Code of Vermont Rules › Agency 13 - AGENCY OF HUMAN SERVICES › Sub-Agency 130 - DEPARTMENT OF CORRECTIONS › Chapter 024 - THE USE OF ADMINISTRATIVE AND DISCIPLINARY SEGREGATION FOR INMATES WITH SERIOUS MENTAL ILLNESS › Section 13 130 024 - THE USE OF ADMINISTRATIVE AND DISCIPLINARY SEGREGATION FOR INMATES WITH SERIOUS MENTAL ILLNESS

Current through June, 2024
Section I Authority
8 V.S.A. § 701(a);
				  28 V.S.A. §
											906;
				  28
				  V.S.A. §
											907.
Section II Purpose Statement
The purpose of this policy is to direct the Department of
				  Corrections in the classification, treatment, and use of administrative and
				  disciplinary segregation, including the maximum length of stay, for inmates who
				  have been diagnosed with serious mental illness. This policy applies to all
				  inmates who have been diagnosed with serious mental illness. It is the intent
				  of the Department of Corrections to offer guidance to staff and contractors
				  regarding their role and responsibilities as required by this rule and to
				  ensure that training, supervision and quality assurance activities promote
				  compliance with this rule.
A review of departmental directives associated with this rule
				  will be completed with any necessary updates of relevant documents within one
				  year of this rule taking effect.
Section
				III Applicability/Accessibility
All individuals and groups affected by the operations of the
				  Vermont Department of Corrections may have a copy of this policy
Section IV Definitions
Qualified Health Care Professional (QHCP): : A physician,
				  physician assistants, nurse practitioners, nurses, dentists, mental health
				  professionals, and others who by virtue of their education, credentials and
				  experience are permitted by law within the scope of their professional practice
				  to evaluate and care for patients.
Qualified Mental Health Professional (QMHP): Psychiatrist,
				  psychologist, psychiatric social workers, psychiatric nurses, and others who by
				  virtue of their education, credentials, and experience are permitted by law to
				  evaluate and care for the mental health needs of patients.
Serious Mental Illness: Substantial disorder of thought,
				  mood, perception, orientation or memory, any of which grossly impairs judgment,
				  behavior, capacity to recognize reality, or ability to meet the ordinary
				  demands of life. This includes, but is not necessarily limited to, diagnoses of
				  schizophrenia, schizoaffective disorder, psychotic conditions not otherwise
				  specified, bipolar disorder, and severe depressive disorders.
Administrative Segregation: A form of separation from the
				  general population when the continued presence of the inmate in the general
				  population would pose a serious threat to life, property, self, staff or other
				  inmates or to the security or orderly running of the institution. Inmates
				  pending investigation for trial on a criminal act or pending transfer may also
				  be included.
Hearing Officer: A person designated by the Commissioner of
				  Corrections and assigned by the Superintendent/Field Manager or designee to
				  conduct hearings.
Disciplinary Segregation: A form of separation from the
				  general population in which inmates committing serious violations of conduct
				  regulations are confined for short periods of time to individual cells
				  separated from the general population. Placement in disciplinary segregation
				  may only occur after finding of a rule violation at an impartial hearing and
				  when there is not an adequate alternative disposition to regulate the inmate's
				  behavior
Section V Policy
Classification, treatment and the use of segregation for
				  inmates with serious mental illness poses unique challenges in the correctional
				  facility setting. Inmates with serious mental illness may often experience an
				  exacerbation of their underlying illness when segregated. The use of
				  segregation for inmates with a serious mental illness will not occur without
				  the direct approval of a physician.
Admission -- Any newly-admitted inmate shall be screened by a
				  qualified health care professional who is trained in mental health screening
				  and referral within 24 hours of admission. Observations and responses shall be
				  documented and recorded on a standardized intake mental health screening form.
				  At the time of the intake mental health screening, qualified health care
				  personnel shall give each inmate information regarding access to mental health
				  services, including a written description of the available mental health
				  services and how to access them.
If the inmate is known or suspected of having serious mental
				  illness and is being considered for housing in a segregation unit, the
				  Superintendent shall ensure that the inmate is properly screened and that
				  qualified health and mental health professionals are involved in alternative
				  housing decisions. The QMHP, in consultation with DOC staff, shall determine
				  the appropriate restrictions on visiting, recreation, telephone use, and other
				  activities. If a physician orders an inmate with serious mental illness be
				  placed in segregated housing, he/she will document the level of monitoring
				  needed by qualified health and mental health care professionals, and the inmate
				  will be provided with ongoing assessment and treatment as clinically indicated.
