Mental Health Policy - Mental Illness and the Criminal Justice System

Mental Health Policy II

The Criminal Justice System

10/28/2015Jane Addams College of Social Work

Mental Health Policy II1

“On any given day, at least 284,000 schizophrenic and manic

depressive individuals are incarcerated, and 547,800 are on probation.

We have unfortunately come to accept incarceration and homelessness

as part of life for the most vulnerable population among us.”

“We are literally drowning in patients, running around trying to put our

fingers in the bursting dikes, while hundreds of men continue to

deteriorate psychiatrically before our eyes into serious psychoses…”

“The emergence of prisons and jails as the largest institutions in the

United States housing the mentally ill reflects the de facto

criminalization of mental illness.”







The Criminal Justice Process



Overview: Key Issues/Questions

• Why are so many people with a mental illness incarcerated or under

criminal justice supervision (e.g., probation or parole)?

• What is the adequacy of health care (including mental health and

substance abuse treatment) within jails and prisons?

• Does incarceration worsen mental illness?

• How is release into the community handled and what problems are

associated with release post-incarceration?

• Has the ACA improved access to care for CJS (criminal justice

system populations)?





Overview: Key Legislation/Policies/Events

• Nixon’s War on Drugs (1970) – Carried out Nixon’s promise of

being tough on crime but disproportionately focused on and harmed

racial minorities (arguably also part of the “southern” political

strategy).

• Estelle v. Gamble (1976) – Established that under the eighth

amendment, failure to provide adequate health care to prisoners

violates the amendments prohibition against “cruel and unusual

punishment.” Requires jails and prisons to provide adequate health

care.

• Sentencing Reform Act (1984) and the Anti-Drug Abuse Acts

(1986, 1988) - established two tiers of mandatory prison terms for

first-time drug traffickers: a five-year and a ten-year minimum

sentence. Under the statute, these prison terms are triggered

exclusively by the quantity and type of drug involved in the offense






• Mentally Ill Offender Treatment and Crime Reduction Act (2004)

– authorized the Justice and Mental Health Collaboration Program

to help states and local governments improve responses to people

with mental disorders. Funding reauthorized in 2008 through 2013.

Funding (~ 50 mill for JMHCP) provides for:

• Specialized law enforcement-based programs and training for law

enforcement officials on safely resolving encounters with people experiencing

a mental health crisis

• Mental health courts

• Mental health and substance use treatment for incarcerated individuals

• Community reentry services

• Cross-training of criminal justice and mental health personnel






• Justice and Mental Health Collaboration Act (2015) – Would

reauthorize and improve on MIOTCRA:• Continues support for mental health courts and crisis intervention teams

• Emphasizes evidence based practices that have been proven effective

through empirical evidence;

• Authorizes investments in veterans treatment courts, which serve arrested

veterans who suffer from PTSD, substance addiction, and other mental health

conditions;

• Supports the development of curricula for police academies and orientations;

• Increases focus on corrections-based programs, like transitional services that

reduce recidivism rates and screening practices that identify inmate with

mental health conditions.







The “Experiment in Mass Incarceration”

At year end 2011, about

1 in every 34 adult

residents in the U.S.

was under some form of

correctional supervision,

down from 1 in 31 in

2007.

10/28/2015 Jane Addams College of Social Work Mental Health Policy II 8

At yearend 2013,

Illinois had a total

of 48,653 adults in

prison (45,000

men and 3,000

women).

These figures are

slightly down

from 2012.

About 31,000 are

released each year.





As the demographic figures suggest, there is “disproportionality”,

“disparity” in who is supervised and who is not.





Incarceration in prisons

is only one part of the

criminal justice system

that accounts for the

large number of

Americans under

supervision of one type

or another.




The Mentally Ill in the CJS

• Prisons and jails can have many adverse consequences on

inmates and especially those with a serious mental illness

• There is risk for infectious diseases such as HIV and tuberculosis

though the HIV infection rate in incarcerate settings is lower than in

the gp (see Dora et al.)

