hjr 26 primer - montana...

1 National Alliance on Mental Illness, "About Mental Illness" and "What is Mental Illness: MentalIllness Facts", www.nami.org.

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HJR 26: A PrimerBackground and Study Questions for the

Study of Mental Health Treatment in Adult and Juvenile Corrections

Pprepared by Sheri S. Heffelfinger, Legislative Research AnalystMontana Legislative Services Division

for theLaw and Justice Interim Committee

July 2007

Purpose

This paper provides general background for the House Joint Resolution No. 26 (HJR 26) study

of mental health treatment in the adult criminal and juvenile justice systems and outlines basic

study questions for discussion by the Law and Justice Interim Committee (LJIC) as it moves

forward with the HJR 26 study.

General Background

About mental illness

A mental illness undermines a person's basic life skills, such as the ability to socialize, to

maintain healthy relationships, to find and maintain employment, and to recognize and seek

treatment for the illness. Mental illness may also lead to substance abuse and behaviors that

prompt action by law enforcement.1

Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive

compulsive disorder, panic disorder, posttraumatic stress disorder, and borderline personality

disorder. Recognizing and diagnosing mental illness can be difficult and complex, especially

with respect to young children and teenagers. Severity and duration of mental illnesses vary

widely. Also, symptoms can be acute and sporadic or can be ongoing and chronic. The

severity and symptoms may be affected by traumatic events, life situations, and physical

2 Ibid.

3 Ibid.

4 See materials available from The National GAINS Center, U.S. Department of Public Health andHuman Services, Substance Abuse and Mental Health Services Administration,http://gainscenter.samhsa.gov.

5 Glaze and James, Mental Health Problems of Prison and Jail Inmates, U.S. Department ofJustice, Office of Justice Programs, Bureau of Justice Statistics, September 2006.

6 Department of Corrections, Biennial Report, State of Montana, 2007, p. 2.

7 Teplin, et.al., "Psychiatric Disorders in Youth in Juvenile Detention", Archives of GeneralPsychiatry, December 2002.

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health.2

Mental illness can be treated with medication, cognitive behavioral therapy, interpersonal

therapy, and participation in support groups. A healthy diet, consistent exercise, adequate

sleep, and meaningful activities are also key components of a mental health treatment plan.

Treatment can stabilize symptoms and allow a person suffering from mental illness to find and

maintain employment, develop social and emotional coping skills, maintain healthy

relationships, and stay sober.3

Mental illness and the adult criminal and juvenile justice systems

Mental illness significantly impacts the criminal justice system in terms of the planning, program

management, staffing, training, and resources needed to provide for mentally ill offenders.4

According to a national 2006 study, 24% of state prison inmates and 21% of local jail inmates

had a recent history of a mental health disorder or illness.5 Furthermore, researchers estimate

that nationally more than 75% of mentally ill offenders in the corrections system also have a co-

occurring substance abuse problem.6

Mental illness and substance abuse in the juvenile justice system are especially problematic. In

a 2002 national study of juveniles in detention, an alarming 65% of boys and 75% of girls were

diagnosed with at least one mental disorder.7 Other studies found that 50% to 75% of youth in

8 National Mental Health Association, "Prevalence of Mental Disorders Among Children in theJuvenile Justice System", Fact Sheet, http://www1.nmha.org/children/justjuv/prevalence.cfm.

9Marcia K. Goin, M.D., Ph.D., President, American Psychiatric Association, "Mental Illness and theCriminal Justice System: Redirecting Resources Toward Treatment, Not Containment", ResourceDocument, May 2, 2004.

10 See Donna Lyons, "Helping Mentally Ill Criminals", State Legislatures, National Conference ofState Legislatures, April 2007, pp. 14-17. See also Sarah Hammond, "Delinquency Detour", StateLegislatures, National Conference of State Legislatures, April 2007, p. 19.

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detention facilities are diagnosed with more than one disorder, including substance abuse.8

With respect to both the adult criminal and juvenile justice systems, mental health treatment

advocates argue that failure to provide for and fund adequate community-based support

systems and treatment for mental illness after release is also a significant cause of recidivism.9

Seeking a comprehensive and collaborative approach

Recognizing that mental illness in the adult criminal and juvenile justice systems presents

challenges transcending federal, state, and local agency boundaries, public health and

corrections administrators, state and local law enforcement officials, judicial officers, community

service providers, and treatment professionals at all levels are seeking ways to develop a

comprehensive strategic approach to these challenges and to collaborate so that they can pool

resources, maximize available funding, and improve outcomes.10 To help states develop mental

health and criminal justice collaborations, The National GAINS Center has published a chart

entitled "Sequential Intercepts for Change: CJ-MH Partnerships". This chart is provided at

Attachment A.

