NACo WebinarNACo Webinar

Henry J. Steadman, Ph.D.April 29, 2010

• On June 30, 2005, approximately 7 million people were under correctionalmillion people were under correctional supervision in the U.S.

J il 747 529– Jail: 747,529 – Prison: 1,446,269 – Probation: 4,162,536 – Parole: 784,408

I 2005 th 14 illi b kiIn 2005, there were 14 million bookings into U.S. jails.

PRA/CSG Jail Prevalence StudyPRA/CSG Jail Prevalence Study

Sites: 5 jails (2 – MD; 3 – NY)

Time: 2002 and 2006

Serious Mental Illness: Depression/Bi-Polar/Schophrenia/Schizo-Affective/Schizophreniform/Brief Psychotics/Delusional/Psychosis NOS

Prevalence: Last month

Prevalence Rates: Men – 14.5%Prevalence Rates: Men 14.5%Women – 31%

Steadman, H.J., Osher, F., Robbins, P.C., Case, B., Samuels, S. (2009). Prevalence of Serious Mental Illness Among Jail Inmates. Psychiatric Services 60, 761-765.

Admission to U.S. Jails (2005)

13 million13 million

Proportion of Jail Inmates With Severe Mental Disorder

Men = 14.5%Women = 31.0%

Number of Annual Admissions to U.S. Jails with Severe Mental Disorder

2.1 million

Prevalence of Current Substance Abuse Among Jail Detainees with Severe Mental DisordersJail Detainees with Severe Mental Disorders

Males Females

Disorder Alcohol Abuse/ D d

Drug Abuse/ D d

Alcohol Abuse/ D d

Drug Abuse/ D dDependence Dependence Dependence Dependence

Schizophrenia 59% 42% 56% 60%

M j D i 56% 26% 37% 57%Major Depression 56% 26% 37% 57%

Mania 33% 24% 39% 64%

Any Severe Di d

58% 33% 40% 60%Disorder

Detainees with severe mental disorder plus

= 72% = 72%

either alcohol or drug abuse/dependence

f “C OAdapted from: Abram, K.M. and Teplin, L.A. “Co-Occurring Disorders Among Mentally Ill Jail Detainees: Implications for Public Policy.” American Psychologist, 46(10):1036-1045, 1991 and Teplin, L.A. “Personal Communication.”

Policy Research Associates, Inc.6/17/98

Trauma History Interview Data (n=978)

PercentPercent Experiencing

LifetimePercent Experiencing in Last 12 Months 1

Witness of Violence 65 4% 31 7%Witness of Violence 65.4% 31.7%

Sexual Abuse 55.2% 31.7%

Physical Abuse 90.2% 65.2%y

Any Trauma 94.0% 64.7%

Any Abuse 92.9% 61.1%y buse 9 .9% 6 . %1 – For Those Respondents Experiencing Trauma in Lifetime

Repeated Cycles

INCARCERATION

ARRESTM t l

PrivateHome

MentalHealth

Inpatient

GroupResidence

S.A.Residential

ShelterStreet

Treatment

Basic Goals

• Keep people out who do not need to be there

• Provide constitutionally adequate services whenProvide constitutionally adequate services when

incarcerated

• Link people to services to keep them from coming back because of mental illness

Diversion = avoiding or radically reducing jail time by using community-j y g ybased treatment as an alternative.

“Diversion”Criminal Justice → Not filing or dropping

Diversion

charges (ATI)

fMental Health → Not filingCondition of bailD f d tiDeferred prosecution (stipulate to police report)Deferred sentencingDeferred sentencingCondition of probation

Public’s Expectations

R d idi i

Public’s Expectations

Reduce recidivism

DiversionReduce violence

Reduce jail days

Reduce costs

Diversion Logic ModelDiversion Logic Model

St 1 St 2 St 3

Improved Mental Health

Stage 1 Stage 2 Stage 3

Identify and Enroll People

Linkage Comprehensive/ Appropriate Community-

/Individual Outcomes

Diversion

in Target Group

Based Services

Improved Public Safety Outcomes

Sequential Intercept ModelSequential Intercept Model

Sequential - People move through the criminal justice system in predictable ways

Intercept - Examine this flow and look for ways to intercept persons with mental illness and p poften co-occurring disorders to ensure:

