Mental Health Screenings for Corrections Doj Handbook 2007
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MAY 07 U.S. Department of Justice Office of Justice Programs National Institute of Justice Research for Practice Mental Health Screens for Corrections www.ojp.usdoj.gov/nij U.S. Department of Justice Office of Justice Programs 810 Seventh Street N.W. Washington, DC 20531 Alberto R. Gonzales Attorney General Regina B. Schofield Assistant Attorney General David W. Hagy Deputy Assistant Attorney General, Office of Justice Programs and Acting Principal Deputy Director, National Institute of Justice This and other publications and products of the National Institute of Justice can be found at: National Institute of Justice www.ojp.usdoj.gov/nij Office of Justice Programs Innovation • Partnerships • Safer Neighborhoods www.ojp.usdoj.gov MAY 07 Mental Health Screens for Corrections� This Research for Practice is based on two final reports to the National Institute of Justice: “EvidenceBased Enhancement of the Detection, Prevention, and Treatment of Mental Illness in the Correction Systems,” by Ford and Trestman, August 2005, NCJ 210829, available online at www.ncjrs.org/ pdffiles1/nij/grants/ 210829.pdf; and “Validating a Brief Jail Mental Health Screen,” by Osher, Scott, Steadman, and Robbins, November 2004, NCJ 213805, available online at www.ncjrs.org/ pdffiles1/nij/grants/ 213805.pdf. Findings and conclusions of the research reported here are those of the authors and do not necessarily reflect the official position or policies of the U.S. Department of Justice. This research was supported by NIJ under grant numbers 2000–IJ–CX–0044 and 2001–IJ–CX–0030. NCJ 216152 RESEARCH FOR PRACTICE / MAY 07 ABOUT THIS REPORT Identifying entering inmates’ mental health needs when they first enter an institution is critical to providing neces sary services and enhancing safety in corrections settings. The purpose of the two proj ects discussed in this report was to create and validate mental health screening instruments corrections staff can use during intake. accurately identify inmates who require mental health interventions. One mental health screen was found to be effective for men and is being adapted for women; the other has effective ver sions for both men and women. What did the researchers find? Corrections administrators and mental health professionals. The researchers created short questionnaires that ii Who should read this report? M E N TA L H E A LT H S C R E E N S F O R C O R R E C T I O N S Julian Ford and Robert L. Trestman/Fred Osher, Jack E. Scott, Henry J. Steadman, and Pamela Clark Robbins Mental Health Screens for Corrections About the Authors Dr. Julian Ford and Dr. Robert L. Trestman are with the University of Connecticut Health Center, Farmington, Connecticut. Dr. Fred Osher and Dr. Jack E. Scott are with the Center for Behavioral Health, Justice, and Public Policy, Baltimore, Maryland. Dr. Henry J. Steadman and Pamela Clark Robbins are with Policy Research Associates, Inc., Delmar, New York. As corrections staff across the United States struggle to keep up with the rapid influx of new inmates while main taining a secure environment, their efforts are increasingly hampered by the presence of individuals with serious men tal illnesses who are entering corrections facilities in grow ing numbers. Numerous stud ies show that jail detainees have a significantly higher rate of serious mental illness (e.g., bipolar disorder, major depression, schizophrenia, and other psychoses) than the general population.1 One pair of studies reported that approximately 6 percent of men and 15 percent of women who were admitted to Chicago’s Cook County jail displayed severe symptoms of mental illness and required treatment.2 Many serious mental illnesses are chronic and are subject to exacerbation and relapse. The stress of incarceration can worsen symptoms in persons with preexisting mental disorders, leading to acute psychiatric distur bances, including harm to self or others; inmates with histories of severe mental ill ness may present an even greater risk. Moreover, sever al studies have shown that inmates with psychiatric impairment may exhibit more serious and more numerous adjustment and disciplinary problems (such as refusal to leave one’s cell or destruction of property) during incarcera tion than unimpaired inmates.3 Prisons and jails have a sub stantial legal obligation to provide health and mental health care for inmates.4 Case law and statutes have not provided a clear definition of what constitutes adequate mental health care. The American Psychiatric Associa tion has, however, recom mended that all corrections facilities provide at minimum mental health screening, referral, and evaluation; crisis intervention and shortterm treatment (most often med ication); and discharge and prerelease planning.5 A national survey of 1,706 U.S. jails reported that 83 percent of them provide some form of initial screening for mental health treatment needs.6 Still, screening procedures are 1 RESEARCH FOR PRACTICE / MAY 07 highly variable; they may con sist of