Abstract
Background: Provision of mental health care in correctional settings presents unique challenges. There is a need for a simple-to-use tool to measure severity of mental illness in correctional settings that can be used by mental health staff from different disciplines. We adapted the severity scale of the Clinical Global Impression for use in correctional settings, which we have called CGI-C, and carried out a reliability study. Method: Clinical descriptions of typical inmate presentations were developed to benchmark each of the seven possible ratings of the CGI. Twenty-one case vignettes were then developed for study of inter-rater reliability, which were then rated using the CGI-C by five forensic psychiatrists (on three occasions) and 11 multidisciplinary health care clinicians (twice). The tool was introduced into clinical practice, and the first 57 joint assessments carried out by both a psychiatrist and a clinician in which a CGI-C was rated were compared to measure inter-rater reliability. Results: We found very good inter-rater and test–retest reliability in all analyses. Gwet’s AC, calculated on initial ratings of the vignettes by the psychiatrists, was 0.85 (95% CI 0.81–0.90, p < 0.001) and 0.87 (95% CI 0.83–0.91, p < 0.001) for clinician ratings. Inter-rater reliability based on 57 joint face-to-face assessments of inmates showed Gwet’s AC coefficient of 0.93 (95% CI 0.88–0.97). Conclusion: The CGI-C is simple to use, can be used by members of the multidisciplinary team, and shows high reliability. The advantage in correctional settings is that it can be used even with the most severely ill and behaviorally disturbed, based on observation and collateral information.
Highlights
Provision of mental health care in correctional settings presents unique challenges
Several scales for rating the severity of psychopathology exist, such as the 24-item Brief Psychiatric Rating Scale (BPRS) [5], which can be administered by semi-structured interview, and the Positive and Negative Syndrome Scale (PANSS) [6], a 30-item rating scale for schizophrenia
The Forensic Early Intervention Service (FEIS) is a team of 6 psychiatrists and 12 clinicians in two provincial jails in Toronto, Canada, and provides assessment and triage of inmates who have or are suspected of having serious mental health needs, and case management for those patients where there are concerns pertaining to their fitness to stand trial or if they may be pursuing a defense of “not criminally responsible” under the Canadian Criminal Code
Summary
Provision of mental health care in correctional settings presents unique challenges. There is a need for a simple-to-use tool to measure severity of mental illness in correctional settings that can be used by mental health staff from different disciplines. We adapted the severity scale of the Clinical Global Impression for use in correctional settings, which we have called CGI-C, and carried out a reliability study. The CGI-C information to those providing care within and outside of the team; 2) to enable the treating clinicians to monitor clinical progress by serial measurement (this is important when there are different clinicians involved in a case, for example, where there may be temporary or locum appointments due to difficulty in recruitment); and 3) for administrative and service planning purposes within an organization, for example, tracking the prevalence of inmates with a given level of severity, and to compare with other institutions and over time. Current rating scales for psychopathology require a fairly detailed mental state examination, which is often not possible to carry out in correctional settings, remand settings due to the very high level of behavioral disorganization of the individuals, resulting in diminished ability to participate in a structured assessment
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