Mental Health Screening,Treatment,and Institutional Incidents: A Propensity Score Matched Analysis of Long-Term Outcomes of Screening

Abstract

There is little study of the impacts of screening on distal outcomes such as recovery or adverse incidents during incarceration. Furthermore, screening practices vary greatly between jurisdictions; many focus on history taking as opposed to current symptoms.

Method. We conducted an observational cohort study of all admissions (N = 13,281) to Canadian prisons over a 33-month period. We used full matching on propensity scores to explore the association between treatment and health, violent and victimization incidents.

Results. Treatment was associated with lower rates of victimization and violence for all inmates, and health incidents among screen-detected cases. Among inmates with pre-existing risk–who accounted for 90% of health incidents—treatment was associated with increased risk of a first incident but decreased risk of recurrent incidents.

Implications. In-depth symptom-based screening identified a group of inmates who benefited from treatment, but accounted for relatively few incidents. Tensions of prioritizing resources for pre-existing vs, incident mental illness were highlighted by weaker treatment effects for those with pre-existing needs. Increased use of diversion options to keep inmates with mental illness out of prisons, and determining the appropriate intensity of intervention to meet the needs of screen-detected cases could alleviate some of these tensions.