Healthcare, Custody, and Control

I recently attended the National Sheriffs’ Association (NSA) conference in Washington D.C. and was pleased to see the American jail as a significant topic for planning, education, training, and advocacy on Capitol Hill by the NSA and American Jail Association. Jails act as a central hub for the criminal justice system and are critical to our success as a society. In speaking with one of our federal partners they stated, “people in jail are still part of our community, that includes the employees and volunteers as well.” It seems our jails are finally starting to receive attention and recognition commensurate with their importance in American society and the criminal justice system.

The United States remains a leader among nations in the rate of individuals detained in jails and prisons. There are currently over 600,000 individuals in our nearly 3,000 jail systems (BJS, 2021). Not only are today’s jail professionals charged with maintaining safety and security, but they also manage all aspects of a city behind walls. One of the challenges that seems to be the most critical is maintaining the medical and mental health of those incarcerated in our jails.

The title of this article was intentional. Many corrections professionals with years on the job were trained with the mantra “care, custody, and control” drilled into them from day one of the academy. Over time, the career has become more complicated, and it is not uncommon to go from an observer to director, to teacher, to enforcer, to social worker, to court or health care monitor and liaison. While basic and in-service training has improved in many agencies across the nation, there is still work to be done. The importance of interdisciplinary collaboration and leadership has never been greater.

The Changing Jail Population

We can all attest to the many challenges in jails that have occurred over the past several years with managing the pandemic, fighting the opioid crisis, and engaging with criminal justice reforms. The implementation of several Criminal Justice Coordinating Councils (NIC, 2024) and changes in state laws throughout the country resulted in faster court processes and more releases back to the community. To many corrections professionals, these changes resulted in jails being compelled to manage individuals who are physically and mentally sicker and more frequently struggling with a substance use disorder. This caused additional concern for many in the field related to inmate health, as well as violence and disorder within our jail facilities.

Over time, health care has become one of the most challenging areas to manage in American jails. The people who are booked are often in a medical or mental health crisis, and/or under the influence of an illicit substance. At intake, jails may be compared to an emergency room where initial screening is critical to identify concerns and begin treatment as soon as possible. Effective physical and mental health screenings should take place by a qualified health professional as soon as possible after arrival in your facility.

Individuals who are identified as having medical or mental health needs should be evaluated and a care plan put in place. While all clinical decision-making is left to the professionals, this is where custody personnel can provide a supporting surveillance role. Officers are vigilant and have the opportunity to see changes in behavior that medical personnel may not see, merely due to the length of interaction. Medical and mental health emergencies are regularly called by custody personnel, and this is why effective collaboration within our jails is critical.

Collaboration at All Levels

One of the positives that came out of the COVID-era, was increased communication and collaboration between custody and medical. The days of “that’s not my job” are hopefully gone forever as we all realize the importance of working together toward common goals. Life and safety are critical, and a team focus has to start from the top.

Effective leadership is key to the success of any organization. “Big picture thinking” and staying in tune with national, state, and local standards are very important (e.g., standards of the National Commission on Correctional Health Care, state or county jail standards, standards of American Correctional Association, etc.). Interdisciplinary leadership teams that include custody, medical and mental health administrators have the ability to set the tone of collaboration to encourage custody and medical to become force multipliers. Custody professionals ensure safety and security, they are also able to provide important information regarding overall inmate condition and behavior during incarceration. Medical and mental health professionals make clinical decisions and when the two groups work together safety is improved. When inmates receive effective medical attention and treatment, they are less likely to file grievances or create violence and disorder in the jail environment.

Mid-level managers and supervisors are critical to be the bridge and ensure effective implementation of custody and medical services. Interdisciplinary training on impactful topics such as suicide prevention, contraband prevention and detection, medication-assisted treatment, and managing the mentally ill can inform and assist medical and custody personnel to be more effective with an educated and collaborative mindset.

