NEW JAILBASED STATEWIDE STANDARDIZED SCREENING TOOL FOR MENTAL HEALTH

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NEW JAIL-BASED STATEWIDE STANDARDIZED SCREENING
TOOL FOR MENTAL HEALTH

• Robert Kurtz, PhD Jodi Harrison, JD
• Justice Systems Innovations Jail Health Law
  Project
• Community Policy UNC School
  of Government
• Management Section
  
• Division of MH/DD/SAS

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New Session Law Requires

• 1. Within available resources, LMEs shall work
  with local health departments and sheriffs to
  provide medical assessments and medication, if
  appropriate, to inmates who are suicidal,
  hallucinating, or delusional.

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New Session Law Requires (cont.)

• 2. A statewide standardized evidence-based
  mental health screening instrument shall be used
  when offenders are booked, beginning Jan. 1,
  2008.

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New Session Law Requires (cont.)

• 3. A designated LME employee will be responsible
  for screening the daily jail booking log for
  known mental health consumers, and sheriffs and
  LMEs will work out protocols for effective
  communication.

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New Session Law Requires (cont.)

• 4. Detention officers shall be trained to
  recognize signs of mental illness.

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What is an LME?

• LMEs are Local Management Entities, which are
  the local agencies responsible for managing,
  coordinating, facilitating and monitoring the
  provision of mental health, developmental
  disabilities, and substance abuse services in
  their geographic areas.
• LMEs offer consumers 24/7 access to services,
  develop and oversee providers, and handle
  consumer complaints.

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Standardized Mental Health Screening Tool

• Jails should use the Brief Jail Mental Health
  Screen (BJMHS) for all inmates.
• The BJMHS may be obtained from DHHS.
• A Spanish language version of the BJMHS may be
  obtained from DHHS.

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The Brief Jail Mental Health Screen

• The BJMHS was
• Derived from and improve upon the Referral
  Decision Scale
• Takes under 5 minutes to administer
• Can be administered by correctional staff
• Was validated on a correctional population
• Uses yes / no format
• Has a specific cutting score
• Was validated against the SCID
• Is available free of charge
• Is recommended by the National Institute of
  Justice
• The Structured Clinical Interview for DSM-IV -
  sometimes called the gold standard of
  diagnostic instruments.

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Brief Jail Mental Health Screen (BJMHS)

• Used with male inmates
• Eight questions
• Yes response to Q7 or Q8 referral
• Yes to two or more of Q1 Q6 referral
• Any/all yes responses should be explained in
  comments
• Any/all refusals to respond or dont know
  responses should be explained in comments

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Referral for further evaluation

• If an inmates score on the BJMHS indicates the
  inmate should be referred for further mental
  health evaluation, the officer should refer the
  inmate for further evaluation consistent with the
  jails medical plan.

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What the BJMHS does

• It assists in the identification of inmates with
  mental illness at booking in order to refer such
  inmates for further evaluation in order to make
  sure they are diagnosed and treated appropriately.

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What the BJMHS does not do

• It does not identify inmates who present a danger
  to self or others at the time of booking
• It does not necessarily identify inmates with
  emergency or urgent mental health needs.
• It does not identify inmates who are suicidal.
• It does not identify inmates with behavioral
  problems.

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Jails Still Need To

• Assess the health of the inmate to see if he or
  she requires urgent or emergency medical care
  and, if so, to promptly provide it
• Determine the inmates current health and medical
  issues for purposes of housing and
  classification and
• Make sure the inmate does not introduce an
  adverse condition into the general population,
  putting at risk other inmates or the facilitys
  employees and staff.

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Other mental health questions

• (Included but not limited to!)
• Current or recent medications
• Current or recent hospitalizations
• Suicidal thoughts, suicide attempts, or
  self-harming behaviors

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Observations

• Does the detainee seem . . .
• Disoriented?
• Despondent?
• Cognitively impaired?
• To be hallucinating (voices)?
• Overly anxious, panicky, or afraid?
• Angry or agitated?
• Extremely embarrassed, shamed or humiliated?
• Incoherent?
• Exhibit unusual affect?

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Other Information

• If possible, gather information about mental
  health history and concerns from
• Family and friends
• Arresting and/or transporting officers
• Prior jail or prison records, if available

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Risk of Suicide In Jails

• Its the leading cause of death in jail.
• Suicide rate 9 X greater in jail.
• Most (51) occur within first 24 hrs.
• Majority (82) were intoxicated.
• Few (only 11) were evaluated for suicide risk
  prior to their suicide.
• From a national study of jail suicides.

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Keep in Mind!!!

• Mental illness is a major risk factor for suicide
  in jail, but non-mentally ill people in jail
  commit suicide, too.
• The BJMHS is meant to supplement, not substitute
  for, an adequate screening for acute mental
  health issues, including suicide potential.

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For additional information

• LME staff or mental health providers should
  contact
• Bob Kurtz, Ph.D., at [phone] or
• by e-mail at Bob.Kurtz_at_ncmail.net
• Sheriffs offices and jail administrators should
  contact
• Jamie Markham, J.D., at [phone] or
• by e-mail at markham_at_sog.unc.edu