EFTA00059325.pdf

Frorn: to: Subjeeb Date: Attadtments: Re: EPSteln Thursday, August 1, 2019 9:24:04 AM teasieestrialf Here are his notes. Elissa R. Miler, Psy D. Chief Psychologist U.S. Department of Justice/ Federal Bureau of Prisons Metropolitan Correctional Center 150 Park Row New Y Office Fax Emai > » NERO Please I need this asap Thank you Original mess From: Elissa Miller Date: 8/1/19 7:47 • To: Lee Plourde Subject: Re Epstein > 8/1/2019 910 AM > » >» 'Elissa Miller 08/01/2019 0747 >> > For who? We need a HIPPA. Elissa R. Miller, Psy.D. Chief Psychologist U.S. Department of Justice/ Federal Bureau of Prisons Metropolitan Correctional Center 150 Park Row New York New York 10007 Office: la Fax: E-mail: »> Lee Plourde < Dr. > 7/31/2019 4:48 PM >" gr ka>1 CIto °Ai a EFTA00059325 Can you send me notes on Epstein on his suicide attempt. Thank you. EFTA00059326 Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED- Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/31/2019 10:35 Provider: Avena, Joke PsyD/DAPC Reg e: 76318-054 Unit Team: 5 Focus of Session Mr. EPSTEIN was seen today by this writer for a follow up appointment after he was removed from Psychological Observation yesterday. Sublective/Objective Presentation Mr. EPSTEIN presented in a pleasant mood and reported he is generally doing well. He stated, "I could be better," but acknowledged he Is doing as well as can be expected given his circumstances. He reported he Is going to court today for a status hearing. He stated he generally slept well last night and is readjusting to being placed back in SHU. He reported getting along well with his cell mate. He was informed of appropriate procedures for contacting Psychology staff while he is in SHU. if needed. Current Mental Status: Mr. EPSTEIN was alert and oriented. He was polite, calm, and cooperative In demeanor. He exhibited a neutral affect with appropriate range. Eye contact and hygiene were appropriate. He spoke with normal rate, tone, and volume. His thoughts were organized and coherent, with no loosening of associations or tangential, circumstantial, or irrelevant content. There was no evidence of perceptual disturbance, delusional ideation, or a formal thought disorder. He did not engage in any bizarre or inappropriate behavior. He noted having normal sleeping and eating habits. Mr. EPSTEIN explicitly denied recent and current suicidal ideation, planning, and intent. He was future- oriented and expressed a commitment to life and safety, agreeing to contact staff immediately should he experience suicidal ideation or psychological distress. He also denied thoughts of harming others. interventionist Supportive interventions and cognitive behavioral therapeutic techniques were utilized. Mr. EPSTEIN was receptive to all interventions. Froaress/Plan Mr. EPSTEIN was educated about both routine and emergency procedures for contacting psychology. There appears to be no need for follow-up at this time and he expressed willingness to self refer to psychology staff if needed. He will continue to be seen during routine SHU rounds and SRI) reviews while he is housed in SHU. He was encouraged to reach out for PRN services should he experience any psychological distress. Completed by Avena, Jolle PsyD/DAPC on 07/31/2019 10:56 Generated 07/31/2019 10 56 by Avena Joke PsyO/OAPC Bureau of Prisons • NYM Page 1 of 1 EFTA00059327 Bureau of Prisons **SENSITIVE BUT UNCLASSIFIED- Psychology Services Institution Disciplinary Process Report Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/30/2019 12:01 Provider: 'men, Darlene PsyD ReaSnaklattunianthlstentlfylnglnicumaihm Inmate Epstein was referred by Unit Manager Proto for an evaluation of competency to proceed with the disciplinary process for actions resulting in an Incident report. On 7/23/19, inmate Epstein was charged with code 228 (Tattooing or Self-Mutilation). These infractions were assigned incident report number 3282555. Background Information According to a Suicide Risk Assessment dated 7/09/19 by Dr. Miller, 'Inmate Epstein denied any history of mental health treatment, either on an inpatient or outpatient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also denied any acute mental health symptoms at this time? According to a Suicide Risk Assessment dated 7/09/19 by Dr. Miller, *Inmate Epstein denied any past or present suicidal ideation, intention or plan. He denied ever engaging in any suicide attempts or self-injurious behavior in the past? According to this writer's Suicide Risk Assessment dated 7/23/19, "It is unclear at this time if he had placed the string around his neck or if someone else did." Clinical Interview and Mental Status Exam Inmate Epstein Still does not remember how he obtained the marks around his neck. Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. There was no indication of disturbed thought process or content. Intellectual ability appeared to be above average. Personal hygiene was adequate. He denied current suicidal or self harm ideation and he agreed to immediately tell staff If he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff if he has these thoughts. Clinical knoresslon According to his last Diagnostic and Care Level Formulation Note dated 7/09/19 by Dr. Miller, "No Diagnosis, No Dx - Current? Fk linos The determination of whether an inmate is competent to proceed with the disciplinary process is based on a clinical assessment of the inmate's (1) ability to understand the nature of the proceedings, and (2) their ability to assist in their own defense. Depending on the outcome of the assessment, one of three findings can be made: (1) the inmate is COMPETENT to proceed with the disciplinary process; (2) the inmate is NOT PRESENTLY COMPETENT but could be restored to competence with treatment or (3) the inmate is NOT COMPETENT and is unlikely to become competent. Recommendations Reaarding Sanctions In the case of inmate Epstein, after a review of available psychological and psychiatric records as well as information pertaining to the offense conduct, it is determined that this inmate is: (X) COMPETENT to proceed with the disciplinary process. ( ) NOT PRESENTLY COMPETENT, but could become competent with treatment: it is recommended that the inmate for an updated competency assessment in 30 days. ( ) NOT COMPETENT and not likely to become competent. Generated 07/3012019 12 33 by Imed Darlene PsyO Bureau of Prisons NYM Page 1 of 2 EFTA00059328 Inmate Name: EPSTEIN. JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility. NYM Date: 07/30/2019 12:01 Provider. Imeri, Darlene PsyD Reg #: 76318-054 Unit Team: 5 Completed by Imeri, Darlene PsyD on 07/30/2019 12:33 Generated 07/3012019 12.33 by Imeri Darlene PsyD Bureau of Prisons NYM Page 2 of 2 EFTA00059329 Bureau of Prisons Psychology Services General Administrative Note "SENSMVE BUT UNCLASSIFIED" Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Faculty: NYM Date: 07/30/2019 12:01 Provider. Imeri, Darlene PsyD Reg St 76318-054 Unit Team: 5 Comments Psych Observation Discontinuation Note: Please see 'arnica! Contact' dated today. Completed by Imeri, Darlene PsyD on 07/30/2019 12:33 Generated 07/30/2019 12.33 by erred, Darlene PsyD Bureau of Prisons - NYM Page 1 of 1 EFTA00059330 Bureau of Prisons -SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/30/2019 12:01 Provider. Imeri, Darlene PsyD Reg #: 76318-054 Unit Team: 5 Focus of Session He was seen by writer while he was on Psych Observation. Sublective/Objective Presentation He stated he hasn't slept well at MCC-NY because he hasn't had his cpap machine. He stated It Is here and he will be able to start using it tonight. He discussed how he does not think he will able to sleep in SHU and how he does not like SHU because of the noise. He discussed issues on not getting some medication with Medical today. The "Eating/Shower Chart" indicated yesterday he ate breakfast and dinner, drank liquids, and took a shower when offered and so far today it noted he ate breakfast and drank liquids. The Psych Observation Log noted he slept, drank water, went to legal, and talked to an Inmate Companion about investments. Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. There was no Indication of disturbed thought process or content. Intellectual ability appeared to be above average. Personal hygiene was adequate. He denied current suicidal or self harm ideation and he agreed to immediately tell staff if he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff if he has these thoughts. intervention's). Supportive and educative interventions were provided. When asked about the Turning Point handouts for coping in SHU, he stated he already knows these strategies before he read the handouts and had tried them when he was in SHU the last time. He stated with the noise In SHU, he said the strategies will not work. He was encouraged to try them. Progress/Plan The Chief Psychologist was consulted. Psych Observation will be discontinued. Mr. Epstein was educated about both routine and emergency procedures for contacting Psychology staff. He will be seen in follow up by Psychology tomorrow to monitor his mental status and to provide further intervention if needed and he was informed that he will be seen by Psychology tomorrow. In the meantime, he was encouraged to self-refer to Psychology if needed to which he agreed and seems capable of doing. If he remains in SHU, he will be seen by Psychology in SHU Rounds and in SHU Reviews. The SHU Lt. was informed that Mr. Epstein needs to be housed with an appropriate cellmate. Completed by Imeri, Darlene PsyD on 07/30/2019 13:54 Generated 07/30/2019 13 54 by limed, Darlene PsyD Bureau of Prisons NYM Page, 1 of 1 EFTA00059331 Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/29/2019 10:01 Provider: Miller, Elissa PhD/Chief Reg tr: 76318-054 Unit Team: 5 Focus of Session Inmate Epstein was seen while on psychological observation today in the hospital area. Subjective/Objective Presentation Same presentation today, but he said he thinks his memory for the incident (injury to his neck) may be impaired because of his sleep apnea. He is supposed to get his CPAP machine today. He is aware he will be returning to SHU, but said he is feeling unwell due to his Inability to sleep and numbness in his arm. He requested to have one good night of sleep with his CPAP and will return to SHU with a ceimate tomorrow. He then asked if he could remain down here where it is 'safe" for the entire week. I told him he can stay down one more night to receive his CPAP and a good nights sleep, but that he would be returned to SHU tomorrow. It was explained that there is no mental health issues precluding him from returning to SHU tomorrow and that we could not house him hi the SW/Hospital area because he felt sale or more comfortable for him. It was explained to him that he would be placed In a safe situation in the SHU. According to his log book and eating/shower chart, he has been eating and drinking when not in his legal visits. He has also been writing and attending his legal visits. Intervention(s) Inmate EPSTEIN was provided with brief supportive interventions and psychoeducation regarding additional coping strategies. Inmate EPSTEIN was somewhat receptive to these interventions, but appears more concerned about getting his various needs in the prison (phone calls, recreation, housing placement concerns, etc.) Erganairien He will remain on psychological observation today and will transition to the SHU tomorrow. He will be seen by psychology daily to assess his mental status and psychological functioning. Completed by Miller, Elissa PhD/Chief Psychologist on 07/29/2019 10:26 Generaled 07/29/2019 10 26 by Miller. Elissa PhO/CNef Bureau of Prisons - NYM Page 1 of 1 EFTA00059332 Bureau of Prisons -SENSITIVE BUT UNCLASSIFIED- Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN. JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M FacNity-. NYM Date: 07/28/2019 08:33 Provider: !men, Darlene PsyD Reg 4, 76318-054 Unit Team: 5 Focus of He was seen by writer while he was on Psych Observation. Subjective/Objective Presentation The "Eating/Shower Chart" noted that yesterday he ate breakfast. He is not In the Psych Observation cell for about 12 hours per day because of being in Attorney Conference with his