The Challenge of Behavioral Health Surveillance in Criminal Justice Populations: Issues and Action Steps to Create a Nationally Representative Surveillance System.

Data from the Bureau of Justice Statistics occasional jail inmate and state prisoner surveys reveal that behavioral health issues-mental health and substance use disorders-are consistently the most prevalent health issues among criminal justice-involved (CJ-I) persons. Although these surveys provide a national-level perspective, they do not provide a true public health surveillance approach to determining the prevalence and types of behavioral health issues that burden the populations who pass through the criminal justice process. The fact that there are no "reportable" behavioral health conditions is cited as a factor in the lack of agreement on what constitutes the case definition of behavioral health disorders. This article takes an organizational systems perspective to provide a "flow" analysis of CJ-I individuals and the organizational entities involved at each step of the criminal justice system decision-making process. Issues associated with questions of "screening," "assessment," and "diagnosis" and how such information is potentially stored and reported to a centralized surveillance agency are explored. Informatics and standardization and the role of accrediting bodies in the development of behavioral health surveillance data are canvassed. A series of "first steps" in the development of a state- and national-level behavioral health surveillance system for CJ-I populations is provided.