The Context in Montana

Draft strategic plan developed

The Department of Corrections (DOC) and the Department of Public Health and Human

Services (DPHHS) agree that they share a common clientele--mentally ill offenders--and that

the two agencies need a consistent, evidence-based treatment and corrections strategy. In July

2006, the departments hired a behavioral health program facilitator, Ms. Deb Matteucci, to act

11 Montana Department of Corrections and Montana Department of Public Health and HumanServices, Draft Strategic Plan: Collaboration of DOC/DPHHS, December 1, 2006, p. 2.

12 Montana Mental Health Oversight Advisory Council, letter from Council Chairperson MignonWaterman to DPHHS Director Joan Miles and Legislative Finance Committee Chairperson Senator JohnCobb, August 21, 2006, p. 1.

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as liaison between the two Departments and to facilitate collaboration. In December 2006, a

draft strategic plan was developed, which identified the following areas in which the

Departments would collaborate:

C in planning;

C in establishing lines of communications and in sharing and disseminating information;

C in developing and allocating resources; and

C in treatment methods.

According to the draft strategic plan, the ultimate objective is a "shared and consistent treatment

modality" that will "support and enable diversion from secure correctional facilities and inpatient

mental health facilities; and [that] will provide linkages for appropriate aftercare services upon

discharge".11 The plan, which is provided at Attachment B, details the goals, objectives, action

steps, responsible parties, and completion dates for various collaborative efforts.

Mental Health Oversight Advisory Council

In August 2006, the Mental Health Oversight Advisory Council (which is under the DPHHS and

whose members include consumers, advocates, members of the general public, legislators,

mental health service providers, and agency representatives) issued findings and

recommendations resulting from its study of the "criminal justice system as it pertains to the

mental health care of people in Montana".12 Among the Council's recommendations were:

C early intervention and identification of mental health issues when an adult or youth

enters, is being supervised in, or is being released from the justice system;

C alternative placements of forensic patients under the Montana State Hospital (MSH) who

are being transferred to prison after treatment at the MSH;

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C better mental health services for mentally ill offenders under the supervision of the DOC,

alternatives to incarceration, a special prerelease center, and more community services

upon release from incarceration.

A copy of all of the Council's findings and recommendations is provided at Attachment C.

Other recent initiatives

Some of the recent efforts by the DOC and the DPHHS related to management of mentally ill

offenders include:

C beginning in the fall of 2006, the operation of the Montana Chemical Dependency Center

(MCDC), which provides inpatient substance abuse treatment to offenders on probation

but at risk of having probation revoked and being returned to prison;

C continuing work on policies and guidelines for sentence calculation, determination of

parole eligibility, notification to crime victims, tracking movement from secure custody to

community placements, and handling "guilty but mentally ill" offenders;

C an analysis of standards for correctional health care and how those standards should be

implemented;

C training for law enforcement officers for crisis intervention and evaluation; and

C training for probation and parole officers to help mentally ill offenders become and

remain stabilized in the community.

A key joint initiative for the DOC and the DPHHS during the regular 2007 legislative session was

establishment of a Secure Treatment and Examination Program (STEP) for mentally ill

offenders and state hospital forensic patients. However, the STEP proposal was not approved

13 Legislative Fiscal Division, Budget Analysis for the 2009 Biennium, January 2007, Volume 6,Section D, p. D-70. See also Legislative Fiscal Division, Fiscal Report for the 2009 Biennium, June 2007,Volume 6, Section D, pp. D-51 and D-52.

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by the legislature. The 120-bed program was to be housed on the Warms Springs campus.13

The HJR 26 Study

Purpose for the study

At the hearings on HJR 26, the resolution's sponsor, Rep. Tim Callahan (D-Great Falls), stated

that the Legislature needed to have a comprehensive blueprint and implementation plan for use

when making policy and funding decisions regarding mental illness and the adult criminal and

juvenile justice systems. He stated that his hope was that HJR 26 would not result in a study of

what has already been studied, but that the HJR 26 study would identify all the necessary

components of a comprehensive strategic approach to mental illness and the adult criminal and

juvenile justice systems and that the study committee would develop such an implementation

plan. These objectives were echoed by each of the study's proponents. Study proponents

included Rep. John Parker (D-Great Falls) speaking as a county prosecutor and representatives

from the DOC, the DPHHS, the Department of Justice, the Montana Advocacy Project, and the

Montana Mental Health Association.

Study tasks and goals

Language in HJR 26 specifies that the objective is "to study and develop an implementation

plan to provide mental health care in the criminal and juvenile justice systems". The resolution

also specifies that the implementation plan should cover:

C youth adjudicated as delinquent;

C convicted adult defendants;

C alternative community treatment and supervision options, including the option of mental

health probation;

C a continuum of care; and

C treatment options prior to the adjudication of a mentally ill youth or the conviction of a

mentally ill adult.

