CLINICAL HANDBOOK OF SCHIZOPHRENIA

358 V. SYSTEMS OF CAREtitled Effective Prison Mental Health Services. These address a broad range of clinical,management, and administrative issues, and include sections on screening and assessment,and mental health treatment; use of seclusion, segregation, and restraints; suicideprevention; treatment of female inmates; psychopharmacological interventions, transition/reentryservices; and treatment of special populations such as violent offenders, sexoffenders, persons with mental retardation or developmental disabilities, and olderadults.IDENTIFICATION AND TREATMENTOF SCHIZOPHRENIA IN JAILS AND PRISONSScreening, Assessment, and Treatment PlanningAs previously noted, jail and prison inmates are four times more likely than nonincarceratedindividuals to have schizophrenia. Most inmates also have concurrent substance usedisorders that significantly affect their treatment needs. Therefore, identification of bothsets of disorders in jails and prisons is of paramount importance. Inmate mental healthinformation is sometimes available through law enforcement reports, arrest records, orprevious prison records, but in most cases, little or no archival mental health informationaccompanies the inmate at the point of initial incarceration. As a result, a standardized,universal, and comprehensive screening for mental health, substance abuse, and otherhealth-related disorders should be provided by all jails and prisons.Screening for mental health and co-occurring substance use disorders should be providedat the earliest possible point during incarceration, such as at time of jail booking orat admission/reception to the prison system. Early screening and identification facilitatesthe rapid stabilization of acute mental health symptoms; initiation of enhanced observationand related management procedures to prevent suicide or other self-injurious behavior,and supervised detoxification from drugs or alcohol, if needed; and engagement inintensive treatment services. Moreover, results from early identification and screening canbe used to place (“classify”) inmates in housing units or in particular institutions (e.g.,within prison systems that include multiple institutions) to expedite involvement in specializedtreatment services, and to provide close monitoring and management of behavioralproblems. Classification to “special needs” units within jails and prisons also assistsin preventing predatory inmates’ victimization of persons with schizophrenia or othermajor mental disorders. Early identification of mental health disorders is of criticalimportance to prosecutors and the courts in evaluating public safety risk, release decisions,legal issues related to “competency to stand trial” and “sanity” at the time of theoffense, and the need for treatment and community supervision. A more comprehensivepsychosocial assessment typically is provided following the inmate’s placement in a mentalhealth or other specialized treatment program.Correctional screening for mental illnesses is not an event, but a process that starts atbooking and continues throughout confinement. Initial screening for mental health andco-occurring substance use disorders in jails and prisons includes observation of hallucinations,delusions, and other unusual behaviors; and review of self-reported symptoms,current and past use of medications, and history of treatment. Brief self-report screeninginstruments are often used in correctional settings to detect mental health disorders andsubstance use disorders. Evidence-based mental health screens for inmates include theBrief Symptom Inventory (BSI; Derogatis & Melisarotos, 1983), the Symptom Checklist–90 (SCL-90; Derogatis, Lipman, & Rickels, 1974), the Brief Jail Mental Health Screen(Steadman, Scott, Osher, Agnese, & Robbins, 2005), the Global Appraisal of IndividualNeeds (GAIN; Dennis, Titus, White, Unsicker, & Hodgkins, 2002), and the Mental