MAY 07

U.S. Department of Justice
Office of Justice Programs
National Institute of Justice

Research for

Practice

Mental Health Screens for Corrections
www.ojp.usdoj.gov/nij

U.S. Department of Justice
Office of Justice Programs
810 Seventh Street N.W.
Washington, DC 20531

Alberto R. Gonzales
Attorney General
Regina B. Schofield
Assistant Attorney General
David W. Hagy
Deputy Assistant Attorney General, Office of Justice Programs 
and Acting Principal Deputy Director, National Institute of Justice

This and other publications and products
of the National Institute of Justice can be
found at:
National Institute of Justice
www.ojp.usdoj.gov/nij

Office of Justice Programs
Innovation • Partnerships • Safer Neighborhoods
www.ojp.usdoj.gov

MAY 07

Mental Health Screens for Corrections�

This Research for Practice
is based on two final
reports to the National
Institute of Justice: 
“Evidence­Based
Enhancement of the
Detection, Prevention,
and Treatment of Mental
Illness in the Correction
Systems,” by Ford and
Trestman, August 2005,
NCJ 210829, available
online at www.ncjrs.org/
pdffiles1/nij/grants/
210829.pdf; and 
“Validating a Brief
Jail Mental Health
Screen,” by Osher, Scott,
Steadman, and Robbins,
November 2004, 
NCJ 213805, available
online at www.ncjrs.org/
pdffiles1/nij/grants/
213805.pdf.

Findings and conclusions of the research reported here are those of the
authors and do not necessarily reflect the official position or policies of the
U.S. Department of Justice. This research was supported by NIJ under
grant numbers 2000–IJ–CX–0044 and 2001–IJ–CX–0030.

NCJ 216152

RESEARCH FOR PRACTICE / MAY 07

ABOUT THIS REPORT
Identifying entering inmates’
mental health needs when
they first enter an institution
is critical to providing neces­
sary services and enhancing
safety in corrections settings.
The purpose of the two proj­
ects discussed in this report
was to create and validate
mental health screening
instruments corrections staff
can use during intake.

accurately identify inmates
who require mental health
interventions. One mental
health screen was found to
be effective for men and is
being adapted for women;
the other has effective ver­
sions for both men and
women.

What did the
researchers find?

Corrections administrators and
mental health professionals.

The researchers created
short questionnaires that

ii

Who should read this
report?

M E N TA L   H E A LT H   S C R E E N S   F O R   C O R R E C T I O N S

Julian Ford and Robert L. Trestman/Fred Osher, Jack E. Scott,
Henry J. Steadman, and Pamela Clark Robbins

Mental Health Screens for
Corrections

About the Authors
Dr. Julian Ford and 
Dr. Robert L. Trestman 
are with the University of
Connecticut Health 
Center, Farmington, 
Connecticut. Dr. Fred
Osher and Dr. Jack E.
Scott are with the Center
for Behavioral Health, 
Justice, and Public Policy,
Baltimore, Maryland. 
Dr. Henry J. Steadman and
Pamela Clark Robbins are
with Policy Research
Associates, Inc., Delmar,
New York.

As corrections staff across
the United States struggle to
keep up with the rapid influx
of new inmates while main­
taining a secure environment,
their efforts are increasingly
hampered by the presence of
individuals with serious men­
tal illnesses who are entering
corrections facilities in grow­
ing numbers. Numerous stud­
ies show that jail detainees
have a significantly higher
rate of serious mental illness
(e.g., bipolar disorder, major
depression, schizophrenia,
and other psychoses) than
the general population.1
One pair of studies reported
that approximately 6 percent
of men and 15 percent of
women who were admitted
to Chicago’s Cook County jail
displayed severe symptoms
of mental illness and required
treatment.2
Many serious mental illnesses
are chronic and are subject to
exacerbation and relapse.
The stress of incarceration
can worsen symptoms in
persons with preexisting
mental disorders, leading to
acute psychiatric distur­
bances, including harm to
self or others; inmates with

histories of severe mental ill­
ness may present an even
greater risk. Moreover, sever­
al studies have shown that
inmates with psychiatric
impairment may exhibit more
serious and more numerous
adjustment and disciplinary
problems (such as refusal to
leave one’s cell or destruction
of property) during incarcera­
tion than unimpaired inmates.3
Prisons and jails have a sub­
stantial legal obligation to
provide health and mental
health care for inmates.4
Case law and statutes have
not provided a clear definition
of what constitutes adequate
mental health care. The
American Psychiatric Associa­
tion has, however, recom­
mended that all corrections
facilities provide at minimum
mental health screening,
referral, and evaluation; crisis
intervention and short­term
treatment (most often med­
ication); and discharge and
prerelease planning.5 A
national survey of 1,706 U.S.
jails reported that 83 percent
of them provide some form
of initial screening for mental
health treatment needs.6 Still,
screening procedures are
1

