All Studies Were Coded By The Primary Author: A Systematic Review: Mental Health Screening Tools In Correctional Institutions

BJMHS generally had a sensitivity of approximately 60 to 65.

At these lower ‘cutoff’ scores that achieved higher sensitivity, there was a significant drop in the specificity of the BJMHS.

While ranging from ’82 95’percentage determined by the breadth of disorders included in the case definition, and the choice of cut off, in one study where the standard cutoffs were not used, the sensitivity of the BJMHS was considerably higher. Its sensitivity was only 34 in a New Zealand study, and in one study the sensitivity for women was 46percent, as exceptions to this. Actually the use of lower cut offs with men, resulted in slightly lower overall accuracy, as the exception to this. In most studies, the overall accuracy was in the range of ‘6575’. Nonetheless, grey and Latino inmates had less prior service utilization, items which result in automatic referral. Also, in validation studies in Canada and New Zealand their performance decreased considerably, especially in the detection of major depression. Our review identified important contextual considerations for those selecting a tool. EMHS relies entirely on historical variables, whereas the BJMHS, the CMHS and the JSAT all include items regarding history and current symptoms.

Both countries have relativelyvery large Indigenous populations who have relatively less utilisation of mental health services in the community.

Poorer performance in ethnically diverse populations may reflect their lack of access to health care in the community, or cultural differences in interpreting the meaning of constructs and tools to measure them, as both the BJMHS and EMHS include items regarding mental health treatment history.

Black and Latino inmates screened with the BJMHS. Gagnon and Evans et al noted that differences between countries in access to health care might influence referral rates on tools like the BJMHS and EMHS which include past psychiatric treatment items. Both the BJMHS and the EMHS performed well in initial studies. On top of that, at its recommended ‘cutoff’ of 6 or more items, the ‘CMHS M’ had a sensitivity of 74percentage, 95percent CI in the development study and 70percent, 90 CI in the replication study for the detection of a Axis I or I disorder.

Whenever, as these cutoffs achieved sensitivity of 80.

The K6 and ‘GHQ28’ may warrant further investigation in settings where the five replicated tools do not perform as well as desired given their widespread use in community and identical settings.

The The NYC State Brief Screening Tool performed well for women especially in a small study with a sensitivity of 88percentage,, 95percent CI and a specificity of 84percentage, 95 CI. Of the tools with single studies, few appeared to perform sufficiently well to justify their implementation. Now look, the sensitivity of the K6 among women was between 58 and 69percent using the prespecified case criterion. Fact, at the cut point with the highest overall accuracy, the GHQ 28 had a sensitivity of 65, 95 CI and a specificity of 69 95percent CI.

Neither tool performed better than the five previously mentioned tools in the initial study.

The CMHS appears to perform slightly better among men than among women.

Steadman et al. As the sensitivity was only 61percent, 95 CI in this second study, others have argued that the BJMHS has not been adequately validated for use among women offenders. Anyways, the CMHS male version contains four additional items as compared to its female counterpart, while items about Post Traumatic Stress Disorder and anxiety were added to the BJMHS in an attempt to improve performance for women. Then again, with a similar specificity, the JSAT also had a slight decrease in sensitivity in a small study with women offenders compared to the original research on the tool. Two tool developers explored the need for sexspecific screening tests. BJMHS, and argued that the original version performed adequately in the second sample of women studied. Lowering the ‘cutoff’ to 3 or 4 associated with mental health screening of incarcerated individuals. With a slight decrease in sensitivity and a slight gain in specificity, on replication among a small sample of women, the tool performed comparably. In a subsequent replication with male offenders the JSAT sensitivity ranged from 38 to 50 determined by the breadth of disorders included in the case definition. Remember, in the development study, the JSAT achieved a sensitivity of 84percent, 95 CI among men with a specificity of 67,, 95 CI. Notice that performance of the JSAT was somewhat more variable across studies, that may reflect the use of structured professional judgement to make referral decisions. In their replication study this recommendation was not pursued.

Few studies reported performance of tools by race.

Conversely, in the Canadian study while the sensitivity of the BJMHS was similar to studies in the United States at approximately 65percent in all cases,, the specificity was considerably lower.

So in case false positive rates are therefore this may lead to an inefficient use of scarce mental health resources. Of course, this may result in large numbers of offenders without mental health needs receiving mental health assessments, possibly delaying treatment for those of highest need. Generally, only one other study to compare performance by race, found comparable performance of the COSDI MD and COSDI SMD among White, Black and Latino offenders.