anything from one or two questions about previous treatment to a detailed, struc tured mental status examina tion. One result of this variability is apparent in data that showed fully 63 percent of inmates who were found to have acute mental symptoms through independently admin istered testing were missed by routine screening per formed by jail staff and remained untreated.7 Clearly, there is a pressing need to develop valid and reliable procedures to screen incoming detainees for signs and symptoms of acute psychiatric disturbance and disorder. Researchers funded by the National Institute of Justice have created and tested two brief mental health screening tools and found that they are likely to work well in correc tional settings. These tools are the Correctional Mental Health Screen (CMHS)8 and the Brief Jail Mental Health Screen (BJMHS).9 The tools are in the appendixes. CMHS. The CMHS uses sep arate questionnaires for men and women. The version for women (CMHS–W) consists of 8 yes/no questions, and the 2 version for men (CMHS–M) contains 12 yes/no questions about current and lifetime indications of serious mental disorder. Six questions regard ing symptoms and history of mental illness are the same on both questionnaires; the remaining questions are unique to each gender screen. Each screen takes about 3–5 minutes to admin ister. It is recommended that male inmates who answer six or more questions “yes” and female inmates who answer five or more ques tions “yes” be referred for further evaluation. BJMHS. The BJMHS has 8 yes/no questions, takes about 2–3 minutes, and requires minimal training to administer. It asks six ques tions about current mental disorders plus two questions about history of hospitaliza tion and medication for men tal or emotional problems. Inmates who answer “yes” to two or more questions about current symptoms or answer “yes” to either of the other two questions are referred for further evalua tion. Instructions for adminis tering the screen appear on the back of the form. Correc tions classification officers, intake staff, or nursing staff can administer the screen M E N TA L H E A LT H S C R E E N S F O R C O R R E C T I O N S without specialized mental health training, but may receive brief informal training before administration. Criteria for Detecting Mental Illness in Jails When inmates enter a correc tions facility, the staff’s first task is to separate out those who may be at significant risk for suicide, acute psychotic breakdown, or complications from recent substance abuse from those who are merely experiencing varying degrees of distress usually associated with arrest, conviction, and detention. Effective mental health triage in the corrections setting can be viewed as a threestage process: (1) routine, system atic, and universal mental health screening performed by corrections staff during the intake or classification stage, to identify those inmates who may need closer monitoring and mental health assessment for a severe mental disorder; (2) a more indepth assessment by trained mental health person nel conducted within 24 hours of a positive screen; and (3) a fullscale psychiatric evaluation when an inmate’s degree of acute disturbances warrants it. Screening is the crucial part of the process, because it is the primary means by which staff can determine which inmates require more special ized mental health assess ment or evaluation, as well as treatment. Unless inmates are identified as potentially needing mental health treat ment, they will not receive it. Screening, however, is the weak link and, as already noted, varies considerably. Until now, there were no valid, standardized tools available that could be recommended for adoption nationwide. A valid standard screen needs to be brief, because corrections classification staff have only a limited amount of time to spend with any one inmate. It also needs to pro vide explicit decision criteria, because the mental health training and experience of corrections staff is likely to be relatively low. Corrections staff traditionally are confi dent in their ability to discern overtly psychotic symptoms, but are considerably more uncertain about identifying less obvious—though equally serious—signs and symp toms of anxiety and depres sion. Thus, they need a tool that can provide them with the basis for a clear decision (“refer” or “don’t refer”). 