RESEARCH FOR PRACTICE / MAY 07

highly variable; they may con­
sist of anything from one or
two questions about previous
treatment to a detailed, struc­
tured mental status examina­
tion. One result of this
variability is apparent in data
that showed fully 63 percent
of inmates who were found to
have acute mental symptoms
through independently admin­
istered testing were missed
by routine screening per­
formed by jail staff and
remained untreated.7
Clearly, there is a pressing
need to develop valid and
reliable procedures to screen
incoming detainees for signs
and symptoms of acute
psychiatric disturbance and
disorder.
Researchers funded by the
National Institute of Justice
have created and tested two
brief mental health screening
tools and found that they are
likely to work well in correc­
tional settings. These tools
are the Correctional Mental
Health Screen (CMHS)8 and
the Brief Jail Mental Health
Screen (BJMHS).9 The tools
are in the appendixes.
CMHS. The CMHS uses sep­
arate questionnaires for men
and women. The version for
women (CMHS–W) consists
of 8 yes/no questions, and the

2

version for men (CMHS–M)
contains 12 yes/no questions
about current and lifetime
indications of serious mental
disorder. Six questions regard­
ing symptoms and history
of mental illness are the
same on both questionnaires;
the remaining questions are
unique to each gender
screen. Each screen takes
about 3–5 minutes to admin­
ister. It is recommended that
male inmates who answer
six or more questions “yes”
and female inmates who
answer five or more ques­
tions “yes” be referred for
further evaluation.
BJMHS. The BJMHS has 8
yes/no questions, takes
about 2–3 minutes, and
requires minimal training to
administer. It asks six ques­
tions about current mental
disorders plus two questions
about history of hospitaliza­
tion and medication for men­
tal or emotional problems.
Inmates who answer “yes”
to two or more questions
about current symptoms or
answer “yes” to either of the
other two questions are
referred for further evalua­
tion. Instructions for adminis­
tering the screen appear on
the back of the form. Correc­
tions classification officers,
intake staff, or nursing staff
can administer the screen

M E N TA L   H E A LT H   S C R E E N S   F O R   C O R R E C T I O N S

without specialized mental
health training, but may
receive brief informal training
before administration. 

Criteria for Detecting
Mental Illness in Jails
When inmates enter a correc­
tions facility, the staff’s first
task is to separate out those
who may be at significant risk
for suicide, acute psychotic
breakdown, or complications
from recent substance abuse
from those who are merely
experiencing varying degrees
of distress usually associated
with arrest, conviction, and
detention.
Effective mental health triage
in the corrections setting can
be viewed as a three­stage
process: (1) routine, system­
atic, and universal mental
health screening performed
by corrections staff during
the intake or classification
stage, to identify those
inmates who may need closer
monitoring and mental health
assessment for a severe
mental disorder; (2) a more
indepth assessment by
trained mental health person­
nel conducted within 24
hours of a positive screen;
and (3) a full­scale psychiatric
evaluation when an inmate’s
degree of acute disturbances
warrants it. 

Screening is the crucial part
of the process, because it is
the primary means by which
staff can determine which
inmates require more special­
ized mental health assess­
ment or evaluation, as well as
treatment. Unless inmates
are identified as potentially
needing mental health treat­
ment, they will not receive it.
Screening, however, is the
weak link and, as already
noted, varies considerably.
Until now, there were no valid,
standardized tools available
that could be recommended
for adoption nationwide.
A valid standard screen
needs to be brief, because
corrections classification staff
have only a limited amount of
time to spend with any one
inmate. It also needs to pro­
vide explicit decision criteria,
because the mental health
training and experience of
corrections staff is likely to
be relatively low. Corrections
staff traditionally are confi­
dent in their ability to discern
overtly psychotic symptoms,
but are considerably more
uncertain about identifying
less obvious—though equally
serious—signs and symp­
toms of anxiety and depres­
sion. Thus, they need a tool
that can provide them with
the basis for a clear decision
(“refer” or “don’t refer”).
3

RESEARCH FOR PRACTICE / MAY 07

A useful jail mental health
screen also needs to exhibit
a low false­negative rate—
that is, it would not miss
many inmates who have
a serious mental disorder
because the potential conse­
quences of not treating an
inmate with a serious mental
illness could be grave. On the
other hand, it must have a
low false­positive rate too,
because mental health
resources in corrections
settings are scarce and bur­
dening trained mental health
staff with the need to assess
many people who do not
have a serious mental illness
is an inefficient use of their
time. Thus, an effective men­
tal health screening tool
would have a high degree
of predictive validity, in that
most of the people who
are flagged by it as being
“positive” should, on further
assessment, be found to
have a treatable serious men­
tal illness.