Attorneys, so the "Eating/Shower Chad" may not reflect all of his meals. He stated he was served one meal in Attorney Conference yesterday. He stated he drinks a lot water at night. The Psych Observation log noted he talked about life in general population and he slept. Earlier he had complained that his right arm was numb and hanging. Nurse Columbo from Medical had seen him for this. When this writer was interviewing him, he said his right arm still feels somewhat numb and he said he cannot make a fist with that hand. He also said he has numbness on his neck. This writer notified Nurse Columbo. He stated last night when he flushed the toilet it kept flushing for 45 minutes. He stated he found it so aversive and upsetting that he said he sat In the corner and held his ears. He said because of this he was agitated for hours and was not able to sleep. The Lt. will be moving him to a different cell and he was Informed of this. He stated the feeling he got with the noise of the toilet was similar to when he was in SHU. He said he may have something on the Autism spectrum. He said in the movie "Rain Man," the person with Autism had an aversion to noise. He stated he Is also really good with numbers. Current Mental Status: He exhibited a mildly anxious mood with a full range of affect His speech was logical and coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. He denied current suicidal or self harm ideation and he agreed to immediately tee staff and Inmate Companions if he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff and Inmate Companions if he has these thoughts. Interventiorqs1 Supportive and educative Interventions were again provided. He had not been given the Turning Point handouts yesterday that were on his cell door, so they were handed to him by staff today. progress/Plan He will remain on Psych Observation in an abundance of caution and pending housing arrangements to be made on Monday. While on Psych Observation, he will be seen daily by Psychology. Completed by Irnen, Darlene PsyD on 07/28/2019 09:24 Generated 0728/201909 24 by Imeri Darlene PsyD Bureau of Prisons NYM Page 1 of 1 EFTA00059333 Bureau of Prisons **SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/27/2019 07:14 Provider Imeri, Darlene PsyD Focus of Session He was seen by writer while he was on Psych Observation. Subjective/Oblective Presentation The "Eating/Shower Chart" indicated yesterday he ate dinner, drank liquids, and took a shower when offered. The Psych Observation Log noted he brushed his teeth, went to a Legal visit, talked about business and investing to an Inmate Companion, ate, and slept. When interviewed, he stated he still cannot remember what happened in SHU that caused the marks on his neck. He stated that for the 5 days before that he had only slept about 30 minutes each night because of noise in SHU. He stated he is anxious about going back to SHU because he stated he is going back to a place where he had gotten marks on his neck and he does not know why It happened. He said he has an appetite and is eating. He said he is waking up every 1 1/2 hours. He stated he feels dehydrated because he is not drinking enough water because he stated he feels he Is not given enough bathroom breaks while with his Attorney. Medical was e-mailed with his complaint of feeling dehydrated. He said his Lawyers and friends are all emotionally supportive. Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. He denied current suicidal or self harm ideation. He stated Tm a coward? He added he does not like pain and even does not like when he has to give blood. He agreed to Immediately tell staff and Inmate Companions If he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff and Inmate Companions if he has these thoughts. Interventionist Supportive and educative Interventions were provided. Turning Points handouts on stress management, sleep, and building a routine in SHU were placed on his cell door to be given to him when his food slot is opened. He stated he wants it noted in his chart that he is being given a pamphlet on sleep, but that is not going to help because of the noise In SHU that prevents him from sleeping. Prowess/Pim He wiN remain on Psych Observation in an abundance of caution and pending housing arrangements to be made on Monday. While on Psych Observation, he will be seen daily by Psychology. Completed by lmed, Darlene PsyD on 07/28/2019 09:19 Generated 07/28/201909:19 by Imeri, Darlene PsyD Bureau of Prisons NYM Page 1 of 1 EFTA00059334 Bureau of Prisons **SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/27/2019 07:14 Provider. Imen, Darlene PsyD Reg #: 76318.054 Unit Team: 5 Focus of Session He was seen by writer while he was on Psych Observation. SubjectiveLOblective Presentation The "Eating/Shower Chart" indicated yesterday he ate dinner, drank liquids, and took a shower when offered. The Psych Observation Log noted he brushed his teeth, went to a Legal visit, talked about business and investing to an Inmate Companion, ate, an When interviewed, he st stated that for the 5 days he is anxious about going back neck and he does not know why I cannot remember what happened in SHU that caused the marks on his neck. He had only slept about 30 minutes each night because of noise in SHU. He stated because he stated he is going back to a place where he had gotten marks on his He said he has an appetite and Is eab He said • Is waking up every 1 1/2 hours. He stated he feels dehydrated because he Is not drinking enough water slated he feels he is not given enough bathroom breaks while with his Attorney. Medical was e-mailed with his • t gf feeling dehydrated. He said his Lawyers and friends are all emotionally supportive. Current Mental Status: He exhibited a neutral mood w9b ly full range of affect His speech was logical and coherent, with no loosening of associations or tangential nlial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. n engage in any bizarre or inappropriate behavior. He denied current suicidal or self harm ideation. He stated" He added he does not like pain and even does not like when he has to give blood. He agreed to immedla t aff and Inmate Companions if he starts to have suicidal or self harm thoughts. He was future oriented. He o be an Immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff and Inmate if he has these thoughts. Interventionfsi Supportive and educative interventions were provided. He was given Tuna outs on stress management, sleep, and building a routine in SHU. He stated he wants It noted in his chart given a pamphlet on sleep, but that is not going to help because of the noise in SHU that prevents him ng. ?regress/Plan He wil remain on Psych Observation in an abundance of caution and pending housing a be made on Monday. While on Psych Observation, he will be seen daily by Psychology. Completed by lmeri, Darlene PsyD on 07/27/2019 08:16 Generated 07/27/2019 0B 16 by 'melt Darlene PsyD Bureau of Prisons - NYrd Pago 1 of 1 EFTA00059335 Bureau of Prisons -*SENSITIVE BUT UNCLASSIFIED** Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/27/2019 07:14 Provider linen, Darlene PsyD Reg #: 76318-054 Unit Team: 5 Focus of Session He was seen by writer while he was on Psych Observation. SubjectivelOblective Presentation The "Eating/Shower Chart" indicated yesterday he ate dinner, drank liquids, and took a shower when offered. The Psych Observation Log noted he brushed his teeth, went to a Legal visit, talked about business and investing to an Inmate Companion, ate, an When interviewed, he st stated that for the 5 days 6 he is anxious about going back neck and he does not know why cannot remember what happened in SHU that caused the marks on his neck. He had only slept about 30 minutes each night because of noise in SHU. He stated because he stated he is going back to a place where he had gotten marks on his He said he has an appetite and is eatiTlg He said Is waking up every 1 1/2 hours. He stated he feels dehydrated because he Is not drinking enough water stated he feels he Is not given enough bathroom breaks while with his Attorney. Medical was e-mailed with his o t 2f feeling dehydrated. He said his Lawyers and friends are all emotionally supportive. Current Mental Status: He exhibited a neutral mood w9a ly full range of affect. His speech was logical and coherent, with no loosening of associations or tangential ntial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. n. engage in any bizarre or inappropriate behavior. He denied current suicidal or self harm ideation. He stated ." He added he does not like pain and even does not like when he has to give blood. He agreed to imrriedia ff and Inmate Companions if he starts to have suicidal or self harm thoughts. He was future oriented. He d o be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff and Inmat: s if he has these thoughts. ritervention(1). Supportive and educative interventions were provided. He was given TurrinrP douts on stress management, sleep, and building a routine in SHU. He stated he wants it noted in his chart given a pamphlet on sleep, but that is not going to help because of the noise in SHU that prevents him ng. Progress/Plan He will remain on Psych Observation in an abundance of caution and pending housing arr be made on Monday. While on Psych Observation, he will be seen daily by Psychology. ir Completed by lined, Darlene PsyD on 07/27/2019 08:16 Generated 07/27/2019 08 16 by 'mart Darlene PsyD Bureau of Prisons - NYM Page 1 of 1 EFTA00059336 Bureau of Prisons Health Services See Amendment Inmate Name: EPSTEIN, JEFFREY EDWARD Reg /4: 76318.054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/27/2019 07:14 Facility: NYM Amendment made to this note by Imerl, Darlene PsyD on 07/28/2019 09:19. Bureau of Prisons - NYM EFTA00059337 Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/26/2019 09:09 Provider: Miller, Elissa PhD/Chief Reg #: 76318.054 Unit Team: 5 Focus of Session Inmate Epstein was seen while on psychological observation in our hospital area. SutdectNe/Oblective Presentation Prior to this writer's contact with him, Inmate Epstein showered and dressed himself for his legal visit today. He was smiling and did crack some jokes during the interview. He did elucidate some complaints and suggested being disappointed with this writer as he wants "to trust me and for me to trust him." He stated he remains unhappy with legal visiting procedures as he cannot go to the bathroom as frequently as he would like to since he has a 'weak bladder." Inmate Epstein also reported since coming to the psychological observation area, he has felt constipated and needs his Colace. He had self-carry Colace in SHU, but since coming to the observation area, he has not had his medication. This writer immediately notified medical and his pills were being processed during the Interview. Inmate Epstein also continues to complain about the conditions of SHU confinement (I.e., feeling punished, smells, noise, and restrictions). With regard to the events which lead to his initial placement on suicide watch, inmate Epstein stated he has no memory of the event. He asked to speak with his old celimate "Nick" to see if he can tell him what happened or see if his memory could be triggered. He remarked, "I am still trying to figure out how I got this (pointing to the scab around his neck)? Inmate Epstein denies remembering harming himself and/or being harmed by his cellmate. He does not exhibit symptoms of any cognitive disorder, seizure disorder, psychotic disorder, or dissociative disorder at this time or in the past. Inmate Epstein denied any current suicidal ideation, intention, or plan. He reported wanting to be alive to fight his legal case and go back and five life. He referred to himself as 'a coward" and "I'm Jewish? He said he Is not the type who likes pain or would ever attempt to harm himself. While on psychological observation, inmate Epstein has been eating his meals, sleeping and interacting with the inmate companions. He is in legal visiting the majority of the day and in the evenings. His log book and eating/shower chart reflect the same. He has been speaking to Inmate companions about Investment strategies and about prison adjustment. Correctional Staff report during his legal visits, he