Even when staff adhere to the most effective screening and assessment protocols, they may yet overlook a small proportion of inmates with mental illness that enter the facility.   Some inmates, concerned about the stigma associated with mental illness, may conceal symptoms of their disease.   In addition, inmates may not present symptoms of mental illness until they have been incarcerated for some time.  In other cases, an inmate's mental status can change dramatically during the course of incarceration.  The prison experience itself, and the inevitable exposure to intimidation, isolation, separation from family, violence, and sometimes victimization can precipitate serious depression or suicidal thoughts.

Furthermore, some inmates' symptoms may reappear as a result of change in medication, discontinuation of a prescription, or noncompliance with the treatment plan.  In jails, offenders who are admitted directly from the streets are often under the influence of alcohol and/or other drugs.  Once they are detoxified, mental illness symptoms can appear - sometimes several days later.

While it would be valuable to conduct periodic mental health screenings on all general population inmates, this is costly and rarely done in most correctional facilities.  Nevertheless, there are several measures correctional administrators and mental health staff can implement, at relatively little cost, to identify these cases that may initially fall through the cracks.

Recommendations:

a.

Reassesses periodically the mental health status of inmates who are at the highest risk of showing signs of mental illness.

b.

Conduct brief mental health assessments upon request of an inmate or by referral from any staff person.

c.

Minimize the stigma that staff and inmates may harbor regarding mental illness.