Different Instruments
for Different Needs
There are few available
screening tools that meet all
of these criteria. Symptom
checklists, like the Symptom
Checklist­90 and the Brief
Symptom Inventory (BSI),10
focus on the recent, self­rated

4

experience of specific symp­
toms within the past week.
These checklists have 90 and
53 items, respectively, and
require more time to adminis­
ter than is desirable. Another
major drawback for the use of
the BSI is its cost, which is
currently more than $1 per
administration. Rating instru­
ments like the Brief Psychi­
atric Rating Scale11 and the
Schedule of Affective Disor­
ders and Schizophrenia—
Change Version12 require
independent symptom rat­
ings by a clinically­trained
interviewer. Although they
can be useful as part of a
followup assessment, these
instruments are not practical
for use as a screen by correc­
tions staff.
One instrument that has
shown promise for meeting
the key criteria is the Referral
Decision Scale (RDS),13 which
was designed to serve as a
rapidly administered and easi­
ly scored screening tool for
use in corrections settings.
As a screening tool, it was
not developed to diagnose
disorders, nor was it intended
to serve as a measure of the
severity of dysfunction.
Rather, the RDS was meant
to flag signs and symptoms
of gross impairment associat­
ed with serious mental health
disorders. The final published

M E N TA L   H E A LT H   S C R E E N S   F O R   C O R R E C T I O N S

version of the RDS consists
of three scales—one each for
schizophrenia, bipolar disor­
ders, and major depression—
incorporating 14 items
predictive of these disorders
that were derived from the
National Institute of Mental
Health’s Diagnostic Interview
Schedule (DIS).14 Each of the
scales contains a cutoff score
that, if met or exceeded,
should result in a referral for
mental health assessment.
Research has provided pre­
liminary evidence of the valid­
ity of the RDS by comparing
results of the RDS with those
of the parent instrument, the
DIS.15 On lifetime diagnoses
of schizophrenia, bipolar dis­
orders, and major depression,
the average sensitivity of the
three RDS scales (how well
they detect illness among
inmates who are truly ill, as
defined here by the DIS) was
reported as 88 percent, and
the mean specificity (how
well they detect no illness
among inmates who do not
have a disorder) was 99 per­
cent. Several researchers
have raised questions, how­
ever, about the RDS’s con­
tent and validity. Notably, one
group of researchers16 ques­
tioned whether several items
in the RDS scales were
appropriate for use with
incarcerated individuals, and

whether the use of lifetime
occurrence of symptoms
rather than current symptoms
may overestimate the current
need for further mental health
services.
In response to these con­
cerns, two teams of re­
searchers set about to create
and validate even better
screens. One team’s screen,
the CMHS, began as an amal­
gam of the RDS and three
other diagnostic tools. The
other screen, the BJMHS, is
a major revision of the RDS.

CMHS: A Gender­
Specific Screen
Development. The
CMHS–W and CMHS–M
were developed by first pre­
senting to study participants
a lengthy, 25­minute compos­
ite of all the questions from
four separate screens, includ­
ing the RDS and part of the
Structured Clinical Interview
for DSM–IV (SCID).17 The
composite contained 53
items. The study participants
were 2,196 adults detained in
5 State of Connecticut jails.
About one­fifth of the partici­
pants were randomly selected
to be brought back 1–5 days
later for an even lengthier
clinical assessment (45–180
minutes) consisting of the

5

RESEARCH FOR PRACTICE / MAY 07

complete SCID plus additional
screening questions.
Statistical analysis was per­
formed, separately by gender,
to determine the questions
with the most statistical sen­
sitivity, specificity, and predic­
tive power to measure nine
clusters of mental health
disorders, including current
depressive disorders, current
anxiety disorders, antisocial
personality disorder, and
posttraumatic stress disorder
(PTSD). On the basis of this
initial analysis, some ques­
tions were eliminated and
others that were judged
redundant were combined.
The result was two composite
pools, one with 38 items for
women and one with 40
items for men. Additional,
complex analysis was then
performed18 leading to the 
8­item CMHS–W and 12­item
CMHS–M, each of which
takes 3–5 minutes to admin­
ister. (See the forms in
appendix A.) These final ver­
sions were validated on an
additional group of 206 partic­
ipants, using the same proto­
col as the first phase of the
study.
Validation. Statistical analysis
of the validation test results
against the clinical assess­
ments showed that the new
screens proved highly valid in

6

identifying depression, anxi­
ety, PTSD, some personality
disorders, and the presence
of any undetected mental
illness. The CMHS–W was
75.0 percent accurate in
correctly classifying female
inmates and the CMHS–M
was 75.5 percent accurate
in correctly classifying male
inmates as having a pre­
viously undetected mental
illness.19
Interestingly, the clinical
assessments that were per­
formed found the incidence
of serious mental illness
among the participants to be
far higher than in the general
population and comparable
to that in psychiatric settings.
This finding is especially sig­
nificant given that inmates
who had already been referred
for mental health hospitaliza­
tion were excluded from the
study.
Assessment. The CMHS
accurately identifies individu­
als in corrections settings
with mental illness. Validation
testing confirmed that ver­
sions for both women and
men showed evidence of
reliability, validity, and pre­
dictive utility in relation to
the accurate identification of
undetected psychiatric
disorders. Both correctly
classified at least 75 percent

M E N TA L   H E A LT H   S C R E E N S   F O R   C O R R E C T I O N S

of inmates, thus providing
reasonable certainty of identi­
fying inmates in need of
mental health services with­
out burdening mental health
providers with the responsi­
bility of evaluating inmates
who have less serious men­
tal health problems.
The CMHS–W has additional
relevance because it is the
first mental health screen
developed and validated
specifically for women. In
contrast to prior studies that
either have not included
jailed women, have included
female inmate samples too
small to develop gender­
specific screening instru­
ments, or used a single
screening measure for both
genders, the CMHS–W
shows promise as a mental
health screen for newly
incarcerated women in jails.