3 RESEARCH FOR PRACTICE / MAY 07 A useful jail mental health screen also needs to exhibit a low falsenegative rate— that is, it would not miss many inmates who have a serious mental disorder because the potential conse quences of not treating an inmate with a serious mental illness could be grave. On the other hand, it must have a low falsepositive rate too, because mental health resources in corrections settings are scarce and bur dening trained mental health staff with the need to assess many people who do not have a serious mental illness is an inefficient use of their time. Thus, an effective men tal health screening tool would have a high degree of predictive validity, in that most of the people who are flagged by it as being “positive” should, on further assessment, be found to have a treatable serious men tal illness. Different Instruments for Different Needs There are few available screening tools that meet all of these criteria. Symptom checklists, like the Symptom Checklist90 and the Brief Symptom Inventory (BSI),10 focus on the recent, selfrated 4 experience of specific symp toms within the past week. These checklists have 90 and 53 items, respectively, and require more time to adminis ter than is desirable. Another major drawback for the use of the BSI is its cost, which is currently more than $1 per administration. Rating instru ments like the Brief Psychi atric Rating Scale11 and the Schedule of Affective Disor ders and Schizophrenia— Change Version12 require independent symptom rat ings by a clinicallytrained interviewer. Although they can be useful as part of a followup assessment, these instruments are not practical for use as a screen by correc tions staff. One instrument that has shown promise for meeting the key criteria is the Referral Decision Scale (RDS),13 which was designed to serve as a rapidly administered and easi ly scored screening tool for use in corrections settings. As a screening tool, it was not developed to diagnose disorders, nor was it intended to serve as a measure of the severity of dysfunction. Rather, the RDS was meant to flag signs and symptoms of gross impairment associat ed with serious mental health disorders. The final published M E N TA L H E A LT H S C R E E N S F O R C O R R E C T I O N S version of the RDS consists of three scales—one each for schizophrenia, bipolar disor ders, and major depression— incorporating 14 items predictive of these disorders that were derived from the National Institute of Mental Health’s Diagnostic Interview Schedule (DIS).14 Each of the scales contains a cutoff score that, if met or exceeded, should result in a referral for mental health assessment. Research has provided pre liminary evidence of the valid ity of the RDS by comparing results of the RDS with those of the parent instrument, the DIS.15 On lifetime diagnoses of schizophrenia, bipolar dis orders, and major depression, the average sensitivity of the three RDS scales (how well they detect illness among inmates who are truly ill, as defined here by the DIS) was reported as 88 percent, and the mean specificity (how well they detect no illness among inmates who do not have a disorder) was 99 per cent. Several researchers have raised questions, how ever, about the RDS’s con tent and validity. Notably, one group of researchers16 ques tioned whether several items in the RDS scales were appropriate for use with incarcerated individuals, and whether the use of lifetime occurrence of symptoms rather than current symptoms may overestimate the current need for further mental health services. In response to these con cerns, two teams of re searchers set about to create and validate even better screens. One team’s screen, the CMHS, began as an amal gam of the RDS and three other diagnostic tools. The other screen, the BJMHS, is a major revision of the RDS. CMHS: A Gender Specific Screen Development. The CMHS–W and CMHS–M were developed by first pre senting to study participants a lengthy, 25minute compos ite of all the questions from four separate screens, includ ing the RDS and part of the Structured Clinical Interview for DSM–IV (SCID).17 The composite contained 53 items. The study participants were 2,196 adults detained in 5 State of Connecticut jails. About onefifth of the partici pants were randomly selected to be brought back 1–5 days later for an even lengthier clinical assessment (45–180 minutes) consisting of the 5 RESEARCH FOR PRACTICE / MAY 07 complete SCID plus additional screening questions. Statistical analysis was per formed, separately by gender, to determine the questions with the most statistical sen sitivity, specificity, and predic tive power to measure nine clusters of mental health disorders, including current depressive disorders, current anxiety disorders, antisocial personality disorder, and posttraumatic stress disorder (PTSD). On the basis of this initial analysis, some ques tions were eliminated and others that were judged redundant were combined. The result was two composite pools, one with 38 items for women and one with 40 items for men. Additional, complex analysis was then performed18 leading to the 8item CMHS–W and 12item CMHS–M, each of which takes 3–5 minutes to admin ister. (See the forms in appendix A.) These final ver sions were validated on an additional group of 206 partic ipants, using the same proto col as the first phase of the study. Validation. Statistical analysis of the validation test results against the clinical assess ments showed that the new screens proved highly valid in 6 identifying depression, anxi ety, PTSD, some personality disorders, and the presence of any undetected mental illness. The CMHS–W was 75.0 percent accurate in correctly classifying female inmates and the CMHS–M was 75.5 percent accurate in correctly classifying male inmates as having a pre viously undetected mental illness.19 