				  Suicide prevention strategies and protocols shall be carefully followed.
Mental Health Services -- Every inmate with serious mental
				  illness shall be seen on a regular basis for mental health services and shall
				  have a treatment plan that creates a specific set of goals and the means by
				  which the goals will be accomplished. This includes inmates in segregation. The
				  plan shall include any or all of the following:
. individual or group psychotherapy designed to address the
				  specific problems and concerns of the inmate as identified in the treatment
				  plan
. cognitive-behavioral interventions
. stress management techniques
. psychoactive medications as prescribed
. crisis services as needed
. case management
. other approaches, including psychosocial support services,
				  deemed appropriate for the goal of returning the inmate to general inmate
				  population.
Inmates with serious mental illness may require services
				  unavailable within the confines of a correctional facility. In such cases the
				  supervising psychiatrist and Department's Healthcare Authority shall refer the
				  inmate to the Vermont State Hospital for possible admission. Other placement
				  options will also be considered as appropriate.
DOC recognizes it is important to minimize sensory
				  deprivation and enhance social support of inmates with serious mental
				  illness.
. To the extent possible consistent with facility, inmate and
				  public safety, the Department will encourage visiting to foster and maintain
				  ties with family, friends and community for inmates with a serious mental
				  illness.
. Restriction or deprivation of visits or phone calls for
				  inmates with a serious mental illness will not be utilized unless expressly
				  ordered by a hearing officer as an outcome of a due process proceeding.
Informed Consent -- To the extent possible, mental health
				  services will be developed and reviewed collaboratively with the inmate. The
				  inmate must give informed consent to any treatment, and refusal of treatment
				  shall be honored. Exceptions to this shall proceed in compliance with
				  prevailing federal, state statute, case law, and state policy. Confidentiality
				  of information obtained in the course of treatment shall be maintained,
				  consistent with state statute, case law and state policy with the only
				  exception being normal legal and moral obligations to respond to a clear and
				  present danger of injury to the inmate or others, the possibility of escape, or
				  other serious security breaches. This confidentiality policy must be explained
				  to the individual prior to the commencement of treatment.
Classification -- When writing a case plan for an inmate with
				  serious mental illness, the caseworker must consult with qualified mental
				  health professionals for input into the case plan. The QMHP will advise whether
				  the individual will require accommodations to successfully complete required
				  programs, or requires further assessment to determine the accommodations, if
				  any. Inmates with serious mental illness will not be classified for
				  out-of-state placement, unless the out-of-state placement is a program capable
				  of assessing, treating and managing persons with serious mental illness.
Placement of Inmates in Disciplinary Segregation -- Inmates
				  with serious mental illness may be placed in disciplinary segregation only
				  after due process and assessment by a QMHP to determine whether
				  contraindications to segregation exist, and upon approval of a physician. If
				  contraindications exist, the QMHP will recommend alternatives to segregation.
				  All alternative options shall be considered prior to placing an inmate with
				  serious mental illness in segregation. These options include, but are not
				  limited to, other disciplinary actions such as loss of privileges, removal from
				  programs or activities, change in living unit, restriction to living unit,
				  early lock-in, point fines, temporary loss of use of personal property,
				  institutional community service/reparation, reprimand, apology, written essay,
				  monetary restitution, restriction to cell or room, or intermittent segregation.
				  The consideration of alternatives must be documented. The Superintendent shall
				  make reasonable efforts to accommodate the behavioral and mental health needs
				  of the inmate with a serious mental illness in a setting other than
				  segregation, consistent with the safety and security of the institution. If the
				  behavior for which the inmate received the disciplinary report proximately
				  results from serious mental illness, the QMHP shall inform and recommend
				  options for disposition to the Hearing Officer who at his or her discretion,
				  may recommend a dismissal of the disciplinary charge and/or alternative
				  disposition, based on the information received. If the hearing officer
				  disagrees with the recommendation of the qualified mental health professional,
				  she/he will request a second opinion from the facility psychiatrist or advanced
				  practice nurse. Under no circumstance may an inmate be placed on disciplinary
				  segregation or receive a disciplinary report for self-injurious
				  behavior.
