Mental Health Screening and Evaluation

• Because mental illness can affect a client’s quality of life and may serve as a barrier to their achieving certain prosocial goals (e.g., employment), it is important to conduct mental health screenings and evaluations with clients who need them.
  • Screening is the process for determining if a client has symptoms associated with mental illness. The outcome is typically yes or no.
    • Screening is often done with a short form that an officer completes with a client.
    • Screening should be completed with all clients at intake, or if they start to show signs of mental illness or high stress.
  • Evaluation is the process of defining the nature of the problem, determining the diagnosis, and developing specific treatment recommendations for addressing the problem or diagnosis (SAMHSA, 2019).
    • Evaluation should be completed if a mental health screener indicates the presence of a mental illness.
• There are many cases where clients who screen positive for mental illness may not need/want intervention to address that illness. Officers should always be ready to provide resources/referrals to assist clients with mental illness, but mandatory treatment is often unnecessary.

• It is recommended that an evidence-based screener be used (see Appendix A1 for a list of free, online tools).
• An evidence-based screener should include the following elements:
  • type of mental health symptoms the client is experiencing (e.g., anxiety, depression, hallucinations [auditory or visual], mood swings)
  • frequency with which the client experiences these symptoms
  • last time the client experienced these symptoms
  • negative impact (social, legal, employment, family) these symptoms may have had on the client’s life
• Risk-need assessment tools are not substitutes for a dedicated mental health screening tool.

How Can It Be Used to Monitor Compliance?

• Screening and evaluation should never be done with the purposes of monitoring the client.

How Can It Be Used as a Supervision Tool?

• If a client begins to have a small-to-moderate amount of compliance issues, screening and evaluation can be an appropriate response to noncompliance to determine the role mental illness is playing.

• When the screener/evaluation has identified a mental illness and when client behavior is connected to the mental illness, psychological interventions (e.g., CBT, DBT, individual or group therapy) are an appropriate response for medium- and high-risk clients with a lot of compliance problems. Such interventions should only be used as a last resort and in cases where the client’s noncompliance is clearly and directly connected to mental illness (e.g., an individual with schizophrenia who is unwilling to apply for a job due to paranoid thought patterns).
  • In all cases, the officer should encourage the client to seek treatment voluntarily first.

What Are the Costs of Mental Health Screening and Evaluation?

• There are many validated mental health screening and evaluation tools available free online (see Appendix A1). In most cases, the cost is equal to the officer’s time taken to administer the tool.

• Supervision staff report that mental health screening and evaluation are
  • sometimes appropriate for all low-risk clients and
  • always appropriate for all medium- and high-risk clients.

Client Outcomes

• Mental illness can manifest as one of several conditions which may affect a client’s quality of life. Such conditions include anxiety, depression, bipolar disorder, and schizophrenia.
• While mental illness can affect a client’s quality of life, evidence indicates that it is not directly linked to criminal behavior.
  • In some cases, in the presence of certain social conditions, mental illness can contribute to criminal behavior.
    • This can occur when people with mental illness are denied access to employment, housing, transportation, etc. In some cases, this may occur due to discrimination.
    • Co-occurring issues like substance use disorder can also make it more likely that a person with mental illness will commit a crime.

• Mental illness can also severely impact a client’s quality of life, contributing to both personal and professional problems.
  • In some cases, these problems can result from the mental illness directly. In other cases, they can result from society’s response to people with mental illness.
• If mental illness is not found to be contributing to dangerous behavior, officers should go no further than to provide resources (and, if requested, assistance) for the client to seek treatment.
  • It is important to remember that not everyone with mental illness wishes to be “cured.”
  • In some cases, the medications used to suppress the symptoms of mental illness are accompanied by unpleasant side effects. For some people experiencing mental illness, these side effects may be more unpleasant and undesirable than the symptoms of the mental illness itself.
• In cases where mental illness severely impacts a client’s quality of life, screening and evaluation can benefit the client by identifying the potential presence of mental illness and revealing how it might be connected to negative life outcomes in ways previously unknown by both officer and client.

Is Mental Health Screening and Evaluation an Evidence-Based Practice?

• Yes, there is a large body of research supporting the effective use of mental health screening and evaluation with clients inside and outside of the criminal legal system (the “criminal justice” or “legal” system is referred to as the criminal legal system in this document).

What Do People Formerly Involved in the Criminal Legal System Think About Mental Health Screening and Evaluation?

• People who have been involved in the criminal legal system report that mental health screening and evaluation is
  • sometimes appropriate for all low-risk clients and
  • sometimes appropriate for all medium- and high-risk clients, except for those who have committed intimate partner violence, for whom it is always appropriate.

Communication That Strengthens the Officer-Client Relationship (Messaging)

• Discuss with the client why the screening and evaluation is occurring and ensure they understand how the information can be used to benefit them.
• Inform the client that the screening is a standard procedure done with all clients on supervision.
• Clients may disagree with the results of the screening/evaluation. When this occurs, clients are more open to officers who present themselves as helpers and who use their experience on the job to push back on clients’ ideas.
• Tell clients how noncompliance with treatment will be treated.
• Client and officer should agree on what the client should do in the case they feel treatment is not working for them.
• Discuss with the client any concerns they might have surrounding mental illness. Potential topics can include stigma, side effects of medication, and time/resources necessary to seek treatment.