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CSC to Launch Computerized Mental Health Screening

Senior Research Manager Dr. Andrew Harris

According to the 2006 Corrections and Conditional Release Statistical Overview, 10 percent of offenders are diagnosed as having a mental health disorder upon entering the federal correctional system. The same report shows that 20 percent of federal offenders are on prescribed psychiatric medication at the time of admission. "The discrepancy suggests that the system does not reliably count and follow individuals with mental health challenges," says Senior Research Manager Dr. Andrew Harris.

Due to the stigma attached to mental illness throughout society, many inmates feel they have to hide their mental health problems upon admission. Offenders who are not screened and flagged for treatment can become disruptive, can be a threat to themselves and others, or, because they are left to cope on their own, in the regular prison population, they can be preyed on by other inmates.

"Finding out who has mental health problems at intake, so we can better respond to their needs, has always been a goal for CSC," says Dr. Harris. "But until recently, we didn't have the tools or the resources to screen everyone."

"Administering mental health assessments is a very time-consuming and expensive process, which makes it impractical for daily screening of large numbers of inmates," he explains.

Extensive consultations with regional staff led to Dr. Harris and his team developing a computerized mental health screening tool, to be pilot-tested in reception centres, over the next two years.

How It Works

All federal offenders arriving at a regional reception centre will be asked to sit down at a private computer station and spend 30 to 40 minutes completing a series of true or false and scale ("not at all", "a bit", "moderately", "a lot") questions. Participation is voluntary.

The tests have been used in correctional settings for some years and include what's known as the Brief Symptom Inventory of mental health indicators such as depression, anxiety, hostility, obsessive-compulsive disorder and paranoia, along with a depression, hopelessness and suicide scale, developed within CSC. A third test, the Paulus Deception Scale, is a safeguard against faked responses.

Offenders who are unable to read the grade six-level questions can have them read aloud by the computer, in French or English. Plans are under way to add major Aboriginal and immigrant languages down the road, along with tests for personality disorders, Fetal Alcohol Spectrum Disorder and Attention Deficit Hyperactivity Disorder.

Project Manager Dr. Ron Frey, a clinical psychologist hired to oversee implementation of the screening tool, emphasizes there are checks and balances built into the process, to allow offenders to take a break when they need to or ask questions. "They're not just alone in a room with a computer," he says. "There will always be a clinician standing by, in case a question is disturbing to an inmate or brings back painful memories that might trigger a safety risk."

Further human contact will come in the form of a face-to-face interview with a psychologist, if necessary, after offenders complete the computerized tests. "In deciding whether an offender requires follow-up assessment, you cannot make decisions on test results alone," says Dr. Frey. "For example, in the case of Aboriginal offenders, you need to have a clinician who understands the culture of the individual sitting across from them so they can properly interpret the psychological tests results."

Results

Once offenders complete the screening process, the data will generate a report that goes to their confidential medical file. If the score exceeds a certain threshold, there will be an automatic referral to a psychologist for a full-blown assessment and therapy, if needed, including placement in a Regional Treatment Centre or other specialized facility.

"It's a more efficient use of our resources," says Dr. Frey, "to do customized assessments only on those offenders who have been flagged. On a system-wide level, the data we gather will also give us regional profiles of mental health needs and help us do a better job of treatment planning, including the right type of follow-up once a person is discharged into the community."

Having all the test results online also gets around the massive problem of data entry and the possibility of human error when punching in the data.

All test results will be uploaded to National Headquarters Research Branch, to be analyzed and will be used to inform programming decisions at all levels, as well as used in making the case for increased mental health resources. "Year-to-year variations in screening results will also allow CSC to respond to future needs," says Dr. Harris.

Similar screening tests are currently being piloted in the Pacific Region, with the difference that they are manually administered in the presence of a psychiatric nurse. Results from that project will be helpful in terms of estimating the nationwide need for hiring more mental health staff.

Project Manager Dr. Ron Frey, a clinical psychologist hired to oversee implementation of the screening tool.

Benefits

"To date, 25 to 30 percent of new offenders coming into the Pacific Region have been identified as having some sort of mental disorder, with admissions to the psychiatric hospital and rehabilitation unit going up accordingly," says Executive Director Art Gordon. "What we've noticed," he comments, "is that simply attending to people by a mental health professional, right at the outset, makes a huge difference to the smooth operation of the entire unit."

"The screening doesn't diagnose anybody," Dr. Harris points out, "but it checks for problems. The big issue here is, if somebody's coming in and they've got a problem, we'll be able to respond proactively and support them as opposed to waiting for them to have a crisis."

"We don't want offenders who are holding it together well enough to get past the reception stage to then be sitting in a cell dealing with mental illness by themselves. It's hard to treat a hidden problem and it's very hard to argue for effective resources for a problem that's difficult to count or where you know your counts are under-estimated."

Apart from the benefits to offenders, CSC staff and management, universal screening also has a wider, societal impact, notes Dr. Harris, with the potential to ease offenders' return to and acceptance into the community.

"We want people to get the most out of their correctional experience so that they don't come back. We can help them best when we have valid, reliable data. It's all about public safety." ♦