EARLY IDENTIFICATION OF MENTAL ILLNESS IN COUNTY JAILS/DENTENTION CENTERS

Mental Health Triage Effective mental health triage in the corrections setting can be viewed as a three ­stage process: 1. Routine universal mental health screening - administered by corrections staff during intake. Purpose: to identify those defendants who may need closer monitoring and/or a mental health assessment for a chronic or severe mental disorder 2. An in-depth assessment by a licensed clinician administered prior to housing assignment Purpose: to identify a diagnosis and treatment plan for possible diversion 3. A complete psychiatric evaluation when an inmate’s degree of acute disturbances require specialized treatment. Purpose: to identify competency and possible transfer from jail

Brief Mental Health Screen A valid standard screen needs to be brief Corrections classification staff have only a limited amount of time to complete initial intake Screen needs a decision criteria Corrections staff are not usually licensed clinicians Corrections staff are usually confident in their ability to identify overtly psychotic symptoms, but are my be uncertain about identifying less obvious—though equally serious—signs and symptoms of anxiety and depression. Correctional staff need a tool that can provide them with the basis for a clear decision to “refer” or “don’t refer” for further evaluation.

Brief Jail Mental Health Screen The BJMHS takes, on average, about 2.5 minutes to administer. It includes 8 items It provides a criteria for Urgent, Routine or No Referral

BJMHS Questions 1.Do you get annoyed when friends and family complain about their problems? Or do people complain you are not sympathetic to their problems? 2.Have you ever tried to avoid reminders of, or to not think about, something terrible that you experienced or witnessed? 3.Some people find their mood changes frequently-as if they spend everyday on an emotional rollercoaster. Does this sound like you? 4.Have there ever been a few weeks when you felt useless, sinful or guilty? 5.Has there ever been a time when you felt depressed most of the day for at least two weeks?

BMHJS Questions 6. Do you find that most people will take advantage of you if you let them know too much about you? 7. Have you been troubled b y repeated thoughts, feelings or nightmares about something terrible that you experienced or witnessed? 8. Have you ever been in a hospital for non-medical reasons, such as a psychiatric hospital (Do not included going to an emergency room if you were not hospitalized) Scoring 5+ yes responses = further evaluation

Brief Jail Mental Health Screen Validity It correctly classified 74% of males It correctly classified 62% of females 11% of screened defendants are identified for further mental health assessment. The BJMHS was not as effective for women. The lower accuracy of the BJMHS among women may be due to the fact that the BJMHS does not measure symptoms of anxiety that are associated with the high incidence of PTSD experienced by women defendants.

TRAINING It is essential that in addition to use of the BJMHS, correctional intake staff and partner agencies coordinate and receive on-going training on: Mental health symptoms Trauma informed care Use of best practices

Essential Elements to Improving Responses to the Mentally Ill at the Pretrial Stage Jurisdictions can improve pre-adjudication services through development and use of essential Elements Collaboration Training Release and Diversion Options Informed Decision Making Quick Connections to Appropriate Behavioral Health and Support Services Community Supervision and Treatment at the Pretrial Stage Performance Measurement and Evaluation Available at csgjusticecenter.org