Brief Jail Mental
Health Screen
Development. The BJMHS
is directly derived from the
RDS. Because the existing
RDS scales have not per­
formed well in discriminating
among schizophrenia, bipolar
disorders, and major depres­
sion, the scoring approach for
the BJMHS was to develop a
single composite scale. Thus,
a positive score now indicates

that an individual has recent
or acute symptoms associat­
ed with any one or more of
the three disorders. The num­
ber of items was reduced
from the original 14 to a
smaller set of 8 items by
eliminating items that had
questionable validity and did
not contribute statistically
to the composite scale. Sev­
eral items were rephrased
to provide clearer wording.
Finally, the timeframe
employed by the RDS was
changed from lifetime occur­
rence to “currently.” (See the
form in appendix B.)
The BJMHS takes, on aver­
age, about 2.5 minutes to
administer. Step­by­step
instructions for recording an
inmate’s responses are print­
ed on the back of the inter­
view form. The first six
questions ask about specific
current symptoms. Two
additional questions ask
whether the inmate has ever
been in a hospital for emo­
tional or mental health prob­
lems and if he or she is
currently taking any medica­
tion prescribed by a physician
for any emotional or mental
health problem. Anyone who
scores positively on two or
more current items, or either
the hospitalization or medica­
tion item should be referred to
mental health services for
immediate attention.
7

RESEARCH FOR PRACTICE / MAY 07

Validation. Although the
BJMHS was intended to be a
step forward in the evolution
of the RDS, important ques­
tions remained about its
operation in a jail setting.
Among the most important—
what was the validity of the
BJMHS when compared to a
“gold standard” such as the
SCID? The SCID must be
administered by a carefully
trained clinician and typically
takes between 1 and 2 hours
to complete. A study was
devised to test the concur­
rent validity (that is, validity
when compared against an
independent, validated instru­
ment) of the BJMHS in rela­
tion to the SCID.
Corrections classification offi­
cers in four county jails—two
in Maryland and two in New
York—participated in informa­
tion sessions that provided
training on administration of
the BJMHS. This unstructured
training, which took place in
the jails, included a brief
description of the research
project and instructions on
completing the BJMHS during
the intake process.
Participants in the validation
study were 11,438 male and
female detainees admitted to
one of the four jails between
May 2002 and January 2003.

8

All participants were given
the BJMHS upon admission
to the jails. 
The BJMHS data were used
to identify a subsample of
detainees (approximately 90
from each jail) who were
given a detailed clinical
assessment conducted by a
trained research interviewer
using the SCID. This subsam­
ple was designed to com­
prise a large enough number
of females to enable separate
analysis by gender.
The results showed that the
BJMHS referrals and nonre­
ferrals matched the SCID
findings of serious mental
illness or no serious mental
illness for 73.5 percent of
males and 61.6 percent of
females. There were 20 false
negatives among males (14.6
percent of male nonreferrals)
and 33 false negatives among
females (34.7 percent of
female nonreferrals). The
large percentage of female
false negatives was cause
for concern.
An examination of the false
negatives among both men
and women showed that 2
of the 20 men and 6 of the
33 women were missed
because the screen focused
solely on current symptoms
as opposed to symptoms in
the past 6 months. 

M E N TA L   H E A LT H   S C R E E N S   F O R   C O R R E C T I O N S

Another problem was the
inconsistent reporting of
symptoms. All the questions
asked on the BJMHS were
repeated during the SCID
interview. They were either
part of the SCID or added for
the research study. In all but
seven of the false negative
cases, the inmates reported
different information to the
SCID interviewer than they
had to the corrections officer.
Had they reported the same
information on the BJMHS,
they would have been
referred for further mental
health assessment and only
one male case and six female
cases would have been
missed.
Assessment. In light of
these data, the BJMHS is
shown currently to be a pow­
erful tool for screening men
booked into U.S. jails. It is
simple to use for intake offi­
cers, requires only modest
training, and is almost 74 per­
cent accurate. Based on cor­
rection officer feedback, the
creators of the BJMHS rec­
ommend the following to
maximize accuracy:
❋�Detailed training of correc­

tions staff on proper admin­
istration of the screen,
including clarifying the
purpose of the screen and
providing help with inter­
viewing techniques.