• Isolation and the generally punitive environment can lead to

deterioration and exacerbate mental illness symptoms

• Homelessness on release and sudden access to drugs (among

other factors) can lead to high mortality rates in the 2 weeks post-

release into the community





• The growing (?) number of mentally ill persons who are

incarcerated in the United States is an unintended consequence of

two distinct public policies adopted over the last thirty years:

• First, elected officials failed to provide adequate funding,

support, and direction for the community mental health systems

that were supposed to replace the mental health hospitals shut

down as part of the “deinstitutionalization” effort that began in

the 1960s.

• Second, elected officials embraced a punitive anti-crime effort,

including a national “war on drugs” that dramatically expanded

the number of persons brought into the criminal justice system,

the number of prison sentences given even for nonviolent

crimes (particularly drug and property offenses), and the length

of those sentences.




The Mentally Ill in the CJS• There are no good national estimates of the prevalence/rates of

SMI among criminal justice populations in the United States. The

BJS published a study saying that the rate was 16% based on 2

questions:

• Do you have a psychiatric problem?

• Were you hospitalized in the past-year for psychiatric

treatment?

• More recently, they used an even more liberal criterion and

concluded that the rate of MI was over 50% among jail and prison

inmates:

Source: Bureau of Justice Statistics [BJS]. (2006). Mental health problems of jail and

prison inmates (U.S. DOJ Publication No. NCJ 213600). Washington, DC: U.S.

Government Printing Office. 10/28/2015 Jane Addams College of Social Work Mental Health Policy II 14




• At midyear 2005 more than half of all prison and jail inmates had a

mental health problem, including 705,600 inmates in State prisons,

70,200 in Federal prisons, and 479,900 in local jails. These

estimates represented 56% of State prisoners, 45% of Federal

prisoners, and 64% of jail inmates. The findings in this report were

based on data from personal interviews with State and Federal

prisoners in 2004 and local jail inmates in 2002.

• Mental health problems were defined by two measures: a recent

history or symptoms of a mental health problem. They must have

occurred in the 12 months prior to the interview. A recent history of

mental health problems included a clinical diagnosis or treatment

by a mental health professional. Symptoms of a mental disorder

were based on criteria specified in the Diagnostic and Statistical

Manual of Mental Disorders, fourth edition (DSM-IV).





Source: BJS, September 200610/28/2015 Jane Addams College of Social Work Mental Health Policy II 16




These estimates are almost certainly too high. There are some

smaller-scale studies to provide guidance. It turns out that the 16%

number is probably closer to the mark.

If we restrict the definition of mental illness to serious mental illnesses

(schizophrenia, bipolar disorder, major depression) and moderate to

severe functional impairment (GAF > 50), then studies have

consistently found a past-year prevalence rate of 15% to 20% among

different criminal justice populations (arrestees, probationers,

detainees, prisoners).

This comports with estimates based on our own studies….





General Population Samples Criminal Justice – Matched Samples

Note. Data obtained from the 2002 National Survey on Drug Use and Health (NSDUH), the 2001 National Health

Interview Survey (NHIS), and Arrestee Drug Abuse Monitoring (ADAM) data collected in Chicago in 2003. The

NSDUH general population sample was comprised of all adult participants who did not report an arrest in the

past year (N = 34,271) while the NHIS general population sample was comprised of all adult participants (N =

33,326). The NSDUH criminal justice sample was comprised of all participants reporting a past-year arrest (N =

1, 684) while the NHIS “’criminal justice” sample (N = 277) was comprised solely of male respondents

demographically matched to the ADAM sample (N = 263), which was also comprised solely of adult male

arrestees.10/28/2015 Jane Addams College of Social Work Mental Health Policy II 18



• Transinstitutionalization (criminalization) is attributable to 4 factors:• Deinstitutionalization

• Tougher (harder to commit) civil commitment laws

• Lack of community support services

• Role of the police

• To these add another three factors:• Rise in drug use among all segments of society (1970s)

• War on drugs as a punitive policy combined with…

• High rates of drug use among those with psychiatric disorders

Contributing Factors - Transinstitutionalization





• Transinstitutionalization first attributable to Penrose (1939)• A relatively stable number of individuals are confined in any

industrial society (hospitals, prisons, jails)

• Inverse relationship between size of the population in mental hospital settings and penal institutions in 18 European countries

• But wait a minute…

• Consider the rates of prison growth in the US compared with the rate of decline in the mental hospital population

• Mental hospitals – declined from 559,000 in 1955 to 55,000 in 2000 with much of the decline in the 1960s and 1970s

• Over that same time, relatively constant prison population

• Prison and jail populations exploded 1970 – 2000 and continue to increase




• Between 1974 and 2001 the number of current or former inmates

increased by 3.8 million men and women.