is interacting with his attorney, animated, laughing, and joking. friterventIonis) Inmate Epstein was provided with supportive and coping skills interventions today. He was receptive to them, but mostly wanted to express his complaints about his current prison confinement status and needs. He wanted this writer to address them. Progress/Plan Inmate Epstein will remain on psychological observation in an abundance of caution and pending housing arrangements to be made on Monday. He continues to be vague and reports memory deficits regarding the events which lead to a piece of sheet being placed loosely around his neck and marks with scabs around his neck. Completed by Miller, Elissa PhD/Chief Psychologist on 07/26/2019 10:05 Generated 07/2612019 10 05 by &tiler, Elissa PhD/Chief Bureau of Prisons NYM Page 1 of 1 EFTA00059338 Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/25/2019 10:14 Provider. Miller, Elissa PhD/Chief Reg IS: 76318.054 Unit Team: 5 Focus of Session Inmate Epstein was seen by this writer this morning while on psychological observation in the hospital area of the prison. Sublective/Objective Presentation Inmate Epstein was in good spirits today and engaged in reciprocal conversation with this writer this morning. He smiled and remarked, "welcome back" when this writer arrived. He continues to assert he does not remember how he received marks around his neck, remarking "I do not remember anything, maybe you can give me some cues.' He stated he just remembers going for a drink of water and the next thing he knew he woke up to the sound of his own snoring. When this writer attempted to get a more detailed account from him, indicating that it would be rare to have such impairments in memory as he does not suffer from an acute cognitive disorder, he smiled and said he understood my position. Inmate Epstein did reveal he Is unhappy with his current confinement in Special Housing (SHU) as he considers it "a punishment cal." He said he finds the restrictions up there unfair as he has not done anything wrong. Inmate Epstein stated he feels It is dangerous in the SHU, he cannot sleep wee up there due to noise from the other inmates, it smells, and it is difficult for him to work on his legal case up there. He slated he has not received the phone calls he was promised nor has he been able to receive recreation. It was explained to him that he spends the entire day in the attorney conference room and it is likely that he has missed the limes when staff members have attempted to give him phone calls and recreation. Inmate Epstein also reported complaints about the attorney conference room, stating they do not take him to the bathroom frequently enough. Inmate Epstein adamantly denied any suicidality at this time, stating "I am too vested in my case to fight it, I have a life and I want to go back to living my life." He denied any acute symptoms at this time. According to his log book, he has been eating, drinking, sleeping, and interacting with the inmate companions. He has also been attending his daily legal visits. Interventionist Inmate EPSTEIN was provided with brief supportive interventions and psychoeducation regarding additional coping strategies. Inmate EPSTEIN was mostly receptive to these interventions. He requested to be housed in genera population rather than the SHU and stated he wanted to remain on psychological observation due to his concerns with being in the SHU. Progress/Plan In an abundance of caution, inmate Epstein will remain on psychological observation. He has yet to give an account of how he sustained the marks around his neck, is not revealing much about his mental status, and there are concerns about his adjustment at this time to being housed in the SHU. Inmate Epstein will be seen dealt by psychology while on psychological observation. Completed by Miller, Elissa PhD/Chlef Psychologist on 07/25/2019 10:43 Generated 07/25/201910 43 by Miller, Elissa PhD/Chief Bureau of Prisons NYM Page 1 of 1 EFTA00059339 Bureau of Prisons Psychology Services Post Suicide Watch Report **SENSITIVE BUT UNCLASSIFIED** Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/24/2019 09:23 Provider: Miss, Samantha Ph.D. Watch Start Date: 07/23/2019 01:40 Total Time on Watch: 31 hrs 5 minutes Watch Conducted By: Both inmates and staff Current Mental Status Watch Stop Date: 07/24/2019 08:45 Transfered to Medical center: No Level of Consciousness: Alert and Oriented Psychomotor Activity: Normal General Appearance: Normal Behavior. Cooperative Mood: Appropriate to Content Thought Process: Goal Directed Thought Content: Normal Current Mental Status: Mr. EPSTEIN was alert and oriented. He was polite, calm, and cooperative in demeanor. He exhibited a neutral affect with appropriate range. Eye contact and hygiene were appropriate. The inmate spoke with normal rate. tone, and volume. His thoughts were organized and coherent, with no loosening of associations or tangential, circumstantial, or irrelevant content. There was no evidence of perceptual disturbance, delusional ideation, or a formal thought disorder. He did not engage in any bizarre or inappropriate behavior. He noted having normal sleeping and eating habits. Mr. EPSTEIN explicitly denied recent and current suicidal ideation, planning, and Intent. He was future-oriented and expressed a commitment to life and safety, agreeing to contact staff immediately should he experience suicidal ideation or psychological distress. He also denied thoughts of harming others. Risk Factors Assessed: This writer screened the inmate for a variety of empirically validated factors commonly associated with risk for self harm. The following STATIC risk factors were assessed to be present and increase the inmate's risk for engaging in suicide related behaviors: High Profile Crime. Lack of family connections, Sex offender status The following DYNAMIC risk factors were assessed to be present and increase the inmate's risk for engaging in suicide related behaviors: Current physical pain, Fear for own safety The following PROTECTIVE factors were assessed to be present and may decrease the inmate's risk of suicide:Able to identify reasons to live. Adequate problem solving skills, Denial of suicidal ideationfintention/plans, Future orientation, View of death as negative, Willingness to engage in treatment Risk Factors: Mr. EPSTEIN has a significant scar around his neck, which is now scabbing over. He reported swelling in this area but denied experiencing any related pain. Mr. EPSTEIN continues to claim a lack of memory for the incident resulting In this scar. The story he provided was vague, such that this writer challenged him a couple of times, but he insisted he was being honest about his lapse in memory. The nature of the incident remain unclear. Mr. EPSTEIN is incarcerated for a very high profile crime with media attention. He was recently denied bail. He also reported difficulty managing his time in the SHU. He reported being fearful for his safety if he is to return to the cell with his previous cell mate. Protective Factors: Mr. EPSTEIN adamantly denied current suicidal ideation or Intent or a history of suicide attempts. He stated, 'I have no interest in killing myself.' He explained, although his situation is "not perfect' due to his being Incarcerated, he noted he has "lots to do for (his) legal case." He described having a "wonderful life," to include interactions with interesting people and proiects.* He said "it would be crazy" to take his life. He furthered, 'I would not do that to myself." He denied feelings of hopelessness, although did report being "depressed" and "unhappy" about his current legal situation. He previously denied a history of childhood abuse. He reported he is sleeping adequately now that he is no longer in the SHU. He appear future-oriented as he endorsed an interest in being housed in general population. Weighing of Risk and Protective Factors: Mr. EPSTEIN adamantly denied sucidality. However, in Tight of his vague self-report regarding the incident which precipitated his placement on Suicide Watch, combined with his fear for his own safety, reported Generated 07/24/2019 12:09 by Di/Asa, Samantha Ph.D. Bureau or Prisons - NYM Page 1 of 3 EFTA00059340 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/24/2019 09:23 Provider: DiMisa, Samantha Ph.D. difficulty managing his time in the SHU, and the high profile nature of his alleged offense, Mr. EPSTEIN will be stepped down from Suicide Watch to Psychological Observation. Changes in Risk Factors Assessed Upon a review of the log book, it was indicated Mr. EPSTEIN has been speaking to the inmate companions about having previously taught mathematics and physics. He has been observed pacing the cell as well as sleeping, eating, and drinking within normal limits. Upon interview today, Mr. EPSTEIN requested he be provided a toothbrush as well as a shower. His requests were made known to the lieutenants and he was provided a shower prior to attending his legal visit. This writer also provided him a toothbrush, toothpaste, and hygiene products. Asked about the alleged incident which transpired yesterday resulting in his placement on Suicide Watch, Mr. EPSTEIN said he is frustrated he has been placed in a "punishment cell for no reason." Specifically, Mr. EPSTEIN was referring to his placement in the SHU. Asked to recall the events surrounding the alleged Incident, Mr. EPSTEIN said his cell mate was "playing with a bed sheer and he claimed he does not recall the events thereafter. He said he recalled eating meat and drinking water and claimed the next event for which he has memory is his hearing himself snore and waking up on a stretcher. Mr. EPSTEIN claimed he does not recall himself or his cell mate tying a string or rope around his neck. He said he has "been trying to remember" and "wracking his mind." Asked if he experienced any interpersonal issues with his cell mate, Mr. EPSTEIN described his cell mate as "agitated" and claimed his cell mate called him a "pedophile" for the first time yesterday. His cell mate was also reportedly reading a newspaper article about Mr. EPSTEIN, which bothered him and it was something he believed to be "strange" for their to be an article about him in his cell. Mr. EPSTEIN recalled throwing away the newspaper photograph of himself by crumpling it and flushing it down the toilet. Asked if his cell mate ever threatened to harm him, he denied this to be the case. Asked why he told the inmate companions yesterday his cell mate tried to kill him, while also claiming no memory of the incident, Mr. EPSTEIN again said he did not recall the incident and further stated, 'I don't know if he put it there as a joke.' Mr. EPSTEIN explained he had been experiencing difficulty sleeping in his SHU cell due to his inmate peers banging on the cell door and window, but has not been experiencing any other acute issues other than this. Reason for Removal from Watch Mr. EPSTEIN stated, "I have no interest in killing myself." He explained although his situation is 'not perfect' due to his being incarcerated, he noted he has "lots to do for [his] legal case." He described having a "wonderful life," to include interactions with "interesting people and projects.' He said "it would be crazy" to take his life. He furthered, 7 would not do that to myself." Mr. EPSTEIN did express a feeling of safety being housed on Psychological Observation rather than in the SHU. He asked if he could remain on this status for a couple of days, he was advised his housing situation will be re-evaluated on a day-to-day basis. He expressed a desire to be housed in general population rather than in the SHU and asked If there were a "safer unit for him to be housed in comparison to the one where he was initially placed. Mr. EPSTEIN claimed there were many MS-13 gang members on the initial unit. He was advised he will be maintained on Psychological Observation in the near future, but his long-term housing situation will be revisited, as it is not ideal for one to remain in isolation on Psychological Observation for extended periods of time. Mr. EPSTEIN acknowledged this information and thanked this writer for her explanation and time. Diagnosis. No Diagnosis, No Dx - Current Conclusions The Overall Acute Suicide Risk for this inmate is: Low Overall Chronic Suicide Risk for this Inmate is: Absent Recommendations 1. Mr. EPSTEIN will be removed from Suicide Watch and stepped down to Psychological Observation. 