Interestingly, the clinical assessments that were per formed found the incidence of serious mental illness among the participants to be far higher than in the general population and comparable to that in psychiatric settings. This finding is especially sig nificant given that inmates who had already been referred for mental health hospitaliza tion were excluded from the study. Assessment. The CMHS accurately identifies individu als in corrections settings with mental illness. Validation testing confirmed that ver sions for both women and men showed evidence of reliability, validity, and pre dictive utility in relation to the accurate identification of undetected psychiatric disorders. Both correctly classified at least 75 percent M E N TA L H E A LT H S C R E E N S F O R C O R R E C T I O N S of inmates, thus providing reasonable certainty of identi fying inmates in need of mental health services with out burdening mental health providers with the responsi bility of evaluating inmates who have less serious men tal health problems. The CMHS–W has additional relevance because it is the first mental health screen developed and validated specifically for women. In contrast to prior studies that either have not included jailed women, have included female inmate samples too small to develop gender specific screening instru ments, or used a single screening measure for both genders, the CMHS–W shows promise as a mental health screen for newly incarcerated women in jails. Brief Jail Mental Health Screen Development. The BJMHS is directly derived from the RDS. Because the existing RDS scales have not per formed well in discriminating among schizophrenia, bipolar disorders, and major depres sion, the scoring approach for the BJMHS was to develop a single composite scale. Thus, a positive score now indicates that an individual has recent or acute symptoms associat ed with any one or more of the three disorders. The num ber of items was reduced from the original 14 to a smaller set of 8 items by eliminating items that had questionable validity and did not contribute statistically to the composite scale. Sev eral items were rephrased to provide clearer wording. Finally, the timeframe employed by the RDS was changed from lifetime occur rence to “currently.” (See the form in appendix B.) The BJMHS takes, on aver age, about 2.5 minutes to administer. Stepbystep instructions for recording an inmate’s responses are print ed on the back of the inter view form. The first six questions ask about specific current symptoms. Two additional questions ask whether the inmate has ever been in a hospital for emo tional or mental health prob lems and if he or she is currently taking any medica tion prescribed by a physician for any emotional or mental health problem. Anyone who scores positively on two or more current items, or either the hospitalization or medica tion item should be referred to mental health services for immediate attention. 7 RESEARCH FOR PRACTICE / MAY 07 Validation. Although the BJMHS was intended to be a step forward in the evolution of the RDS, important ques tions remained about its operation in a jail setting. Among the most important— what was the validity of the BJMHS when compared to a “gold standard” such as the SCID? The SCID must be administered by a carefully trained clinician and typically takes between 1 and 2 hours to complete. A study was devised to test the concur rent validity (that is, validity when compared against an independent, validated instru ment) of the BJMHS in rela tion to the SCID. Corrections classification offi cers in four county jails—two in Maryland and two in New York—participated in informa tion sessions that provided training on administration of the BJMHS. This unstructured training, which took place in the jails, included a brief description of the research project and instructions on completing the BJMHS during the intake process. Participants in the validation study were 11,438 male and female detainees admitted to one of the four jails between May 2002 and January 2003. 8 All participants were given the BJMHS upon admission to the jails. The BJMHS data were used to identify a subsample of detainees (approximately 90 from each jail) who were given a detailed clinical assessment conducted by a trained research interviewer using the SCID. This subsam ple was designed to com prise a large enough number of females to enable separate analysis by gender. The results showed that the BJMHS referrals and nonre ferrals matched the SCID findings of serious mental illness or no serious mental illness for 73.5 percent of males and 61.6 percent of females. There were 20 false negatives among males (14.6 percent of male nonreferrals) and 33 false negatives among females (34.7 percent of female nonreferrals). The large percentage of female false negatives was cause for concern. An examination of the false negatives among both men and women showed that 2 of the 20 men and 6 of the 33 women were missed because the screen focused solely on current symptoms as opposed to symptoms in the past 6 months. M E N TA L H E A LT H S C R E E N