The Superintendent shall provide a monthly roster to the
				  Department's Healthcare Authority and supervising psychiatrist detailing the
				  inmates in segregation; the mental health diagnoses, if any; the reasons for
				  the segregation; and the specific length of stay. No inmate with serious mental
				  illness shall be kept in segregation continuously for more than fifteen (15)
				  days
Placement of Inmates in Administrative Segregation -- Inmates
				  with serious mental illness may be placed in administrative segregation only
				  after due process and assessment by a QMHP and upon approval of a physician.
				  The Superintendent shall make reasonable efforts to accommodate the behavioral
				  and mental health needs of the inmate in a setting other than segregation,
				  consistent with the safety and security of the institution. These options
				  include, but are not limited to, removal from programs or activities, change in
				  living unit, restriction to living unit, early lock-in, restriction to cell or
				  room, or intermittent segregation. The reasons for which the inmate is placed
				  in administrative segregation must be reviewed by the mental health treatment
				  team, and the supervising psychiatrist must concur with this decision.
The Superintendent shall provide a monthly roster to the
				  Department's Healthcare Authority and supervising psychiatrist detailing the
				  inmates in segregation, the reasons for segregation, and the specific length of
				  stay. Inmates in administrative segregation shall be reviewed by the treatment
				  team not less often than monthly and considered for alternative placement,
				  treatment plan changes, and other adjustments that might facilitate their
				  release from segregation. The treatment plan of each inmate in administrative
				  segregation shall include release from segregation as a specific goal and shall
				  include the means by which that goal may be accomplished. The treatment team,
				  in consultation with DOC staff, shall determine the appropriate restrictions on
				  visiting, recreation, telephone use and other activities.
Mental Health Rounds in Segregation Units -- Inmates with a
				  serious mental illness shall receive daily visits from QHCPs or QMHPs to assess
				  their status and initiate/refer for any needed changes in the treatment
				  regimen. These assessments shall document physical observations, the inmate's
				  affect, any suicidal or self-harming ideation, and health complaints. The needs
				  of inmates who are experiencing a current, severe psychiatric crisis, including
				  but not limited to acute psychosis and suicidal depression, shall be addressed
				  promptly, consistent with the inmate's willingness to accept treatment.
				  Alternative placements, consistent with their security, health and mental
				  health needs, shall be considered.
QMHPs shall conduct regular mental health rounds on all
				  inmates confined in segregation to ensure that the inmates receive appropriate
				  mental health services and that symptoms are detected and treated in a timely
				  manner. QMHPs shall conduct regular mental health rounds on all inmates with
				  serious mental illness at least three (3) times a week and will document visits
				  and their findings in the health record.
Restraints -- Restraints may be used, but only as a last
				  resort, by a correctional officer as an emergency intervention when necessary
				  for justifiable self-defense, protection of others, and protection from
				  self-harm, protection of property, to restore order and to prevent escapes.
				  Once an inmate who has a serious mental illness has been restrained in an
				  emergency situation, medical personnel must be immediately consulted.
Any inmate who remains in restraint beyond the initial
				  emergency AND who has a serious mental illness must have an immediate
				  face-to-face assessment by health care personnel. They must then notify the
				  psychiatrist on-call and obtain an order for the restraints to be
				  continued.
. The use of metal handcuffs, metal ankle cuffs, leg irons or
				  waist chains is not permitted for restraining inmates with serious mental
				  illness other than in the initial emergency situation.
. The use of oleoresin capsicum (also known as "OC spray" or
				  "pepper spray") in any type of restraint situation should be avoided with
				  seriously mentally ill inmates.
o The documentation of any such use of oleoresin capsicum
				  will include the alternatives attempted and explain the necessity of the
				  use.
. Foreign agents shall not be used on inmates with a serious
				  mental illness except in situations of actual or imminent violence which cannot
				  be controlled by less forceful and less intrusive interventions. Medical review
				  shall occur immediately following use of foreign agents. Deployment shall be in
				  accordance with manufacturers' instructions by trained staff.
. When a calculated use of force is necessary for an inmate
				  who has a serious mental illness, DOC staff will consult with a qualified
				  health care professional to determine if any contraindications exist prior to
				  its use.
. After two (2) hours, a repeat face-to-face assessment shall
				  be conducted by a member of the health or mental health personnel, the results
				  of which shall be communicated to the physician or psychiatrist who gave the
				  initial order, who may renew the order by telephone for an additional two (2)
				  hours.