• This included an additional 1.1 million adults in prison (up from

216,000 inmates in 1974) and almost 2.7 million more former

inmates (up from 1,603,000 former prisoners in 1974).

• Almost two-thirds of the increase in the number of those who had

ever been incarcerated resulted from an increase in first

incarceration rates. One-third of the increase was attributed to

growth in the U.S. resident population and increases in life

expectancy.





Contributing Factors

• So some other factors besides deinstitutionalization have to be at

work?

• The institutional population in the United States has NOT been

stable and the proportion of the population in prisons and jails has

grown dramatically over the past 30 years while the decline in

mental hospital beds has slowed….

• This means that the decline in state hospital admissions can not

account for the increase in the prison and jail populations even

allowing for an increase in the general population between the

1950s and 2000s.




Contributing Factors – Community Health Care

• Lack of Access to Community Care

• Underfunded CMHC resulted in lack of access to services,

especially for those with serious and persistent mental illnesses

No place else to go! Streets or jails and prisons….




Contributing Factors – Community Health Care

• There appears to be little in the way of a ‘‘dose response’’relationship between a locale’s level of mental health services and

the criminal justice involvement of its mental health system’s

clientele.

• Nor do any of these data directly support the notion that the

deinstitutionalization process has led to increased involvement of

person with mental illness in the criminal justice system. To make

such a case, one would have to show that the prevalence of mental

illness in the correctional system is significantly higher today than in

1970.




• The police, who

• Lack training in recognizing mental illness and distinguishing it

from criminal conduct and belligerence.

• Charged with protecting community safety.

• Parens patriae authority which dictates protection for citizens

with disabilities who cannot care for themselves, such as those

with mental illnesses. The state as a “parent”…

Contributing Factors – Police




But!

• Studies of policing lend no support to the premise that officers

systematically use arrest as a means of managing the behavior of

persons with mental illness. For example, Engel and Silver (2001),

analyzing data from two large scale, multi-site studies of police

behavior, found that police were in fact not more likely to arrest

mentally disordered suspects.

• Several studies conducted at both the system and person levels

have failed to detect significant crossovers between the mental

health and criminal justice systems that could be attributed either

to changes in mental health law or to the general reduction in state

hospital census.





• The data (I have seen) also do not support the contention that people

with SMI are arrested and brought to jail for “nuisance crimes” (e.g.,

disturbing the peace)…

• Consider these arrest history data we collected from detainees at the

Cook County Jail in psychiatric treatment in 2004…



Male (N = 15) Female (N = 15)

Illegal Drug Use 54% 39%

Drug Sales 15% 8%

Forgery/Fraud 15% 17%

Prostitution 15% 31%

Burglary/ Auto Theft 46% 23%

Theft 58% 39%

Robbery 15% 8%

Violent Offense

(assault/battery/homicide) 44% 69%

Mean # Prior Arrests (SD) 20.5 (21.1) 8.9 (13.9)




Note. Figures indicate at least one self-reported arrest in the charge category.10/28/2015 Jane Addams College of Social Work Mental Health Policy II 28



Contributing Factors – Homelessness

Homelessness

• One quarter of the homeless living on the streets have an

SMI and have no or inadequate access to appropriate

housing

• Within mental health, adequate housing has not been

considered a part of treatment

• Federal government support for affordable housing has

decreased over past two decades…




The role of drugs:

• Since the 1970s, increase in drug use beginning with heroin

epidemic and then followed by cocaine and crack-cocaine eras

in the 1980s through 1990s

• Country adopted punitive policies in the 1980s (Bill Bennett as

drug czar) – determinate and longer sentencing for drug

violations – “War on Drugs”

• Self-medication and vulnerability to drug use among the SPMI

and high rates of drug use

Contributing Factors – War on Drugs





The role of drugs:

• Drug use brings SPMI into contact with police because they are:

• Using illegal drugs

• Committing crimes to get money for drugs

• Destabilized by drug use (exacerbated symptoms, increased propensity towards violence)

• Inept criminals (impulsive, poor, obvious)

• Recent study by S&L found that drug use explained all or most of the increased risk for arrest for property and drug offenses and a good proportion of the increased risk of arrest for violent offenses

• Similar findings in other countries (Australia, Finland)





Note. The unweighted N for all models = 35,955 and excludes 415 cases with missing data for past-year arrest. All

standard errors are based on data weighted for sampling probabilities and controlling for design effects due to

stratification and clustering. All models include the following covariates: gender, age group, race/ethnicity, marital

status, education level, employment status, and population density. The additional drug use covariates include:

alcohol use/dependence, marijuana use/dependence, and use/dependence on other illegal drugs.




Does Mental Illness Cause Crime Per se?

• Increased mental health services often do not translate into reduced recidivism, even for “state of the art” services.Caslyn et al., 2005; Clark, Ricketts, & McHugo, 1999; Skeem & Eno Louden, 2006; Steadman & Naples, 2005

• Untreated mental illness is a criminogenic need for only a small proportionoffenders with serious mental illness. Junginger et al. (2006), Peterson et al. (2009)

• Strongest criminogenic needs are shared by those with- and without-mental illness. Bonta et al., (1998); Skeem et al. (2009)




• Some people with serious mental illness may “engage in offending and other forms of deviant behavior not because they have a mental disorder, but because they are poor. Their poverty situates them socially and geographically, and places them at risk of engaging in many of the same behaviors displayed by persons without mental illness who are similarly situated”• Fisher et al. (2006), p. 553




Contributing Factors (Fisher & Wolf)

Offenders with mental illness have significantly more “central 8” risk factors for crime

….and these predict recidivism more strongly than risk factors unique to mental illness (e.g., diagnosis, symptoms, treatment compliance)



The Criminal Justice System “Central eight” for criminal behavior

(Andrews, 2006)

Risk Factor Need

History of criminal behavior Build alternative behaviors

Antisocial personality pattern*** Problem solving skills, anger management

Antisocial cognition* Develop less risky thinking

Antisocial peers Reduce association with criminal others

Family and/or marital discord** Reduce conflict, build positive relationships

Poor school and/or work performance* Enhance performance, rewards

Few leisure or recreation activities Enhance outside involvement

Substance abuse Reduce use


Direct Relationship(One-Dimensional Model)

(Untreated) Mental Illness

Criminal Behavior

Fully Mediated Relationship(Criminological & Social Psychological Models)

Mental Illness

Third Variable

General Risk

Factors

Criminal Behavior

Moderated Mediation Effect of Mental Illness on Criminal Behavior

Moderator (age of onset for criminal behavior?)

Evidence-based corrections

Evidence-based psychiatric services

(late?) (early?)




Evidence-based Corrections Targets Recidivism

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• Focus resources on high RISK cases

• Target criminogenic NEEDS like anger, substance abuse, antisocial attitudes, and criminogenic peers (Andrews et al., 1990)

• RESPONSIVITY - use cognitive behavioral techniques like relapse prevention (Pearson, Lipton, Cleland, & Yee, 2002)

• Consider packaged programs like “Reasoning and Rehabilitation”(Young and Ross, 2007)

• Ensure implementation (Gendreau, Goggin, & Smith, 2001)




Treatment Options – What Works?




Treatment Options – What Works?