❋�Administration of the

screen by nurses (where
available) in cases of unco­
operative inmates or those
who state discomfort
answering corrections
officers’ questions about
mental illness.
❋�Use of a computer­assisted

version of the tool, which
may reduce the problem of
symptom underreporting.
The BJMHS was not as
effective for women. That it
correctly identified 54.9
percent (28 of 51 women)
of the true positives among
the women participants
is an improvement over
current practices. Still, the
screen missed 34.7 percent
of women with current
symptoms.
The lower accuracy of the
BJMHS among women may
be due to the fact that the
BJMHS does not measure
symptoms of anxiety that are
associated with the high inci­
dence of PTSD experienced
by women detainees.20 Sub­
sequent modifications of the
BJMHS for women will need
to add questions that capture
anxiety symptoms. It may
also be that women are less
likely to disclose symptoms
to corrections officers, who
are most often male, on

9

RESEARCH FOR PRACTICE / MAY 07

intake. Whatever the explana­
tion, research is needed to
create an appropriate jail
intake screen for women. The
developers of the BJMHS
have received additional NIJ
funding to test and refine the
screen further for female
inmates.

Both Screens Meet
Needs at Intake
Both the BJMHS and the two
gender­specific versions of
CMHS offer improvement
over existing tools in stan­
dardizing and increasing the
accuracy of initial mental
health screening in correc­
tions facilities. Their brevity,
use of yes/no questions, sim­
ple scoring techniques, and
availability at no cost make
them well suited for quick
mental health screening of
large numbers of inmates dur­
ing intake. Their effectiveness
in identifying inmates in need
of mental health treatment
compares favorably with the
longer, more cumbersome,
and training­intensive tools
currently used in clinical
assessments. Based on their
successful validation results,
it is anticipated that these
tools will be disseminated
nationwide for use in all cor­
rections facilities.

10

Notes
1. See, for example, Jemelka, Ron,
Eric W. Trupin, and John A. Chiles,
“The Mentally Ill in Prisons: A
Review,” Hospital and Community
Psychiatry 40 (May 1989): 481–490;
Teplin, Linda A., “The Criminalization
Hypothesis: Myth, Misnomer, or
Management Strategy,” in Law and
Mental Health: Major Developments
and Research Needs, ed. S.A. Shah
and B.D. Sales, Rockville, MD:
National Institute of Mental Health,
1991: 149–183.
2. Teplin, Linda A., “Psychiatric and
Substance Abuse Disorders Among
Male Urban Jail Detainees,” Ameri­
can Journal of Public Health 84 (Feb­
ruary 1994): 290–293; Teplin, Linda
A., Karen M. Abram, and Gary M.
McClelland, “Prevalence of Psychi­
atric Disorders Among Incarcerated
Women,” Archives of General Psychi­
atry 53 (June 1996): 505–512.
3. Toch, Hans, and Kenneth Adams,
“Pathology and Disruptiveness
Among Prison Inmates,” Journal of
Research in Crime and Delinquency
23 (1) (February 1986): 7–21; Toch,
Hans, Kenneth Adams, and James
Douglas Grant, Coping: Maladapta­
tion in Prison, New Brunswick, NJ:
Transaction, 1989; McCorkle, Richard
C., “Gender, Psychopathology and
Institutional Behavior: A Comparison
of Male and Female Mentally Ill
Prison Inmates,” Journal of Criminal
Justice 23 (1) (January 1995): 53–61;
Lindquist, Christine H., and Charles
A. Lindquist, “Gender Differences in
Distress: Mental Health Conse­
quences of Environmental Stress
Among Jail Inmates,” Behavioral
Sciences and the Law 15 (Autumn
1997): 503–523.

M E N TA L   H E A LT H   S C R E E N S   F O R   C O R R E C T I O N S

4. Cohen, Fred, and Joel Dvoskin,
“Inmates with Mental Disorders: A
Guide to Law and Practice,” Mental
and Physical Disability Law Reporter
16 (3–4) (1992): 339–346, 462–470.
5. American Psychiatric Association,
Psychiatric Services in Jails and
Prisons: A Task Force Report of the
American Psychiatric Association,
2nd ed., Washington, DC: American
Psychiatric Association, 2000.
6. Steadman, Henry J., and Bonita
M. Veysey, Providing Services for Jail
Inmates with Mental Disorders,
Research in Brief, Washington, DC:
National Institute of Justice, January
1997, NCJ 162207, available at
www.ncjrs.gov/pdffiles/162207.pdf. 
7. Teplin, Linda A., “Detecting Disor­
der: The Treatment of Mental Illness
Among Jail Detainees,” Journal of
Consulting and Clinical Psychology,
58 (2) (April 1990): 233–236.
8. Ford, Julian, and Robert L. Trest­
man, “Evidence­Based Enhance­
ment of the Detection, Prevention,
and Treatment of Mental Illness in
Correctional Systems,” final report
for National Institute of Justice, grant
number 2001–IJ–CX–0044, Washing­
ton, DC: National Institute of Justice,
2005, NCJ 210829, available at
www.ncjrs.gov/pdffiles/nij/grants/
210829.pdf.
9. Osher, Fred, Jack E. Scott, Henry
J. Steadman, and Pamela Clark Rob­
bins, “Validating a Brief Jail Mental
Health Screen,” final report for
National Institute of Justice, grant
number 2001–IJ–CX–0030, Washing­
ton, DC: National Institute of Justice,
2004, NCJ 213805, available at
www.ncjrs.gov/pdffiles/nij/grants/
213805.pdf.

