Miami-Dade changes jail culture to meet the needs of people with mental illness

The core mission of correctional institutions has traditionally been the safe and secure detention of inmates. Over the years, the demo­graphics of the inmate population have changed with an increasing number of inmates diagnosed with mental illness.

The U.S. Department of Justice’s Bureau of Justice Statistics study, Mental Health Problems of Prison and Jail Inmates, found that 64 percent of jail inmates had a mental health problem.

This high prevalence has changed the landscape of jail man­agement, requiring correctional institutions to go beyond their core missions to ensure the safety of people with mental illnesses in jails.

Correctional institutions have traditionally been ill-equipped to manage the needs of this special population. Limited resources and institutional attitudes made it difficult to effectuate real change towards incarcerated inmates with mental illness.

Over the last several years, however, Miami-Dade Correc­tions and Rehabilitation Depart­ment (MDCR), the local jail for Miami-Dade County, Fla., has been working to change its overall jail culture while focusing efforts on people with mental illnesses in the jail. These inmates require a therapeutic environment with specialized services and treatment. Top on the list was housing.

MDCR evaluated various op­tions until deciding on using an existing facility to create the Mental Health Treatment Center (MHTC).

A phased-in construction plan was developed and the extensive renovation of three housing units began. This initial phase, which concluded last December, resulted in acute and sub-acute people with mental illnesses being transferred to MHTC. Additional housing units are in the process of being renovated to transition the remain­ing people with mental illnesses by the end of 2015.

The new mental health unit looks and acts less like a traditional cellblock. It has glass-front doors for each of the 96 cells, which are designed to hold one person at a time rather than several people.

A big change involves additional space for therapy and recreation programs within the unit.

Previously all people housed at the jail were in their cells for 23 hours per day, which is not conducive to recovery goals. The new space is used for therapy, yoga, classes, groups and other activities. The new unit also includes space for nurses and doctors to see patients rather than having to transport them elsewhere for medical care.

Programming meaningful treat­ment is also a crucial component in managing people with mental illnesses in jail.

With the transition of these inmates to a new physical environ­ment, additional treatment and services are now being offered. Along with our service partners, music therapy, art therapy and yoga have been incorporated into the daily schedule.

Another positive outcome of the MHTC is the ability of the medical service provider to now offer group therapy sessions.

The selection of personnel willing and able to work with this special needs population was important. MDCR developed a competitive selection process with staff assigned to the MHTC required to successfully complete a 56-hour training curriculum, which included the National Institute of Corrections’ Advanced Crisis Intervention Training. Advanced Crisis Intervention Training is an intense, scenario-based training that prepares trainees to recog­nize the signs and symptoms of major mental illness and provides useful tools when interacting with inmates and responding to situations unique within correc­tional settings. Trainees develop an increased sensitivity and under­standing to mental disorders and strengthen their “first responder” skills.

Despite these efforts, there is much more work to be done. Diversion of people with mental illnesses away from the criminal justice system into necessary treat­ment needs to become a priority across the nation. The availability of social service programs for these inmates upon their release is severely lacking.

Appropriate levels of com­munity support including mental health services are necessary to decrease the likelihood of reoff­ending. Working together, criminal justice and social service providers should develop a comprehensive approach to meet the needs in their jurisdictions.

This article is the second in a series from criminal justice and behavioral health experts and practitioners, and govern­ment leaders on mental illness and jails and focuses specifically on innovative policies, practices and programs within the Miami-Dade County, Fla. jail.