S F O R C O R R E C T I O N S Another problem was the inconsistent reporting of symptoms. All the questions asked on the BJMHS were repeated during the SCID interview. They were either part of the SCID or added for the research study. In all but seven of the false negative cases, the inmates reported different information to the SCID interviewer than they had to the corrections officer. Had they reported the same information on the BJMHS, they would have been referred for further mental health assessment and only one male case and six female cases would have been missed. Assessment. In light of these data, the BJMHS is shown currently to be a pow erful tool for screening men booked into U.S. jails. It is simple to use for intake offi cers, requires only modest training, and is almost 74 per cent accurate. Based on cor rection officer feedback, the creators of the BJMHS rec ommend the following to maximize accuracy: ❋�Detailed training of correc tions staff on proper admin istration of the screen, including clarifying the purpose of the screen and providing help with inter viewing techniques. ❋�Administration of the screen by nurses (where available) in cases of unco operative inmates or those who state discomfort answering corrections officers’ questions about mental illness. ❋�Use of a computerassisted version of the tool, which may reduce the problem of symptom underreporting. The BJMHS was not as effective for women. That it correctly identified 54.9 percent (28 of 51 women) of the true positives among the women participants is an improvement over current practices. Still, the screen missed 34.7 percent of women with current symptoms. 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 inci dence of PTSD experienced by women detainees.20 Sub sequent modifications of the BJMHS for women will need to add questions that capture anxiety symptoms. It may also be that women are less likely to disclose symptoms to corrections officers, who are most often male, on 9 RESEARCH FOR PRACTICE / MAY 07 intake. Whatever the explana tion, research is needed to create an appropriate jail intake screen for women. The developers of the BJMHS have received additional NIJ funding to test and refine the screen further for female inmates. Both Screens Meet Needs at Intake Both the BJMHS and the two genderspecific versions of CMHS offer improvement over existing tools in stan dardizing and increasing the accuracy of initial mental health screening in correc tions facilities. Their brevity, use of yes/no questions, sim ple scoring techniques, and availability at no cost make them well suited for quick mental health screening of large numbers of inmates dur ing intake. Their effectiveness in identifying inmates in need of mental health treatment compares favorably with the longer, more cumbersome, and trainingintensive tools currently used in clinical assessments. Based on their successful validation results, it is anticipated that these tools will be disseminated nationwide for use in all cor rections facilities. 10 Notes 1. See, for example, Jemelka, Ron, Eric W. Trupin, and John A. Chiles, “The Mentally Ill in Prisons: A Review,” Hospital and Community Psychiatry 40 (May 1989): 481–490; Teplin, Linda A., “The Criminalization Hypothesis: Myth, Misnomer, or Management Strategy,” in Law and Mental Health: Major Developments and Research Needs, ed. S.A. Shah and B.D. Sales, Rockville, MD: National Institute of Mental Health, 1991: 149–183. 2. Teplin, Linda A., “Psychiatric and Substance Abuse Disorders Among Male Urban Jail Detainees,” Ameri can Journal of Public Health 84 (Feb ruary 1994): 290–293; Teplin, Linda A., Karen M. Abram, and Gary M. McClelland, “Prevalence of Psychi atric Disorders Among Incarcerated Women,” Archives of General Psychi atry 53 (June 1996): 505–512. 3. Toch, Hans, and Kenneth Adams, “Pathology and Disruptiveness Among Prison Inmates,” Journal of Research in Crime and Delinquency 23 (1) (February 1986): 7–21; Toch, Hans, Kenneth Adams, and James Douglas Grant, Coping: Maladapta tion in Prison, New Brunswick, NJ: Transaction, 1989; McCorkle, Richard C., “Gender, Psychopathology and Institutional Behavior: A Comparison of Male and Female Mentally Ill Prison Inmates,” Journal of Criminal Justice 23 (1) (January 1995): 53–61; Lindquist, Christine H., and Charles A. Lindquist, “Gender Differences in Distress: Mental Health Conse quences of Environmental Stress Among Jail Inmates,” Behavioral Sciences and the Law 15 (Autumn 1997): 503–523. M E N TA L H E A LT H S C R E E N S F O R C O R R E C T I O N S 4. Cohen, Fred, and Joel Dvoskin, “Inmates with Mental Disorders: A Guide to Law and Practice,” Mental and Physical Disability Law Reporter 16 (3–4) (1992): 339–346, 462–470. 5. American Psychiatric Association, Psychiatric Services in Jails and Prisons: A Task Force Report of the American Psychiatric Association, 2nd ed., Washington, DC: American Psychiatric Association, 2000. 