10. Derogatis, Leonard R., SCL–90R:
Administration, Scoring, and Proce­
dures Manual, Baltimore, MD: Clini­
cal Psychometrics Research, 1977;
Derogatis, Leonard R., BSI: Adminis­
tration, Scoring, and Procedures
Manual, 3d ed., Minneapolis, MN:
National Computer Systems, 1993.
11. Overall, John E., and Donald R.
Gorham, “The Brief Psychiatric Rat­
ing Scale,” Psychological Reports 10
(1962): 799–812.
12. Spitzer, Robert L., and Jean Endi­
cott, Schedule of Affective Disorders
and Schizophrenia—Change Version,
New York: Biometrics Research,
1978.
13. Teplin, Linda A., and James A.
Swartz, “Screening for Severe Mental
Disorder in Jails,” Law and Human
Behavior 13 (1) (March 1989): 1–18.
14. Robins, Lee, John Helzer, Jack
Croughan, and Kathryn S. Ratcliff,
“National Institute of Mental Health
Diagnostic Interview Schedule: Its
History, Characteristics, and Validity,”
Archives of General Psychiatry 38
(April 1981): 381–389.
15. Teplin and Swartz, “Screening for
Severe Mental Disorder in Jails”
(see note 13).
16. Veysey, Bonita M., Henry J.
Steadman, Joseph P. Morrissey,
Matthew Johnsen, and Jason Beck­
stead, “Using the Referral Decision
Scale to Screen Mentally Ill Jail
Detainees: Validity and Implementa­
tion Issues,” Law and Human Behav­
ior 22 (2) (April 1998): 305–315.
17. DSM–IV is the common abbrevia­
tion for the Diagnostic and Statistical
Manual of Mental Disorders—Fourth
Edition, published by the American
Psychiatric Association in 1994.

11

RESEARCH FOR PRACTICE / MAY 07

In the United States, it is the main
reference used by mental health
professionals to diagnose mental
disorders.

6 or more “yes” answers out of 12
on the CMHS–M were considered
“positive” results for referral to addi­
tional mental health assessment.

18. For a detailed discussion of the
additional analysis, see the final
report, available online at www.ncjrs.
org/pdffiles1/nij/grants/210829.pdf.

20. Veysey, Bonita M., “Specific
Needs of Women Diagnosed With
Mental Illnesses in U.S. Jails,” in
Women’s Mental Health Services:�
A Public Health Perspective, ed. B.L.�
Levin, A.K. Blanch, and A. Jennings,�
Thousand Oaks, CA: Sage, 1998.�

19. Five or more “yes” answers out
of 8 questions on the CMHS–W and

12

M E N TA L   H E A LT H   S C R E E N S   F O R   C O R R E C T I O N S

Appendix A*
Correctional Mental Health Screen for Women (CMHS-W)
Correctional Mental Health Screen for Women (CMHS-W)
Name
Name

__________________
__________________
Last, First,
MI
MI
Last, First,

_________
_ _ /_ _ /_ _ _ _
_________
_ _ /_ _ /_ _ _ _
Detainee
# Date mm/dd/year
Detainee # Date mm/dd/year

Questions
No Yes
No Yes
1. Do you get annoyed Questions
when friends and family
1. complain
Do you get
annoyed
when friends
family
about
their problems?
Or and
do people
complainyou
about
problems? Ortodo
people
complain
aretheir
not sympathetic
their
problems?
complain
you are
to their
problems?
2. Have
you ever
triednot
to sympathetic
avoid reminders
of, or
to not
2. think
Have about,
you ever
tried to avoid
reminders
or to not
something
terrible
that you of,
experienced
think
about, something terrible that you experienced
or
witnessed?
or witnessed?
3. Some
people find their mood changes frequently-as if
3. they
Somespend
people
find their
changesrollercoaster.
frequently-as if
everyday
onmood
an emotional
they
spend everyday
an emotional
rollercoaster.
For
example,
switchingon
from
feeling angry
to
For example,
switching
from
feeling
angry
to this
depressed
to anxious
many
times
a day.
Does
depressed
to anxious many times a day. Does this
sound
like you?
sound
like ever
you? been a few weeks when you felt you
4. Have
there
4. were
Have useless,
there ever
been
few weeks when you felt you
sinful,
oraguilty?
were
useless,
guilty?
5. Has
there
ever sinful,
been aor
time
when you felt depressed
5. most
Has there
time 2when
you felt depressed
of theever
day been
for ataleast
weeks?
most
thethat
day most
for atpeople
least 2will
weeks?
6. Do
youoffind
take advantage of
6. you
Do you
find
most
people
will take
advantage
of
if you
letthat
them
know
too much
about
you?
you ifyou
youbeen
let them
know
much about
you?
7. Have
troubled
bytoo
repeated
thoughts,
7. feelings,
Have youorbeen
troubledabout
by repeated
thoughts,
nightmares
something
terrible that
feelings,
or nightmares
about something terrible that
you
experienced
or witnessed?
you experienced
or in
witnessed?
8. Have
you ever been
the hospital for non-medical
8. reasons,
Have yousuch
everas
been
in the hospital
for non-medical
a psychiatric
hospital?
(Do NOT
include
going
to an
Room
if you were
not
reasons,
such
as Emergency
a psychiatric
hospital?
(Do NOT

