Robert Kurtz, PhDJodi Harrison, JD Justice Systems Innovations Jail Health Law Project Community Policy UNC School of Government Management Section Division.

Robert Kurtz, PhD Jodi Harrison, JDJustice Systems Innovations Jail Health Law Project Community Policy UNC School of Government

Management Section Division of MH/DD/SAS

1. Within available resources, LMEs shall work with local health departments and sheriffs to provide medical assessments and medication, if appropriate, to inmates who are suicidal, hallucinating, or delusional.

2. A statewide standardized evidence-based mental health screening instrument shall be used when offenders are booked, beginning Jan. 1, 2008.

3. A designated LME employee will be responsible for screening the daily jail booking log for known mental health consumers, and sheriffs and LMEs will work out protocols for effective communication.

4. Detention officers shall be trained to recognize signs of mental illness.

LMEs are “Local Management Entities,” which are the local agencies responsible for managing, coordinating, facilitating and monitoring the provision of mental health, developmental disabilities, and substance abuse services in their geographic areas.

LMEs offer consumers 24/7 access to services, develop and oversee providers, and handle consumer complaints.

Jails should use the “Brief Jail Mental Health Screen” (BJMHS) for all inmates.

The BJMHS may be obtained from DHHS.

A Spanish language version of the BJMHS may be obtained from DHHS.

• The BJMHS was: Derived from and improve upon the Referral Decision Scale Takes under 5 minutes to administer Can be administered by correctional staff Was validated on a correctional population Uses “yes / no” format Has a specific cutting score Was validated against the SCID* Is available free of charge Is recommended by the National Institute of Justice

The Structured Clinical Interview for DSM-IV - sometimes called the “gold standard” of diagnostic instruments.

The Brief Jail Mental Health Screen

Used with male inmates Eight questions “Yes” response to Q7 or Q8 = referral “Yes” to two or more of Q1 – Q6 = referral Any/all “yes” responses should be

explained in “comments” Any/all refusals to respond or “don’t know”

responses should be explained in “comments”

Referral for further evaluationReferral for further evaluation

“If an inmate’s score on the BJMHS indicates the inmate should be referred for further mental health evaluation, the officer should refer the inmate for further evaluation consistent with the jail’s medical plan.”

It “assists in the identification of inmates with mental illness at booking” in order to refer such inmates for further evaluation in order to make sure they are diagnosed and treated appropriately.

What the BJMHS does…

It does not identify inmates who present a danger to self or others at the time of booking:• It does not necessarily identify inmates with

emergency or urgent mental health needs.• It does not identify inmates who are suicidal.• It does not identify inmates with behavioral

problems.

What the BJMHS does not do…

Assess the health of the inmate to see if he or she requires urgent or emergency medical care and, if so, to promptly provide it;

Determine the inmate’s current health and medical issues for purposes of housing and classification; and

Make sure the inmate does not introduce an adverse condition into the general population, putting at risk other inmates or the facility’s employees and staff.

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The Screening Process

Mental health screenings should not rely on just test results alone – consider other factors.

(Included but not limited to!)

Current or recent medications Current or recent hospitalizations Suicidal thoughts, suicide attempts, or self-

harming behaviors

Does the detainee seem . . .• Disoriented?• Despondent?• Cognitively impaired?• To be hallucinating (voices)? • Overly anxious, panicky, or afraid?• Angry or agitated?• Extremely embarrassed, shamed or humiliated?• Incoherent?• Exhibit unusual affect?

If possible, gather information about mental health history and concerns from…

• Family and friends • Arresting and/or transporting officers• Prior jail or prison records, if available

It’s the leading cause of death in jail. Suicide rate 9 X greater in jail. Most (51%) occur within first 24 hrs. Majority (82%) were intoxicated. Few (only 11%) were evaluated for suicide

risk prior to their suicide.

*From a national study of jail suicides.

Mental illness is a major risk factor for suicide in jail, but non-mentally ill people in jail commit suicide, too.

The BJMHS is meant to supplement, not substitute for, an adequate screening for acute mental health issues, including suicide potential.

LME staff or mental health providers should contact:• Bob Kurtz, Ph.D., at (919) 715-2771 or by e-mail at [email protected]

Sheriffs offices and jail administrators should contact:• Jamie Markham, J.D., at (919) 843-3914 or by e-mail at [email protected]