Jail Screening Assessment Tool (JSAT): Guidelines for Mental Health Screening in Jails

According to research reviewed in Jail Screening Assessment Tool's (JSAT), about one in four persons entering jails has a mental condition that requires a comprehensive mental health evaluation and an immediate response to avert dangers such as suicide. The JSAT was designed to identify these persons at jail intake. The authors claim that no other tool has been developed for mental health screening of adults entering jails.

City jails may process as many as 300 persons daily. Screening means reviewing every person admitted in order to determine whether he or she needs referral. This process creates difficult specifications for a successful screening tool. For example, the procedure must be extremely brief and requires the collection of the least amount of data necessary to do its job. Moreover, jail budgets could never afford enough psychiatrists or psychologists to meet the demand, so the tool must be designed for use by non-mental health professionals.

The JSAT meets these requirements. It is a structured interview, requiring about 20 minutes, that consists of several questions in each of eight sections: identifying information, legal situation, violence issues, social background, substance use, mental health treatment, suicide and self-harm issues, and mental health status, which is the Brief Psychiatric Rating Scale with rating modified to a 3-point continuum.

The JSAT is not a psychometric test. It has no scoring and thus no summary scores and no score-based decision rules. Screeners obtain inmates' self-report answers to the JSAT questions, then make decisions about referral based on general guidelines offered for each of the sections; for example, for suicide and self-harm, suggestions are made for referral or suicide watch when the inmate expresses intent to self-harm or when other behavioral and historical factors seem to suggest concern. So screeners have considerable discretion regarding how the data are used to make referral decisions.

This reliance on structured clinical judgment has several implications. First, the JSAT must be used by screeners who, although not necessarily mental health professionals, have some familiarity with mental disorders and have sensitivity in interviewing persons with mental disorders. The authors recommend that screeners have graduate training in psychopathology and assessment, which suggests that master's degree psychologists or social workers would be preferred. Additional training specifically with the JSAT is necessary, although this manual does not describe what the training would involve.

The second implication is that establishing validity is very difficult for instruments that rely on users' discretionary judgments. In the authors' own research, JSAT screeners' judgments about referrals identified most inmates who met standardized criteria for DSM-IV axis I disorders. Users must recognize, however, that this is evidence for the validity of judgments of JSAT screeners who were selected and trained by the authors. It is not known whether other jail screening programs, with inevitable variability in screeners, training, and quality control, can produce similar results. Validity is a problem for any psychological test but a greater problem for tools that have no scores and rely on the interviewing and inferential skills of the user. Nevertheless, the JSAT is a promising advance for programs seeking to identify mental health problems among adults admitted to jails.