• http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/about.asp• Integrated dual diagnosis treatment (IDDT)

• Supported employment

• http://consensusproject.org/updates/features/GAINS-EBP-factsheets• Supported housing

• Trauma interventions


http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/about.asp

http://consensusproject.org/updates/features/GAINS-EBP-factsheets



Combining Clinical and Risk Assessment

• Identify offenders with mental illnesses, using a validated tool like the K-6 or BJMHS

• http://www.hcp.med.harvard.edu/ncs/k6_scales.php

• http://gainscenter.samhsa.gov/HTML/resources/MHscreen.asp

• Or MAYSI, for youth http://www.maysiware.com/MAYSI2Research.htm

• Assess risk of recidivism, using a validated tool like the LS/CMI (includes youth version)

Example: Good

supervision + ACT

Example: RNR

supervision + ACT

Good supervision +

good treatment

Example: RNR

supervision + good

treatment

Screen and assessTarget criminogenic risk & clinical needs with EBPs


http://www.hcp.med.harvard.edu/ncs/k6_scales.php

http://gainscenter.samhsa.gov/HTML/resources/MHscreen.asp

http://www.maysiware.com/MAYSI2Research.htm



The Risks-Needs-Responsivity Model

• First proposed in 1990 by Andrews, Bonta, and Hoge, the risk-need-responsivity model has become one of the most influential models guiding treatment interventions in corrections (Ogloff & Davis, 2004).

• Although the number of principles have greatly increased since the 1990 paper (presently numbering 15 principles; Andrews & Bonta, 2010a, Andrews & Bonta, 2010b), the three core principles that were initially outlined continue to dominate. These three principles can be summarized as follows:




The Risks-Needs-Responsivity Model

Risk principle: Match the level of services to the risk level of the offender. Provide intensive services to higher risk clients and minimal services to lower risk clients.

Need principle: In treatment, set criminogenic needs as the target of intervention. Criminogenic needs are the dynamic risk factors associated with criminal behaviour (e.g., procriminal attitudes, substance abuse, criminal associates). Non-criminogenic needs (e.g., vague complaints of emotional distress, self-esteem without consideration of procriminal attitudes) are relevant only in that they may act as obstacles to changes in criminogenic needs.

Responsivity principle: Match the style and mode of intervention to the ability and learning style of the offender. Social learning and cognitive-behavioral styles of influence (e.g., role playing, prosocial modeling, cognitive restructuring) generally work best with offenders.10/28/2015 Jane Addams College of Social Work Mental Health Policy II 45

Mandated Treatment and the Courts – Drug Courts

• Opened in 1989 in Dade County, Florida

• Majority are pre-sentence (called diversion), with charges

dropped if all conditions are met/treatment completed.

• Can be post-sentence also but less common.

• Characterized by:

• Integration of treatment with supervision/case processing

• Access to a continuum of treatment services

• Abstinence monitored through frequent testing

• Graduated sanctions

• Close supervision by judge (therapeutic jurisprudence)


Civil Commitment Laws and other forms of leverage





As of June 2014, the estimated number of drug courts operating in the U.S. is over 3400. More than

half target adults, including DWI (driving while intoxicated) offenders and a growing number of

Veterans; others address juvenile, child welfare, and different case types




In the state of Illinois, there are (at least) 39 adult and juvenile drug courts in

operation including the following:

* Champaign County Adult * Coles County Adult

* Cook County Adult (4 programs) *Dekalb County Adult

* Cook County Juvenile

* Dewitt County Adult * DuPage County Adult

* Effingham County Adult * Grundy County Adult

* Jersey County Adult * Kane County Adult

* Kankakee County Adult * Macon County Adult

* Madison County Assessment and Treatment Alternative Court

* Peoria County Adult * Peoria County Juvenile

* Pike County Adult * Rock Island County Adult

* Saline County * Will County Adult

* Will County Juvenile * Winnebago County Adult





The Illinois statutes that encourage the formation of drug courts (730 ILCS 166

and 705 ILCS 410) incorporate “ten key components” of drug courts developed by

the Drug Court Standards Committee of the National Association of Drug Court

Professionals. These ten key components are as follows:

1. Drug courts integrate drug treatment services with justice system case

processing.

2. Use a non-adversarial approach, prosecution and defense counsel promote

public safety while protecting participants’ due process rights.

3. Eligible participants are identified early and promptly placed in the drug court

program.

