Screening and Assessment of Co-Occurring Disorders in the Justice ...

Executive SummaryA significant and growing number of persons in the justice system have cooccurringmental and substance use disorders. For example, over 70 percent ofoffenders have substance use disorders, and as many as 15 percent have majormental disorders — rates that greatly exceed those found in the general population(Ditton, 1999; National GAINS Center, 2004; Peters, Greenbaum, Edens, Carter,& Ortiz, 1998). Persons with co-occurring disorders present numerous challengeswithin the justice system. These individuals exhibit greater impairment inpsychosocial skills, are less likely to enter and successfully complete treatment,and are at greater risk for criminal recidivism and relapse. The justice system isgenerally ill equipped to address the multiple needs of this population, and fewspecialized treatment programs exist in jails, prisons, or court or communitycorrections settings that provide integrated mental health and substance abuseservices (Peters, LeVasseur, & Chandler, 2004).Of major concern is the failure to effectively screen and assess persons withco-occurring disorders in the justice system (Chandler, Peters, Field, & Juliano-Bult, 2004). Key problems related to screening and assessment include: failure tocomprehensively examine one or more of the co-occurring disorders; inadequatestaff training to identify and assess the disorders; bifurcated mental healthand substance abuse service systems that feature separate screening andassessment processes; use of ineffective screening and assessment instruments;and the absence of management information systems to identify and trackthis population. Another challenge in conducting screening and assessment isdetermining whether psychiatric symptoms are caused by recent substance abuseor reflect the presence of a mental disorder. Several other important threats to theaccuracy of screening and assessment information include the disabling effectsof co-occurring disorders on memory and cognitive function and the perceivedconsequences related to self-disclosure of mental health or substance abuseproblems. Failure to accurately identify offenders with co-occurring disordersoften prevents their involvement in treatment or leads to inappropriate placementin treatment (e.g., in less intensive services than are needed), resulting in high ratesof criminal recidivism following release from custody and utilization of expensivecommunity resources such as crisis care and hospital beds.... over 70percent ofoffenders havesubstance usedisorders, andas many as 15percent havemajor mentaldisorders—rates thatgreatly exceedthose foundin the generalpopulation(Ditton, 1999;National GAINSCenter, 2004; Peters,Greenbaum, Edens,Carter, & Ortiz, 1998).This monograph provides an overview of the systemic and clinical challengesin screening and assessment of persons with co-occurring disorders involvedin the criminal justice system. The most current state-of-the art screening andassessment practices and instruments are reviewed to help guide administrators,v