Mental health screening in jails

More than seven million individuals were admitted to North American jails in 2007, many with a serious mental disorder. Mentally disordered inmates are at an increase risk for self-harm and suicide, victimization and institutional disruption. The large number of mentally disordered inmates and the limited resources available in correctional settings make the proper identification of mentally disordered inmates difficult but critical. Legal and professional standards require jails to screen every inmate for mental health problems immediately upon intake. Despite these requirements, many jails do not systematically screen for mental disorder or employ practices with questionable validity. Recently, researchers have worked to develop and validate mental health screening tools designed specifically for the correctional setting. In this study, the utility of two such measures, the Brief Jail Mental Health Screen (BJMHS) and the Jail Screening Assessment Tool (JSAT) is examined. 1339 inmates in a British Columbia male pretrial centre were screened using both the BJMHS and the JSAT in a random counterbalanced fashion. When screened with the BJMHS, 45.0% of inmates screened positive whereas only 14.3% screened positive with the JSAT. 1 to 3 days after the screen (M = 1.61), 106 inmates were administered the Structured Clinical Interview for DSM. The BJMHS and JSAT’s overall agreement was 65.0% while their chance corrected-agreement was k = .244. Using various subsets of DSM Axis I disorders, 4 definitions of mental disorder were created. The validity of the BJMHS and JSAT were assessed by examining the results of the screen with each of these 4 definitions. The sensitivity and specificity of the BJMHS and JSAT varied by definition of mental disorder. While the BJMHS had better sensitivity across all definitions, the JSAT had better specificity across most definitions. Implications for correctional mental health care are discussed.