Jail Screening Assessment Tool (JSAT)

The Jail Screening Assessment Tool (JSAT) is a screening tool developed for the purpose of identifying mentally disordered offenders in jails and prisons. The JSAT is administered by a mental health professional during a brief interview. Initial studies support the JSAT’s validity and use as an effective screening device to identify inmates’ mental health needs.

Incontrovertible evidence now exists to show that the prevalence of mental disorder among those in the criminal justice system (prisoners, offenders on community orders, and accused on remand) is significantly greater than is found in the general population. Despite the prevalence of mentally disordered people in the criminal justice system, and the potential consequences of failing to adequately address the related issues, relatively few services exist either in prisons or in the community to help identify these people and prevent them from entering or remaining in the criminal justice system.

A number of contributing factors have been identified that help explain the high numbers of people with mental illnesses in the criminal justice system. Considerable concern has been raised about the capacity of community-based mental health services to address the needs of mentally ill offenders. Community-based mental health services work best for those who have reasonable connections and support within the community. While the presence of mentally ill people in the criminal justice system presents challenges and raises concerns, the fact is that the justice system provides an opportunity to identify and deliver treatment to people who are otherwise likely to remain outside the reach of services. As such, it has been suggested that mental health services in the judicial system present an opportunity for identifying those with mental illnesses and making services available to them that would otherwise be nonexistent.

Estimating the prevalence of mental disorder in the criminal justice system is a somewhat inexact practice as the population is inconsistently defined and markedly heterogeneous. Differences may exist on the basis of age, gender, diagnosis, or culture. The prevalence of mental disorder in the criminal justice system indicates that identifying such disorders is of paramount importance. Nonetheless, given the volume of prisoners admitted to jails and prisons on a daily basis, it is not possible to conduct a comprehensive mental health assessment with every person who enters the institution. Thus, screening is vital to identify those who do require a comprehensive evaluation. The aims of screening are to identify mentally disordered offenders and provide the necessary treatment, prevent violent and disruptive incidents in institutions, allocate resources for those with the greatest or most immediate need, and reduce the cycle of admissions to the criminal justice system. To ensure that those requiring mental health treatment are seen by mental health professionals in jails and prisons, screening processes should aim to minimize the number of “false negatives” (failing to identify an actually mentally disordered person), even at the expense of making “false positives” (those identified as possibly being mentally disordered who are not).

The JSAT was developed and refined over a 10-year period that included screening assessments on almost 50,000 prisoners. According to the authors of the JSAT, there are several aims involved in screening for mental disorders in the criminal justice system: identifying mentally disordered inmates for the purpose of treatment, preventing violent behavior, allocating limited resources for the inmates most in need of services, and reducing the demands on the criminal justice, health, and social welfare systems.

Mental health screening should normally be completed within the first day of admission to jail. The purpose of this screening is to detect serious mental disorder requiring rapid management, treatment, or further evaluation. It is desirable to minimize false-negative errors at this screening stage (inmates who have a mental disorder that is not detected). It will allow those inmates who do have a mental illness to be evaluated further.

Administration of the JSAT involves a brief interview with the prisoner (i.e., approximately 20 minutes) and consideration of relevant history. Although the interview is brief, the JSAT is designed to elicit sufficient information to make initial decisions about the mental health needs of incoming inmates. The JSAT is designed to be administered by a mental health professional, most typically a psychiatric nurse, a clinical psychologist, or an intern.

The screening procedure includes completion of a brief semistructured mental status interview and a revised version of the Brief Psychiatric Rating Scale. The interview covers 10 content areas: personal/demographic information and social background, legal status, mental health assessment and treatment, suicide and self-harm risk, violence issues, criminal history, recent social adjustment, recent mental status, substance use and abuse history, and mental health history. Following the administration of the JSAT, the clinician makes recommendations for any prisoner needs if mental health concerns are identified. Typically, a more comprehensive assessment is then recommended and undertaken.

The JSAT is not a standardized psychological test and does not use cut scores for identifying people requiring further assessment. Rather, the JSAT is an example of structured professional judgment, a decision-making approach in which professional judgment is guided by a formal, standardized structure. The JSAT is also unique in that it involves screening inmates for violence and victimization as well as self-harm, suicide, and mental disorder.

Validation data reported by Nicholls and colleagues indicated that the JSAT has a very high degree of validity. The JSAT has been validated for both male and female prisoners. Indeed, 100% of those identified as having psychotic illnesses, obsessive compulsive illnesses, or suicide risk were subsequently referred to a mental health program.

References:

  1. Nicholls, T. L., Lee, Z., Corrado, R., & Ogloff, J. R. P. (2004). Women inmates’ mental health needs: Evidence of the validity of the Jail Screening Assessment Tool (JSAT). International Journal of Forensic Mental Health, 3, 167-184.
  2. Nicholls, T. L., Roesch, R., Olley, M. C., Ogloff, J. R. P., & Hemphill, J. F. (2005). Jail Screening Assessment Tool (JSAT): Guidelines for mental health screening in jails. Burnaby, BC: Simon Fraser University, Mental Health, Law, and Policy Institute.

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