6. Steadman, Henry J., and Bonita M. Veysey, Providing Services for Jail Inmates with Mental Disorders, Research in Brief, Washington, DC: National Institute of Justice, January 1997, NCJ 162207, available at www.ncjrs.gov/pdffiles/162207.pdf. 7. Teplin, Linda A., “Detecting Disor der: The Treatment of Mental Illness Among Jail Detainees,” Journal of Consulting and Clinical Psychology, 58 (2) (April 1990): 233–236. 8. Ford, Julian, and Robert L. Trest man, “EvidenceBased Enhance ment of the Detection, Prevention, and Treatment of Mental Illness in Correctional Systems,” final report for National Institute of Justice, grant number 2001–IJ–CX–0044, Washing ton, DC: National Institute of Justice, 2005, NCJ 210829, available at www.ncjrs.gov/pdffiles/nij/grants/ 210829.pdf. 9. Osher, Fred, Jack E. Scott, Henry J. Steadman, and Pamela Clark Rob bins, “Validating a Brief Jail Mental Health Screen,” final report for National Institute of Justice, grant number 2001–IJ–CX–0030, Washing ton, DC: National Institute of Justice, 2004, NCJ 213805, available at www.ncjrs.gov/pdffiles/nij/grants/ 213805.pdf. 10. Derogatis, Leonard R., SCL–90R: Administration, Scoring, and Proce dures Manual, Baltimore, MD: Clini cal Psychometrics Research, 1977; Derogatis, Leonard R., BSI: Adminis tration, Scoring, and Procedures Manual, 3d ed., Minneapolis, MN: National Computer Systems, 1993. 11. Overall, John E., and Donald R. Gorham, “The Brief Psychiatric Rat ing Scale,” Psychological Reports 10 (1962): 799–812. 12. Spitzer, Robert L., and Jean Endi cott, Schedule of Affective Disorders and Schizophrenia—Change Version, New York: Biometrics Research, 1978. 13. Teplin, Linda A., and James A. Swartz, “Screening for Severe Mental Disorder in Jails,” Law and Human Behavior 13 (1) (March 1989): 1–18. 14. Robins, Lee, John Helzer, Jack Croughan, and Kathryn S. Ratcliff, “National Institute of Mental Health Diagnostic Interview Schedule: Its History, Characteristics, and Validity,” Archives of General Psychiatry 38 (April 1981): 381–389. 15. Teplin and Swartz, “Screening for Severe Mental Disorder in Jails” (see note 13). 16. Veysey, Bonita M., Henry J. Steadman, Joseph P. Morrissey, Matthew Johnsen, and Jason Beck stead, “Using the Referral Decision Scale to Screen Mentally Ill Jail Detainees: Validity and Implementa tion Issues,” Law and Human Behav ior 22 (2) (April 1998): 305–315. 17. DSM–IV is the common abbrevia tion for the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition, published by the American Psychiatric Association in 1994. 11 RESEARCH FOR PRACTICE / MAY 07 In the United States, it is the main reference used by mental health professionals to diagnose mental disorders. 6 or more “yes” answers out of 12 on the CMHS–M were considered “positive” results for referral to addi tional mental health assessment. 18. For a detailed discussion of the additional analysis, see the final report, available online at www.ncjrs. org/pdffiles1/nij/grants/210829.pdf. 20. Veysey, Bonita M., “Specific Needs of Women Diagnosed With Mental Illnesses in U.S. Jails,” in Women’s Mental Health Services:� A Public Health Perspective, ed. B.L.� Levin, A.K. Blanch, and A. Jennings,� Thousand Oaks, CA: Sage, 1998.� 19. Five or more “yes” answers out of 8 questions on the CMHS–W and 12 M E N TA L H E A LT H S C R E E N S F O R C O R R E C T I O N S Appendix A* Correctional Mental Health Screen for Women (CMHS-W) Correctional Mental Health Screen for Women (CMHS-W) Name Name __________________ __________________ Last, First, MI MI Last, First, _________ _ _ /_ _ /_ _ _ _ _________ _ _ /_ _ /_ _ _ _ Detainee # Date mm/dd/year Detainee # Date mm/dd/year Questions No Yes No Yes 1. Do you get annoyed Questions when friends and family 1. complain Do you get annoyed when friends family about their problems? Or and do people complainyou about problems? Ortodo people complain aretheir not sympathetic their problems? complain you are to their problems? 2. Have you ever triednot to sympathetic avoid reminders of, or to not 2. think Have about, you ever tried to avoid reminders or to not something terrible that you of, experienced think about, something terrible that you experienced or witnessed? or witnessed? 3. Some people find their mood changes frequently-as if 3. they Somespend people find their changesrollercoaster. frequently-as if everyday onmood an emotional they spend everyday an emotional rollercoaster. For example, switchingon from feeling angry to For example, switching from feeling angry to this depressed to anxious many times a day. Does depressed to anxious many times a day. Does this sound like you? sound like ever you? been a few weeks when you felt you 4. Have there 4. were Have useless, there ever been few weeks when you felt you sinful, oraguilty? were useless, guilty? 5. Has there ever sinful, been aor time when you felt depressed 5. most Has there time 2when you felt depressed of theever day been for ataleast weeks? most thethat day most for atpeople least 2will weeks? 6. Do youoffind take advantage of 6. you Do you find most people will take advantage of if you letthat them know too much about you? you ifyou youbeen let them know much about you? 7. Have troubled bytoo repeated thoughts, 7. feelings, Have youorbeen troubledabout by repeated thoughts, nightmares something terrible that feelings, or nightmares about something terrible that you experienced or witnessed? you experienced or in witnessed? 