Spotlight on the Standards

Mental Health Assessment: A Three-Part Process

Often misunderstood, mental health assessment is actually three separate processes involving two of the NCCHC standards: E-02 Receiving Screening and E-05 Mental Health Screening and Evaluation. Thus, it is helpful to consider both standards together.

Assessing Immediate Needs
Upon admission to a facility, all inmates need to be assessed for immediate mental health concerns. Standard E-02 has a twofold intent when applied to mental health issues: to identify and meet any urgent need and any known or easily identifiable needs that require intervention before the full mental health screening. Foremost among the problems to be “caught at the door” are suicidal intent and the need to continue prescribed medication.

The immediate assessment of mental health needs may be done by the staff member completing the entire receiving screening. This can be a health professional or, in jails, prisons with fewer than 500 inmates and juvenile facilities, a trained correctional or custody staff member. Although some questions appear the same as those asked later under the full mental health screening, the inquiry at this point is meant to pick up significant, immediate needs.

Although admission is not the ideal time to complete a comprehensive mental health history and inquiry, some facilities combine the questions mandated by E-02 with the screening inquiries required by E-05. In such cases, if the combined questions are asked by the same person, it must be a health staff member. No matter how well trained, correctional or custody staff are not authorized to conduct the mental health screening that is the first part of standard E-05.

In-Depth Screening & Evaluation
The intent of E-05 Mental Health Screening and Evaluation is to ensure that serious mental health needs, including developmental disability and addictions, are identified. At least once during an individual’s incarceration, but always within 14 days of admission, a mental health professional undertakes a comprehensive review of mental health history and functioning.

This inquiry is a two-tier process in which only those inmates with positive responses to in-depth screening questions need to proceed to the second step: evaluation.

For inmates with no significant mental health problems, the assessment stops with the completion of the screening aspect of E-05. If that screening is done by a qualified mental health professional (psychiatrist, psychologist, psychiatric nurse and others who by virtue of their education, credentials and experience are permitted by law to evaluate and care for patients’ mental health needs), both the screening and evaluation aspects of the standard are met in the one visit.

But if the screening is done by a mental health staff member (qualified health care professional who has received instruction and supervision in identifying and interacting with individuals who need mental health services), patients with identified mental health issues require further evaluation and must be referred to a qualified mental health professional to complete the evaluation. The timing of this further evaluation is determined by clinical need.

When screening points to significant mental health issues, standard E-05 requires thorough clinical evaluation of the patient. Any identified treatment needs are then addressed in keeping with the standards covering mental health services, special needs treatment plans, chronic diseases and so forth.

Inquiry as Assessment Tool
Some practitioners raise concerns about three areas of inquiry mandated by standard E-05: history of violent behavior, victimization and sex offenses (Compliance Indicator 3.a). Their concerns fade when they understand the reason for these inquiries. The inquiries are not forensic in nature, and the intent is not to get a history of criminal behavior, per se. Rather, they are clinical inquiry into life experiences and emotional background that may provide clues to mental health problems.

Gathering the information is required; whether to use that information or to address root causes in therapy is a clinical decision like all other treatment decisions made by qualified clinicians. For example, a history of childhood sexual abuse may or may not be addressed in the therapeutic plan, but the fact of the abuse remains.

When working with inmates whose mental instability is linked to violent behavior, including sexual violence, it is important to understand the triggers. Knowing the circumstances under which a patient is likely to become unstable and act out will guide staff interaction with the patient and also help the patient to control his or her behavior.

(This article first appeared in the Spring 2006 issue of CorrectCare.)

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