There should be, at a minimum, an annual review of all policies and procedures for custody and medical services. All policies should be compared and contrasted to ensure they are complementary to one another and not in conflict. Policies should be based on accepted national-level standards. Our custody and medical supervisors are charged with ensuring these policies are followed (i.e., auditing security and medical operations) to guarantee safety and a constitutionally required level of health care is provided.

“Boots on the ground” line officers and medical personnel provide individual-level services and deserve appreciation and recognition for having extraordinarily complicated and impactful duties each shift. These professionals make a city behind walls operate in real time. When leadership has effectively set the tone of professionalism and collaboration, policy and training, the direction will be clear, and these heroes will exceed expectations and manage the incarcerated population with a very high level of success. Some unfortunate incidents will occur, but our best efforts will minimize these and provide a stable jail environment.

Taking Care of Business and Ourselves

While jail and medical professionals work hard to manage and care for those in custody, we sometimes forget to take care of ourselves. The stress and illnesses found within jail walls are not unique to those detained, they are felt and suffered by those in charge as well. Consistently focusing on others can result in negative impacts to the health and well-being of corrections officers, medical professionals, and volunteers.

In addition to healthy eating and regular exercise, one area we should all keep on the front burner is suicide prevention. Those of us who have worked in corrections for any significant amount of time have likely experienced the death of another. Sometimes, we can all feel isolated or overwhelmed in our personal and/or professional lives. Many agencies have instituted employee assistance programs that are great but sometimes there remains resistance to opening up to peers or a department-related group. There are other resources out there and many people want to help, we all need to be open to asking for help and being observant to identify those who may need help. While some may be aware, the “988” suicide prevention and crisis hotline is available 24/7. Simply dial 988 and there is someone always available to help you. They manage a national network of services and can coordinate local care and resources for you that are in line with national standards and best practices.

Stay Safe and Healthy

The professionals working and volunteering in our nation’s jails are often overworked and underrecognized. Whether you’re sworn or civilian, a medical professional, or a volunteer, you are responsible for maintaining all of life’s necessities and care for people who don’t want to be there and often import a disproportionate amount of medical and mental illness. Please remember to take care of yourself, we all need to be at our best to continue to provide the highest levels of health care, custody, and control.

Thank you for everything you do, stay safe and healthy!

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Fred Meyer, MA, CJM, CCHP has 27 years of experience working in county jails. Starting in an Illinois jail in 1996 then moving to Las Vegas in 1999, he has professional knowledge in all areas of safety, security, management, and leadership. In 2018, Fred was appointed as deputy chief with the Las Vegas Metropolitan Police Department (LVMPD) where he was responsible for the largest jail operation in the state of Nevada. Fred retired from the LVMPD in 2022 and currently leads the consulting arm of the National Commission on Correctional Health Care. He is an instructor and graduate of the National Jail Leadership Command Academy, graduate of the Jail Executive Development Program, is a Certified Jail Manager, and sits on the AJA Board of Directors in the role of Parliamentarian. For more information, he can be contacted at fredmeyer@ncchcresources.org.

References

Correctional Populations in the United States, 2021—Statistical tables | Bureau of Justice Statistics. (n.d.). Bureau of Justice tatistics. https://bjs.ojp.gov/library/publications/correctional-populations-united-states-2021-statistical-tables

National Commission on Correctional Health Care. (2024, January 4). NCCHC–National Commission on Correctional Health Care. https://www.ncchc.org/

988 Suicide & Crisis Lifeline. (n.d.). 988 Suicide & Crisis Lifeline–Call. Text. Chat. 988 Suicide & Crisis Lifeline. https://988lifeline.org/

Welcome to Guidelines for Developing a Criminal Justice Coordinating Council | Guidelines for developing a Criminal Justice Coordinating Council. (n.d.). https://info.nicic.gov/cjcc/home

Wp-Support. (2022, November 1). New Suicide Prevention Resource Guide for corrections. National Commission on Correctional Health Care. https://www.ncchc.org/new-suicide-prevention-resource-guide-for-corrections/