8. Have you ever been the hospital for non-medical 8. reasons, Have yousuch everas been in the hospital for non-medical a psychiatric hospital? (Do NOT include going to an Room if you were not reasons, such as Emergency a psychiatric hospital? (Do NOT __:__ Time __:__ Time Comments Comments hospitalized.) include going to an Emergency Room if you were not hospitalized.) General TOTAL # YES: ______ Comments: General TOTAL # YES: ______ Comments: Refer for further Mental Health Evaluation if the Detainee answered Refer forto further Mental Health if the Detainee answered Yes 5 or more items OR IfEvaluation you are concerned for any other reason Yes to 5 or more items OR If you are concerned for any other reason URGENT Referral on _ _/ _ _/ _ _ _ _ to _____________________ URGENT Referral on _ _/ _ _/ _ _ _ _ to _____________________ ROUTINE Referral on _ _/ _ _/ _ _ _ _ to _____________________ ROUTINE Referral on _ _/ _ _/ _ _ _ _ to _____________________ Not Referred Not Referred Person Completing Screen: _________________________ Person Completing Screen: _________________________ * The forms in appendixes A and B are shown exactly as they are provided to correctional institutions. 13 RESEARCH FOR PRACTICE / MAY 07 INSTRUCTIONS FOR COMPLETING THE CMHS-W General Information: The CMHS is a tool designed to assist in the early detection of psychiatric illness during the jail intake process. The Research Team under the direction of Drs. Julian D. Ford and Robert L. Trestman at the University of Connecticut Health Center developed this Correctional Mental Health Screen for Women (CMHS-W), with a grant funded by the National Institute of Justice. Instructions for administration of the CMHS-W: Correctional Officers may administer this mental health screen during intake. Name: Detainee#: Date: Time: Detainee’s name- Last, first and middle initial Detainee’s facility identification number Today’s month, date, year Current time (24hr or AM/PM) Questions #1-8 may be administered as best suits the facility’s policies and procedures and the reading level, language abilities, and motivation of the detainee who is completing the screen. The method chosen should be used consistently. Two recommended methods: • Staff reads the questions out loud and fills in the detainee’s answers to the questions on the form • Staff reads the questions out loud, while the detainee reads them on a separate sheet and fills in her answers Each question should be carefully read, and a check mark placed in the appropriate column (for “NO” or “YES” response). The staff person should add a note in the Comments Section to document any information that is relevant and significant for any question that the detainee has answered “YES.” If the detainee declines to answer a question or says she does not know the answer to a question, do NOT check “YES” or “NO.” Instead, record DECLINED or DON’T KNOW in the Comments box. Total # YES: total number of YES responses General Comments: Staff may include information here to describe overall concerns about the responses (for example: intoxicated, impaired, or uncooperative) Referral Instructions: Urgent Referral: A referral for urgent mental health evaluation may be made by the staff person if there is any behavioral or other evidence that a detainee is unable to cope emotionally or mentally or is a suicide risk. Routine Referral: A detainee answering “YES” to 5 or more items should be referred for routine mental health evaluation. A referral also may be made if the staff person has any concerns about the detainee’s mental state or ability to cope emotionally or behaviorally. ** If at any point during administration of the CMHS-W the detainee experiences more than mild and temporary emotional distress (such as severe anxiety, grief, anger or disorientation) she should be referred for immediate mental health evaluation. Referral: Check the appropriate box for whether a detainee was referred. If referred, check URGENT or ROUTINE, enter the date of the referral and the mental health staff person or mental health clinic to whom the referral was given. Person completing screen: Enter the staff member’s name 14 M E N TA L H E A LT H S C R E E N S F O R C O R R E C T I O N S Correctional Mental Health Screen for Men (CMHS-M) Name __________________ Last, First, MI _________ Detainee # Date _ _ /_ _ /_ _ _ _ mm/dd/year __:__ Time QUESTIONS NO YES COMMENTS 1. Have you ever had worries that you just can’t get rid of? 2. Some people find their mood changes frequently – as if they spend everyday on an emotional roller coaster. Does this sound like you? 3. Do you get annoyed when friends or family complain about their problems? Or do people complain that you’re not sympathetic to their problems? 4. Have you ever felt like you didn’t have any feelings, or felt distant or cut off from other people or from your surroundings? 5. Has there ever been a time when you felt so irritable that you found yourself shouting at people or starting fights or arguments? 