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Referral form for family members to identify mental health needs of people in jail

Family members of people in custody can inform the jail of the person’s mental health needs.

Local Examples

Santa Cruz County, CA Santa Cruz Jail

  • The jail provides an online form, the jail crisis intervention team referral, that people can fill out to refer someone in custody to the jail's Crisis Intervention Team.
For a sample from this example, see this resource:

Los Angeles County, CA Los Angeles County Sheriff's Department

  • The inmate medication information form can be used to provide information on the mental health and medical needs of a person in the jail.
  • Promoted through National Alliance on Mental Illness, this form is now in use in multiple facilities in California.
For a sample from this example, see this resource:
For more information on this example, see this resource:

Policy & Practice


3 - Increase connection to treatment

Last updated: April 21, 2019