Behavioral Health Strategies in
Restrictive Housing:
The Kansas Model
Ray Roberts
Viola Riggin
Secretary of Corrections
Kansas Department of
Director of Healthcare, UKP
Kansas Department of
Why review restrictive housing
• Bring the State into compliance with standards
associated with the caring for mentally ill offenders in
Restrictive Housing (RH).
• Increase access to treatment for the mentally ill in RH.
• Better understand the clients we serve in RH units.
• Provide a safe environment in RH for staff and offenders.
• Provide a safer plan for releasing mentally ill offenders
from RH.
Background - KDOC
Special Needs Offenders
• The table shows the number
of offenders requiring
consistent mental health
follow up due to serious
mental illness. The graph
indicates historical numbers
from FY09 through FY14.
• On average, the special
mental health needs
population increased 13.8%
each year (year-to-year)
between FY09 and FY14.
Average Special Needs
FY 9
FY 10 FY 11 FY 12 FY 13 FY 14
KDOC Statistics for Mentally Ill
Mentally Ill Inmate Population
As of September 4, 2014 | Of the 9,616 total KDOC inmate population:
1,057 (11%)
Severely Persistently Mentally Ill (SPMI)
Serious Mental Illness (SMI)
1,827 (19%)
673 (7%)
Transient Mental Health Issues
SMI Housed in RH Units
SPMI Housed in RH Units
• In 2011: 646 mentally ill offenders, representing 7.0% of the population,
were housed in RH Units.
• In 2014: the number reduced more than half to 292 mentally ill
offenders in RH Units.
• Today, 3% of the total SMI population and 0.48% of the SPMI population
are housed in RH Units.
Development Team
Secretary of Corrections established a multi-disciplinary
development team to investigate and improve the overall
identification and treatment of the mentally ill housed in RH Units.
Team members included:
• Deputy Secretary of Facilities Management
• Director of Healthcare Services
• Mental Health Program Administrator
• Wardens from five prisons with largest population of mentally ill in
RH Units
• Classification Staff
• Deputy Warden for Programs
Development Team: Primary Goals
• Buy-in from Wardens and classification staff
• Standardize definition of “long-term restrictive housing”
• Review and establish policies to affect long-term change in RH
• Address safety issues by defining the role of members of the
“Restrictive Housing Review Board’ to a multi-disciplinary team
• Develop facility space for treatment / programming activities
• Identify alternative and creative means to provide treatment
• Develop additional training for behavioral health professionals
and operations staff
• Establish outcome measures to track progress
MH Classification
Type of Program
MH Levels 4, 5 & 6
MH Level 3 in crisis
 RH with BH TX Program
(Due Processed)
 Treatment Units
MH Levels 3, 4, 5, & 6
 RH with BH TX Program
 Treatment Unit
MH Levels 3, 4, 5, & 6
 Treatment Unit
MH Levels 3, 4, 5, & 6
 RH with BH Treatment
MH Levels 3, 4, 5, & 6
 Treatment Unit
MH Levels 3-4
 RH with BH TX Program
 Treatment Unit
MH Levels 3-4
 RH with BH TX Program
 Treatment Unit
MH Levels 3 – 4
 RH with BH TX Program
All Other
RH Units
MH Levels 1 – 2
 RH with Access to BH TX
no formal program
Type of program by
facility –
are designated
facilities for
offenders requiring
the highest level of
(level 5 & 6)
Example: RH Unit with Treatment
LCMHF will be the primary treatment facility for the highest acuity mentally ill
offenders. LCMHF houses the following Mental Health Level 3 – 6 offenders:
• 1 unit (30 beds) RH-BH Treatment
• 3 units (90 beds) Treatment Units
TCF-TU will be the primary treatment facility for the highest acuity mentally
ill female offenders.
• 1 unit (10 Bed) RH- Behavioral Health Treatment Unit
• 1 unit (15 Bed) TU-Treatment Unit for Females
• Provide approximately 10 hours of BH treatment and 10 hours of KDOC
activities weekly to offenders who have proven to be especially violent
when placed less-structured environments.
