for controlling the situation, including the determination to order emergency

psychiatric medications if clinically indicated in the above cases. In no way should

emergency medications be used to negate the need to potentially pursue commitment

under 18 U.S.C. § 4245. Any use of force under this provision must comply with

procedures in the Program Statement Use of Force, Application of Restraints, and

Firearms.

■ Access to Treatment. Because SMHUs function independently from other components

in the institution, they are given separate consideration if lockdowns occur. Unless

security concerns are present on the SMHU, out-of-cell programming and recreation are

not ordinarily suspended for lockdowns. Return to normal operations in the SMHU will

be determined by the Warden and will occur as soon as practical unless there are specific

security concerns on the unit.

■ CCARE Functions. The Secure Treatment Team meeting can also function as a CCARE

team meeting in accordance with the Program Statement Treatment and Care of

Inmates With Mental Illness.

■ Scheduling. The Secure Treatment Team will create and ensure adherence to a weekly

schedule of events (e.g., use of indoor and outdoor recreation space, use of the closed-circuit DVD channel, use of group treatment space, use of socialization space, and use of

any other common areas used for programming and treatment activities). A member of

the Secure Treatment Team will distribute this calendar to inmates and post it on the unit

in a highly visible location.

■ Tracking. The Secure Treatment Team is responsible for tracking how long each inmate

has been housed in the SMHU. Except for Secure PTPs, ordinarily, inmates placed in a

Secure PTU will not remain there longer than 90 days. If the Secure Treatment Team

determines an inmate requires more than 90 days in a Secure PTU, the team will consult

with the PSB and the Chief Psychiatrist, Health Services Division, to determine any

appropriate changes to treatment. In Secure PTPs, this consultation occurs if the person

has exceeded 18 months and is still in an SMHU. This consultation will be documented

by either a psychologist or a psychiatric provider in the EHR.

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d. Quality Improvement (QI). The PSB will develop and initiate a minimum of one quality

improvement study quarterly in which they evaluate the effectiveness of interventions used for

inmates living in the SMHU. Examples of appropriate QI activities include improving

psychotropic medication adherence, reducing incident report frequency, increasing hours

engaged in therapeutic activities, improving promptness and appropriateness of medication

renewals, reducing suicide attempts, reducing use of restraints, and reducing use of force

incidents (immediate and calculated). These studies must be submitted by AD of Reentry

Services division within one month of the end of each quarter. Findings will be routed to the

Regional Director and Warden for consideration.