Montgomery County Correctional Facility (MCCF) employs a Mental Health Therapeutic Program Manager tasked with developing all mental health policy and procedures with providing direction and oversight regarding the delivery and development of all Mental Health services and programs so they are in compliance with all state and local laws and meet community standards of care.
The Department also employs a Supervisory Therapist responsible for the daily operations of CIU and the direct supervision of four full-time DOCR Therapists.
Mental Health Assessments:
Mental health assessments consist of a mental status evaluation, psychiatric history if available, DSM-IV diagnostic impression with treatment and management recommendations. Therapists utilize the standard Statistical Manual of Mental Disorders for diagnostic codes in keeping with community standards.
The contract psychiatrist performs routine, emergency and follow-up evaluations for all of its sites including MCCF, the Montgomery County Detention Center (MCDC) and the Pre‑Release and Re-entry Services (PRRS) for all individuals under custody and this includes persons who are on home confinement as well. The psychiatrist consults with staff regarding treatment plans as needed. A psychiatric evaluation includes a mental status examination, DSM‑IV diagnosis, and the prescription of psychotropic medications as indicated. Inmates on psychotropic medications are re-evaluated at scheduled intervals. Referrals for unscheduled follow-up assessments can take place any time if therapists have concerns for an inmate’s mental status or well being at any time prior to their scheduled appointment.
State law specifies that a person suffering from a mental illness and who poses a threat to self or others, may be involuntarily committed to a state mental hospital for evaluation or treatment. Involuntary commitments require certification by two licensed physicians who are generally DOCR contract physicians; however, emergency room physicians may also be accessed in a crisis. Most inmates who are involuntarily committed to a state hospital are transported to either Springfield Hospital Center (SHC) or Clifton T. Perkins Hospital. The hospital site is determined by the inmates required level of security. The DOCR psychiatric nurse coordinating this admission must obtain pre-approval by the state’s Central Admission and Referral Center (CARC) prior to admission to any of these hospitals.
Competency to stand trial refers to a defendant's ability to understand the charges against him/her and his/her ability to cooperate with legal counsel in the preparation of his/her defense. If the court suspects that a defendant may lack competence to stand trial because of a mental illness or intellectual deficit, the court may order a competency screening evaluation by a court appointed provider. If the diagnostic screener finds that competency evaluation needs to be performed, the defendant is ordered to a State hospital for a full competency evaluation. Individuals hospitalized under competency statutes are usually transported to Springfield State Hospital, but hospitalization at Clifton T. Perkins may occur if the person has charges of a violent nature, which prohibit admission to Springfield.
Crisis Intervention Unit:
The Crisis Intervention Unit (CIU) at MCCF exists to provide a safe, humane environment for incarcerated offenders suffering from acute or chronic mental illness which precludes them from effectively adapting to the general population environment. While the purpose of CIU housing is to offer a therapeutic environment and therapeutic interventions to stabilize individuals so they may safely return to general population, some individuals with serious chronic or acute conditions may remain in CIU for the duration of their incarceration. CIU defendants have direct access or know how to access mental health services and/or inquire about therapeutic programs. While individuals in CIU are eligible to participate in individual therapy, skills groups or other psychotherapeutic groups, eligible persons may also attend other programs or activities outside of CIU. The Crisis Intervention Unit therapists, aside from the Re-entry therapists from the Department of Health and Human Services, may also contact community resources or family members to enhance the delivery of mental health services and prepare discharge plans.
Dialectical Behavior Therapy (DBT):
MCCF boasts of the first jail-based DBT program in the nation that meets all of the requirements for DBT. DBT constitutes the primary therapeutic modality practiced by all DCOR therapists and the program is currently offered to all individuals housed in the Crisis Intervention Unit. DBT is a principle-based complex method of treatment that borrows from a combination of cognitive/behavioral and psychodynamic therapies as well as from Zen mindfulness practice. DBT therapists utilize a variety of therapeutic strategies to help clients problem-solve and to change maladaptive behaviors that cause significant impairment in most areas of their lives. Although DBT was originally designed to treat Individuals with severe emotional and/or cognitive dysregulation, who engage in self-injurious behavior and pose a high risk for suicide (i.e. individuals with Borderline Personality Disorder), DBT has been adapted for and proven to be very effective in the treatment of other disorders such as substance abuse/dependence and/or co-occurring disorders, PTSD, eating disorders and other.
DBT Skills Groups:
DBT skills training takes place in a group context. These groups may be co-lead by CIU therapists, Officers, and/or graduate-level Psychology interns. In these groups, inmates are taught skills that address problems and maladaptive behaviors exhibited by most individuals who cannot regulate their emotions and thus may pose a risk to self or others.
The specific DBT groups include:
- Core mindfulness skills.
- Interpersonal effectiveness skills.
- Emotion regulation skills.
- Distress tolerance skills.
These skills groups are an essential component of DBT. They are offered primarily to individuals housed in CIU who are committed to this program.
Former CIU participants may also return to CIU to attend these groups if cleared by his therapist due to his committed to DBT and benefits derived from the groups. Each group leader reserves the right to screen individuals on the waiting lists and to choose those who are clinically appropriate for the group.
Each skills group has specific requirements that also include behavioral expectations and group rules. The requirements are clearly articulated to the participants by the group leader. Failure to comply with these requirements may result in termination from the group.
Weekly individual therapy is an essential component of the DBT program and it is offered to all inmates housed in CIU. DOCR therapists are assigned a caseload in CIU and individual therapy sessions are contingent upon the individual’s ability to participate in therapy. During individual therapy sessions, the individuals review DBT homework, focus on treatment goals and conduct behavioral chain analysis aimed at developing insight about the maladaptive responses that negatively affect their lives.
Graduate Student Intern Program:
This program provides a valuable service to Mental Health Services section.
The interns are graduate-level students of Psychology or Counseling from local universities who work for academic credit only. They are recruited, oriented, trained, supervised, and evaluated by the chief of Mental Health Services. Most student interns remain at MCCF for an academic year and are assigned an average of six to ten individuals weekly either for individual counseling or group therapy.
Inmates diagnosed with a substance abuse or addiction are referred to the Jail Addiction Services (JAS) program. This program is run by addictions counseling therapists of the Montgomery County Health and Human Services. Admission to JAS is contingent upon meeting eligibility requirements as established by the JAS protocol.
Community Re-entry Services (CRES):
CRES focuses on providing services to mentally ill Montgomery County residents who are housed in CIU. Non-Maryland residents, and individuals not housed in CIU are referred to the Jail’s Re-entry Program to develop a discharge plan that will refer them to appropriate community based mental health treatment programs.
Projects Assisting Transition from Homelessness (PATH):
In addition to CRES, community re-entry services and development of discharge plans are also provided by PATH counselors and therapists whose primary goal is to assist individuals diagnosed with chronic and persistent mental illness.
Mental Health Training:
Psychologists and Therapists Training:
Psychologists and Therapists receive training in specialized areas to stay abreast of current developments in the mental health field. Given that the primary therapeutic modality in CIU is Dialectical Behavior Therapy, continued training and practice in this area is required. Additionally, training to meet licensing requirements is mandatory.