Pretrial Mental Health Screening and Services
The following is a summary of the NAMI/MAJR Pretrial Mental Health Screening and Services in Maryland: Stakeholders’ Focus Group Report
What’s the Problem?
Maryland jail wardens and national studies agree that more mentally ill persons are in our jails and prisons than in psychiatric hospitals. Wardens also complain of insufficient resources for both community-based, in-jail, and post-release treatment. Studies show the following:
- At least 39% of Maryland’s local jail inmates have mental health disorders. For nearly 9 of 10 such inmates—or 35% of the total—drug abuse complicates their conditions. Such people are said to have “co-occurring disorders.” About one-quarter of those confined in local jails are estimated to suffer serious disorders like schizophrenia, bipolar, and major depression.
- 95% of county jail inmates will eventually return to the community and, if mental health and substance abuse issues remain untreated, they are very likely to cycle back into the system through the county jail, again and
- Effective November 2017, 7 of 24 Maryland counties’ detention centers had no systemic pretrial mental health screening system and, even in counties with programs, there is no uniform screening system. Therefore, the State lacks sufficient data to properly target resources.
What’s one Solution?
Considering these inconsistencies among Maryland counties and the lack of treatment resources in most Maryland counties, the Focus Group agreed to recommend that the State should adopt the following plan:
- Beginning in 2019, to initiate uniform mental health screening of Marylanders held in pretrial detention[1] based on established best practices. The group emphasized that this step will not be costly or time consuming.
- Beginning in 2020, to compile and analyze annual screening results in order to target resources efficiently to meet Marylanders’ needs for further mental assessments and services, as well as funding, staffing and other steps needed in light of counties’ unequal resources. The group recognized that in the long run, such preventive services will result in savings in the cost of law enforcement, detention, victims, and community
Will this work?
Earlier and more effective focus of mental health resources on inmates in pretrial detention could substantially reduce costs and problems presented by mental health disorders.
Focus group participants pointed out that uniform mental health screening tools are readily available and have been recommended by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) (NCSL 2018, p. 7). Such screening could be administered reliably by lay persons given brief, appropriate training with very little cost to taxpayers. For example, the time required to administer the Brief Jail Mental Health Screen is estimated at less than 3 minutes. In Virginia, online webinars approximately 90 minutes in length were used to provide standardized training to local staff in every county. The same resource could be adopted at no cost by the State of Maryland.
Focus Group participants agreed that three components are essential in pretrial mental health services:
- Mental health screening should be conducted by trained staff and would consist of brief standardized questions to rate the need for further mental health assessment and for suicide prevention measures.
- Mental health assessment should be conducted by a licensed mental health professional and should result in a diagnosis and treatment
- Mental health services and medication should be offered, if appropriate, based on the diagnoses.
Learn More!
NAMI/MAJR Pretrial Mental Health Screening and Services in Maryland: Stakeholders’ Focus Group Report
Bureau of Justice Statistics Special Report, “Mental Health Problems of Prison and Jail Inmates,” Revised December 14, 2006)
Governor’s Office of Crime Control and Prevention, Substance Use and Mental Health Disorders Gaps and Needs Analysis, December 31, 2016.
Justice Reinvestment Coordinating Council, Final Report, December 2015.
Maryland Correctional Administrators Association and the Maryland Alliance for Justice Reform, Pretrial, Screening, Mental Health and Reentry Services Available at Maryland’s Local Detention Centers, November 2017.
Maryland Office of the Public Defender, Brief Jail Mental Health Screen Pilot Project, Justice and Mental Health Collaboration Program Grant, 2017.
NAMI Maryland, Johns Hopkins School of Education, and Johns Hopkins University Bloomberg School of Public Health, Summit Report Course Correction: Collaboration of Criminal Justice and Behavioral Health Advancing New and Proven Models for State and Local Government, Report of Summit held on November 10, 2017.
National Conference of State Legislatures, “The Legislative Primer Series for Front End Justice: Mental Health,” August 2018.
Treatment Advocacy Center and National Sheriffs Association, More Mentally Ill Persons are in Jails and Prisons than Hospitals: A Survey of the States (May 2010).
[1] Pretrial” here would mean after defendants’ initial commissioner hearing but before bail review. As with competence and presentence reports, screening results would be confidential but available to judges, attorneys and court personnel as needed.