2. While on Psychological Observation, he will be continuously observed by Inmate Companions. 3. While on Psychological Observation, he will be seen daily by Psychology. 4. Supportive and educative interventions were provided. 5. Mr. EPSTEIN was provided novels and a request was made for his legal paperwork to be provided to him on Psychological Generated 07/24/2019 12.09 by DiMisa. Samantha PhD. Bureau of Prisons - NYM Page 2 of 3 EFTA00059341 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01120/1953 Sex: M Facility: NYM Unit Team: 5 Date: 07/24/2019 09:23 Provider: DiMisa, Samantha Ph.D. Observation. 6. This writer contacted the Pharmacy to Indicate Mr. EPSTEIN has not been receiving his medication used to alleviate his constipation. 7. Mr. EPSTEIN attended a legal visit today, after having been provided a shower. 8. Mr. EPSTEIN was educated about both routine and emergency procedures for contacting psychology. 9. The inmate was encouraged to reach out for PRN services should he experience any psychological distress. Completed by 'Wise, Samantha Ph.D. on 07/24/2019 12:09 Generated 07/24/2019 12.09 by Dibt/sa, Samantha PhD Bureau of Prisons - NMI Pago 3 or 3 EFTA00059342 Bureau of Prisons Psychology Services Suicide Risk Assessment "SENSITIVE BUT UNCLASSIFIED** Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/23/2019 10:09 Provider: Imeri, Darlene PsyD Reg #: 76318.054 Unit Team: 5 Type of Housing: SHU- Administrative Segregation Cell Accommodation: Double-Cell EINDINGZ This assessment and the resulting recommendations are based on the following sources of information: Clinical Interview, Medical Record, Psychology Data System, Sentry Reason for Referral The On Call Psychologist, Dr. Miller, had been contacted by the Operations Lt. at about 2 AM on 7/23/19 to inform her that Mr. Epstein was being placed on Suicide Watch because he was found with a string around his neck. Mr. Epstein was seen by this writer for a Suicide Risk Assessment at about 9:10 AM on 7/23/19. This note Is being entered at about 3:35 PM on 7/23/19. Mental Health History According to a Suicide Risk Assessment dated 7/09/19 by Dr. Miller, "Inmate Epstein denied any history of mental health treatment, either on an inpatient or outpatient basis. Inmate Epstein denied any treatment In the past or present with psychotropic medication. He also denied any acute mental health symptoms at this time." Self-Harm History According to a Suicide Risk Assessment dated 7/09/19 by Dr. Miller, "Inmate Epstein denied any past or present suicidal ideation, intention or plan. He denied ever engaging in any suicide attempts or self-injurious behavior in the past." Substance Abuse History According to a Suicide Risk Assessment dated 7/09/19 by Dr. Miller, "Inmate Epstein denied any alcohol or substance abuse. He said it is well-known that he does not even drink alcohol." Current Problem Earlier this morning Mr. Epstein was found by SHU staff in his cell with a string loosely tied around his neck. It Is unclear at this time if Mr. Epstein had placed the string around his own neck. When Mr. Epstein was asked by this writer how he ended up on Suicide Watch, he denied remembering. He stated he got a drink of water last night in his cell and went back to bed. He said the next thing he remembered is hearing himself snore. He said he wants to know why he is on Suicide Watch. He was informed that staff stated he was found in his cell with a string on his neck. According to Medical records, he had been seen by Medical for this and had a rule out of self Inficted injuries. When this writer reviewed the Staff Suicide Watch Log, It noted that Mr. Epstein told the staff watching him that his cellmate tried to kill him, which Mr. Epstein did not tell this writer when this writer had interviewed Mr. Epstein. This writer was not able to ask Mr. Epstein about this, since Mr. Epstein was now in Legal. The Captain was notified about this notation and the Captain stated they were already aware of this statement. Current Mental Status Level of Consciousness: Alert and Oriented Psychomotor Activity: Normal General Appearance: Normal Behavior. Cooperative Mood: Appropriate to Content Generated 07/23/2019 15:38 by 'men, Darlene PsyD Bureau OS Prisons • NYM Page 1 of 3 EFTA00059343 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/23/2019 10:09 Provider: Imeri, Darlene PsyD Thought Process: Goal Directed Thought Content: Normal Current Mental Status: He exhibited a neutral mood with a full range of affect. His speech was logical and coherent, with no loosening of associations or tangential, circumstantial or irrelevant speech. Auditory and visual hallucinations were denied, and delusions were not elicited. He did not engage in any bizarre or inappropriate behavior. He denied current suicidal or self harm ideation and he agreed to immediately tell staff if he starts to have suicidal or self harm thoughts. He was future oriented. He does not appear to be an immediate danger to self. He denied thoughts of hurting others and he agreed to tell staff if he has these thoughts. RISK AND PROTECTIVE FACTORS ASSESSED This writer screened the inmate for a variety of empirically validated factors commonly associated with risk for self-harm and suicide. The following STATIC risk factors were assessed to be present and increase the inmate's risk for engaging in suicide related behaviors: High Profile Crime, Lack of family connections, Sex offender status The following DYNAMIC risk factors were assessed to be present and increase the inmate's risk for engaging in suicide related behaviors: Current physical pain The following PROTECTIVE factors were assessed to be present and may decrease the inmate's risk of suicide:Able to identify reasons to live, Adequate problem solving skills, Denial of suicidal ideation/intention/plans, Future orientation, View of death as negative, Willingness to engage In treatment Risk Factors: He was found by staff in his cell in SHU with a string loosely tied around his neck, which Mr. Epstein stated he cid not remember anything about. It is unclear at this time if Mr. Epstein had placed the string around his own neck or if someone else did. According to Medical, he had a circular line around the base of his neck, which he denied knowing how he obtained. He staled his throat hurts which was reported to Medical. He has a high profile sex offense case and recently was denied bail. When asked if he has any friends or family that are emotionally supportive, he stated he does not know what that means. When emotional supports were explained to him and then again asked if he as any family or friends that are emotionally supportive, he was vague and said he has a lot of people. Reg #: 76318-054 Unit Team: 5 Protective Factors: He denied current suicidal or self harm thoughts or ever having these thoughts. He denied a history of self harm and suicide attempts. He denied a family history of suicidal and self harm attempts. He denied having any chronic medical conditions. He denied feeling hopeless. He denied a history of childhood abuse. He denied fearing for his safety. He denied feeling like a burden to anyone. He reported he is sleeping adequately. He stated he lives to have fun, to enjoy life, and to learn. He said his future plans include fighting his case and going back to his normal life. Whereas, he is denying suicidal and self harm thoughts and has a lot of protective factors, he is denying that he remembers how he ended up on Suicide Watch and has marks encircling his neck. It is unclear at this time if he had placed the string around his neck or if someone else did. He will remain on Suicide Watch for further observation and safekeeping. DIAGNOSIS• No Diagnosis, No Dx - Current CONCLUSIONS The Overall Acute Suicide Risk for this Inmate is: Overall Chronic Suicide Risk for this Inmate is: Moderate Absent RECOMMENDATIONS 1. Mr. Epstein will remain on Suicide Watch for further observation and safekeeping. 2. While on Suicide Watch, he will be continuously observed by Inmate Companions. 3. While on Suicide Watch, he will be seen daily by Psychology. 4. Supportive and educative Interventions were provided. 5. Medical was informed that he reported his throat hurts. Suicide Watch: A suicide watch was Initiated by non-clinical staff and continues to be warranted Suicide Watch was Initiated on: 07/23/2019 01:40 Generated 07/23/20191538 by freed Darlene PsyD Bureau of Prisons NYM Page 2 of 3 EFTA00059344 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/23/2019 10:09 Provider: Imeri, Darlene PsyD Reg #: 76318-054 Unit Team: 5 Completed by !men, Darlene PsyD on 07/23/2019 15:38 Generated 07/23/2019 15 38 by linen, Darlene PsyD Bureau of Prisons • NYM Page 3 of 3 EFTA00059345 Bureau of Prisons Psychology Services General Administrative Note "SENSITIVE BUT UNCLASSIFIED" Inmate Name: EPSTEIN. JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/23/2019 07:56 Provider: Miller, Efissa PhD/Chief Reg #: 76318-054 Unit Team: 5 Comments This On-Call Psychologist was contacted by the Operations Lt. at about 2 AM on 7/23/19 to inform Mr. Epstein was being placed on Suicide Watch because he was found with a string loosely hanging around his neck. Mr. Epstein will be seen today by the duty psychologist for a Suicide Risk Assessment. Completed by Miller, Elissa PhD/Chief Psychologist on 07/24/2019 07:59 Generated 07/24/2019 07:59 by Miller. Elissa PhD/CAW! Bureau of Prisons - NYM Page 1 of 1 EFTA00059346 Bureau of Prisons Psychology Services SHU Review "SENSITIVE BUT UNCLASSIFIED** Inmate Name: Date of Bkth: Date: EPSTEIN, JEFFREY EDWARD 01/20/1953 Sex: M Facility NYM 07/18/2019 07:21 Provider. Miler, Elissa PhD/Chief Rag X: 76318-054 Unit Team: A&O Placed In SHU: Status: Basis of Review: Mental Status: 07/10/2019 ADMIN.DETENTION Inmate was interviewed No significant mental health Issues. Type: Threat to Self: Adjustment: Threat to Others: SHU Low Satisfactory, segregation not detrimental Low Comments Monthly SHU Review Note Inmate Epstein was meeting with his legal team today and has a court hearing. He was not able to be seen for a SHU review. Another attempt to interview him for a SHU review will be done in the near future. Completed by Miller. Elissa PhD/Chief Psychologist on 07/18/2019 12:06 Generated 07/18/2019 12:08 by feller. Besse PhD/Chief Bureau of Prisons • NYM Page 1 of 1 EFTA00059347 Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/16/2019 12:48 Provider: Miller, Elissa PhD/Chief Reg #: 76318-054 Unit Team: A&O focus of Session Inmate Epstein called for this writer in attorney conference today. The officer In attorney conference notified this writer that he was asking to be seen. Sublective/Oblective Presentajlon Inmate Epstein reported he has not received a spoon or soap in SHU, nor did he receive the phone calls that were "promised to him." He told this writer we need to have mutual trust that his needs are met in the prison. This writer told inmate Epstein that she would address his concerns. On the way out, a staff member told this writer she witnessed inmate Epstein receive two phone calls from the Lt. Nonetheless, this writer informed the SHU lieutenant of his concerns and he said he would ensure that he had soap, a spoon, and his initial SHU phone call. Inmate Epstein did not have any psychological concerns today. He denied any mental health symptoms or suicidality. He has been eating as best as he can and has requested a Kosher diet. InterventIon(st Inmate EPSTEIN was provided with brief supportive and psychoeducation regarding additional coping strategies. Inmate EPSTEIN was receptive to these interventions. He continued with his legal visit. Proaress/Plan Inmate EPSTEIN was educated about both routine and emergency procedures for contacting Psychology staff. He was reminded of the self-help books and audiotapes available through the Psychology department There appears to be no need for follow up at this time. He will be seen in SHU for rounds and monthly SHU reviews. Completed by Miller, Elissa PhD/Chief Psychologist on 07/18/2019 13:05 Generated 07/18/2019 