Testing Approaches to Mental Health Screening at Prison Entry,Considering Both Concurrent and Predictive Validity in Men and Women

Abstract

Mental health screening at prison entry is important given the burden of unmet need and the challenge of prioritizing scarce resources, but the evidence to guide approaches to screening is limited. Screening at prison-entry (into prisons or jails receiving people at any stage of the trial or sentencing process) must achieve several aims, from uncovering untreated symptoms to recognizing the need to recommence treatment for established illness, and for a range of mental health conditions. The current exploratory observational study examines different approaches to screening and considers the results of both concurrent (structured diagnostic interview) and predictive (post-screening receipt of prison mental healthcare) methods for validation, in a sample (n = 291) of men and women entering prison in New South Wales, Australia. A high prevalence of mental health problems, particularly for women was identified across the three screening approaches (i.e., screening for previous psychiatric history, current symptoms, and psychological distress). No single screening approach was superior across validation methods, supporting a broad approach to mental health screening, and differences in validity outcomes were seen between men and women. Prioritizing sensitivity to avoid false-negative cases requires a broad approach to prison-entry mental health screening but a second-stage triage assessment is likely necessary.