Evidence-Based Enhancement of the Detection, Prevention, and Treatment of Mental Illness in the Correction Systems.
Julian Ford, Ph.D. and Robert L. Trestman, M.D., Ph.D.
The goal of the present project was to develop and validate a brief mental health screening instrument suitable for use by correctional custody or healthcare staff in identifying jail detainees who warrant specialized mental health evaluation for undetected psychiatric impairment. Participants included English-speaking women (N=670) and Men (N=1526), 40% Black, 20% Hispanic, 40% White, ages 18-76 years old, who had no institutionally-identified serious mental health condition, were randomly recruited 24-72 hours after entry to jail. A randomly selected sub-sample (201 women; 307 men) received a structured diagnostic interview within five days. All data collection occurred in state-run jails for men (four sites) and women (one site) in the State of Connecticut, with data collection techniques involving the administration of a 25-minute “Composite Screening” interview in Phase 1. 20% of participants were then invited to complete a longer, more intensive “Structured Interview” one week later, which established a more detailed account of Axis I and Axis II psychiatric disorders and psychosocial functioning. Correctional Records Data was also obtained including Mental Health Scores and Overall Risk Scores. In Phase 2, the newly developed Screening Tool was then tested on an additional 206 participants, following the same protocol as in Phase 1. Exploratory (EFA) and Confirmatory (CFA) Factor Analyses were calculated to derive the best subset of items to be used in the brief mental health screen. Sensitivity, specificity, and positive and negative predictive power were calculated for the results of empirically-derived gender-differentiated brief screening instruments in relation to psychiatric diagnoses obtained by blind researchers using the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-P) and the Clinician Administered PTSD Scale as criterion standards. Results. The main outcome measures derived from this project are: The Correctional Mental Health Screen for Females (CMHS-F; 8 items) and The Correctional Mental Health Screen for Males (CMHS-M, 12 items). Epidemiology of mental health disorders is also reported.
Conclusions: This new brief screening tool is designed to expedite the process of accurately identifying individuals in the correctional system with mental illness. Dissemination of this tool can help to standardize screening practices nationwide. Prevalence rates of psychological disorders were found to be comparable to those found in psychiatric settings, and timely, proper identification of psychological illness in jails can aid in the treatment process for these individuals.
Click here to download (PDF 388 K) Revised instruments:
Correctional Mental Health Screen for Men
Correctional Mental Health Screen for Women
Validating a Brief Jail Mental Health Screen
Fred Osher; Jack E. Scott; Henry J. Steadman; Pamela Clark Robbins
The purpose of this project was to validate a jail mental health screening instrument that can be utilized by correctional classification staff to identify adult inmates during the booking phase that may require a more detailed mental health assessment. Since 1986, there has been a 250% increase in the size of the U.S. jail population, with epidemiologic data suggesting that prevalence rates of persons with mental illnesses in jail are 3- 5 times higher then the general population. The risk of suicide is an especially significant problem, particularly among new detainees. Suicide rates among jail and prison populations are higher than among the general population. About one-third of all jail suicides occur within the first week in custody, underscoring the importance of early identification. In addition, jail administrators report that inmates with mental illnesses are significantly more difficult to manage resulting in increased jail cost. Early identification could allow improvement in classification and management strategies. Jails have a substantial legal obligation to provide health and mental health care for inmates, yet screening procedures across American jails are highly variable. Currently, there is no valid, practical, standardized tool available. The Referral Decision Scale (RDS) had been previously tested as a screening instrument but was found to have significant concerns related to its predictive validity. Building upon RDS studies, we developed a revised instrument called the Brief Jail Mental Health Screen (BJMHS), testing it in both prisons and jails in Maryland and New York. The BJMHS takes an average of 2.5 minutes to administer, correctly classifying 73.5% of males, but only 61.6% of females based on SCID diagnoses. With suggested cut-off scores, the BJMHS identifies 11% of screened detainees for further mental health assessment.
Conclusions: The study concluded that the BJMHS is a practical, efficient tool for jail correction officer intake screening for male detainees. While an improvement over other screening instruments for all inmates, it has an unacceptably high false negative rate for female detainees.
Click here to download (PDF 172 K)
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