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Tennessee County Agrees to Improve Mental Health Care for Prisoners

Tennessee County Agrees to Improve Mental Health Care for Prisoners

The Civil Rights Division of the U.S. Department of Justice (DOJ) has reached an agreement to settle a civil complaint that alleged the rights of mentally ill prisoners at the Robertson County Detention Facility (RCDF) in Springfield, Tennessee were being violated.

A combination of complaints from prisoners to the U.S. Attorney’s Office for the Middle District of Tennessee and an evidentiary hearing by a district court into conditions at RCDF prompted the DOJ to investigate.

The initial complaints concerned the food served at the jail, though the DOJ found prisoners were being properly fed. Investigators, however, cited serious issues with the provision of mental health care: nurses had little or no mental health training, and there was limited access by prisoners to mental health care and unsafe practices in handling suicidal prisoners.

It was alleged in the DOJ’s lawsuit that prisoners could be removed from suicide watch by signing contracts stating they would not hurt themselves. “For someone with suicidal ideation who is actively suicidal, these ‘contracts for safety’ fail to protect prisoners from attempting and/or completing suicide,” the complaint stated.

In 2012 there were two suicides at RCDF. In July 2012, a drug suspect hanged himself in his cell. Then in September, a bank robbery suspect was able to kill himself, also by hanging. Neither was on suicide watch.

The district court approved the settlement agreement on April 30, 2013, which mandates a complete array of mental health services at RCDF.

The first substantive provision addresses suicide prevention and requires all prisoners to be “screened for risk of self-harm using an appropriately validated screening instrument.” Jail officials are to ensure that prisoners are protected from identified risks for suicide or self-injury commensurate with their level of risk.

A suicide prevention training program will be implemented for all staff. RCDF must also ensure that all “prisoners suffering from mental illness receive treatment appropriate to their condition and adequate to prevent unnecessary suffering or risk of harm.” This outcome is to be achieved by ensuring that sufficient and qualified “staff perform comprehensive assessments, provide comprehensive multidisciplinary treatment planning and medication management, and monitor medication side effects.”

The use of “unnecessary or excessive use of restraints on prisoners with mental illness or requiring suicide precautions” is to be prevented. The settlement also provides for procedures related to the release and transfer of mentally ill prisoners.

In such cases, qualified medical staff is to be contacted by RCDF and provided “a summary detailing major mental health concerns and listing current medications and dosages, as well as medication history while at RCDF, in order to ensure continuity of care.” Such prisoners are also to be provided a three-day supply of their medications upon release or transfer.

Finally, the settlement requires that all provisions be implemented within 180 days and establishes reporting requirements and enforcement measures.

According to the first monitoring report issued by independent consultant Lindsay M. Hayes on April 30, 2013, the jail had failed to substantially comply with almost all of the 48 provisions in the settlement agreement. The following year, when a second monitoring report was submitted to the court on January 28, 2014, the county was found in substantial compliance with only three of the 48 provisions and in partial compliance with the remaining 45. Hayes noted that the private company contracted to provide medical and mental health care at the jail, Southern Health Partners, “had been unable to hire an additional qualified mental health professional until early October 2013.”

Disturbingly, one of the provisions found in only partial compliance specified “The County shall implement comprehensive policies and protocols to ensure that prisoners at risk of self harm are identified, protected, and treated in a manner consistent with the Constitution. The County shall continuously track and analyze prisoners’ risk of self harm and implement measures to protect prisoners by reducing or eliminating the risk of harm.”

The most recent monitoring report filed with the district court, dated February 11, 2015, showed significant improvement – including substantial compliance with 33 of the 48 settlement provisions and partial compliance with the remaining 15. Those in partial compliance included four provisions related to suicide prevention and 10 related to mental health care. See: United States v. Robertson County, U.S.D.C. (M.D. Tenn.), Case No. 3:13-cv-00392.


Additional source: The Tennessean


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Related legal case

United States v. Robertson County