Many remand prisoners suffer from mental disorder, but this usually remains undetected by prison reception health screening. We set out to comprehensively evaluate the prison screening process with the intention of finding ways in which the process might be improved.
The prison screen for mental disorder of 546 consecutive male remands to Durham prison in England was compared with an independent research screen. The prison reception and induction processes during which health screening took place were observed, the findings of the screens compared, prison healthcare staff interviewed, and prisoners' views on health screening recorded. Information collected by the research assessment was used to construct a model to identify those at high risk of suffering from mental illness.
Health assessments took place under unsatisfactory conditions, many prison healthcare staff lacked appropriate training, relationships with prisoners did not encourage inmates to volunteer information, and screening records were missing or seriously incomplete in one in ten cases. We identified four variables that together were the best predictors of mental illness in this population. The screening instrument used by prison healthcare workers included questions relating to all four variables, and this assessment was the most informative of the two prison reception health screens. The subsequent mental health assessment carried out by prison doctors was often cursory and added little further information.
We concluded that the health screen for new prisoners needs revision and improvement. We recommend a preliminary screen administered by a trained prison healthcare worker which focuses on a limited amount of information, aimed at identifying prisoners at high risk of suffering from mental illness. The routine assessment of mental health carried out by prison doctors on every new prisoner should be dispensed with, and the prison doctor should instead focus on a more in-depth assessment of those who screen positive according to the healthcare worker's assessment. Copyright © 2000 Whurr Publishers Ltd.