Year of Publication
Doctor of Nursing Practice
Dr. Elizabeth Tovar
Dr. Angela Grubbs
Dr. Sharon Lock
BACKGROUND: Prisoners who are detained in jails and detention centers have higher rates of Severe Mental Illness (SMI) compared to the general population. However, SMI is often unidentified in this population, largely due to lack of assessment using effective SMI screening tools and lack of knowledge among prison staff about the prevalence of SMI and the importance of identification in the correctional setting. Prisoners with SMI often act out violently against others and themselves. Current standard practice for SMI screening varies significantly across jails. Many jails use standard medical questionnaires which help obtain a brief medical history but often miss the history of SMI. The Brief Jail Mental Health Screening (BJMHS) tool is a valid and reliable tool that can identify prisoners with SMI in correctional settings. Advantages of this tool include: it can be used with both men and women; and it does not require a trained health professional to administer the assessment.
PURPOSE: The purpose of this study was to evaluate the use of the BJMHS tool to identify SMI in a jail setting and facilitate early mental health intervention for prisoners who screened positive for SMI based on the BJMHS tool.
METHODS: This study design was cross-sectional. Data was collected through chart audits to extract baseline, and post-intervention assessment, through screening and referral of eligible participants using the BJMHS tool. This occurred over a two-month period from November 2021 through January 2022. During the first 30-day period prisoners who met inclusion criteria in the study were screened by the PI using the BJMHS tool within the first 48 hours of their arrest. Records were audited at the close of the study to assess whether prisoners who screened positive for SMI were referred. At the close of the study period a separate 30-day period evaluating the current practice of behavioral screening using two questions on the standard medical questionnaire (SMQ) were reviewed.
RESULTS: There were 181 prisoners booked into the jail during the 30-day screening period. 100 of the 181 prisoners were eligible to participate in the study, 89 of which agreed to participate. More than one-quarter (28%; n= 25) screened positive for SMI using the BJMHS screening tool. Of the 25 prisoners who screened positive for SMI, 10 were lost-to-follow-up before an intervention could occur due to release from custody. The remaining 15 (n=15) were offered a mental health intervention, and eight (53%) were restarted on medication. Among the remaining seven prisoners, three (20%) were initiated medication and the other four prisoners (27%) received suggestions for alternative therapy. Among the prisoners who were screened with the BJMHS tool, 28% screened for having SMI, compared to only 3% utilizing the SMQ (p
CONCLUSION: Over one quarter of the participants in the study screened positive for SMI utilizing the BJMHS tool. The standard practice was able to identify only 3% of the prisoners as having SMI, compared to 28% of the prisoners who were screened with the BJMHS tool. This suggests that the BJMHS tool is effective at identifying prisoners for SMI and is likely more effective than the facility’s current practice.
Kohl, Stephanie, "Screening for Severe Mental Illness in a Correctional Setting using the Brief Jail Mental Health Screening Tool" (2022). DNP Projects. 392.