They suggested comparable performance of the CMHS across races for both men and women, aside from a suggestion to consider a lower cutoff score to improve the sensitivity of the tool for white women.

It had been argued that a tiered screening system which accepts higher false positive rates is a preferred option.

Two studies failed to replicate the performance of the BJMHS and the EMHS in countries with high rates of indigenous inmates, while not a direct test of performance in different racial/ethnic groups. Albeit as discussed below performance differed by disorder, in New Zealand, the BJMHS and EMHS lacked sensitivity all in all. Anyways, we have not reproduced the analyses by combination of sex and race presented by Ford and colleagues for space reasons. Now look. Given that the BJMHS was developed to address limitations of the RDS, we would discourage adoption of the RDS. Paucity of replication studies and study quality problems for quite a few tools limit conclusions regarding their application. Our review identified loads of screening tools in the literature.

BJMHS, the CMHS M, the CMHSW, the EMHS, the JSAT, and the RDS are best studied.

They did not find a higher detection rate of psychotic disorders as observed by Teplin.

Past studies have found poor identification of offenders with mental illness for treatment services. Similar results were found in the United Kingdom by Birmingham et al. Higher rates of mental disorders have consistently been reported in correctional settings as compared to the general public. Offenders with mental illness have enough chances to engage in institutional violence and rule infractions, especially those with psychotic or depressive symptoms. Similarly, offenders with mental illness are less going to be released on parole and similar forms of discretionary release and can be more gonna have their community supervision revoked. That said, similarly, whereas 45percent of those with a psychotic disorder were detected by jail personnel, only 7percent of those with major depression were identified.

Two ‘metaanalyses’ showed that interventions for offenders with mental illness can be effective at improving outcomes while incarcerated and at preventing further crime.

Therefore this same study noted mental health needs were more going to be identified among those with a past psychiatric treatment.

In their study, 23percentage of those with a current mental illness were identified by prison staff. Teplin found that only 32 dot 5 of inmates with severe mental illness were detected at intake. Few studies compared the performance of tools to detect various disorders. Evans et al reported that dozens of false negatives using the EMHS and BJMHS were depressive disorders, whereas the tools missed very few cases of psychosis.

Accordingly the CMHSM and CMHS W, JSAT, and K6 performed comparably across a range of diagnostic categories.

We calculated missing statistics where possible to address variable reporting of results.

PPV and NPV were calculated for 5 studies. Essentially, we recalculated sensitivity and specificity values for two other studies. We ‘recalculated’ unweighted statistics from the raw data provided, since no other studies accounted for over sampling by sex. For 17 studies, we calculated the referral rates using the sensitivity, specificity and either. You see, for another study, data were weighted by sex, as sampling was stratified. Confidence intervals were only reported in 2 studies. Overall accuracy was calculated for 13 studies and could not be calculated for another 3. For one study we calculated these values by sex from raw data provided.

One study did not report sensitivity and specificity values.

IC is supported by the Canada Research Chairs program.

MM was supported by a Canadian Institutes of Health Research Training Fellowship through the Social Aetiology of Mental Illness Training Program. Normally, tools were rated using the QUADAS 2. Tool requires an assessment of four domains. However, study quality was assessed by the primary author. Even if the tool identifies very few individuals with mental illness, I’d say if the prevalence of illness is very low, overall accuracy can be the primary consideration. Alternatively, a tool with high overall accuracy might be overburdened by a screening tool which refers many inmates who do not require services. In this case, a tool with high specificity and adequate sensitivity will be used to determine what adequate performance of a screening tool means within every specific context. Screening is a critical component to a correctional mental health strategy, and there appear to be So there’re quite a lot of factors that may impact the performance of screening tools just like sex, race/ethnicity/culture, jail versus prisons, country factors, and staff qualifications and training that have received minimal attention in the literature. Also, veysey and colleagues noted that the RDS lacked specificity to distinguish the three diagnoses categories, and cautioned against the use of the tool being that the potential for results to be misinterpreted.

BJMHS was developed to address limitations of the RDS, most notably concerns with the naming of the subscales corresponding with specific diagnostic categories.

With low specificity, in loads of studies with the general offender population, the RDS had high sensitivity.

