Table 3.

Mental Health Staffing and Supplementary Services.

Mental Health Staffing	Availability	Coverage	Distinction by Jail Size
Overall Mental Health Staffing	Among all study jails (n = 34), participants, nearly half (n = 15) reported the absence of routine onsite mental health staffing of any kind (e.g., counselors, psychiatric prescribing providers)	Most jails (n = 21) reported that onsite mental health staffing of any kind was limited to once a week or less, only in crises, or nonexistent Of jails with any onsite mental health staff available (n = 19), most had (n = 13) onsite staffing at least 2 times per week; six jails had onsite staffing once per week	The majority of jails (n = 9) with full-time or nearly full-time onsite mental health counseling tended to be larger jails with a capacity of more than 500 incarcerated individuals The majority of jails (n = 17) with limited (once a week or less) or no onsite mental health counseling tended to be jails with capacities of 200 or fewer incarcerated individuals
Medication Management Staffing	Less than a third of jails (n = 10) reported regularly-scheduled onsite prescribing mental health providers (e.g. psychiatric nurse practitioners or psychiatrists) available for medication management and referrals Other jails (n = 9) reported using a psychologist or mental health counselor to evaluate individuals and make medication recommendations to a prescribing provider not specifically trained in prescribing psychiatric medications (e.g. physician, physician’s assistant, or nurse practitioner)	Most jails (n = 25) reported limited onsite prescribing mental health provider coverage at once a week or less, or none at all Almost all jails (n = 9) reporting onsite prescribing mental health provider coverage reported it as occurring more than once a week
Onsite Counseling Staffing	Most jails (n = 18) reported regularly- scheduled onsite counseling staff (e.g., psychologist, social worker, or therapist) Almost half of jails (n = 15) reported no onsite mental health counseling coverage or only occurring on an as- needed basis (e.g., for court evaluations) or in crisis circumstances (e.g., suicide assessments) Other jails (n = 11) reported full-time or nearly full-time onsite mental health counseling	Most jails (n = 21) reported limited onsite counseling staff coverage at once a week or less, or none at all Most jails with regularly-scheduled onsite counseling staff (n = 11) reported onsite counselor coverage at more than once a week
Telemedicine- Based Mental Health Staffing	Some jails (n = 9) utilized telemedicine for medication management and/or mental health counseling in addition to or instead of onsite staff	Most jails providing telemedicine services (n = 6) reported it as occurring once a week or less Most jails (n = 24) reported that a prescribing provider or a mental health counselor was available 24/7 via phone or telemedicine to discuss patients deemed to be in crisis
Community and Prison System Resources	Other jails (n = 7) relied on offsite community mental health agencies to supplement a lack of onsite mental health staff One state utilized a program in which jails unable to provide sufficient health care onsite could, for a fee, transfer a limited number of individuals to the state prison system for care; half of jails (n = 6) using this program reported using it specifically for individuals with severe mental illnesses	Community mental health service coverage was often described as ad hoc and was used to address episodes considered to be psychiatric emergencies