1. Jail Triage

2. Duty to Protect

3. Program Goals Lessen the likelihood of custodial suicide
Help Jails manage mental health crises

4. Triage Objectives Identify inmates at risk for suicide
Identify inmates with serious mental Illness

5. Operational Objectives
Proper restraint and housing
Timely observation and documentation
Timely and reasonable provision of suicide risk management

6. Operational Failures Knowledge of a behavioral health risk
Understanding the consequences of the risk
Wanton or intentional failure to reasonably avoid the risk
Resulting harm from the failure

7. How Jail Triage Works

8. Free to Participating Jails
Inmates at risk for Suicide or Mental Health Crisis
Call

9. Triage Assessment
Once a risk has been Identified a call to the Jail Triage line will begin the assessment process to determine:
Level of risk: Critical, High, Moderate, Low
Recommended jail protocols
Follow-up requirements

10. Identifying Jail Risk

11. When to Triage
Any time suicide or mental health concerns arise

12. At Intake
When arresting or transporting officer responds to Jail Intake Assessment questions
arrestee makes statements of self harm
family or friends warn of statements or actions indicating self harm
arrestee’s reaction to arrest suggests risk of self harm
arrestee’s behaviors suggest mental illness

13. At Booking / Screening Arrestee reports prior suicide attempts
Arrestee reports current suicide ideation
Arrestee reports hospitalization for mental illness in the past year
Arrestee reports a serious mental health condition

14. Institutional ALERTS
Prior critical or high risk for suicide or self harm
Prior critical or high risk for serious mental illness

15. Event-Driven Risk In response to a disciplinary action
In response to severity of charge or length of sentence
In response to upsetting court appearance or news about case
In response to a bad phone call or visit
In response to the death of a loved one

16. Observation of Risk Another inmate expresses concern for self harm
Staff observe indices of suicidal intent or actions
Inmate presents overt signs of depression, psychosis or other acute distress
Family or another third party contacts the jail to express concern

17. Overt Symptoms of Distress
Making instruments of suicide: noose, shank, hoarding medication
Engaging in self injury: Self mutilation, head banging
Refusing meals, medication
Terminating communication: letters, phone calls, visits
Declining showers, recreation, commissary
Saying goodbye, giving away property, preparing will
Exhibiting significant emotional distress, agitation, or withdrawal including requests for segregation

18. The Jail Triage Process
Jail staff will be asked to provide Triage with basic information from all available sources such as:
Name, SSN, DOB, charges noting felonies, booking date, known substances in use, withdrawal potential, any flags they had at booking.
The concern that prompted the call to Triage
Any past institutional ALERTS
Current inmate presentation

19. Risk Leveling
Critical
High
Moderate
Low

20. Critical Risk Critical Active suicide attempts
Other self injurious behavior

21. High Risk High Active suicidal thoughts
History of suicide attempts less than 2 years old
Concern related to charge related risk
Agitated psychosis
Lower level risk compounded by such things as substance use that jeopardizes inmate's immediate safety

22. Moderate Risk Moderate Suicidal history between 2 and 10 years old
Family history of completed suicide
Significant MH treatment history
Psychiatric hospitalization in last year
Active emotional distress without suicide ideation
Lower level risk compounded by added risk factors

23. Low Risk Low Suicide history of attempts older than 10 years
Minor mental health history
Absence of other compounding risk factors

24. Recommended Jail Protocol
Critical
High
Moderate
Low
Housing
Restraint Chair
Single or Safe Cell
General Population
Observation
Constant
Staggered
Individualized
Normal
Property
None
None or Suicide Blanket
Full
Clothing
Regular
Suicide Smock
Jump Suit
Food
Finger

25. Kingsley v. Hendrickson
Any force used to prevent suicide or other injury must be objectively reasonable. For example:
Using a safety chair to prevent an active suicide attempt is preferable to forced clothing removal for subsequent placement in a suicide smock.
It is reasoned that the safety chair is less traumatic than a forced clothing removal
Placement in a safety chair after clothing removal in a smock further traumatizes the inmate as the smock often fails to cover genitals and is often recorded

26. Clinician Recommendations
Maintain risk level pending contact with mental health within a specified time frame
Maintain risk level for a specified timeframe and then call Jail Triage again to retriage
Maintain the risk level for a specified period of time and then reduce to the next lower level if no concerns arise

27. Fail Safe Regardless of recommendation, when in doubt call:
JAIL TRIAGE

28. Mental Health Follow-Up
Jail Triage may recommend contact with local mental health for further suicide assessment.
Jail staff will be responsible for making the inmate available once mental health contacts the jail to speak to the inmate.
In the event of inmate refusal or safety concerns regarding this contact, the risk level will be maintained pending a follow-up call to Jail Triage
In addition to leveling recommendations, mental health may suggest such things as involuntary hospitalization, use of inmate watchers, or referrals to medical, the chaplain, internal mental health staff, or ongoing treatment options.
Using Jail Triage does not preclude contracting with local mental health for additional services as jail administration sees fit.

29. Retriage
If a retriage is recommended, jail staff initiates this by calling Jail Triage after the recommended timeframe.
Jail staff should be prepared with all documentation to date on inmate, including recommendations made after any contact with local mental health.
Jail staff will also be asked if inmate continues to report any thoughts of suicide or other distress, about inmate’s current presentation and any other changes in status since the last triage or contact with mental health.
Triage staff will use this information to reassess inmate’s risk level and make recommendations accordingly.

30. 202a Commitments
202a assessments for involuntary psychiatric hospitalizations are provided by the local mental health agency serving that judicial district
Jail Triage cannot initiate a 202a petition or perform the assessment but can provide Jail Triage information to the local MH provider if requested
If the jail receives a 202a petition or initiates paperwork for a 202a assessment, the appropriate contact is the local mental health provider.

31. Jail Triage Limitations
The legal jurisdiction of Jail Triage begins when custody is accepted and ends upon legal release or custody transfer from the holding jail
Risk leveling by Jail Triage applies to in-custody assessments and not to community release
Any inmate being released from the jail that was on a high or critical risk leveling status will be advised to seek community MH services
In the case where a critical or high risk inmate is being released from custody the jail should consider providing:
A 202a referral
A call to the inmate's emergency contact number
Business card with community mental health contact information or number for the community mental health crisis line

32. Community MH Crisis Line Numbers
Adanta
Bluegrass –
Centerstone
Communicare –
Comprehend
Cumberland River / (after hours)
Four Rivers
Kentucky River
LifeSkills
Mountain Comp
NorthKey
Pathways
Pennyroyal
River Valley –

33. Community Engagement
As the jail assumes a duty to protect inmates from suicide, it is prudent to engage an inmate’s family, friends and professional associates in suicide prevention. Signage and phone messaging should advise significant others as to their responsibility to notify the jail staff of any inmate action or communication that threatens the safety of an inmate. We all share the responsibility to prevent harm to those in custody.

34. MH Jail Training
4 hours of MH training required during the first year of service
1 hour of mental health training required each year thereafter
Jail Triage is willing to provide that training for a fee
Jail Triage online training materials available at Click the Jail Triage link at the bottom of the home page.