I know that the RDS has the most extensive body of research, as the oldest of the screening tools considered in the review. Major problems in choosing a standard are determining the most important mental health conditions to detect and what referral rate can be managed with local resources. You should take this seriously. In screening for rare but severe illness, a two stage screening process should be tolerable to have a high false positive rate in the first stage, followed by secondary level triage to identify those in greatest need of service. With lower needs individuals using disproportionately high levels of services, in community settings, so this has been challenging. Besides, this article is published under license to BioMed Central Ltd.

Only four studies included prison populations.

Of these tools, only the RDS had been tested in both jail and prison settings.

The COSDI MD, COSDI SMD, the MCMI II, the NYS BST and the RDS are only one tools to be tested in a prison setting. With that said, this study was the original crossvalidation by the developers, that relied on a secondary data set, while the RDS had a relatively high sensitivity and specificity in a prison setting as compared to other studies of the RDS. Limiting our ability to draw conclusions about many tools reviewed, there been considerable reductions in performance in the replication of now this study is limited by the lack of replication studies of otherwise well designed tools.

There’s a lack of consensus about what constitutes acceptable performance for a screening tool. Possible standards that administrators could attempt to achieve include. In a study using a highly similar fouritem tool, a sensitivity of 76, 95 CI was reported. Did you know that the EMHS achieved perfect sensitivity in a small pilot study for men over the age of 21 and for women although the sensitivity was only 50percent for the small subsample of ‘1821year’ old males,. Now please pay attention. In a replication study in New Zealand, however, the sensitivity of the EMHS was only 42percent, 95 CI. That’s where it starts getting serious. Overall accuracy for the EMHS was above 80 for the small pilot study. Twenty four studies met all inclusion and exclusion criteria for the review.

All articles were coded by two independent authors.

With an independent measure of mental illness, only studies involving adult jail or prison populations, were included.

With additional studies identified from a search of reference lists, mEDLINE and PsycINFO up to 2011. Studies in forensic settings to determine fitness to stand trial or criminal responsibility were excluded. Therefore this lowered cut off results in a sharp increase in the false positive rate with a specificity of 49,, 95 CI. At its recommended cut off of 5 or more items, the ‘CMHSW’ had a sensitivity of 65, 95 CI, in the development study and 64percentage, 95percent CI, in the replication study for the detection of a Axis I or I disorder. Whenever, as this cutoff achieved a sensitivity of 85percentage. Only two studies included in this review compared these tools against each other.

Evans et al compared the BJMHS and the EMHS, and found that they had roughly comparable performance.

Except for Black women, ford et al found higher accuracy of the CMHS tools compared to the BJMHS and RDS.

Whereas the BJMHS, CMHS M and CMHS W and EMHS are brief tools that can be administered by health or custodial staff, the JSAT is completed by nursing or psychology staff, and requires 20 30minutes to complete. That said, the remaining authors any coded approximately one the articles third to establish ‘interrater’ agreement. All studies were coded by the primary author. Intraclass correlation coefficients exceeded dot 95 for continuous variables. Kappa exceeded dot 70 for categorical variables. It’s a well coders used a data extraction form developed for this study to collect information about the study setting, the sex and racial composition of the sample, the reference standard, and statistical information regarding the performance of the screening tool, and referral rates). We conducted a systematic review of existing research in the position, as there’s little guidance to inform the selection of an appropriate mental health screening tool in correctional settings.

Actually the review was guided by four questions.

Of the studies among men using the RDS some found slightly worse performance among men particularly regarding the specificity.

It may be noted that these two studies used different cutoff scores from the traditional RDS scoring. In both studies, referral rates exceeded 60percentage, while the sensitivity of the NYS BST was approximately 20 higher for women than for men. With lower specificity, the RDS had high sensitivity in two studies with women. Ford et al used a cutoff So lack of trials evaluating screening tools limits our ability to assess the improvements in detection rates following the introduction of a mental health screening tool. It was depending on the results of Teplin from approximately twenty years earlier, while the argument supports the use of the tool. Fact, I know it’s possible that detection will have improved since this time without screening given increased attention to mental illness in corrections. Oftentimes noted that it represented an improvement over previous screening results, in their development study, Steadman and colleagues acknowledged that the BJMHS performed worse for women offenders. There’s little guidance to support the selection of an appropriate tool.

Past studies have identified poor rates of detection of mental illness among inmates. Mental health screening is a typical feature to various correctional mental health strategies and best practice guidelines.