13 05 by Miller, Elissa PhD/Chief Bureau of Prisons • NYM Page 1 of 1 EFTA00059348 Bureau of Prisons ^SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/11/2019 15:21 Provider: Miller, Ellssa PhD/Chief Reg tr 76318.054 Unit Team: A&O Focus of Session Inmate Epstein was seen for his psychological observation follow-up in attorney conference this afternoon. Subjective/Objective Presentation Inmate Epstein reported he has been consulting with his attorney most of the day. He elucidated concems about his incarceration including not receiving his property yet In SHU, feeling cold in his cell, not receiving his Colace, not having enough water lo attorney conference, and a desire to recreate In SHU.' Inmate Epstein was also upset about wearing an orange jumpsuit and being treated like "a bad guy" when he did not do anything wrong in the prison. Custody and security concerns were addressed with inmate Epstein including why he has to wear his orange jumpsuit (due to his being housed in SHU). He requested that he be placed In a brown uniform during his legal visits. He was told his concerns would be addressed in the SHU meeting. Inmate Epstein stated he is not having any current problems with his ceilmate and indicated he at bran cereal for breakfast and took a shower yesterday. He did not sleep well last night. Inmate Epstein continues to deny any suicidal Ideation, intention or plan. He did not appear to be in any distress at this time. Intervention(s) Inmate EPSTEIN was provided with brief supportive interventions, CBT-based interventions, and psychoeducation regarding additional coping strategies. Inmate EPSTEIN was receptive to these interventions. fr_ooress/Plan Inmate EPSTEIN was educated about both routine and emergency procedures for contacting Psychology staff. He was reminded of the self-help books and audiotapes available through the Psychology department. He will be seen next week after his bail hearing to assess his mental status and psychological stability. Completed by Miller, Elissa PhD/Chief Psychologist on 07/12/2019 07:51 Generated 07/12/2019 07:51 by Miller, Elissa PhD/Chief Bureau of Prisons - NYM Page 1 of 1 EFTA00059349 Bureau of Prisons Psychology Services General Administrative Note "SENSITIVE BUT UNCLASSIFIED" Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility. NYM Date: 07/11/2019 14:28 Provider: Imeri, Darlene PsyD Reg #: 76318-054 Unit Team: A8O Comments This writer attempted to see Mr. Epstein in the morning and then again in the afternoon for a Psych Observation Follow Up, but he was in Attorney Conference. Completed by Imeri, Darlene PsyD on 07/11/2019 15:51 Generated 07/111201915 51 by hen, Darlene PsyD Bureau of Prisons - NYM Page 101 1 EFTA00059350 Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Clinical Intervention - Clinical Contact Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/10/2019 08:38 Provider: Miller, Elissa PhD/Chief Reg #: 76318-054 Unit Team: A84O Focus of Session Inmate Epstein was seen today for a psychological observation contact in the hospital area by this writer. Sublective/Oblective Present- Ion Inmate Epstein appeared well and it was noted in his log book and eating/sleeping chart that he has been eating his meals, sleeping, interacting with the inmate companions, and pacing in his cell. Today, he presented this writer with numerous concerns and requests. He staled he does not want to be housed in the SHU because he is not comfortable there; he wants to be single-celled if he goes to the SHU; he wants Colace, not the Ducolex he received from medical yesterday; he wants to be able to walk around and go to recreation; he does not want to wear an orange uniform to his legal visits because he is treated like a punished inmate; he wants a phone call before he leaves the psychological observation area; he wants a shower and towel; he would like to be housed In the cadre (5S) unit; and would like his property, paper, and a pen. Inmate Epstein's concerns were addressed by this writer and it was explained to him he will not be single-celled or placed in a housing unit for safety and security concerns. His medical concerns (constipation) were discussed with health services as well as his desire to be placed on Colace. Inmate Epstein was provided a shower this morning. intervention(s) Inmate Epstein was provided with supportive intervention and coping skips strategies today. He was receptive to interventions and was able to elucidate his various needs. He did not present with any acute psychopathology and continues to deny any suicidal ideation, Intention, or plan. He is locking forward to his bail hearing on Monday but stated he is aware that even if he gets bail, it will take at least two weeks to sort things out so he can leave the jail. Ematrastaan Inmate Epstein is not in any psychological distress, does not present with any mental health symptoms or complaints, and Is denying any sulcidality. He appears psychologically stable at this time and can be released from the psychological observation area. Inmate Epstein will be housed in the 9S area with a cellmate. He will be seen again tomorrow by psychology to evaluate his mental status and psychological stability. Completed by Miller, Elissa PhD/Chief Psychologist on 07/10/2019 09:09 Generated 07/10/2019 09 09 by Miller, Elissa PhD/Chief Bureau of Prisons - NYM Page 1 of 1 EFTA00059351 Bureau of Prisons **SENSITIVE BUT UNCLASSIFIED" Psychology Services Diagnostic and Care Level Formulation Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/09/2019 10:13 Provider: Miller, Ekssa PhD/Chief Reg tr: 76318-054 Unit Team: MO Revant Historical Information Inmate Epstein is a 66-year-old Caucasian male, currently incarcerated on sex trafficking charges. He denied any history of mental health treatment, either on an inpatient or outpatient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also denied any acute mental health symptoms at this time. Inmate Epstein denied any past or present suicidal Ideation, intention or plan. lie denied ever engaging In any suicide attempts or self-injurious behavior in the past. Inmate Epstein denied any alcohol or substance abuse. He said it is well-known that he does not even drink alcohol. presentina Problem/Symptom Inmate Epstein was seen by this writer for suicide risk assessment today, 7/9/19 at 7:30 a.m. for precautionary reasons. He returned from court yesterday evening. He did not mark any mental health items or symptoms on his Psychology Questionnaire (PSIQ) when he entered the institution. Nonetheless, Inmate Epstein has various risk factors for suicidaNty including a high profile case with media attention, sex offense/trafficking charges, pre-trial status, and he had a court proceeding yesterday which could have given him bad news regarding his legal situation. Inmate Epstein returned from court after duty hours yesterday evening and staff notified the on-call psychologist. Inmate Epstein was placed on a precautionary psychological observation status until psychology could interview him this morning to conduct a formal suicide risk assessment in order to determine whether he is currently at-risk for suicidality. Diagnostic Formulation Inmate Epstein has no history of mental health problems and does not exhibit suicidality at this time. He has never received inpatient or outpatient mental health treatment and denied any history of suicidality. Currently, he does not exhibit any acute psychopathology, is currently psychologically stable and is in no psychological distress. As such, he is being classified as a CCI-MH inmate at this time. CARE1-MH is indicative of an inmate who either has no Identifiable mental illness (Axis I "No Diagnosis") or is mildly ill and requires clinical intervention on an as-needed basis. Care Level Formulation CARE1-MH is indicative of an inmate who shows no significant level of functional impairment associated with a mental Illness and demonstrates no need for regular mental health Intervention. Diagnosis: No Diagnosis, No Dx - Current Completed by Miller, Elissa PhD/Chief Psychologist on 07/09/2019 10:40 Generated 07/09/2019 10:40 by Miller, Elissa PhD/Chief Bureau of Prisons - NYA1 Page 1 of 1 EFTA00059352 Bureau of Prisons Psychology Services Diagnostic and Care Level Formulation "SENSITIVE BUT UNCLASSIFIED** Inmate Name Date of Birth: Date: EPSTEIN, JEFFREY EDWARD 01/20/1953 Sex: 07/09/2019 10:13 Provider: M Facility: NYM Miller, Elissa PhD/Chief Reg #: 76318054 Unit Team: A&O Relevant Historical Information Inmate Epstein Is a 66-year-old Caucasian male, currently incarcerated on sex trafficking charges. He denied any history of mental health treatment, either on an inpatient or outpatient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also denied any acute mental health symptoms at this time. Inmate Epstein denied any past or present suicidal Ideation, Intention or plan. He denied ever engaging In any suicide attempts or self-injurious behavior in the st. Inmate Epstein denied any alcohol or substance abuse. He said it is well-known that he does not even drink Presenting Problem/Svm•i Inmate Epstein was seen k assessment today for precautionary reasons. He did not mark any mental health items or symptoms on h'•. logy Questionnaire (PSIQ) when he entered the institution. Nonetheless, Inmate Epstein has various risk factors including a high profile case with media attention, sex offense/trafficking charges, pre-trial status, and he had proceeding yesterday which could have given him bad news regarding his legal situation. Inmate Epstein return •m court r duty hours yesterday evening and staff notified the on-call psychologist. Inmate Epstein was placed on nary psychological observation status until psychology could Interview him this morning to conduct a fo risk assessment to determine whether he is currently at-risk for suicidality. Diagnostic Formulation Inmate Epstein has no history of mental health probte received inpatient or outpatient mental health treatment exhibit any acute psychopathology, is currently psychologic being classified as a CC1-MH inmate at this time. CARE1-M mental illness (Axis I "No Diagnosis") or is mildly ill and requires Care Level Formulation not exhibit suicidality at this time. He has never any history of suicidality. Currently, he does not d is In no psychological distress. As such, he is of an Inmate who either has no identifiable ntion on an as-needed basis. CARE1-MH is indicative of an inmate who shows no significant level of illness and demonstrates no need for regular mental health intervention. Diagnosis: No Diagnosis, No Dx - Current Completed by Miller, Elissa PhD/Chief Psychologist on 07/09/2019 10:32 Generated 07109/2019 1O 32 by Miller, Elissa PhD/Chief rment associated with a mental Bureau of Prisons NYM Page 1 of 1 EFTA00059353 Bureau of Prisons "SENSITIVE BUT UNCLASSIFIED" Psychology Services Diagnostic and Care Level Formulation Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/09/2019 10:13 Provider. Miller, Elissa PhD/Chief Reg #: 76318-054 Unit Team: MO Relevant Historical information Inmate Epstein Is a 66-year-old Caucasian male, currently incarcerated on sex trafficking charges. He denied any history of mental health treatment, either on an inpatient or outpatient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also denied any acute mental health symptoms at this time. Inmate Epstein denied any past or present suicidal ideation, Intention or plan. He denied ever engaging In any suicide attempts or self-injurious behavior in the st. Inmate Epstein denied any alcohol or substance abuse. He said it is well-known that he does not even drink Presenting Problern/Svm Inmate Epstein was seen 1 sk assessment today for precautionary reasons. He did not mark any mental health items or symptoms on h logy Questionnaire (PSI()) when he entered the institution. Nonetheless, Inmate Epstein has various risk factors Including a high profile case with media attention, sex offense/trafficking charges, pre-trial status, and he had proceeding yesterday which could have given him bad news regarding his legal situation. Inmate Epstein return rom court duty hours yesterday evening and staff notified the on-call psychologist. Inmate Epstein was placed on lonary psychological observation