__:__
Time __:__
Time

Comments
Comments

hospitalized.)
include going to an Emergency Room if you were not
hospitalized.)

General
TOTAL # YES: ______
Comments:
General
TOTAL # YES: ______
Comments:
Refer for further Mental Health Evaluation if the Detainee answered
Refer
forto
further
Mental
Health
if the Detainee
answered
Yes
5 or more
items
OR IfEvaluation
you are concerned
for any other
reason
Yes to 5 or more items OR If you are concerned for any other reason
URGENT Referral
on _ _/ _ _/ _ _ _ _ to _____________________
URGENT Referral
on _ _/ _ _/ _ _ _ _ to _____________________
ROUTINE Referral
on _ _/ _ _/ _ _ _ _ to _____________________
ROUTINE Referral
on _ _/ _ _/ _ _ _ _ to _____________________
Not Referred
Not Referred
Person Completing Screen: _________________________
Person Completing Screen: _________________________

* The forms in appendixes A and B are shown exactly as they are provided to correctional
institutions.

13

RESEARCH FOR PRACTICE / MAY 07

INSTRUCTIONS FOR COMPLETING THE CMHS-W
General Information:
The CMHS is a tool designed to assist in the early detection of psychiatric illness
during the jail intake process. The Research Team under the direction of Drs. Julian D. Ford
and Robert L. Trestman at the University of Connecticut Health Center developed this
Correctional Mental Health Screen for Women (CMHS-W), with a grant funded by the
National Institute of Justice.

Instructions for administration of the CMHS-W:
Correctional Officers may administer this mental health screen during intake.
Name:
Detainee#:
Date:
Time:

Detainee’s name- Last, first and middle initial
Detainee’s facility identification number
Today’s month, date, year
Current time (24hr or AM/PM)

Questions #1-8 may be administered as best suits the facility’s policies and procedures
and the reading level, language abilities, and motivation of the detainee who is completing
the screen. The method chosen should be used consistently. Two recommended methods:
• Staff reads the questions out loud and fills in the detainee’s answers to the
questions on the form
• Staff reads the questions out loud, while the detainee reads them on a separate
sheet and fills in her answers
Each question should be carefully read, and a check mark placed in the appropriate column
(for “NO” or “YES” response).
The staff person should add a note in the Comments Section to document any information
that is relevant and significant for any question that the detainee has answered “YES.”
If the detainee declines to answer a question or says she does not know the answer to a
question, do NOT check “YES” or “NO.” Instead, record DECLINED or DON’T KNOW in the
Comments box.

Total # YES: total number of YES responses
General Comments: Staff may include information here to describe overall concerns
about the responses (for example: intoxicated, impaired, or uncooperative)
Referral Instructions:
Urgent Referral: A referral for urgent mental health evaluation may be
made by the staff person if there is any behavioral or other evidence that a
detainee is unable to cope emotionally or mentally or is a suicide risk.
Routine Referral: A detainee answering “YES” to 5 or more items should
be referred for routine mental health evaluation. A referral also may be made if
the staff person has any concerns about the detainee’s mental state or ability to
cope emotionally or behaviorally.
** If at any point during administration of the CMHS-W the detainee experiences
more than mild and temporary emotional distress (such as severe anxiety, grief,
anger or disorientation) she should be referred for immediate mental health
evaluation.
Referral: Check the appropriate box for whether a detainee was referred. If
referred, check URGENT or ROUTINE, enter the date of the referral and the mental
health staff person or mental health clinic to whom the referral was given.
Person completing screen: Enter the staff member’s name

14

M E N TA L   H E A LT H   S C R E E N S   F O R   C O R R E C T I O N S

Correctional Mental Health Screen for Men (CMHS-M)