4. Drug courts provide access to a continuum of drug treatment and

rehabilitation services.





5. Abstinence is monitored by frequent drug testing.

6. A coordinated strategy governs drug court responses to participants’compliance.

7. Ongoing judicial interaction with each drug court participant is essential.

8. Monitoring and evaluation measure the achievement of program goals and

gauge effectiveness.

9. Continuing interdisciplinary education promotes effective drug court planning,

implementation, and operations.

10. Forging partnerships among drug courts, public agencies, and community-

based organizations generates local support and enhances drug court

effectiveness.


Mandated Treatment and the Courts – Mental Health Courts

• First mental health court opened in 1997 in Broward County,

Florida modeled after drug courts and involve close monitoring

by judge. (There were earlier courts established in Indiana in

the 1980s and early 1990s but these did not survive).

• Came about as a result of the popularity of drug courts.

• There are an estimated 414 mental health courts in operation

nationally.




Mandated Treatment and the Courts – Mental Health Courts

MHCs have 4 defining characteristics (but no established set of

guidelines as with drug courts):

Court docket for people with mental illness

Team of criminal justice and mental health specialists to

recommend treatment and supervision

Assurance treatment is available

Court monitoring with possible sanctions for noncompliance,

such as reinstituting charges and sentences (incarceration).






Illinois Mental Health Court Treatment Act

Purpose of the Act

Create specialized mental health courts with the

necessary flexibility to meet the problems of criminal

defendants with mental illnesses and co‐occurring

mental illness and substance abuse problems

Effective June 1, 2008




Conclusions of the General Assembly

• Large percentage of criminal defendants have diagnosable mental

illness

• Mental illness has a dramatic effect on criminal justice system

• Mental illness and substance abuse co‐occur in substantial

percentage of criminal defendants

• Need a program that will reduce recidivism among this population

• Provide appropriate treatment for this population

• Reduce the incidence of crimes committed as a result of mental

illness or co‐occurring




Statistics

• In 2004, Winnebago County determined that 16% of inmates had a

severe mental illness.

• Commonly cited figures about jail detainees with mental illness are

in the range of 10 to 15% with some estimates much higher.

• In 2009, the Council of State Governments released a study of

more than 20,000 adults entering 5 local jails and found serious

mental illnesses in 14.5 % of men and 31% of women, or 16.9%.

These rates are 3 to 6 times those found in the general population.




Currently 21 Mental Health Courts in Illinois. By county:

• Champaign

• Cook (7)

• Dupage

• Kane

• Lake

• Lee

• Macon

• Madison

• McHenry

• McLean

• Peoria

• Rock Island

• St. Claire

• Will

• Winnebago




Eligibility under Mental Health Court Treatment Act:

Admitted with the agreement of the prosecutor and defendant and

with approval of the court

Exclusions:

• Crime is a crime of violence

• Defendant does not demonstrate a willingness to participate in a

treatment program

• Defendant has been convicted of a crime of violence in the past 10

years excluding incarceration

• Defendant previously completed or has been discharged from a

mental health court with in the last 3 years




Exclusionary Crimes of Violence Include:

• First degree murder

• Second degree murder

• Predatory criminal sexual assault of a child

• Aggravated criminal sexual assault or Criminal sexual assault

• Armed Robbery

• Aggravated Arson or Arson

• Aggravated Kidnapping or Kidnapping

• Stalking or aggravated stalking

• Any offense involving the discharge of a firearm




Eligibility Requirement Concerns

Defendant previously completed or has been discharged from a

mental health court within the last 3 years

Is this section necessary?

If Mental Health Courts are effective why do we want to

preclude someone from the Court

Lack of medication compliance is not a criminal act


Mental Health and Drug Courts – Research Findings



MacArthur Study” Steadman, Redlich, Callahan, Robbins, & Vesselinov

(2013): 4 sites, pre/post design, comparison group (jail/treatment as usual)

– felonies and misdemeanors

Findings:

• Post-entry annualized (time at risk to reoffend) re-arrest rate

significantly lower for MHC sample.