– Prompt access to treatment– Opportunities for diversion

Intercept 1Law

Intercept 2 Intercept 3 Intercept 4 Intercept 5Law enforcement

Initial detention / Initial court hearings

Jails / Courts

urt

Reentry Community corrections

Violation

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911

ent

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Spec

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Co

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Pris

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Ree

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Paro

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n

Violation

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Law In

Firs

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Jail

Dis

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Jail

Re-

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Prob

atio

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Now What?Now What?

• List/map what you haveList/map what you have

• Identify biggest gaps/highest need

• Prioritize programs

• Plan, implement and operate

MappingMapping

• Group processGroup process

• All relevant playersy

• Create a picture

Drug Court

Mental Health Court

Intercept 4Reentry

ARD

Job Court

Intercept 1 Law enforcement / Emergency services

Intercept 2Initial detention / Initial court hearings

Lancaster County, PA Sequential Intercepts for Change: Criminal Justice - Mental Health Partnerships June 2009

Intercept 3Jails / Courts

Intercept 5Community corrections/Community support

T F ilg

Reentry Court

PA Board of

Probation & Parole

MU

NIT

Y CO

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Adult

PA D

ept

Cor

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ions

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cem

ent

emen

t jur

isdi

ctio

ns

entio

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oldi

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gnm

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t Jud

ges

Courts

County Wide

Communications

911

Violation

earin

g

To Family

CO

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UN

ITY

AdultProbation &

Parole Special

Offender Unit

Pre-Parole Unit

Law

En

30 la

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Loca

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Prel

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0 M

agis

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Lancaster CountyPrison

Primecare MH Services

Drug & Alcohol Education Block Re-entry from Jail

Violation

Arrest

MH Crisis Intervention;

Mobile Outreach

MH Crisis Counselor - Lancaster City Police

Prel

imin

ary

He

Assess

Bail ROR

Community & Faith-Based Services

Re-entry from Jail

State Hospital

Local Hospitals (LGH Behavioral Health Area) Reentry Management

Organization RMO Case

Management White Deer Run D & A Call Center –for Detox

MH/MR In reach

PrimeC

are Alert

Community Supports

NAMI of Lancaster I Can Drop In Center

MH AmericaCharges MH AmericaCHOC

Charges Dismissed Public

Benefits

Gaps/NeedsGaps/Needs

• What is already in place?What is already in place?

• “Frequent flyers”y

• Politically viable

• Biggest community impact

Prioritizing ProgramsPrioritizing Programs

• “Where’s the juice”?Where s the juice ?

• Early successes most probabley– Build political capital

• Leveraging existing programs/services• Leveraging existing programs/services

Plan, Implement and Operatep p1. Designate a lead person

2. Identify the key agencies

3. Meet regularly

4. Identify key positions

5. Specify the pathways of your diversion process

6. Designate specific responsibilities

7 Develop a basic management information system7. Develop a basic management information system

8. Plan for the collection of basic data

9 C i t l l9. Communicate regularly

To download a copy, please visit

www.gainscenter.samhsa.gov

If You Don’t Map?If You Don t Map?

• Keep Sequential Intercept Model picture in mindKeep Sequential Intercept Model picture in mind as a road map

• Don’t build any programs without knowing what• Don t build any programs without knowing what else REALLY is there

• Think systemically; not programatically

Other ResourcesOther Resources

• Munetz, M. & Griffin, P. (2006). A systemic approach to the de-Munetz, M. & Griffin, P. (2006). A systemic approach to the decriminalization of people with serious mental illness: The Sequential Intercept Model. Psychiatric Services, 57, 544-549.

• CMHS National GAINS Center. (2009). Developing a Comprehensive Plan for Mental Health and Criminal Justice Collaboration: The Sequential Intercept Model. Delmar, NY: Author.