Improving early detection of mental disorders & emergencies in resource-limited prison systems: development of a structured screening and risk stratification instrument in Indonesia

Background Mental health screening in prisons is vital to uphold prisoners' right to mental health services, ensure safety, improve quality of life and reduce recidivism among incarcerated individuals. As frontline staff, correctional officers need a guideline for this screening to refer cases to the appropriate medical services. The currently available screening tool in Indonesia is unsuitable for detecting a number of relevant mental health issues and lacks sensitivity. Therefore, this study aimed to develop a new screening tool for mental disorders among inmates in Indonesia through an evidence-based approach.Methods To develop a standardized screening tool for mental disorders in Indonesian inmates, we conducted a literature review, needs assessment survey, and Delphi-based expert consensus to identify gaps in Indonesia's present tool, to refine and modify the domain items in line with the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.Results Six widely used screening tools were reviewed and the mental disorders screened were examined. Findings from the needs assessment survey and expert panel highlighted several key needs, including clearer operational definitions, more observable item indicators, integration of assessment methods, and the inclusion of structured risk stratification and emergency management flowcharts. We designed an eight-domain (depression, risk of suicide, anxiety, psychosomatic disorder, aggression, bipolar disorder, psychotic disorders, and psychiatric/medical drug consumption history) and 27-item screening tool to screen for mental disorders among inmates in Indonesia.Conclusion The new 27-item screening tool was developed based on a review of the international research literature, needs assessment survey, and Delphi-based expert consensus. The tool demonstrated preliminary content validity through expert consensus and may serve as a structured screening framework for early identification of priority mental health conditions in Indonesian correctional settings. Further psychometric and field validation studies are required before routine implementation.