Every correctional system has procedures in place to receive a sentenced inmate admitted to an institution. These intake procedures typically are used for inmates who arrive at the institution from a detention facility immediately following their sentencing or for inmates who have been transferred from a different institution.

Recommendations under this policy statement explain how corrections administrators can ensure that each sentenced offender entering the institution is screened for potential mental illness. These recommendations include the following: the key elements of a screening instrument and its administration; procedures to follow up on the results; and protocols for evaluating its effectiveness.

Typically, when institutional intake staff receive inmates, they fingerprint them, conduct a medical exam, and review a host of issues in order to make decisions about classification, housing, and other programmatic or special needs. Determining whether the inmate needs mental health services should be a critical component of the inmate booking and receiving process. Immediately upon the inmate's arrival at the facility, it is especially important for staff to determine whether the inmate has any suicidal tendencies or poses a danger to self or others, and whether he or she is taking psychotropic medication.

Not adequately screening inmates to determine the possible existence of a mental illness jeopardizes the safety of personnel and inmates alike. Identifying and addressing mental illness among inmates will minimize the likelihood of an offender's risk of hurting him-or herself or others. It may also minimize the incidence of hospitalization, assaults on officers or other inmates, or other incidents that may generate considerable harm and costs. Responding to mental illness at a late stage requires the most expensive and intensive level of mental health care as well as collateral costs such as lost personnel time, overtime, and compensatory time when officers are injured.

In addition, with a consistent, system-wide approach in place for identifying inmates with mental illness, correctional administrators are able to compile the data needed to understand the scope of mental illness within their institutions. This, in turn, enhances their ability to project the future mental health needs of their agencies and communicate to policymakers the changing needs of prisoners.

Some correctional administrators fear that a mental health screening process may overstate the mental health needs of the inmate population, and thus generate excessively expensive use of mental health services. Aside from identifying those individuals who are of immediate concern and who should receive urgent attention, however, a properly designed and implemented screening function during the receiving and intake process only suggests when there may be a potential mental health problem that should be further assessed. It serves as a form of triage, ensuring a cost-effective use of resources. Screening alone is not intended to provide a diagnosis or determine the need for services or medication.

Implementation recommendations contained here are consistent with the American Psychiatric Association's (APA) Task Force for Psychiatric Services in Jails and Prisons, which, since 1990, has developed guidelines for the delivery of mental health services in jails and prisons. Consistent with the APA, recommendations under this policy statement recognize the varying levels of services provided upon admissions: ^[1]  

Receiving Mental Health Screening. Mental health information and observations gathered for every new admitted inmate during the intake procedures as part of the normal reception and classification process by using standard forms and following standard procedures.

Referral. The process by which inmates who appear to be in need of mental health treatment receive targeted assessment or evaluation so that they can be assigned to appropriate services.

Intake Mental Health Screening. A more comprehensive examination performed on each newly admitted inmate within 14 days of arrival at an institution. It usually includes a review of the medical screening, behavior observations, an inquiry into any mental health history, and an assessment of suicide potential.

As a result of the above, the APA advises, professional clinicians would then conduct the following:

Comprehensive Mental Health Evaluation. A face-to-face interview of the patient and a review of all reasonably available health care records and collateral information. It includes a diagnostic formulation and, at least, an initial treatment plan.

Recommendations:

a.

Incorporate screening for mental illness and referral to mental health services into the existing receiving/admission protocol by integrating into the process a screening instrument along with observations by those charged with booking newly received inmates into the receiving/admission process.

b.

Ensure consistency of screening protocols within correctional system by using the same screening instrument at all facilities statewide and training facility staff in their use.

c.

Develop a system of triage to ensure that follow-up responses to the screening results reflect the immediacy of the inmate's needs.

d.

Evaluate periodically the effectiveness of the screening instrument employed, as well as the mental health assessment and mental health evaluation protocols.

e.

Conduct a comprehensive mental health evaluation of every inmate flagged as having significant mental health issues during the professional mental health assessment process.