The Last Resort

DHHS and DHHS MH agree with the findings numbered F2, F4, F5 and F6.

There is a lack of Mental Health providers willing to work for the County Department of Health and Human Services. Agree The Department of Health and Human Services (DHHS) Director and DHHS-Mental Health (MH) Director agree with this finding. All positions that are vacant have been continually recruited for with interviews conducted and offers extended to qualified applicants. Most often the applicants decline the offers of employment within the Jail. The Jail can be a dynamic and complicated environment to work within. Most applicants choose not to work in this environment when they have other options. There is not a shortage of positions available to licensed staff in Humboldt County and throughout the state. This is the employment climate DHHS is working with. DHHS has even tried to incentivize these positions with the offering of hazard pay and the possibility of approved overtime and flexible work schedules. DHHS has had some success with these efforts as evidenced by all but two of the positions being filled at the present time. DHHS is currently in the hiring process with those positions.

Humboldt County Correctional Facility staff hindered in their tasks by the inability of Department of Health and Human Services to recruit and retain permanent clinical staff. Partially Agree The DHHS Director and DHHS-MH Director partially agree with this finding. It is difficult to determine how recruitment efforts hinder HCCF staff. In addition to the steps taken to meet staffing needs mentioned in response to Finding 2, above, DHHS has created an onboarding process for new hires that includes orientation and initial training. This includes an onboarding “toolkit” for programs to use and customize for their unique programs. DHHS has also worked to reduce staff burn out by working with the University of Kentucky around training and supporting staff around secondary trauma. Both efforts have been empirically proven to improve employee retention.

The amount of time the Psychiatrist provides direct patient care to inmates per week is inadequate. Agree 2 The DHHS Director and DHHS-MH Director agree with this finding. DHHS has a Medical Director on staff that provides two days per week of psychiatric coverage within the jail until DHHS can hire a fulltime practitioner. Mental Health acknowledges the need to have a full-time prescriber within the jail and has been continually recruiting for that position for some time.

The amount of time mental health clinicians are available in the Humboldt County Correctional Facility is insufficient. Agree The DHHS Director and DHHS-MH Director agree with this finding. DHHS has had difficulty finding qualified clinicians willing to work within the jail, as noted in response to Finding 2, above. DHHS are currently only down one clinician for the jail and DHHS has expanded service delivery through the weekend for both nursing and counseling. Additionally, DHHS is in process of hiring a midlevel practitioner for the jail. This position is part-time, however will add to the existing two days per week DHHS have a Medical Director working in the jail. DHHS’s efforts to recruit and hire a full-time practitioner continue.

Department of Health and Human Services & Humboldt County Correctional Facility mental health staff are negatively impacted by lack of dedicated therapeutic environments and counseling to provide care as required by law. Agree The DHHS Director and DHHS-MH Director agree with this finding. There is limited space within the jail to provide counseling services. The counseling services will greatly expand with the jail expansion project that is scheduled to begin next year. With that project completion there will be numerous counseling offices available to provide clinical services that are “therapeutic” and “confidential”.

There is a lack of direction to clinical staff about who has the legal authority to prescribe treatment orders for inmates in need of mental health treatment. Disagree The DHHS Director and DHHS-MH Director disagree with this finding entirely. All of staff hired to work in the jail are trained in their scope of practice during the onboarding process. The scope of practice guidance is clear around this matter.

The lack of written policies and procedures concerning the care of mentally ill inmates at Humboldt County Correctional Facility inhibits the ability to provide quality mental health care. Disagree The DHHS Director and DHHS-MH Director disagree with this finding entirely. DHHS-MH jail staff have 21 policies and procedures that guide their practices in the jail. Many of these policies have been in place since 2006.

Difficulty in differentiating between drug-induced behavior and mental health issues lead to treatment errors. Partially Agree The DHHS Director and DHHS-MH Director partially agree with this finding. DHHS need to consider the details of what is meant by “treatment errors.”

There is a lack of agreement of the roles and responsibilities between the Patient’s Rights Advocate and the Department of Health and Human Services and Mental Health Administration. Partially Agree The DHHS Director and DHHS-MH Director partially agree with this finding. The DHHS-MH Director has weekly meetings with the PRA to support this role in the county. The DHHS-MH Director has also involved County Counsel in determining the scope of the PRA role in the county.

There are few long-term mental health plans in place for dealing with inmates serving extended sentences. Partially Agree The DHHS Director and DHHS-MH Director partially agree with this finding. Every treatment plan is unique and has many variables that influence long-term treatment planning for inmates.

The inmate mental health transition plan for ongoing care after discharge from the Humboldt County Correctional Facility is incomplete. Partially Agree The DHHS Director and DHHS-MH Director partially agree with this finding. It is DHHS’s practice that every inmate who receives mental health or substance use disorder treatment in the jail is provided resources for aftercare, following release, with the exception of those who are released without DHHS-MH’s awareness.

The legal 5150 implementation in both the Humboldt County Correctional Facility and Sempervirens is at times in dispute amongst Department of Health and Human Services staff and local law enforcement agencies. Partially Agree The DHHS Director and DHHS-MH Director partially agree with this finding. While it is difficult to keep DHHS staff and HCCF staff educated on the practice of 5150 holds 100 percent of the time, the department actively engages with HCCF and local law enforcement in training in this area. Workgroups have been formed and trainings are conducted regularly. The collaborative Crisis Intervention Training (CIT) conducted annually is a good example of this, as well as the current MOUs that are under review by law enforcement entities, local hospitals and the HCCF.

There is a lack of sufficient Department of Health and Human Services administrative involvement in the treatment and care of mentally ill inmates in Humboldt County Correctional Facility. Partially Agree The DHHS Director and DHHS-MH Director partially agree with this finding. While there have been transitions within DHHS over the last few years, there has been significant focus by MH Administration on jail services. MH Administration meets regularly with jail managers and supervisors. Additionally, MH Administration regularly attends the Sequential Intercept Mapping, jail Continuous Quality Improvement meetings and is actively involved in the planning meetings related to Medication Assisted Treatment implementation in the jail.