• Post-entry incarceration days significantly lower for MHC sample.

• More intensive treatment episodes and therapeutic treatment episodes

than similar defendants. In other words, among MHC participants, there

is a shift from crisis treatment to intensive treatment.

• MHC participants access community treatment more quickly following

discharge from jail than similar defendants.





Other Findings:

• Re-arrest rates lower for MHC participants who:

• Graduate from the program

• Had lower pre-arrest and incarceration rates

• Had treatment at baseline interview/admission to MHC

• Re-incarceration rates lower for MHC participants who:

• All of the above plus

• Did not use illegal substances in past 30 days

• Had a diagnosis of bi-polar disorder, rather than depression or

schizophrenia


• One year project (2007) to collect self-report, medical records and arrest

data from CCDOC detainees in RTU.

• Sampling with certainty monthly admissions to RTU stratified by gender

• Two-step recruitment process (overall recruitment rate of 67.5% of

eligible cases; main reason not accessed before transfer or discharge)

• Administered WHO-CIDI via laptop computers

• Medical record abstraction (not completed – too many missing charts)

• Arrest data from ISP via CJIA



A Study of Co-occurring Health and Psychiatric Conditions at

CCDOC


Reception and

Classification

(~ 300 per day)

Cermak Health Services

General Population

Admissions/Acute Care

(48 hrs., 2 dorms, 40 beds)

( ~ 600 in “outpatient”medication

management)

Medication Clinic

Women

(Division 3 - 120 beds)

Men

(Division 8 - 300 beds)

Residential Treatment Units

RTU/RU

Intensive Care

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Key research questions:

• Epidemiology of psychiatric, substance use, and medical disorders.

• Access to medical and behavioral healthcare services when not incarcerated and what have been the primary barriers to service access?

• Determine what community-based medical and behavioral healthcare services are most needed upon release from the jail?

• Determine how community-based medical and behavioral healthcare services should best be coordinated post-release.

• What are the criminal careers of those in psychiatric treatment within the jail and do the number and severity of crimes committed vary by the type of psychiatric disorder and/or the presence of substance use and medical disorders?

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Epidemiology of psychiatric, substance use, and medical

disorders

• Substance use disorders including alcohol and drug abuse and

dependence (81.8%);

• Nicotine dependence (64.5%);

• Conduct disorder (56.5%);

• Anti-social Personality Disorder (ASP) (47.2%);

• PTSD (44%);

• Major affective disorder (61%; major depressive episode most common

– 50%)

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Epidemiology of psychiatric, substance use, and medical

disorders

• Women more likely to have:

• Major depressive episode or disorder

• PTSD

• Men more likely to have

• Non-affective psychosis

• Gambling disorder

• Alcohol abuse

• About 20% did not meet DSM-IV criteria for any diagnosis!

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Treatment access and use

• A majority of participants have had prior psychiatric care and around

60% to 70% have been hospitalized in the community.

• Only 54 percent reported having a regular doctor and only 40

percent reported having a regular place to go for routine medical

services.

• Only 35 percent saw a dentist or obstetrician (among women) in the

year preceding their arrest.

• More participants visited a medical facility for emergency or urgent

care (52.5%) than for a scheduled surgery or routine care (17.6%).

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• Contact with treatment professionals was uneven in a number of

ways:

• By disorder (PTSD, ADHD relatively undertreated)

• By professional contact (psychiatrists most common, other

health care professionals relatively less common).

• Few have private health insurance and less than half (45%) have

any kind of government insurance such as Medicaid/Medicare.

Given psychiatric disability, many more should be on Medicaid.

• However, lack of insurance was not the main reason most people

reported delaying getting treatment. Most said they wanted to handle

their problems on their own. Or that they were not bothered much by

their problem.

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Lack of insight appears to be a general and important issue that affects

service use:

• 33% rate their overall mental health as ‘very good’ to

‘excellent’.

• 59% rate their overall physical health as ‘good’ to ‘excellent’.

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Mental Health Policy - Mental Illness and the Criminal Justice System

Health & Medicine

Transcript of Mental Health Policy - Mental Illness and the Criminal Justice System