status until psychology could Interview him this morning to conduct a fo yi = risk assessment to determine whether he is currently at-risk for suicidality. Diagnostic Formulation Inmate Epstein has no history of mental health proble received inpatient or outpatient mental health treatment exhibit any acute psychopathology, Is currently psychologic being classified as a CC1-MH Inmate at this time. CARE1-M mental illness (Axis I "No Diagnosis") or is mildly ill and requires Care Level Formulation not exhibit suicidality at this time. He has never any history of suicidality. Currently, he does not nd is in no psychological distress. As such, he is e of an inmate who either has no identifiable ention on an as-needed basis. CARE1-MH is indicative of an inmate who shows no significant level of illness and demonstrates no need for regular mental health intervention. Diagnosis: No Diagnosis, No Dx - Current Completed by Miller, Elissa PhD/Chief Psychologist on 07/09/2019 10:32 Generated 07109/2019 10 32 by Mdler. Elissa PhD/Chief airment 4 0 air associated with a mental 00 e0 r Bureau of Prisons - NYM Page 1 of 1 EFTA00059354 Bureau of Prisons Health Services See Amendment Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Date: 07/09/2019 10:13 Facility: NYM Amendment made to this note by Miller, Ellssa PhD/Chief Psychologist on 07/09/2019 10:40. Bureau of Prisons - NYM EFTA00059355 Bureau of Prisons Psychology Services Suicide Risk Assessment "SENSITIVE BUT UNCLASSIFIED** Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex M Facility: NYM Unit Team: A8O Date: 07/09/2019 08:41 Provider. Miller, Elissa PhD/Chief Psychologist Type of Housing: Other Psychological Observation Cell Accommodation: Single Cell FINDINGS This assessment and the resulting recommendations are based on the following sources of Information: Medical Record, Clinical interview Inmate Epstein was placed on psychological observation when he returned from court yesterday evening 7/8/19 for precautionary reasons. He Is not on a suicide watch at this time. He was seen this morning for a psychological observation contact and suicide risk assessment this morning, 7/9/19, at 7:30 a.m. as it was determined he possessed some at-risk factors for suicidality. Reason for Referral Inmate Epstein Is being seen for suicide risk assessment today for precautionary reasons. Inmate Epstein has various risk factors for suicidality at this time including a high profile case with media attention, sex offense/trafficking charges, pre-trial status, and he had a court proceeding yesterday which could have given him bad news regarding his legal situation. As such, this writer instructed R&D staff, as well as the Lieutenant's Office, to immediately notify the psychology department when he returned from court. Inmate Epstein returned from court after duty hours and denied suicidality. The aforementioned staff notified the on-call psychologist and inmate Epstein was placed on a precautionary psychological observation status until psychology could interview him this morning to conduct a suicide risk assessment. Developmental History Inmate Epstein denied any history of being the victim and/or perpetrator of physical or sexual abuse. Educational History/Cognitive Imoairment Inmate Epstein reported he obtained his high school diploma and attended some graduate classes in the area of mathematics. Arrest History and Experience of Incarceration Inmate Epstein reported he has served time in Palm Beach County jail on sex offense charges (soliciting prostitution) in the past. He is now being charged with sex trafficking, on a federal level. Mental Health History Inmate Epstein denied any history of mental health treatment, either on an Inpatient or outpatient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also denied any acute mental health symptoms at this time. Self-Harm History Inmate Epstein denied any past or present suicidal ideation, intention or plan. He denied ever engaging in any suicide attempts or self-injurious behavior in the past. Substance Abuse History inmate Epstein denied any alcohol or substance abuse. He said it is well-known that he does not even drink alcohol. Medical Concerns Inmate Epstein denied any significant medical problems, other than a history of high triglycerides. He reported feeling constipated at this time. Current Problem Inmate Epstein is currently on psychological observation due to his having multiple risk factors associated with suicIdality. He denies any suicidality at this time and has no mental health or suicide history. He Is being seen for a suicide risk assessment in an abundance of caution. Current Mental Status Generated 07/10/2019 09:20 by Miller, Elissa PhD/Chief Bureau of Prisons - NYM Page 1 of 3 EFTA00059356 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg it 76318.054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: A&O Date: 07/09/2019 08:41 Provider. Miller, Elissa PhD/Chief Psychologist Level of Consciousness: Alert and Oriented Psychomotor Activity Normal General Appearance: Normal Behavior Cooperative Mood: Appropriate to Content Thought Process: Goal Directed Thought Content: Normal Inmate Epstein did not exhibit any acute psychopathology and exhibited a clear mental status. Current Mental Status: Mr. EPSTEIN was alert and oriented. He was polite, car, and cooperative In demeanor. He exhibited a neutral affect with appropriate range. Eye contact and hygiene were appropriate. The inmate spoke with normal rate, tone, and volume. His thoughts were organized and coherent, with no loosening of associations or tangential, circumstantial, or Irrelevant content. There was no evidence of perceptual disturbance, delusional ideation, or a formal thought disorder. He did not engage in any bizarre or Inappropriate behavior. He noted having normal sleeping and eating habits. Mr. EPSTEIN explicitly denied recent and current suicidal ideation, planning, and intent. He was future-oriented and expressed a commitment to life and safety, agreeing to contact staff immediately should he experience suicidal ideation. RISK AND PROTECTIVE FACTORS ASSESSED. This writer screened the inmate for a variety of empirically validated factors commonly associated with risk for self-harm and suicide. The following STATIC risk factors were assessed to be present and increase the inmate's risk for engaging in suicide related behaviors: Sex offender status, Lack of family connections, High Profile Crime Of the DYNAMIC risk factors assessed, none were found to be present. The following PROTECTIVE factors were assessed to be present and may decrease the inmate's risk of suicide:Willingness to engage in treatment, View of death as negative, Future orientation, Denial of suicidal ideation/intention/plans, Adequate problem solving skills, Able to identify reasons to live As noted above, Inmate Epstein is a 66-year-old Caucasian male. He has various risk factors for suicidality at this time including a high profile case with extensive media attention, sex offense/trafficking charges, pre-trial status, and he had a court proceeding yesterday which may have given him bad news regarding his legal situation. Inmate Epstein also informed this writer that his only family at this time is his brother, with whom he does not have a close relationship with. Despite these risk factors, inmate Epstein possesses a number of protective factors at this time. Inmate Epstein adamantly denied any suicidal ideation, intention or plan. He was very future oriented and requested a phone call, to meet with his attorney, to take a shower, and to brush his teeth. He was eating his cereal when this writer arrived and said "I have my paper spoon here? He reported he is going to have a bail hearing on Monday and believes he is going to be released from jail. Inmate Epstein reported he is a Banker and has a "big business' in the community and that "being alive is fun? He also revealed he enjoys learning and teaching. He has confidence in his attorney and described him as 'competent." Inmate Epstein denied any mental health history or history of suicidality. He also reported none of his family members have mental health histories. Inmate Epstein stated he is a mathematician and took post graduate classes in this area of study. Inmate Epstein stated he has a support system in the community, Including friends and other associates. Finally, Inmate Epstein demonstrated a good sense of humor and did not appear dysphoric, agitated or anxious. No acute psychopathology was noted. Overall, inmate Epstein has numerous protective factors at this time that outweigh his risk factors for suicidality. He has a positive outlook regarding his legal case, demonstrates no psychiatric symptoms, has no psychiatric or suicide history, and verbalized a desire to be alive at this time and future orientation. DIAGNOSIS• No Diagnosis, No Dx - Current Generated 07/10/2019 09 20 by Miller, Elissa PhD/Chief Bureau of Prisons NYM Page 2 of 3 EFTA00059357 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318.054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: A8O Date: 07/09/2019 08:41 Provider: Miller, Elissa PhD/Chief Psychologist CONCLUSIONS The Overall Acute Suicide Risk for this Inmate is: Low Overall Chronic Suicide Risk for this Inmate is: Absent RECOMMENDATIONS Inmate Epstein is currently on psychological observation pending suitable housing placement. In light of his current sex offense charges and extensive media coverage on the television, he will need to be confined In a suitable housing unit. Inmate Epstein will be seen daily while on psychological observation and will be seen for a psychological observation follow-up session once he is released from observation. Inmate Epstein denied the need for psychological intervention, self-help materials, or follow-up. He has been classified as a CC1-MH inmate at this time. CARE1-MH is indicative of an inmate who shows no significant level of functional impairment associated with a mental illness and demonstrates no need for regular mental health intervention. Suicide Watch: A suicide watch Is not warranted at this time Completed by Miller, Elissa PhD/Chief Psychologist on 07/10/2019 09:20 Generated 07/10/201909:20 by Miller, Elissa PhD/Cfrel Bureau of Prisons - NYM Page 3 of 3 EFTA00059358 Bureau of Prisons Psychology Services Suicide Risk Assessment "SENSITIVE BUT UNCLASSIFIED— Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: A8O Date: 07/09/2019 08:41 Provider. Miller, Ellssa PhD/Chief Psychologist Type of Housing: Other Psychological Observation Cell Accommodation: Single Cell FINDINGS This assessment and the resulting recommendations are based on the following sources of information: Clinical Interview, Medical Record Inmate Epstein was placed on chological observation when he returned from court yesterday evening 7/8/19 for precautionary reasons. He Is l a suicide watch at this time. Reason for Referral Inmate Epstein is being seen e risk assessment today for precautionary reasons. Inmate Epstein has various risk factors for suicidality at thi 444' g a high profile case with media attention, sex offense/trafficking charges, pre-trial status, and he had a court 17. • ng yesterday which could have given him bad news regarding his legal situation. As such, this writer instruc staff s well as the Lieutenants Office, to immediately notify the psychology department when he returned fr Inmate Epstein returned from court after duty hours and denied sulcidality. The aforementioned staff notifi call psychologist and inmate Epstein was placed on a precautionary psychological observation status until psycholo terview him this morning to conduct a suicide risk assessment. peveloomental History Inmate Epstein denied any history of being the victim Educational History/Cognitive Imintirrnent Inmate Epstein reported he obtained his high school diplom mathematics. Arrest History and Experience of Incarceration Inmate Epstein reported he has served time in Par Beach County jail se charges (soliciting prostitution) in the past. He is now being charged with sex trafficking, on a federal level. 7 .