Systems monitoring and quality improvement

Abstract Class action litigation that includes a focus on constitutionally inadequate correctional mental health care has been a major and effective force in jail and prison reform during the past four decades. Benefits to correctional mental health systems resulting from such litigation have included increased resources to implement basic policies and procedures that are necessary for a constitutionally adequate system. Following the passage of the Prison Litigation Reform Act of 1995, newly initiated consent decrees related to class action litigation involving correctional mental health services significantly decreased. The reduction in litigation related to this act followed from limiting the discretion of judges in approving such decrees that were previously allowed. Private settlement agreements and/or memoranda of agreement or their equivalents (“Agreements”) have been substituted for the consent decree process. Although judicial enforcement of these Agreements is weak, the monitoring process is very similar to those previously used with consent decrees. This chapter will summarize the monitoring process frequently involved in an Agreement resulting from a class action lawsuit specific to a correctional mental health care system. Emphasis will be placed on the importance of developing a quality improvement process that should ultimately eliminate the need for a monitor external to the mental health care system.