Mental Health Identification Practices of Jails: The Unmet Needs of the “Silent” Population

Abstract

The overrepresentation of individuals with mental illness in the criminal/legal system is well documented. While professional associations urge diversion towards treatment, little is known about the practices these institutions use to identify this population. One understudied space in the criminal/legal continuum is jails. This exploratory study compares two types of mental health identification at jail booking to assess jail‐ and community‐based service outcomes by identification type (N = 2956): (a) staff observation and (b) a standardized screening instrument. Individuals identified through staff observation were significantly more likely to receive jail‐ and community‐based services, even though current symptomology and substance misuse were both significantly higher for individuals identified only by the screening instrument. These findings point to the importance of jails in providing stabilizing services during incarceration, but further, show the impact that identification practices have on individuals as they transition to the community. Community context showed varied rates of jail staff observations of mental illness, showing greater risks for individuals in rural communities. Implications include a need for system‐level changes by instituting evidence‐based identification practices in jails, and improving professional collaboration practices between mental health and criminal/legal practitioners as individuals enter and exit jails.

County jails’ responses to COVID-19: Practices, procedures, and provisions of behavioral health services.

“…Until appropriate levels of funding are given to, and robust services are provided by the community mental health system, policy interventions to address behavioral health needs in jail should include the recommendations of the American Psychiatric Association (2016): A screening, referral, and assessment process. Given that corrections and booking staff are not trained behavioral health clinicians, it is critical that a validated instrument is utilized to screen for these needs at booking (Comartin, Milanovic, et al, 2021; Kubiak et al, 2020). While state-level policy and regulations may require the identification of behavioral health needs, there is little guidance or oversight of its implementation in practice.…”

Behavioral health service use post‐jail release and reduced risk of return to jail

“…Partnership between jail staff, clinicians, and community‐based service providers is important for successful transition care coordination within and across systems (Comartin et al, 2021). The effect of behavioral health treatment will be maximized when jail discharge planning and transition care coordination address racial/ethnic disparity in the risk of jail recidivism (Freudenberg, 2002; McGovern et al, 2009; The PEW Charitable Trusts, 2010; Travis et al, 2014), different transition needs by gender (Spjeldnes et al, 2014), and social determinants of health such as housing, employment, and education (Bonfine et al, 2020).…”

Gender, Geography, and Justice: Behavioral Health Needs and Mental Health Service Use Among Women in Rural Jails

“…This aligns with other studies including Kubiak and colleagues (2020), which found a significant proportion of the jail identified population who were missed by a screening instrument. A study by Comartin, Milanovic, and colleagues (2021) makes the full implication of under-identification clear: a sizable proportion of individuals undetected by jail staff had significant behavioral health needs, yet received significantly fewer services both in jail and also upon their return to the community. These findings suggest a combination of empirical identification instruments validated for use with both women and men, training of correctional staff to visually identify behavioral health needs, and use of behavioral health questions to identify and then address behavioral health needs.…”