-2 Mental Health History (Y Inmate Epstein denied any history of mental health treatment, either on an inpati tient basis. Inmate Epstein denied any treatment in the past or present with psychotropic medication. He also d cute mental health symptoms at this time. Self-Harm History Inmate Epstein denied any past or present suicidal ideation, intention or plan. He denied ever edging in any suicide attempts or self-Injurious behavior in the past. Substance Abuse History Inmate Epstein denied any alcohol or substance abuse. He said it is well-known that he does not even drink alcohol. Medical resurarna Inmate Epstein denied any significant medical problems, other than a history of high triglycerides. He reported feeling constipated at this time. Current Problem Inmate Epstein is currently on psychological observation due to his having multiple risk factors associated with suicidality. He denies any suicidality at this time and has no mental health or suicide history. He is being seen for a suicide risk assessment in an abundance of caution. trator of physical or sexual abuse. ed some graduate classes in the area of Current Mental Status Level of Consciousness: Alert and Oriented Generated 07/09/2019 10 36 by Milker, Elossa PhD/Chief Buroau of Prisons • NYM Page 1 of 3 EFTA00059359 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: A8O Date: 07/09/2019 08:41 Provider. Miller, Elissa PhD/Chief Psychologist Psychomotor Activity: Normal General Appearance: Normal Behavior: Cooperative Mood: Appropriate to Content Thought Process: Goal Directed Thought Content: Normal Inmate Epstein did not exhibit any acute psychopathology and exhibited a dear mental status. Current Mental Status: Mr. EP a neutral affect with approp 'a and volume. His thoughts irrelevant content. There not engage In any bizarre or ina explicitly denied recent and curre commitment to life and safety, agreei IN was alert and oriented. He was polite, calm, and cooperative in demeanor. He exhibited . Eye contact and hygiene were appropriate. The inmate spoke with normal rate, tone, ized and coherent, with no loosening of associations or tangential, circumstantial, or nce of perceptual disturbance, delusional ideation, or a formal thought disorder. He did e behavior. He noted having normal sleeping and eating habits. Mr. EPSTEIN eation, planning, and Intent. He was future-oriented and expressed a tact staff immediately should he experience suicidal ideation. RISK AND PROTECTIVE FACTORS ASSESSED; This writer screened the inmate for a variety o suicide. The following STATIC risk factors were assessed t behaviors: High Profile Crime, Lack of family connect' Of the DYNAMIC risk factors assessed, none were foun y validated factors commonly associated with risk for self-harm and and increase the inmate's risk for engaging in suicide related ender status The following PROTECTIVE factors were assessed to be pros, may decrease the inmate's risk of suicide:Able to identify reasons to live, Adequate problem solving skills, Denial of sulci ntention/plans, Future orientation, View of death as negative, Willingness to engage in treatment As noted above, Inmate Epstein is a 66-year-old Caucasian male. He k factors for suicidality at this time including a high profile case with extensive media attention, sex offense/tr Lc c arges, pre-trial status, and he had a court proceeding yesterday which may have given him bad news regarding his leg I Inmate Epstein also informed this writer that his only family at this time is his brother, with whom he does not hay cl tionship with. Despite these risk factors, inmate Epstein possesses a number of protective factors a Inmate Epstein adamantly denied any suicidal ideation, intention or plan. He was very future oriented and reques call, to meet with his attorney, to take a shower, and to brush his teeth. He was eating his cereal when this writ "'• said "I have my paper spoon here." He reported he Is going to have a bail hearing on Monday and believes he is go sed from jail. Inmate Epstein reported he is a Banker and has a 'big business' in the community and that "bei un." He also revealed he enjoys learning and teaching. He has confidence in his attorney and described him as mpetent." Inmate Epstein denied any mental health history or history of suiddality. He also reported none of his family members have mental health histories. Inmate Epstein stated he is a mathematician and took post graduate classes in this area of study. Inmate Epstein stated he has a support system In the community, Including friends and other associates. Finally, inmate Epstein demonstrated a good sense of humor and did not appear dysphoric, agitated or anxious. No acute psychopathology was noted. Overall, inmate Epstein has numerous protective factors at this time that outweigh his risk factors for suiddality. He has a positive outlook regarding his legal case, demonstrates no psychiatric symptoms, has no psychiatric or suicide history, and verbalized a desire to be alive al this time and future orientation. DIAGNOSIS. No Diagnosis, No Dx - Current CONCLUSIONS The Overall Acute Suicide Risk for this Inmate is: Low Overall Chronic Suicide Risk for this Inmate is: Absent Generated 07/09/2019 10 36 by Moller. Elissa PhD/Chlel Bureau of Pnsons • NYM Page 2 of 3 EFTA00059360 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318.054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: MO Date: 07/09/2019 08:41 Provider: Miller, Elissa PhD/Chief Psychologist RECOMMENDATIONS Inmate Epstein is currently on psychological observation pending suitable housing placement. In light of his current sex offense charges and extensive media coverage on the television, he will need to be confined in a suitable housing unit. Inmate Epstein will be seen daily while on psychological observation and will be seen for a psychological observation follow-up session once he is released from observation. Inmate Epstein denied the need for psychological intervention, self-help materials, or follow-up. He has been classified as a CC1-MH inmate at this time. CARE1-MH is Indicative of an Inmate who shows no significant level of functional impairment associated with a mental illness and demonstrates no need for regular mental health intervention. Suicide Watch: A suicide watch Is not warranted at this time Completed by Miller, Efissa PhD/Chief Psychologist on 07/09/2019 10:36 NOV 0 1 4 % 6 St Generated 07109/2019 10.36 by Miller, Elissa PliD/Chlef Bureau of Prisons NYM Page 3 of 3 EFTA00059361 Bureau of Prisons Psychology Services Suicide Risk Assessment -*SENSITIVE BUT UNCLASSIFIED** Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #. 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: A&O Date: 07/09/2019 08:41 Provider: Miller, Elissa PhD/Chief Psychologist Type of Housing: Other Psychological Observation Cell Accommodation: Single Cell FINDINGS This assessment and the resulting recommendations are based on the following sources of information: Clinical Interview, Medical Record Inmate Epstein was placed on chological observation when he returned from court yesterday evening 7/8/19 for precautionary reasons. He is t a suicide watch at this time. Beason for Retain' Inmate Epstein is being seen e risk assessment today for precautionary reasons. Inmate Epstein has various risk factors for suicidallty at MI Bing a high profile case with media attention, sex offense/trafficking charges, pre-trial status, and he had a court ing yesterday which could have given him bad news regarding his legal situation. As such, this writer instruc D staff s well as the Lieutenant's Office, to immediately notify the psychology department when he returned fr.:41 . Inmate Epstein returned from court after duty hours and denied suicidality. The aforementioned staff notifi T". all psychologist and Inmate Epstein was placed on a precautionary psychological observation status until psychol..,.:/•• terview him this morning to conduct a suicide risk assessment. Developmental History Inmate Epstein denied any history of being the victim Educational History/Cognitive Impairment Inmate Epstein reported he obtained his high school diplom mathematics. Arrest History . N. osience of incarceration rator of physical or sexual abuse. o ltied some graduate classes in the area of Inmate Epstein reported he has served time in Palm Beach County }ail se charges (soliciting prostitution) in the past. He is now being charged with sex trafficking, on a federal level. Mental Health History Inmate Epstein denied any history of mental health treatment, either on an inpati denied any treatment In the past or present with psychotropic medication. He also d symptoms at this time. Setf+larrn History tient basis. Inmate Epstein cute mental health Inmate Epstein denied any past or present suicidal ideation. intention or plan. He denied ever effS / gi Cng in any suicide attempts or self-injurious behavior in the past. Substance Abuse History Inmate Epstein denied any alcohol or substance abuse. Medical Concerns Inmate Epstein denied any significant medical problems. constipated at this time. Current Problem Inmate Epstein is currently on psychological observation due to his having multiple risk factors associated with suicidality. He denies any suicidality at this time and has no mental health or suicide history. He is being seen for a suicide risk assessment in an abundance of caution. Current Mental Status Level of Consciousness: Alert and Oriented Generated 07109/2019 10 36 by Miller, Elissa PhD/Chiel He said it is well-known that he does not even drink alcohol. other than a history of high triglycerides. He reported feeling Bureau of Prisons NYM Page 1 of 3 EFTA00059362 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318.054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: A&O Date: 07/09/2019 08:41 Provider. Miller, Elissa PhD/Chief Psychologist Psychomotor Activity: Normal General Appearance: Normal Behavior. Cooperative Mood: Appropriate to Content Thought Process: Goal Directed Thought Content: Normal Inmate Epstein did not exhibit any acute psychopathology and exhibited a clear mental status. . Current Mental Status: Mr. EP a neutral affect with approptkt: and volume. His thoughts irrelevant content. There not engage in any bizarre or Ma explicitly denied recent and cure commitment to life and safety, agree' IN was alert and oriented. He was polite, calm, and cooperative in demeanor. He exhibited . Eye contact and hygiene were appropriate. The inmate spoke with normal rate, tone, ized and coherent, with no loosening of associations or tangential, circumstantial, or ce of perceptual disturbance, delusional ideation, or a formal thought disorder. He did e behavior. He noted having normal sleeping and eating habits. Mr. EPSTEIN ation, planning, and intent. He was future-oriented and expressed a act staff immediately should he experience suicidal ideation. RISK AND]'ROTECTIVE FACTORS S SSW- This writer screened the inmate for a variety o validated factors commonly associated with risk for self-harm and suicide. The following STATIC risk factors were assessed t and Increase the Inmate's risk for engaging In suicide related behaviors: High Profile Crime, Lack of family connecti s ender status Of the DYNAMIC risk factors assessed, none were bun The following PROTECTIVE factors were assessed to be pres reasons to live, Adequate problem solving skills, Denial of suici negative, Willingness to engage in treatment As noted above, Inmate Epstein is a 66-year-old Caucasian male. He Including a high profile case with extensive media attention, sex offense& proceeding yesterday which may have given him bad news regarding his leg writer that his only family at this time is his brother, with whom he does not hay decrease the Inmate's risk of suicide:Able to identify ention/plans, Future orientation, View of death as factors for suicidality at this time rges, pre-trial status, and he had a court Inmate Epstein also informed this tionship with. Despite these risk factors, inmate Epstein possesses a number of protective factors a Inmate Epstein adamantly denied any suicidal ideation, intention or plan. He was very future oriented and requests call, to meet with his attorney, to take a shower, and to brush his teeth. He was eating his cereal when this writ said 1 have my paper spoon here." He reported he is going to have a bail hearing on Monday and believes he is go ed from jail. Inmate Epstein