Mental Illness in Correctional Populations: The Use of Standardized Screening Tools for Further Evaluation or Treatment

Posted by Justin | July 22, 2007 .

Screening for SMI involves a brief initial evaluation about a client’s need for mental health services, which can be done at the point of arrest, sentencing, or imprisonment. It also can be done formally or informally, and can trigger either an immediate decision or a more comprehensive psychiatric evaluation designed to help make subsequent mental health-related decisions about a case. For example, police officers at the scene determine who should be diverted for an emergency hospitalization instead of arrested and who is at risk of attempting suicide in lockup. Probation officers conduct mental health screening as part of an overall needs assessment to determine offender classification and service brokerage. Detention and correctional officers screen incoming prison inmates and jail detainees for mental illness in order to assign them to specialized housing and programming.

This article examines the use of actuarial screening tools that have been developed to flag persons with SMI for further assessment, diagnosis, and treatment in institutional and community-based correctional facilities. In the absence of such tools, the mentally ill in the criminal justice system are likely to go unrecognized and untreated. The paper is divided into four major sections. The first discusses the prevalence of persons with SMI in jail, prison, and probation populations and the dearth of mental health services for them. The second emphasizes the use of valid and reliable screening tools as an important first step in providing services for offenders with mental illness. The third presents the results of two studies that have tested mental health screening tools for use with criminal justice populations. The fourth concludes with recommendations for the incorporation of mental health screening tools in the intake protocols of correctional departments.

Mentally III in Criminal Justice Settings

Over the past 20 years, several epidemiclogical studies have shown that substantial numbers of persons involved in the criminal justice system have SMI, such as schizophrenia, bipolar disorder, and major depression (Abram & Teplin, 1991; Abram et al., 2003; Ditton, 1999; Diamond et al., 2001; Human Rights Watch [HRW], 2003). The three largest psychiatric facilities in the United States are urban jails: the Los Angeles County Jail, the Cook County Jail (CCJ) in Chicago, and the jail at Riker’s Island in New York City (Insel, 2003). One estimate suggests that 900,000 individuals with SMI are admitted to our nation’s jails annually (Steadman, Scott, Osher, Agnese, & Robbins, 2005). Many factors explain the large numbers of the mentally ill in offender populations. These factors include transinstitutionalization, stricter civil commitment laws, homelessness, public order policing, and the fragmentation of the mental health and drug treatment service systems (HRW, 2003; Lamb & Weinberger, 1998; Lurigio, 2005; Lurigio & Swartz, 2000).

Ditton (1999) has conducted the only national study to date on the prevalence of the mentally ill in correctional populations. She reported that, at midyear 1998, an estimated 283,800 mentally ill offenders were incarcerated in our nation’s prisons and jails. A total of 16 percent of those surveyed in each population reported either a mental health condition or an overnight stay in a mental hospital. Approximately 16 percent, or an estimated 547,800 probationers, indicated that they had experienced in their lifetime a mental disorder or stayed overnight in a mental hospital.