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.
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Recommendations for Implementation
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a.
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Reassesses periodically the mental health status of inmates who are at the highest risk of
showing signs of mental illness.
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Correctional mental health staff should incorporate
regular, informal mental health screening into existing practices without
burdening the service delivery system.
Corrections administrators should also consider establishing a system to
code the mental health status (and risk of exhibiting signs of mental illness)
of all inmates.
Example:
Virginia Department of Corrections
Since 1992, all inmates in the Virginia
correctional system are periodically assessed and a determination is made as to
their mental health status and mental health needs. The determination is alphanumerically coded and sorted by the
least to the greatest need for mental health services. The code is reviewed and, if necessary,
updated annually. The code is used for programmatic and institutional
assignments, as well as for release planning and community supervision.
Reassessing the mental health status of inmates enables
corrections officials tomaintain
accurate, current data regarding the demand for services within the prison
system, and it facilitates a projection of the need for community-based mental
health services for inmates approaching their release date.
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b.
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Conduct brief
mental health assessments upon request of an inmate or by referral from any
staff person.
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Prisons and jails should have effective mechanisms to
permit and encourage inmates and detainees to self-refer for a confidential
mental health assessment. Self-referral
forms provided to inmates should be culturally sensitive and, given the
generally low reading level of inmate populations, easily understandable. Institutional health staff might also
consider instituting clinical rounds at intake facilities.
Example:
Referral for Mental Health Services, Albany
County (NY) Correctional Facility
The Albany County Correctional Facility utilizes
a mechanism whereby facility staff, correctional officers, medical staff,
inmate service unit staff, and the inmates themselves are able to put in
requests for mental health contact. All
written requests are followed up, and any inmate referred is seen face to face
by a mental health staff member.
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c.
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Minimize the stigma that staff and inmates may harbor regarding mental illness.
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Over the previous two decades, many corrections systems
have successfully educated staff about HIV and AIDS, about how the virus is
transmitted and how it is treated.
Correctional systems should undertake a similar public health education
initiative regarding mental illness. (See Policy Statement 30: Training for
Corrections Personnel; also Policy Statement 32: Educating the Community and
Building Community Awareness and Policy Statement 43: Advocacy, for more on
stigma)
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