reported he is a Banker and has a "big business" in the community and that 'bei n.' He also revealed he enjoys learning and teaching. He has confidence in his attorney and described him as patent." Inmate Epstein denied any mental health history or history of suicidality. He also reported none of his family members have mental health histories. Inmate Epstein stated he is a mathematician and took post graduate classes In this area of study. Inmate Epstein stated he has a support system in the community, including friends and other associates. Finally, inmate Epstein demonstrated a good sense of humor and did not appear dysphoric, agitated or anxious. No acute psychopathology was noted. Overall, inmate Epstein has numerous protective factors at this time that outweigh his risk factors for suicidality. He has a positive outlook regarding his legal case, demonstrates no psychiatric symptoms. has no psychiatric or suicide history, and verbalized a desire to be alive at this time and future orientation. DIAGNOSIS- No Diagnosis, No Dx - Current CONCLUSIONS The Overall Acute Suicide Risk for this Inmate is: Low Overall Chronic Suicide Risk for this Inmate is: Absent Generated 07/09/2019 1038 by Miler. Elena PhD/Chlef Bureau of Prisons - NYM Page 2 of 3 EFTA00059363 Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318-054 Date of Birth: 01/20/1953 Sex: M Facility: NYM Unit Team: A8O Date: 07/09/2019 08:41 Provider. Miler, Elissa PhD/Chief Psychologist JICOMMENDATIONS Inmate Epstein is currently on psychological observation pending suitable housing placement. In light of his current sex offense charges and extensive media coverage on the television, he will need to be confined in a suitable housing unit. Inmate Epstein will be seen daily while on psychological observation and will be seen for a psychological observation follow-up session once he is released from observation. Inmate Epstein denied the need for psychological intervention, self-help materials, or follow-up. He has been classified as a CC1-MH inmate at this time. CARE1-MH Is indicative of an Inmate who shows no significant level of functional impairment associated with a mental illness and demonstrates no need for regular mental health intervention. Suicide Watch: A suicide watch Is not warranted at this time Completed by Miller, Elissa PhD/Chief Psychologist on 07/09/2019 10:35 Generated 07/09/2019 10 36 by Miller. Elissa PhD/Chief Bureau of Prisons - NYM Page 3 of 3 EFTA00059364 Bureau of Prisons Health Services See Amendment Inmate Name: EPSTEIN, JEFFREY EDWARD Reg #: 76318.054 Date of Birth: 01/20/1953 Sex: M Race: WHITE Encounter Dale: 07/09/2019 08:41 Facility- NYM Amendment made to this note by Miller, ElIssa PhD/Chief Psychologist on 07/10/2019 09:20. Bureau of Prisons • NYM EFTA00059365 Bureau of Prisons Psychology Services General Administrative Note **SENSITIVE BUT UNCLASSIFIED** Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/08/2019 10:41 Provider: Miller, Elissa PhD/Chief Reg 76318-054 Unit Team: A&O Comments This writer consulted with Dr. Robert Nagle, Central Office, regarding inmate Epstein. Inmate Epstein has various risk factors for suicidality including a high profile case with media attention, sex offense charges, pre-trial status, and a court proceeding today which could potentially be giving him bad news regarding his legal situation. As such, when inmate Epstein returns from court, R&D staff as well as Lieutenant's have been Informed to Immediately notify the psychology department. If he returns after duty hours, the aforementioned staff were instructed to notify the on-call psychologist and to place Inmate Epstein on a watch status until psychology can conduct a thorough suicide risk assessment. Completed by Miller, Elissa PhD/Chief Psychologist on 07/08/2019 10:49 Generaled 07/08/2019 10:49 by Miler, Elissa PhD/Chief Bureau of Prisons - NYM Page 1 of 1 EFTA00059366 Bureau of Prisons Psychology Services Risk of Sexual Abusiveness "SENSITIVE BUT UNCLASSIFIED" Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: t1 Facility: NYM Date: 07/08/2019 09:35 Provider: Schlessinger, K. PsyD/PhD Reg #: 76318-054 Unit Team: A8O Comments Risk of Sexual Abusiveness During the intake screening process, for Inmate Epstein, based on the documentation available at the time of the screening, and Inmate Epsteln's self-report, he was Identified as being at risk for sexual abusiveness due to previous perpetration of sexual abuse in the community or in an institutional setting, as evidenced by the following objective criteria: ( ) Having a history of prior institutional violence or sexual abuse perpetration (X ) Having a history of prior sexual abuse perpetration in the community (X ) Having prior convictions of violent offenses As required by P5324.11, Sexually Abusive Behavior Prevention and Intervention, Inmate Epstein was seen by Psychology on today's date to assess his risk factors for sexual abusiveness. At the onset of this clinical contact, the inmate was informed about the BOP requirements regarding PREA. Inmate Epstein indicated he understands the institution's policy against engaging in sexual behavior. His risk factors for sexual abusiveness were assessed and include: ( ) History of prior sexual victimization in prison ( X ) History of prior prison sexual predation ( ) History of head injury with loss of consciousness ( ) History of childhood psychological, physical, sexual abuse ( ) Witnessed family violence ( ) Antisocial Personality Disorder traits of irritability/aggressiveness and recklessness ( ) Hypersexuality (defined by eight or more orgasms a week prior to prison) ( ) Hypermasculinity ( ) Other: Based on this clinical assessment, the inmate is considered to be at: (X ) Low Risk of Abusiveness at this facility (Note: Even though this inmate Is judged to be at low risk of sexual abusiveness, an unforeseen change in risk factors may significantly alter his risk level.). Programming recommendations Included sex offender treatment. Inmate Epstein declined programming recommendations.The inmate understands the procedure for contacting Psychology for routine or emergent services. ( ) Moderate Risk of Abusiveness. The Unit Team and Correctional Staff have been notified regarding Psychology staff's recommendation that he not be housed In a cell with any inmates identified as at increased risk for sexual victimization. Psychology also recommends a greater level of supervision regarding his work and education assignments. Programming recommendations include XXXXX. Inmate =inmateLastName is agreeable to/ declined programming recommendations. ( ) High Risk of Abusiveness. It Is recommended this inmate be housed in the Special Housing Unit in accordance with P5324.11 to "keep separate those inmates at high risk of being sexually victimized from those at high risk of being sexually abusive until Correctional Services and Correctional Programs staff can assess his appropriateness for general population at this facility. This inmate should not be housed with any inmates judged to be at an increased risk for sexual victimization. Programming recommendations include XXXXX. Inmate =inmateLastName is agreeable to/ declined programming recommendations. Generated 07/0B/2019 09 41 by ScNessinger. K. PsyD/PhO Bureau of Prisons - NYM Page 1 of 2 EFTA00059367 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/08/2019 09:35 Provider. Schlessinger, K. PsyD/PhD Reg #: 76318-054 Unit Team: MO Completed by SchlessInger, K. PsyD/PhD on 07/08/2019 09:41 Generated 07/0812019 0941 by SchlessInger. K. PsyD/PtiD Bureau of Prisons - NYM Page 2 of 2 EFTA00059368 Bureau of Prisons Psychology Services Intake Screening "SENSITIVE BUT UNCLASSIFIED" Inmate Name: EPSTEIN. JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/08/2019 09:24 Provider: Schlessinger, K. PsyD/PhD Reg St. 76318-054 Unit Team: A8O Limits of Confidentiality Limits of confidentiality were reviewed with inmate EPSTEIN. He expressed an understanding of the limits of confidentiality and consented to be interviewed accordingly. Data Source(*) The following data sources were reviewed in conjunction with this Initial Intake Evaluation: Self-Report, SENTRY, Staff Observation. Inmate Epstein is a 66-year-old, Black male who was seen by Psychology Services due to newly arriving at MCC-NY. He denied a history of mental health treatment on his Psychology Services Intake Questionnaire. Mental Health History and Current Symptoms No history of mental health issues was noted. No history of prior mental health treatment was noted. No current mental health symptoms were noted. No suicidal ideation, attempts, or self-harm were noted. Substance Abuse No history of substance abuse was noted. No history of substance abuse treatment was noted. Sex Offenses No sexual offense convictions were noted. No history of sexual predation in a correctional setting was noted. Relevant PsychosocIal History Noteworthy psychosocial issues: Other. Inmate Epstein Is currently incarcerated for a Sex Trafficking. He stated he was previously incarcerated three months f or prostitution. Inmate Epstein stated he is single and does not have any children. He revealed he was living in New York. He slated he completed high school. He stated he was employed in banking work prior to his Incarceration. Adjustment to Incarceration Adjustment to incarceration concerns were identified: Other. SEXUAL ABUSE HISTORY Inmate Epstein denied being the victim of physical or sexual abuse. He is currently charged with sex trafficking and has previously been charged with prostitution. He was informed of the programs offered by MCC-NY as well as the Bureau of Prisons. Additionally, he was informed of this institutions self-help program. Inmate Epstein reported he was not currently interested in any treatment programs. MENTAL STATUS: Inmate Epstein appeared calm, controlled, without signs of psychomotor agitation or retardation. He was fully cooperative, maintained good eye-contact, and related in an interpersonally appropriate manner with interviewer. Speech and thought processes were organized, coherent, logical, and goal-directed. Based on Informal assessment during this interview, this Inmate's cognitive functioning appeared within normal limits, as reflected by adequate long and short-term memory, good attention, and appropriate concentration during interview, as well as adequate receptive and expressive language skills. Inmate denied any current sleep disturbances and described his appetite as adequate. This inmate denied recent or present morbid thoughts, passive or active suicidal ideation, intent or plan and contracted for safety. This inmate's verbalizations were optimistic, future oriented, and without indications of helpless or hopeless thinking. Inmate Brown denied any familial history of suicide behaviors or attempts. This inmate was provided with supportive psychotherapy, and psycho-education to strengthen coping skills and facilitate adjustment to incarceration. Findings Care Level: CARE1-MH Generaled 07/08/2019 09:30 by Schlessinger. K. PsyD/PhO Bureau of Prisons - NYM Page 1 of 2 EFTA00059369 Inmate Name: EPSTEIN, JEFFREY EDWARD Date of Birth: 01/20/1953 Sex: M Facility: NYM Date: 07/08/2019 09:24 Provider; Schlessinger, K. PsyD/PhD Inmate EPSTEIN denied any history of mental health symptoms or treatment. He denied any current mental health symptoms. He does not meet criteria for any current psychological diagnosis. He meets criteria for Mental Health Care Code 1. CARE1-MH is indicative of an inmate who shows no significant level of functional Impairment associated with a mental illness and demonstrates no need for regular mental health intervention. Recommendations The following psychological services are recommended: Other. Inmate EPSTEIN was educated about both routine and emergency procedures for contacting Psychology staff. He does not appear to be In distress at this time. He agreed to contact psychology if he feels he needs psychology services in the future. He meets criteria for CC1 and does not require scheduled follow up at this time. Completed by Schlessinger, K. PsyD/PhD on 07/08/2019 09:30 Reg ft 76318.054 Unit Team: MO Generated 07/0812019 09.30 by Schlessinger. K. PsyD/PhD Bureau of Prisons - NYM Page 2 of 2 EFTA00059370