Evidence for the ecological validity of the Brief Jail Mental Health Screen: Positive predictive value among remanded men and women.

BACKGROUND: Individuals with severe mental illness are over-represented in correctional institutions. The scarcity of mental health services in prison settings has increased the demand for tools to screen effectively for mental health need. While the need for sensitivity is widely recognised, there has been less attention to specificity of screening tools. In addition, prior studies have focussed on research-informed diagnostic performance rather than real-world service provision. OBJECTIVE: To examine the performance of the Brief Jail Mental Health Screen (BJMHS) for indicating secondary mental health need in 'real world' conditions. METHODS: Retrospective data were collected from 2977 individuals (2256 male) remanded in either of two correctional facilities in Ontario, Canada, who had been screened on reception as having clinically significant mental health needs by correctional health staff using the BJMHS and examined by specialist mental health staff at triage. The positive predictive value (PPV) of the BJMHS was calculated, using actual secondary mental health service referral as the performance criterion. RESULTS: Overall, the positive predictive value of the BJMHS was 67.2%. It was significantly higher for men (69.5%) than women (60.1%). CONCLUSIONS: While these findings add support to the use of the BJMHS in screening mental health need among people under custodial remand, its false positive rate, particularly among women suggests a need to improve its performance. One potentially important avenue for future research would be whether repeating the screen after an interval prior to specialist referral would improve efficiency.

A Systematic Review of Reviews of Correctional Mental Health Services Using the STAIR Framework.

BACKGROUND: Rising demand for correctional mental health services (CMHS) in recent decades has been a global phenomenon. Despite increasing research, there are major gaps in understanding the best models for CMHS and how to measure their effectiveness, particularly studies that consider the overall care pathways and effectiveness of service responses. The STAIR (Screening, Triage, Assessment, Intervention, and Re-integration) model is an evidence-based framework that defines and measures CMHS as a clinical pathway with a series of measurable, and linked functions. METHOD: We conducted a systematic review of the reviews of CMHS elements employing PRISMA guidelines, organized according to STAIR pillars. We assessed the quality of included studies using the AMSTAR-2 criteria. Narrative reviews were read and results synthesized. RESULTS: We included 26 review articles of which 12 were systematic, metaanalyses, and 14 narrative reviews. Two systematic reviews and seven narrative reviews addressed screening and triage with strong evidence to support specific screening and triage systems. There was no evidence for standardised assessment approaches. Eight systematic reviews and seven narrative reviews addressed interventions providing some evidence to support specific psychosocial interventions. Three systematic reviews and six narrative reviews addressed reintegration themes finding relatively weak evidence to support reintegration methods, with interventions often being jurisdictionally specific and lacking generalizability. CONCLUSIONS: The STAIR framework is a useful way to organize the extant literature. More research is needed on interventions, assessment systems, care pathway evaluations, and reintegration models.