Screening for Mental Health and Substance Misuse in Michigan Jails

Policy Brief  |  March 2020

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The Michigan Mental Health Diversion Council (MMHDC) and the Wayne State University Center for Behavioral Health and Justice (CBHJ) recommend that the State of Michigan adopt valid screening for mental health issues and substance use disorder—particularly risk of withdrawal—at jail intake that is consistent across the state.

Quick Facts:

  • Over half (55%) of individuals booked into ten county jails reported problematic substance use (2019).
  • Over one third (33%) of individuals booked into ten county jails had an indication of a mental health disorder (2017).
  • Use of a valid mental health screen at booking improved identification of mental health issues up to 33% across ten county jails (2017).
  • Screening standards are regulated by MDOC administrative rules. However, these guidelines offer little direction around types of screening and how screening practices should be implemented.
  • In the absence of consistent screening practices, there is no way to compare the prevalence of mental health or substance use disorders across Michigan's 83 jails or determine statewide statistics.

Background:

The use of standardized screens during jail intake provides several key benefits to correctional institutions. It facilitates identification of individuals who present immediate risk for harming themselves or others, including high-risk individuals whose symptoms may not be evident to corrections staff. Identification is the first crucial step to preventing potential violence and withdrawal, mitigating risk, and providing treatment.

Current screening practices across Michigan's 83 jails are not consistent, and most do not use standardized measures. Therefore, there is no way to compare prevalence across jails or to determine statewide prevalence of behavioral health risk across the state.

Standardized screens are those that have been document in research to reliably predict the possible presence of a problem--in this case, serious mental illness and substance use disorder. Standardized screens allow jails to define what they are looking for and identify reliable indicators of those issues, including extreme psychological distress, risk of opioid, alcohol, or other substance use disorder, or serious and persistent mental illnesses eligible for care by Community Mental Health agencies.

Recommendations:

Modifying MDOC Administrative Rules to provide more clarity around screening in jails provides an opportunity to standardize practices across the state. Screening for mental health issues and substance withdrawal risk should be take place as soon after an individual enters a facility as possible. The American Psychological Association (APA) standards for identification recommend that screening occurs during booking, intake, or classification.

Effective screens are those which have been validated for justice-involved populations, are brief, cost-effective, and can easily be scored by non-clinical staff. The MMDHC and the CBHJ recommend the following screens for mental health issues and substance withdrawal/misuse:

Screens for mental health:

  • Kessler 6 (K6): The K6 is a 6-item screen that takes approximately 2-3 minutes to administer. It was designed to detect any past-year diagnosis of a mental disorder, and has been validated in criminal justice settings for men and women to measure psychological distress. When used with a modified cut score of 9, it has been shown to be superior to other instruments for justice-involved females, who are at greater risk for a mental health disorder. When accompanied by self-reported psychiatric medication history, the K6 has been demonstrated to be more effective than alternate screening tools.
  • Brief Jail Mental Health Screen (BJMHS): The BJMHS is an 8-item screen that takes approximately 2-3 minutes to administer. It includes questions about psychiatric treatment history. The BJMHS has been validated in criminal justice settings.

Screens for substance withdrawal/misuse:

  • Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): ASSIST is an 8-item measure that covers 10 substances (tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants, inhalants, sedatives, hallucinogens, opioids and 'other drugs'.
  • Rapid Opioid Dependence Screen (RODS): The RODS is an 8-item measure of opioid dependence designed for quick, targeted screening. It has an average administration of less than 2 minutes and can easily be administered as a stand-alone instrument or as part of a comprehensive interview, and assesses use of eight types of opioids and the physiological, behavioral and cognitive factors associated with opioid use.
  • Michigan Alcohol Screening Test (MAST): The MAST was designed to provide a consistent, quantifiable, structured interview instrument to detect alcoholism, with 25-imtes that were designed to be rapidly administered, asking for self-appraisal of social, vocational, and family problems associated with heavy drinking.
  • Texas Christian University Drug Screen (TCUDS): The TCUDS-5 uses the symptoms from the Diagnostic and Statistical Manual 4 to determine the severity of an individual's substance use and/or risk for developing more severe substance use problems. It is also a clinically sensitive instrument, making it likely to identify individuals who are engaging in experimental substance use or who may be underreporting current use. Empirically, the TCUDS-5 has been proven effective in providing information regarding problem severity (mild, moderate, or severe SUD) for individuals involved in the criminal/legal system (Knight et al., 2018; Peters et al., 2000). The TCUDS-5 also has an opioid screening supplement to identify persons who may have a need for immediate services to address issues around opioid use. 

Substance Withdrawal/Misuse Screens At-A-Glance:

Screen # of items Time to administer
(approximate)
Admin.
method
Designed for
Opioids
Designed for
Alcohol
Designed for
Drugs (General)
Designed for
Behavioral factors
ASSIST: 8 8-9 min Interview X X X  
RODS: 8 2 min Interview X     X
MAST: 22 8 min Interview   X    
TCUDS: 17 5-10 min Self-report separate
supplement
  X