Name

__________________
Last, First,
MI

_________
Detainee #

Date

_ _ /_ _ /_ _ _ _
mm/dd/year

__:__
Time

QUESTIONS
NO YES COMMENTS
1. Have you ever had worries that you just can’t get rid of?
2. Some people find their mood changes frequently – as if they
spend everyday on an emotional roller coaster. Does this sound
like you?
3. Do you get annoyed when friends or family complain about
their problems? Or do people complain that you’re not
sympathetic to their problems?
4. Have you ever felt like you didn’t have any feelings, or felt
distant or cut off from other people or from your surroundings?
5. Has there ever been a time when you felt so irritable that you
found yourself shouting at people or starting fights or
arguments?
6. Do you often get in trouble at work or with friends because you
act excited at first but then lose interest in projects and don’t
follow through?
7. Do you tend to hold grudges or give people the silent treatment
for days at a time?
8. Have you ever tried to avoid reminders, or to not think about,
something terrible that you experienced or witnessed?
9. Has there ever been a time when you felt depressed most of
the day for at least 2 weeks?
10. Have you ever been troubled by repeated thoughts, feelings, or
nightmares about something you experienced or witnessed?
11. Have you ever been in a hospital for non-medical reasons such
as in a psychiatric hospital? (Do NOT include going to an
Emergency Room if you were not hospitalized.)

12. Have you ever felt constantly on guard or watchful even when
you didn’t need to, or felt jumpy and easily startled?

TOTAL # YES:

______

General
Comments:

Refer for further Mental Health Evaluation if the Detainee answered
Yes to 6 or more items OR If you are concerned for any other reason
URGENT Referral on _ _/ _ _/ _ _ _ _ to _____________________
ROUTINE Referral on _ _/ _ _/ _ _ _ _ to _____________________
Not Referred
Person Completing Screen: _________________________

15

RESEARCH FOR PRACTICE / MAY 07

INSTRUCTIONS FOR COMPLETING THE CMHS-M
General Information:
The CMHS is a tool designed to assist in the early detection of psychiatric illness
during the jail intake process. The Research Team under the direction of Drs. Julian D. Ford
and Robert L. Trestman at the University of Connecticut Health Center developed this
Correctional Mental Health Screen for Men (CMHS-M) with a grant funded by the National
Institute of Justice.

Instructions for administration of the CMHS-M:
Correctional Officers may administer this mental health screen during intake.
Name:
Detainee#:
Date:
Time:

Detainee’s name- Last, first and middle initial
Detainee’s facility identification number
Today’s month, date, year
Current time (24hr or AM/PM)

Questions #1-12 may be administered as best suits the facility’s policies and procedures
and the reading level, language abilities, and motivation of the detainee who is completing
the screen. The method chosen should be used consistently. Two recommended methods:
• Staff reads the questions out loud and fills in the detainee’s answers to the
questions on the form
• Staff reads the questions out loud, while the detainee reads them on a separate
sheet and fills in his answers
Each question should be carefully read, and a check mark placed in the appropriate column
(for “NO” or “YES” response).
The staff person should add a note in the Comments Section to document any information
that is relevant and significant for any question that the detainee has answered “YES.”
If the detainee declines to answer a question or says he does not know the answer to a
question, do NOT check “YES” or “NO.” Instead, record DECLINED or DON’T KNOW in the
Comments box.

Total # YES: total number of YES responses
General Comments: Staff may include information here to describe overall concerns
about the responses (for example: intoxicated, impaired, or uncooperative)

Referral Instructions:
Urgent Referral: A referral for urgent mental health evaluation may be
made by the staff person if there is any behavioral or other evidence that a
detainee is unable to cope emotionally or mentally or is a suicide risk.
Routine Referral: A detainee answering “YES” to 6 or more items should
be referred for routine mental health evaluation. A referral also may be made if
the staff person has any concerns about the detainee’s mental state or ability to
cope emotionally or behaviorally.
** If at any point during administration of the CMHS-M the detainee experiences
more than mild and temporary emotional distress (such as severe anxiety, grief,
anger or disorientation) he should be referred for immediate mental health
evaluation.
Referral: Check the appropriate box for whether a detainee was referred. If
referred, check URGENT or ROUTINE, enter the date of the referral and the mental
health staff person or mental health clinic to whom the referral was given.
Person completing screen: Enter the staff member’s name

16

M E N TA L   H E A LT H   S C R E E N S   F O R   C O R R E C T I O N S

Appendix B�

17

RESEARCH FOR PRACTICE / MAY 07

18

The National Institute of Justice is the
research, development, and evaluation
agency of the U.S. Department of Justice.
NIJ's mission is to advance scientific research,
development, and evaluation to enhance the
administration of justice and public safety.

NIJ is a component of the Office of Justice
Programs, which also includes the Bureau
of Justice Assistance, the Bureau of Justice
Statistics, the Office of Juvenile Justice
and Delinquency Prevention, and the
Office for Victims of Crime.

Washington, DC 20531
Official Business
Penalty for Private Use $300

U.S. Department of Justice
Office of Justice Programs
National Institute of Justice

MAILING LABEL AREA (5” x 2”)
DO NOT PRINT THIS AREA
(INK NOR VARNISH)

*NCJ~216152*

PRESORTED STANDARD
POSTAGE & FEES PAID
DOJ/NIJ
PERMIT NO. G–91

MAY 07