6. Do you often get in trouble at work or with friends because you act excited at first but then lose interest in projects and don’t follow through? 7. Do you tend to hold grudges or give people the silent treatment for days at a time? 8. Have you ever tried to avoid reminders, or to not think about, something terrible that you experienced or witnessed? 9. Has there ever been a time when you felt depressed most of the day for at least 2 weeks? 10. Have you ever been troubled by repeated thoughts, feelings, or nightmares about something you experienced or witnessed? 11. Have you ever been in a hospital for non-medical reasons such as in a psychiatric hospital? (Do NOT include going to an Emergency Room if you were not hospitalized.) 12. Have you ever felt constantly on guard or watchful even when you didn’t need to, or felt jumpy and easily startled? TOTAL # YES: ______ General Comments: Refer for further Mental Health Evaluation if the Detainee answered Yes to 6 or more items OR If you are concerned for any other reason URGENT Referral on _ _/ _ _/ _ _ _ _ to _____________________ ROUTINE Referral on _ _/ _ _/ _ _ _ _ to _____________________ Not Referred Person Completing Screen: _________________________ 15 RESEARCH FOR PRACTICE / MAY 07 INSTRUCTIONS FOR COMPLETING THE CMHS-M General Information: The CMHS is a tool designed to assist in the early detection of psychiatric illness during the jail intake process. The Research Team under the direction of Drs. Julian D. Ford and Robert L. Trestman at the University of Connecticut Health Center developed this Correctional Mental Health Screen for Men (CMHS-M) with a grant funded by the National Institute of Justice. Instructions for administration of the CMHS-M: Correctional Officers may administer this mental health screen during intake. Name: Detainee#: Date: Time: Detainee’s name- Last, first and middle initial Detainee’s facility identification number Today’s month, date, year Current time (24hr or AM/PM) Questions #1-12 may be administered as best suits the facility’s policies and procedures and the reading level, language abilities, and motivation of the detainee who is completing the screen. The method chosen should be used consistently. Two recommended methods: • Staff reads the questions out loud and fills in the detainee’s answers to the questions on the form • Staff reads the questions out loud, while the detainee reads them on a separate sheet and fills in his answers Each question should be carefully read, and a check mark placed in the appropriate column (for “NO” or “YES” response). The staff person should add a note in the Comments Section to document any information that is relevant and significant for any question that the detainee has answered “YES.” If the detainee declines to answer a question or says he does not know the answer to a question, do NOT check “YES” or “NO.” Instead, record DECLINED or DON’T KNOW in the Comments box. Total # YES: total number of YES responses General Comments: Staff may include information here to describe overall concerns about the responses (for example: intoxicated, impaired, or uncooperative) Referral Instructions: Urgent Referral: A referral for urgent mental health evaluation may be made by the staff person if there is any behavioral or other evidence that a detainee is unable to cope emotionally or mentally or is a suicide risk. Routine Referral: A detainee answering “YES” to 6 or more items should be referred for routine mental health evaluation. A referral also may be made if the staff person has any concerns about the detainee’s mental state or ability to cope emotionally or behaviorally. ** If at any point during administration of the CMHS-M the detainee experiences more than mild and temporary emotional distress (such as severe anxiety, grief, anger or disorientation) he should be referred for immediate mental health evaluation. Referral: Check the appropriate box for whether a detainee was referred. If referred, check URGENT or ROUTINE, enter the date of the referral and the mental health staff person or mental health clinic to whom the referral was given. Person completing screen: Enter the staff member’s name 16 M E N TA L H E A LT H S C R E E N S F O R C O R R E C T I O N S Appendix B� 17 RESEARCH FOR PRACTICE / MAY 07 18 The National Institute of Justice is the research, development, and evaluation agency of the U.S. Department of Justice. NIJ's mission is to advance scientific research, development, and evaluation to enhance the administration of justice and public safety. NIJ is a component of the Office of Justice Programs, which also includes the Bureau of Justice Assistance, the Bureau of Justice Statistics, the Office of Juvenile Justice and Delinquency Prevention, and the Office for Victims of Crime. Washington, DC 20531 Official Business Penalty for Private Use $300 U.S. Department of Justice Office of Justice Programs National Institute of Justice MAILING LABEL AREA (5” x 2”) DO NOT PRINT THIS AREA (INK NOR VARNISH) *NCJ~216152* PRESORTED STANDARD POSTAGE & FEES PAID DOJ/NIJ PERMIT NO. G–91 MAY 07