CLINICAL HANDBOOK OF SCHIZOPHRENIA

35. Treatment in Jails and Prisons 359Health Screening Form–III (Carroll & McGinley, 2000). Evidence-based substance abusescreens for inmates include the Simple Screening Instrument (SSI; Center for SubstanceAbuse Treatment, 1994), the Texas Christian University Drug Screen (TCUDS; Knight,Simpson, & Hiller, 2002), the Alcohol Dependence Scale (ADS; Skinner, 1982), and theAlcohol and Drug Use sections from the Addiction Severity Index (ASI; McLellan et al.,1992).The majority of female inmates and a large proportion of male inmates have a historyof physical, sexual, or emotional abuse. As a result, all inmates should receivescreening and assessment in this area, and the staff should be trained to provide referralto institutional and community services to address related treatment needs. An undiagnosedhistory of trauma often leads to misattribution of behavior (e.g., defensiveness, resistanceto treatment) and may undermine inmates’ engagement in traditional treatment services.A variety of brief standardized screening instruments are available to identify symptomsof trauma.Because of the high risk of suicide by persons with schizophrenia while in custody,effective suicide prevention programs within jails and prisons are imperative. Suicidescreening instruments are essential components of these programs. New York’s SuicidePrevention Screening Form is one example of such a standardized screening measure.Other components of effective suicide prevention programs include the following:• Suicide prevention training for correctional, medical, and mental health staff.• Effective and ongoing communication with outside agencies, facility staff, and thesuicidal inmate.• Suicide resistant, protrusion-free housing for suicidal inmates.• Structured levels of supervision for suicidal inmates.• Timely emergency interventions following suicide attempts.• Critical incident stress debriefing to affected staff members and inmates, as well asa multidisciplinary mortality review of suicides and serious attempts.There are several significant challenges in conducting effective screening and assessmentfor schizophrenia and other, related disorders in jails and prisons. As mentionedpreviously, most inmates entering correctional facilities do not have much accompanyinginformation regarding their treatment needs and treatment history (e.g., current medicationuse). Several communities have recently established data links between public mentalhealth providers and law enforcement authorities to identify new arrestees in jails whohave serious mental illness. Due to the disorienting effects of mental health disorders,substance abuse, or stress related to incarceration, arrestees are sometimes unreliable informantsin these areas, and available correctional records describing diagnoses may bedated and inaccurate. Additionally, the majority of recently arrested inmates have useddrugs or alcohol in the 48 hours prior to incarceration, creating difficulties in differentiatingbetween the toxic effects of substances and symptoms of major mental health disorders.Inmates are often wary of disclosing mental health or other disorders, due to the riskof being placed under close monitoring (e.g., suicide watch), in more restrictive housingunits, and in intensive treatment programs. Self-disclosure of mental health or co-occurringdisorders may also reduce opportunities for bail or other types of pretrial release and parole,or may create more restrictive conditions of pretrial or postsentence release. Inmatesmay malinger or exaggerate symptoms in correctional settings to obtain more favorablehousing, to postpone or to facilitate transfer to another housing unit or facility, or toobtain medication. Yet persons with schizophrenia are unlikely to exaggerate their condition.The staff should exercise caution in attributing mental health symptoms to malin-