Screening for mental and physical health needs and substance abuse disorders should be among the first steps of the intake procedure. All intake staff, and jail staff in particular, should be aware that individuals admitted to their facilities may be withdrawing from a psychoactive drug (one that affects the mind or mental processes), including both illicit substances and psychotropic medication. It is important that an observation period extend through the first 72 hours of detention and that the screening protocol be repeated if the detainee's behavior suddenly indicates the possibility of post-acute withdrawal or mental decompensation. Those inmates whose screenings suggest that they may have physical health, mental health, and/or substance abuse problems should then be more fully assessed within 72 hours of screening, in order to establish the severity of their condition and to determine any urgent treatment needs.

Finally, as noted with regard to individuals in jails in Recommendation c, above, corrections administrators should institute policies to provide inmates with information about and documentation of their health-related examinations and to link individuals to community-based care.

Mental Health

Mental health disorders that staff should screen for at the outset include risk of suicide, depression, and psychosis. Those inmates that are deemed at risk for one or more of these factors should be referred for further assessment (described in Recommendation h, below), and safety and suicide-prevention protocols should be applied.

In screening individuals upon admission, intake staff should seek information on past psychiatric services and current medications or diagnoses. This is most commonly done through a series of questions posed to the person being screened, as well as by reference to his or her existing institutional record or record of involvement with other criminal justice or mental health agencies.

Example: Brief Jail Mental Health Screen, National Institute of Justice

Recognizing the need for a reliable screening tool, the National Institute of Justice has recently funded research at the University of Maryland to develop and test a nine-item Brief Jail Mental Health Screen. Correctional settings in Maryland and New York are participating in a study of this instrument.

Until a validated instrument emerges for initial mental health screening, corrections administrators should work with their mental health staff to ensure that questions that are asked early in the intake process are sensitive to critical mental health issues.

Physical Health

Screening for physical health problems and risks is as important as screening for mental health issues and should result in referrals for further assessment and treatment as necessary. For many people who are confined briefly within jails, the medical screening performed upon intake may be the most extensive personal medical evaluation that they are likely to receive, surpassing what they may have received in the community. For individuals confined in prisons, the medical screening process is only the first step in the compilation of a long-term medical record which should be updated throughout the incarceration period. (See Policy Statement 20, Continuity of Care, for more on the creation of a summary health record.)

In addition to identifying acute conditions in need of treatment, the medical assessment should also identify communicable diseases (such as sexually transmitted diseases) in order to plan for and minimize the risks posed by an infected inmate to staff, other inmates, and (when release is imminent) the community.

Substance Abuse

Approximately 80 percent of all state prisoners report a history of drug use, and 56 percent were using drugs in the month prior to the offense for which they were incarcerated. ^[1]   Substance abuse can co-occur with mental or physical health problems or impact inmates in the absence of other issues. Incarceration presents an opportunity to identify and treat substance abuse issues among individuals who might otherwise be difficult or impossible to identify and reach. Any intake procedure should screen individuals for substance abuse issues so that they can receive further assessments and appropriate programming or treatment. Many instruments in use by community-based treatment providers may be transferable or adaptable to the corrections setting. (See sidebar, "Selected Substance Abuse Assessment Tools.")