. After eight (8) hours, the inmate MUST be seen by the
				  psychiatrist or advanced practice nurse.
o Assessment should include, but not be limited to, a
				  clinical formulation and creation of a behavioral management plan, which
				  includes the goal of limiting the need for future use of restraints. To the
				  maximum extent possible, the inmate should be involved in developing a
				  contingency plan that minimizes the future need for restraints.
. If restrained for more than twelve (12) hours, the Medical
				  Directors for Medical and Mental Health Services and the DOC Health Services
				  Director or their designees must be notified and alternative interventions
				  proposed, including the secure care mental health unit at Springfield and/or
				  the Vermont State Hospital.
. Restraints may not be used for punitive purposes;
. Restraint equipment must be medically appropriate;
. Restrained inmates shall be allowed bathroom privileges as
				  soon as practical.
Concurrent Disabilities -- Inmates with serious mental
				  illness may also suffer from cognitive impairments, developmental disabilities,
				  and traumatic brain injury (TBI), as well as an assortment of health
				  conditions. Additionally, functional problems such as very low reading level,
				  communication problems, and poor adaptive living skills may complicate the
				  management, assessment, and treatment of seriously mentally ill inmates. Since
				  these conditions may not be readily apparent to correctional staff who
				  supervise inmates, QMHPs and other clinical staff will assess these or refer
				  for specialized assessment as needed and will assist in the development of both
				  treatment and custody plans which accommodate these conditions. This includes
				  not only diagnosis, but also recognition of the interaction between serious
				  mental illness and other disabilities, and how this interaction manifests
				  itself in the correctional environment.
If the QMHP has reason to believe an inmate is unable to
				  comply with behavioral requirements due to a concurrent condition or
				  complication, the treatment plan will include accommodations to minimize
				  confusion and allow alternative approaches to gaining the inmate's cooperation.
				  An example is to provide verbal explanations of rules and expectations, rather
				  than rely on written handbook instructions. Another is the use of positive
				  reinforcement for successes.
Incarcerated Women and Youth with Serious Mental Illness --
				  Female inmates with serious mental illness require additional considerations. A
				  high prevalence of trauma and abuse history can make the issue more complex.
				  QMHPs will assess these factors and incorporate them into case and treatment
				  planning.
Residential mental health services for incarcerated women may
				  be limited due to population size, resources, and other issues beyond the
				  Department's immediate control. It is, therefore, incumbent on clinical and
				  security staff to find alternative approaches and strategies specific to the
				  clinical needs of women. Use of resources outside the correctional facility,
				  including the Vermont State Hospital, may be necessary to provide alternatives
				  to administrative segregation for women with serious mental illness.
Youthful offenders also have unique characteristics which
				  must be assessed and addressed in a developmentally appropriate manner. The
				  onset of certain types of serious mental illness corresponds with the age of
				  youthful offenders (16-22 years of age.) Thus, it is imperative that clinical
				  staff recognize, diagnose and treat the early onset of these disorders in a
				  therapeutic context. The symptomatic behaviors may include an inability to
				  understand or follow rules, confusion, inability to form relationships, and
				  thought disorder.
Section
				VI Training
The Department of Corrections will ensure that facility-based
				  security, casework and supervisory staff receive training in the identification
				  of individuals with possible emotional and mental disorders. Current staff who
				  have not already received such instruction will do so through scheduled
				  training workshops.
This training will include the following:
1) Recognition of signs and symptoms of
				mental and emotional disorders prevalent in the inmate population;
2) Recognition of signs of chemical
				dependence and the symptoms of drug and alcohol intoxication and
				withdrawal;
3) Recognition of
				adverse reactions to psychotropic medications;
4) Recognition of signs of developmental
				disability, especially mental retardation;
5) Recognition of the potential for
				concurrent disabilities;
6)
				Recognition of the unique considerations associated with serious mental illness
				in incarcerated women and younger offenders;
7) Recognition of potential mental health
				emergencies and instruction in appropriate action in crisis situations,
				including self-harm;
8)
				Identification of medical problems of inmates housed in mental health units and
				proper referral for care;
9)
				Suicide prevention;
10) Instruction
				in the procedures for referring an inmate to mental health services for
				immediate evaluation;
11) Relevant
				Departmental Policy and Administrative Directives
The Superintendent shall ensure that all facility-based
				  security casework and supervisory staff or transferred staff have received such
				  training within one (1) year of their date of employment or transfer, and all
				  current staff have received such training within one (1) year of this rule
				  taking effect. Hearing Officers and Disciplinary Committee members shall
				  receive additional specific training in the risks of segregation of inmates
				  with serious mental illness.