For overcoming mental health challenges and substance use disorders
The Fairfax-Falls Church Community Services Board (CSB) has a clinical staff on site at Fairfax County's Adult Detention Center to provide behavioral health services to individuals brought to the ADC. CSB services offered at the ADC include crisis response, assessment and referral. Group counseling is also offered, with the goal of helping individuals establish healthy skills while they are at the ADC.
Crisis intervention is a large part of the CSB’s work at the ADC. The onsite CSB staff partners with staff from the Fairfax County Sheriff’s Office staff and CSB Emergency Services to address emergency mental health needs. Case management services are also being provided to link individuals to supports they need to be successful after they return to the community and to reduce the likelihood of their return to the ADC.
CSB staff at the ADC – Who they are and what they do
CSB employees who work in the ADC’s Behavioral Health section have different roles and qualifications.
Therapists – Therapists have Master’s degrees in Mental Health Counseling, Social Work or a related field. They assess individuals and diagnose mental health and substance use disorders. Therapists partner with psychiatric staff to contribute to assessment and ongoing evaluation. They also provide mental health and substance use disorder counseling and education, including separate substance abuse education groups for men, women and Spanish-speaking men. Therapists and nurses work to assist with connections to community providers when assistance is needed throughout treatment and at time of release from the ADC.
Psychiatrist and Nurse Practitioner – A psychiatrist and a nurse practitioner perform assessments and attempt to incorporate collateral information from sources that are available when the assessment is conducted. They prescribe medications as indicated based on the assessment and continue to monitor individuals while they are at the ADC.
Nurse – A CSB nurse manages the ordering and administration of medication, and performs assessment, counseling and ongoing evaluation. The nurse also educates patients at the ADC about medications and about managing mental illness, and provides feedback to therapists and psychiatric staff.
Opportunities for behavioral health intervention
When an individual is brought into the Adult Detention Center, the Sheriff’s Office staff uses screening protocol to identify whether the individual may have substance abuse and/or mental health needs. Referrals are made to CSB’s onsite behavioral health staff when someone is identified as having a history of mental illness or substance use disorder. All individuals at the ADC are continually being monitored by deputies to identify possible mental health needs. Deputies who have received Crisis Intervention Team (CIT) training are located throughout the ADC, and all are able to make referrals to CSB’s behavioral health staff as needed. Referrals, by ADC staff or self-referrals, can be made at any time for both mental health and substance use disorder services.
Individuals coming into the Adult Detention Center are screened to determine their psychiatric needs. Access to the psychiatrist is triaged based on the seriousness of the symptoms and risk. Medications may or may not be prescribed, depending on various factors. Medications have the potential to reduce an individual’s symptoms, but there are risks as well as benefits that guide prescribing decisions. Factors considered when deciding whether to prescribe medications may include:
- Seriousness of mental illness
- Recent substance use
- Nature of offense
- Medications in question/requested
- Potential for hoarding/overdose
- Other medical illness, such as diabetes or hypertension
- Length of expected stay at the ADC
- Information available to CSB staff in electronic health record or from other psychiatric provider
- Willingness to having medications prescribed
Psychiatric medications and substance use
When an individual presents with psychiatric symptoms, the possible role of substance use is also evaluated. This evaluation is based on information that is available to the CSB staff and may involve information from friends and relatives, medical records, physical evaluation, and laboratory results or other information from the ADC Medical Team. The underreporting of symptoms and the effects of substances on mood states and other symptoms make accurate diagnoses difficult. Substance use itself can produce psychiatric symptoms that will improve significantly with abstinence. Careful monitoring of individuals with substance use histories allows psychiatrists to make informed decisions with regard to prescribing.
Behavioral health staff members assess individuals and try to identify risk factors that would require a jail transfer, Emergency Custody Order or Temporary Detention Order. An individual can only receive medications over their objection if their risk factors allow them to be transferred to a mental health hospital.
An individual is placed on restricted status when they are a risk of harm to self or others and may be pending transfer to a state hospital. Behavioral health staff provides ongoing assessment to monitor risk factors and housing status with a goal of moving individuals out of restricted housing and into direct supervision.
Benzodiazepines are a type of tranquilizer. Familiar names include Valium and Xanax. Benzodiazepines are commonly abused. This abuse is partially related to the toxic effects that they produce and also to their widespread availability. They can be chronically abused or, as seen more commonly in hospital emergency departments, intentionally or accidentally taken in overdose. Death and serious illness rarely result from benzodiazepine abuse alone; however, they are frequently taken with either alcohol or other medications. The combination of benzodiazepines and alcohol can be lethal.
Anyone can self-refer for Behavioral Health Services. Individuals known or suspected to have a mental illness are given priority. Individuals who are not on restricted status may attend groups.
All individuals are screened by Sheriff’s Office staff and are referred to CSB behavioral health staff when risk factors are present. People needing services will be seen by a CSB therapist, nurse and/or psychiatrist, who will be evaluating for the potential of a diagnosis. If one is indicated it will be given.
The goal is to see individuals and offer services before they are a risk to self or others. They can receive services even if they are not at risk of harm.
Psychiatric medications are complex, and decisions about when and what to prescribe are not always clear. Psychiatrists may make different decisions about what to prescribe based upon the individual’s current presentation and circumstances.