HRRJ's Medical and Mental Health Services Changed the Landscape of Inmate Care
Sharon P. Scott, MPA
Hampton Roads Regional jail (HRRJ) was founded a quarter-century ago with the objective of alleviating overcrowding issues in five regional jurisdictions: Newport News, Hampton, Chesapeake, Portsmouth, and Norfolk. The agency has undergone a transformative journey, adapting its mission to exceed conventional standards of medical and mental health services in jails. As leadership and staff prepared for the scheduled April 2024 closure, they were honored to be able to share the profound impact HRRJ made in effectively providing care to a diverse inmate population. Professional services included the chronically ill, mentally challenged, and individuals with behavioral issues.
Medical and Mental Health Care at HRRJ
From its inception, HRRJ leaders have been unwavering in their commitment to prepare inmates for successful reintegration into society. What began as an agency formed to address overcrowding concerns has, over 25 years, evolved into a beacon of excellence, consistently outperforming local jails by executing necessary medical and mental health provisions. HRRJ’s core mission has remained steadfast during years of growth and change, which ensured the well-being of its inmate population.
HRRJ’s 24-hour a day clinical operations were a testament to the organization’s dedication to provide a spectrum of on-site medical services. This included acute care, routine healthcare visits, emergency response, chronic care, and specialized clinics. HRRJ’s facility, staffed by licensed professionals, epitomizes a multi-disciplinary unparalleled approach to patient care among its peer facilities.
The inmate care journey at HRRJ, which ranged from admission to release, was a well-orchestrated process, encompassing diverse healthcare pathways. Clinic services spanned a gamut of interventions, from intake assessments to routine healthcare visits, sick call triage, emergency response, chronic care, telehealth, annual wellness follow-ups, on-site specialty clinics, and coordination of off-site specialty medical appointments. The laboratory at HRRJ provided point-of-care services, and conducted routine tests such as blood glucose, urine dipstick, pregnancy, and drug screening.
Equipped with state-of-the-art panoramic digital x-ray equipment, the Dental Suite adhered to the highest standards. Dental services, extending beyond routine check-ups, included mitigation of infection and pain, restorations, extractions, and emergency care. The pharmacy at HRRJ operated under an accredited pharmaceutical management program, providing on-site prescription distributions twice a day. This comprehensive program covered formulary and non-formulary distributions, record-keeping, licensure, DEA management, utilization management, patient compliance, and secure storage of medications.
HRRJ’s Dialysis Services Suite, an essential component of inmate healthcare, was comprised of two dialysis chairs and two dialysis units, which enabled dual treatment. The frequency of operations, which occurred three days per week, ensured continuity of care and the need for costly and time-consuming off-site treatment was eliminated.
Standard imaging needs were provided by a licensed X-ray technician and accommodated on-site through X-ray services approximately 20 hours per week, available on a PRN or STAT basis.
When mental health is included, the landscape of inmate healthcare is complete. This area of care became a top priority at HRRJ, as inmate needs changed with the diverse population. Recognizing that approximately 90 percent of the inmate population required some level of mental health intervention, leadership pioneered initiatives to address this complex aspect of inmate well-being. Former HRRJ Mental Health Director Eric Jones emphasized the critical importance of comprehensive suicide prevention and mental health programs within correctional facilities. “These programs, tailored to the complex needs of incarcerated individuals, were instrumental in mitigating the risk of successful suicides,” Jones said.
Effective collaboration between security and mental health professionals redefined HRRJ’s approach to mental health care. The establishment of a multi-disciplinary team, which included security personnel, gave rise to a comprehensive care model that incorporated behavioral and cognitive approaches. This path marked a significant departure from the prior model, which failed to effectively support the diverse inmate population’s needs.
In addressing multifaceted needs of inmates struggling with mental health challenges, the mental health professionals, correctional staff, and outside healthcare providers collaborated to ensure comprehensive care for at-risk individuals. The post-suicide watch follow-up process at HRRJ was a testament to the commitment of patient care. This process involved further mental health evaluations, personalized counseling, and individualized care plans.
HRRJ’s focus shifted towards improving the transition or step-down process for inmates. The phased approach to transitioning back to the general population involved a comprehensive assessment of the individual’s readiness, appropriate support, ongoing monitoring, and continued mental health services. Notably, the organization significantly reduced the number of suicides, and celebrated 58 months without a suicide in 2023.
Mental health initiatives at HRRJ have been cohesive and services extended beyond addressing suicide incidents. Healthcare professionals successfully tackled other mental health issues, including anxiety, depression, and severe mental illnesses (SMI). Active listening and vigilant care have been crucial components and became the catalyst for achieving positive outcomes.
HRRJ’s conglomerate of professionals remained committed to addressing the complex mental health needs of incarcerated individuals. This commitment was evident through continuous improvement to approaches of care and adopting a collaborative stance. The mental health department provided on-site care seven days a week, including holidays. Services included psychiatry, individual therapy, and behavior management plans. Both jail officers and mental health professionals were trained in suicide prevention, verbal de-escalation, and crisis intervention.
Strategic Housing
In general, inmates with mental health needs were strategically housed in distinct housing areas, targeting specific requirements:
1 & 2. Acute and Secure Mental Health Care housed inmates diagnosed with SMI, requiring suicide watch observation in suicide-resistant cells. Mental health professionals conducted daily rounds to assess and support inmates. Psychiatry services were offered through Telehealth five days per week, with an on-call psychiatrist available 24 hours a day, seven days a week. Officers conducted constant one-to-one watches or 15-minute random watches.
3. Behavioral Modification and Treatment Unit (BMU) was proposed, but not brought online before closing. It was designated for inmates who experienced a mental health crisis with less severe needs and/or significant character pathology, who had threatened or engaged in violent acts. Programs and treatment services were tailored to inmates contemplating self-harm.
4. Transition and Recovery Unit (TRU) was proposed, but not brought online before closing and would have housed inmates with SMI or Mental Health Special needs, requiring increased programming and treatment in a structured environment. Inmates whose crisis had ended would have stepped down to TRU, using a multi-disciplinary treatment approach and group therapy.
5. Mental Health General Population (MHGP) exclusively housed inmates with SMI and/or less severe forms of mental illness.
Over time, the primary services at HRRJ shifted towards housing inmates with acute medical or mental health diagnoses, constituting approximately 80-90 percent of the inmate population by 2024. Captain T. Nash, who oversaw Medical and Mental Health Services, highlighted the emphasis on mental health initiatives, crisis intervention, mental health first aid, and suicide prevention, which reflected a commitment to comprehensive inmate population care.
Noteworthy is the increased staff involvement in inmate care, including one-on-one counseling and group sessions. This holistic approach has likely contributed to improvements in inmate behavior and a reduction in disciplinary issues.
Superintendents Colonel Jeff Vergakis and Lieutenant Colonel William Anderson expressed gratitude for all stakeholders and partnerships which played a pivotal role in making HRRJ a diverse and effective regional agency. They acknowledge the unwavering role that quality staff and other entities played in the agency’s success, Vergakis said, “As HRRJ closes its doors, the legacy of excellence and commitment to inmate well-being and transition will leave an indelible mark on the landscape of inmate care.”
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Sharon P. Scott MPA is the Public Information Officer for Hampton Roads Regional Jail, is a Notary, Motivational Speaker, Former Journalist, Retired Councilwoman, and President of Full Circle Foundation, Inc., a nonprofit 501c3, Scott holds a Master’s in Public Administration and Bachelors in English. Lt. Col. Anderson contributed to this article.