• Allow an avenue for offenders to move toward a less-structured BH unit as
violent behavior lessens.
Phase I: Training
Staff within RH units receive specialized training from an advanced
curriculum. Those requiring specialized training include:
• Facility Administration
• Unit management staff
• Security staff in special
placement units
• Nursing staff
Specialized training should focus on:
• Characteristics/risk factors
associated with managing
offenders in RH
• Understanding mental illness
• Recognizing symptoms of
major mental disorders
• Suicide/self-injury prevention
• Detecting signs of deterioration
• Crisis response
• Indicators for referrals
• Motivational aspects
Phase II: Measuring Progress
Secondary review process
• Central Office BH program staff reviews offenders placed in RH and
treatment units to ensure offenders with SMI are recognized and provided
• Self-monitor through the quality assurance process by on-site clinical staff
monthly – site level
• Central Office BH program staff conducts at least quarterly monitoring for
compliance with program requirements.
• Submit monthly report
• Identifying numbers of offenders in each program
• Additional outcomes to the Deputy Secretary of Facilities Management
• Review offenders with recurring patterns of RH placement of more than 6
times in a 12-month period and with a MH classification of 3-6.
• Develop outcome measures for clinical and administrative management of
mentally ill offenders in RH.
Obstacles During Program Development
• Establishing a balance between safety and treatment options
• Behavioral health clinical staff:
• Lack clinical staff /funding for staff
• Where to place treatment units that had adequate community support
• Lack of space/space not adequate for treatment needs
• Current staff training and skill sets did not meet needs identified
• Lack of staff to mine data to identify the types of offenders and their needs
• Operational Issues:
• Training did not meet site staff needs
• Correctional officer staffing levels and skill set had to increase
• Safety concerns for dealing with erratic behavior
• Cost – funding
• Burnout for staff who work high-intensity units
Key Successes: What’s Changed
• Early support from the Governor
• Led to legislative support on budgeting for MH staff increases
• Buy in by senior management
• Development of a team approach
• Train staff often and early
• Participation of line staff to change and add ideas during the development
phase provided great enhancement ideas
• Developed a draft plan that forces the function to create individualized case
management and treatment through a multi-disciplinary approach
• Screened clients and mined the data to identify who needed services and
where they were
• Made the data important
• Implementing follow up/monitoring tools to maintain the program long term
Resources Used in the Program
• Dr. Lorelei Ammons, Psy.D. Kansas University Physician Inc. Kansas Department of Corrections.
• American Correctional Association (2003). Standards for Adult Correctional Institutions 4th Edition.
• American Correctional Association (2012). 2012 Standards Supplement.
• American Correctional Association (2014). Town Hall Meeting on Offenders with Mental Illness In
restrictive Housing. January, Tampa, FL.
• American Correctional Association (2014). Plenary Session on Offenders with Mental Illness in
Restrictive Housing. September, Salt Lake City, UT.
• American Psychiatric Association (2012). Position Statement on Segregation of Prisoners with Mental
• Aufderheide, D. (2013) Mental Illness in Administrative Segregation: 10 Key Components to
Bulletproof Your Mental Health Program Against Litigation.
• Brown, J. (2013). ACLU Uncovers Increased proportion of Mentally Ill Inmates in Solitary. The Denver
• Dvoskin, Joel; Controversies Concerning Supermax Confinement and Serious Mental Illness; based on
Metzner, JL & Dvoskin, JA. (2006) Controversies concerning Supermax Confinement and Mental
Illness. Psychiatric Clinics of North America. Philadelphia: Elsevier. Volume 29, No.3.
• Metzner JL, Dvoskin JA: An Overview of Correctional Psychiatry. Psychiatric Clinics N Am, 29: 761772, 2006.
• Morgan DW, Edwards AC, Faulkner LR: The adaptation to prison by individuals with schizophrenia.
Bulletin of the American Academy of Psychiatry and the Law, 21, 427-433, 1993.