Policy Goal 3: Implement universal screening and timely clinical assessment
Does the state support or require mental health, substance use disorder, and homelessness screenings and timely identification of people who are suicidal or acutely intoxicated upon admission to jail?
RATIONALE: Universal screening at admission serves at least two purposes: identifying people who need particular care to remain safe while in custody and developing data to inform policy decisions. Having universal screening at the time of admission to jail using a validated screening tool and an established process to complete a follow-up assessment for people who screen positive is the first step toward a clear and accurate measure of the prevalence of behavioral health conditions in local criminal justice systems—particularly jails—across the state.
Having a local jail baseline also positions the county to better determine whether progress is being made in reducing the prevalence rate, along with the corresponding average length of stay for the population in the jail with behavioral health needs. Screening also improves population management at local jails as people who are screened positive are referred for assessment and treatment and placed in appropriate jail housing that allows access to treatment programs within the jail.
Using one prescribed, validated tool and process in a culturally affirming manner will
- Ensure consistency in identifying target populations (e.g., people with SMI, SUD) within and across jurisdictions,
- Identify capacity needs for connections to care and programming, and
- Help capture data about people with behavioral health needs that can be used for additional analyses (e.g., connections to housing upon release).
Ways to do it
- Implement through direct oversight in states with a unified corrections system.
- Pass legislation amending or creating state minimum standards for jails with adoption support provided.
- States that have not been able to tie in adoption support pass voluntary standards with technical assistance for implementation and incentives and recognition for compliance.
- Incorporate universal screening into requirements for existing funding streams.
- Require or incentivize accreditation. National accreditation and membership organizations, such as the National Commission on Correctional Health Care, have standards related to substance use screening.
- Partner with state membership associations to incentivize screening. State commissions on jail standards, state sheriffs’ associations, and state associations of counties may also either require or support screening for severe mental illness or substance use disorders in jails.
Things to consider
- Screen every person who enters jail at booking (i.e., universal screening). Behavioral health screening (i.e., for mental health and substance use needs) should be simple and mandatory, conform to common definitions, and coordinated with other jail intake processes completed at booking (e.g., collecting demographic and emergency contact information, determining classification, and conducting pretrial or criminogenic risk screenings).
- Use validated tools.
- See this comprehensive resource for a list of validated screening tools for substance use disorder.
- Many communities have adopted validated, non-proprietary screening tools, such as the Brief Jail Mental Health Screen (BJMHS) or the Correctional Mental Health Screen for Men (CMHS-M) and the Correctional Mental Health Screen for Women (CMHS-W).
- Many existing validated tools have limited cultural and linguistic responsiveness. Training is essential to ensure that staff understand and consider cultural differences when conducting screening and assessment. Translation services should also be available to ensure that screenings are linguistically responsive.
- Follow up on positive screenings with a clinical assessment by a licensed behavioral health professional within 72 hours (or as soon as possible).
- Clinical assessments can be conducted by the jail medical provider or contracted behavioral health provider, via in-reach by behavioral health provider, or by social workers who work at the jail.
- Develop policy to share information with defense attorney and treatment and supervision agencies to ensure connection to care upon release or form cross-system case planning partnerships such as collaborative comprehensive case plans.
- Homelessness screenings can link people to the homelessness service system. An alternative is to alert the homelessness service system through the sharing of jail rosters, so that the system can provide linkages or in-reach.