Chapter 5 – Adult Custody and Security Operations

54040.10 Return to Triage and Treatment Area/Receiving & Release

• Upon the return of the victim from the SART/SANE Exam, the offender will be assessed following Inmate Medical Services Policies and Procedures (IMSP&P). The TTA Registered Nurse will also complete a request for an emergent Suicide Risk and
  Self-Harm Evaluation (SRASHE). Mental health staff will evaluate the victim within four hours of referral. Until that time, the offender shall be placed under constant and direct supervision to ensure he/she does not attempt to hurt him/herself or someone else.

• Staff are reminded to be aware of warning signs of post-trauma mental health problems. These behaviors would typically be a change from their usual behavior prior to the alleged assault. No single behavior listed below indicates mental health problems, but if several or more are present you should make a referral to or consult with the mental health program. 

  • Sleep problems

  • Agitation or restlessness (for example, pacing in the cell or housing unit)

  • Suspiciousness or heightened vigilance – may have an exaggerated startled response

  • Withdrawal from customary activities and friends

  • Loss of appetite

  • May stand and stare blankly

  • Hyperactivity

  • New ritualistic or highly repetitive behavior

  • Crying or tearfulness

  • Fear of others

  • Marked change in personality

  • No longer wants to engage in activities

  • Self-injurious or suicidal behavior

  • May be heard putting themselves down or be very critical of themselves

  • Bizarre or unusual behavior or outbursts

  • Fear of venturing beyond “security blanket” areas

  • Newly developed clinginess on friends or custody staff

  • May display impulsiveness or violence toward others (new behavior)

• Upon the victim’s return to the institution TTA or designated medical location, the custody supervisor will arrange housing for the victim.  All housing options should be considered, including input from the victim regarding his/her housing preference, a bed move, a transfer to a sister institution and safety concerns.  Consideration should also be given to housing the victim with another offender with compatible housing needs.

• Mental Health Responsibilities:

  • Within four (4) hours of the inmates return to the facility, following the SANE forensic medical examination or refusal of the SANE examination, mental health staff must complete a face-to-face emergency mental health evaluation in a confidential location. The mental health evaluation shall include a (SRASHE), determination of the patient’s mental health treatment and monitoring needs, along with arrangements made for any necessary mental health follow-up services. If appropriate, the victim shall be given educational materials to provide information related to the mental health conditions, which may result after being subjected to sexual violence and/or staff sexual misconduct. As clinically indicated, victims shall be monitored for signs and symptoms of self-harm, suicidality, post-traumatic stress disorder, depression, and other mental health issues which may arise secondary to sexual abuse.  Mental health staff shall document the evaluation on a PREA note in the Electronic Health Record System (EHRS).  Specific responsibilities of mental health staff shall be consistent with statewide IMS P&P, MHSDS Program Guide (2009), and supplemented by local operating procedures.