Located in downtown Las Vegas, the Clark County Detention Center is the largest jail in the state of Nevada, with an average daily population of more than 4,200 inmates and more than 60,000 bookings every year. The jail also serves as the largest mental health facility in the state, with approximately 20 percent of the inmates prescribed psychotropic medications.
Managing such a large inmate population with mental health needs is a challenge. Custody and clinical staff work together daily to manage inmates needing the most resources, and work diligently to build and maintain partnerships throughout the justice and social service communities in Southern Nevada.
Having large groups of inmates suffering from mental illness poses a concern for housing them safely while still ensuring they get access to the care and resources they need to improve their outcomes. As an alternative to housing step-down inmates in cells, we opened a direct supervision housing unit staffed with officers who are trained in crisis intervention to manage the special population.
Previously, the focus for this population had been stabilization and crisis management, but we thought we could do better by helping these inmates improve their coping strategies so that they could more effectively transition back to the community upon release. We structured the daily activities after a local mental health facility where many of the same offenders were previously clients or patients. One area that was identified as needing further development in the jail was individual and group counseling.
Reforms have targeted restrictive and segregation housing management policies recently. Although these populations in the Clark County Detention Center receive daily visits from mental health care workers and regular interactions with correctional staffers, they often cycle in and out of the units, and experience poor outcomes after being stepped down to less restrictive housing.
Repeated threats of self-harm, uncontrolled outbursts, property damage and staff assaults often make these populations the most dangerous and time-consuming to manage. Preventive mental health care and increased interaction with mental health staff, including case management, has been effective in the most difficult cases.
Identifying the scope
Through our contracted medical services partner, NaphCare Inc., our facility has licensed social workers (LSWs) who create discharge plans and conduct small group classes related to mental health, but they are unable to conduct individualized therapy in the restrictive and segregated populations.
As a way to fund this service, our office allocated money from the Inmate Trust Fund to increase staffing in this area and supplement the current mental health team. Approval was granted to hire two additional licensed clinical social workers (LCSWs) to conduct individual therapy, and another LSW to increase small group sessions that focus on inmates in segregation, as well as with discharge planning.
Inside the Mental Health Department of Clark County Detention Center, the Las Vegas Metropolitan Police Department, in conjunction with NaphCare, currently employs one LSW and two LCSWs. They are responsible for answering inmate requests specific to their disciplines, but individually, their duties differ based on their credentials.
Chief among these duties is triage for immediate psychiatric medication and scheduling appointments for the psychiatrist or nurse practitioner to see inmates. A solid working relationship with court officials helps them arrange the coordination and continuation of current prescriptions and treatments upon an inmate’s discharge.
LCSWs can initiate or terminate a suicide watch, and develop plans of action or programming with security to assist in moving inmates who may self-mutilate or self-harm away from physical restraints. They can recommend a step-down status of observation or eventually, normal oversight. The LCSW conducts rounds daily on suicidal/homicidal inmates to provide therapy and assist in stabilization. The LCSW has the ability to determine if a suicide watch can be discontinued or should be extended, and will provide necessary documentation, including scheduling of a follow-up appointment.
Once an inmate is released from suicide watch, the LSW provides a 24-hour follow-up to continue the brief counseling session and further assist with stabilization.
LCSWs are also utilized for one-on-one programming with inmates in restrictive housing to help them progress to more normal living situations. They can provide input to the facility’s mental health doctors on individual behaviors that may require medication adjustments. We also use LSWs for group programming, focusing on the mentally ill and juvenile modules, but the new LSW will focus on group programming for the general population.
LCSWs and LSWs alike are tasked with connecting inmates with community services or gaining assistance with Medicaid applications. Additionally, the LCSWs and LSWs collaborate with religious services when counseling pregnant females to determine post-delivery solutions and provide bereavement counseling for inmates who have lost a loved one. As a team of professionals, LCSWs and LSWs respond to routine and emergent psychiatric situations while assisting each other, the psychiatric providers, medical team and custody staff.
We are excited at the prospect of adding additional LCSWs and LSWs to provide additional psychiatric services to our population. They will open a new array of possibilities that include a reduction in suicidal behaviors that necessitate increased services and tax our resources.
An analysis found that on average, 10 percent of the inmate population has attempted suicide, made a suicidal gesture or was previously on a suicide watch. When we interviewed the inmates, we believe many of these incidents could have been avoided with consistent follow-up, and these new positions will provide that. These positions will also assist with discharge planning, which should begin at booking and include primary care follow-up as well as psychiatric services; advocate for inmates lacking basic needs such as transportation to community outpatient facilities; increase visits/groups to disciplinary, administrative segregation modules; and provide counseling to address substance abuse issues.
All of the above allows the psychiatrist or nurse practitioner to focus on medication management, and allows the social workers to excel in their roles as essential members of a treatment team.
Measuring success
Data will be drawn monthly and reported to the command staff to track the effective utilization of the increased staffing. Specific data measures that will be collected include a potential decrease in the number of inmates placed on suicide watch; an increase in the mental stability of all inmates, which in turn could decrease disciplinary needs; a more comprehensive approach to mental health care (including increased medication compliance); and an increase in services to populations in restrictive and segregation housing units.
To measure our success, we track all suicides, suicide attempts, and suicide gestures. We believe if we close the gap by being proactive instead of reactive with continual follow-up on inmates who have exhibited suicidal behaviors in the past, we will significantly reduce suicides, attempts and gestures. Inmates who self-harm have had a significant impact on our overtime budget due to one-on-one observation and hospital transport. If we can reduce the overtime we track toward these two areas, we will also be able to measure a fiscal impact.
We also track all our restrictive housing inmates and have our Restrictive Housing Committee meet weekly. If we’re able to conduct one-on-one programming with a housing structure that allows us to progressively down-class, we can track and measure our success by the reduction of inmates in restrictive housing. In the last 10 years, the growth of our restrictive housing population has far exceeded the growth of our ADP.
Our goal is to save lives and help the Clark County Detention Center reach our vision: Being the safest jail in America.
About the Author
Deputy Chief Rich Suey was hired as a corrections officer by the Las Vegas Metropolitan Police Department (LVMPD) in 1992. He has since worked his way up to the rank of Deputy Chief, and is now LVMPD’s Detention Services Division Commander. Suey is a graduate of Harvard’s Kennedy School of Senior Executives in Public Government and the National Jail Leadership Academy at Sam Houston University, and has served as a trainer for the National Institute of Corrections (NIC).
Editor's Note:
This story originally appeared in the Nov/Dec 2017 issue of Sheriff & Deputy magazine and is reprinted with the permission of the National Sheriffs' Association.
Richard Suey
Deputy Chief Rich Suey was hired as a corrections officer by the Las Vegas Metropolitan Police Department (LVMPD) in 1992. He has since worked his way up to the rank of Deputy Chief, and is now LVMPD’s Detention Services Division Commander. Suey is a graduate of Harvard’s Kennedy School of Senior Executives in Public Government and the National Jail Leadership Academy at Sam Houston University, and has served as a trainer for the National Institute of Corrections (NIC).
