Mental health is as important as our physical health, yet nationally, mental health conditions often go undiagnosed and/or untreated. Justice system professionals, especially those working in prisons and jails, regularly witness the long-term impacts of untreated mental health disorders, especially severe mental illness.
According to the Centers for Disease Control and Prevention, more than 50 percent of Americans will be diagnosed with a mental illness or disorder at some point in their lifetime. Within a given year, one in five Americans will experience a mental illness and one in 25 individuals will live with a serious mental illness (schizophrenia, bipolar disorder, major depression).
These numbers are overrepresented in prisons and jails for various reasons, including higher rates of individuals with adverse childhood and life experiences, biological factors or chemical imbalances in the brain, and feelings of loneliness and isolation. Many people entering prison or jail are in a heightened state of crisis that can easily be exacerbated by the reality of their loss of freedom and a fear of or anxiety about daily activities in the justice system.
Mental Health Begins at Booking
Improving mental health among people in the care and custody of the justice system begins at intake/booking. Health screenings conducted by medical providers upon entry, as well as cursory mental health questionnaires, help to identify immediate and ongoing medical needs, as well as whether or not the individual may have a mental health condition or mental illness.
To diagnose and begin to provide appropriate treatment, a follow-up mental health assessment conducted by a mental health professional is recommended within the first few days of booking. These questionnaires and assessments will provide the basis for improving mental health because they directly inform the treatment plan and resources needed for individuals experiencing mental health conditions or severe mental illness.
Davis County Sheriff’s Office in Utah operates a correctional facility where some individuals are awaiting justice and others are completing their sentencing requirements, including individuals on contract from the Utah State Prison. Significant incidents, including several deaths, prompted the Davis County Sheriff’s Office to restructure their booking/intake process, as well as to revamp internal procedures and resources offered to improve the mental health and well-being of those in their care and custody.
Since 2019, Davis County Sheriff’s Office has prioritized medical and mental health care by creating a Life Safety Committee; implementing initial health screenings and mental health questionnaires conducted by a registered nurse during intake; contracting with mental health counselors to perform in-depth assessments within the first 48 hours of booking; conducting security checks every 15–30 minutes on newly-booked individuals; enhancing access to medical, mental, and behavioral health care; availing additional mental health professionals after significant incidents in the jail; requiring Mental Health First Aid training for sworn and civilian employees; encouraging and incentivizing Crisis Intervention Training for deputies; and they recently opened a 33-bed medical wing that will allow them to provide more in-house medical care and to connect individuals in their care and custody with 24/7 telehealth providers, including mental health counselors, while maintaining community well-being and safety.
These evidence-based efforts are improving mental health and saving lives. From September 2021 to September 2022, Davis County Jail staff successfully intervened in a total of 90 suicide attempts by inmates, an average of 7 times a month.
“When an individual is struggling with mental health or substance use issues, it affects many people—the individual, their family, friends, neighbors, the community as a whole—and the impact on all of these people doesn't really stop when the individual becomes involved with the justice system. Our goal is to ensure these individuals are safe while in our care and custody and that we do all we can to ensure they are healthier, better citizens when they return to the community. We sincerely believe, and know from evidence-based outcomes, that this is how we can best change behavior, reduce recidivism, and improve community well-being and public safety.” —Sheriff Kelly V. Sparks, Davis County Sheriff’s Office
Mental Health Treatment as a Protective Factor
Providing mental health treatment in prisons and jails builds protective factors for all parties and, for many individuals with mental health conditions, their first or most consistent access to treatment often occurs in correctional environments.
Mental health treatment extends beyond prescription medications—it requires a holistic, collaborative approach between justice system professionals, medical personnel, mental health providers, and program staff. It also requires positive, informative interactions—not just transactions—with the people involved in the justice system.
Explaining processes and procedures upon booking is a simple practice that builds protective factors and reduces risk factors for everyone in prisons and jails. When people have a better understanding of what to expect while in the justice system, anxiety and/or fear of the unknown lessens and, subsequently, negative behaviors decrease which improves safety for everyone. Proactively explaining other processes throughout the person’s involvement with the system helps to reduce distrust and angst among those whose life experiences have conditioned them to expect and respond to violence and perceived or real threats. These initial and ongoing collaborative communications and interactions are critical to positive mental health in prisons and jails because they enhance safety and reduce retraumatization.
Professional Development, Policies, and Procedures
Training focused on recognizing mental illness and how to respond to mental health crises is a basic requirement for correctional officials around the country. Regular reviews of existing mental health training requirements within one’s agency and implementation of additional evidence-based professional development opportunities that improve mental health in prisons and jails should be one of several correctional administration priorities.
Training and professional development should provide an understanding of mental health conditions and mental illness, include suicide prevention, and should equip correctional officials with evidence-based, trauma-informed responses that de-escalate situations while maintaining community well-being and safety.
Policies and procedures specific to intake, assessments, early and consistent access to mental health treatment, suicide prevention, and response to crises should also be regularly reviewed and revised to complement evidence-based decision-making and best practices specific to improving mental health in prisons and jails.
Carey Group’s Behavioral Intervention Tools
Using evidence-based practices in prisons and jails helps improve outcomes for individuals involved in the justice system and correctional staff. By using evidence-based practices, facilities can be more effective in addressing the specific needs of individuals and creating an environment that supports rehabilitation.
Decades of experience demonstrate that aligning justice systems around evidence-based policies and practices offers the greatest promise of success. Carey Group offers services and products for justice system professionals, from evidence-based consulting to interactive workbooks that help improve the mental health and lives of people with involvement in the justice system.
Carey Group’s evidence-based training and consulting services address the needs of the justice system and behavioral health professionals. Training is an essential tool for keeping staff, supervisors, leadership, and stakeholders up to date with emerging knowledge and expectations for improved outcomes. Carey Group offers in-person, online, and self-directed courses on evidence-based practices, motivational interviewing, core professional competencies, case planning and management, continuous quality improvement, coaching, and the use of behavior-change tools and supervisor resources.
Additionally, the Mental Health Carey Guide helps people understand their symptoms, learn to identify how different situations affect their mental health, and find techniques to include in their daily lives activities that can decrease their symptoms. This guide is part of the Carey Guides, a comprehensive package of 33 cognitive-behavioral handbooks containing 100 tools that help staff use evidence-based practices with their clients. These tools are designed to help clients understand and address risk factors, triggers, and other conditions essential to their success. In total, the Guides support a long-term case management approach that can help justice-involved people build skills and make positive changes in their lives.
Carey Guides 2nd Edition Paper Version
Carey Group (Consulting and Publishing) is a national consulting and publishing firm that equips justice system and behavioral health professionals with knowledge, skills, and tools that improve the lives of clients. We make this possible by providing an array of staff training, organizational consulting services, and evidence-informed intervention tools. Contact us today to learn more about our evidence-based training and consulting services.
Learn more:
https://nicic.gov/tags/mental-health
https://www.cdc.gov/mentalhealth/learn/index.htm
https://www.nami.org/about-mental-illness/mental-health-conditions
https://www.samhsa.gov/serious-mental-illness
https://www.apa.org/monitor/2019/03/mental-heath-inmates
https://www.annualreviews.org/doi/abs/10.1146/annurev-criminol-032317-092326