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Study questions

The following represents staff's analysis of the study questions that need to be answered in

completing the study tasks outlined in HJR 26. These questions are offered for discussion by

the LJIC and stakeholders and for further development as the study moves forward.

I. Study Task: Define the adult criminal and juvenile justice continuum, identify all the

components needed to manage mental illness along the continuum, and determine the

gaps

A. Adults

(1) What is the criminal justice continuum?

(2) What are the mental health components that should be in place along this

continuum? (See the GAINS chart for some of the components that are

recommended or in place in other states.)

(3) What mental health components are already in place in Montana?

(4) What are the mental health gaps?

The "continuum" depicted on the GAINS chart is asfollows:

1. Law enforcement2. Initial detention and initial court hearings3. Jails/courts4. Reentry

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B. Youth

(1) What is the juvenile justice continuum?

(2) What are the mental health components that should be in place along this

continuum?

(3) What mental health components are already in place in Montana?

(4) What are the mental health gaps?

II. Study Task: Identify and analyze options

A. Adults

(1) What are the options for filling the identified gaps along the adult criminal

justice continuum?

(2) Which of the options should be implemented in Montana?

B. Youth

(1) What are the options for filling the identified gaps along the juvenile

justice continuum?

(2) Which of the options should be implemented in Montana?

III. Study Task: Develop a "big picture" blueprint and implementation plan as a tool for

legislators

A. Adults:

(1) When should each of the selected components needed to fill in the gaps

along the continuum be implemented (i.e., what are the priorities)?

(2) How should each recommended component be funded?

14 See Sheri Heffelfinger, Work Plan Proposal for the Law and Justice Interim Committee, July2007, which is accessible online from http://leg.mt.gov and by navigating to staff reports on the website forthe Law and Justice Interim Committee.

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B. Youth:

(1) When should each of the selected components needed to fill in the gaps

along the continuum be implemented (i.e., what are the priorities)?

(2) How should each recommended component be funded?

Overlap with SJR 24 and SJR 6

Some of the HJR 26 study tasks involve study of alternatives to incarceration for mentally ill

offenders. These tasks are also study tasks under the SJR 24 study of prison population

growth and diversion alternatives.

Some of the HJR 26 study tasks involve study of the juvenile justice system. These tasks are

component parts of the study tasks under the larger study of juvenile justice requested in

SJR 6.

Study Plan and Work Schedule

Staff anticipates that the LJIC will need to devote at least 25% of each meeting's agenda to the

HJR 26 study. Please refer to the work plan proposal for a detailed outline of how staff

proposes that the HJR 26 study tasks would be accomplished in conjunction with the LJIC's

other activities and studies this interim.14

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Strategic PlanCollaboration of DOC/DPHHS

December 1,2006

Introduction:The Departments of Corrections and Public Health and Human Services have embarked on acollaborative effort to bridge needed services for a very wlnerable and difficult to managepopulation. These large departments have identified that they lack a consistent treatmentstrategy and modality across their two systems for offenders with serious mental illness and/orco-occurring substance use disorders.

In July 2006, the two departments jointly hired the state's,first Behavioral Health ProgramFacilitator to act as a liaison between these two cultura departments. This position hasbeen created to assist the movement of offenders the Criminal justice, mental health andsubstance abuse treatment systems; facilitate the DOC and DPHHS. andto ensure the lasting, systemic change policymakbrs upon initialcooperative efforts, begin to collaborate and, ultimately;

Mission StatementsDepartment of CowectionsThe Montana Department of Corrections enhances public safety, positive change inoffender behavior, reintegrates offenders into the community and supports victims of crime.

Department of Public ServicesOur mission is to i the health, well-being, and self-reliance of all Montanans.

v6tonThe mission of the AddictiveDeparhnent of Public Health

Division (AMDD) of the MontanaServides is to implement and improve an appropriate

statewide systern of prevention, and rehabilitation for Montanans with mentaldisorders or addictions to drugs or

The Child and Family Services Division (CFSD) is a part of the Montana Department of PublicHealth and Human Services. Its mission is to keep Montana's children safe and families strong.

Points in Common

o IMPROVE - Rehabilitation/positive behavior change

o INCLUDE - All Montanans/Into the Community

o PROTECT - Keep Children Safe/enhance public safety/support victims

o PROGRESS - protect the health/self reliance/enhance/improve/prevent

ATTACHMENT B

Purpose:The failure of these systems to connect effectively endangers lives, wastes money, and threatenspublic safety - frustrating crime victims, consumers, family members and communities ingeneral. A shared and consistent treatment modality will support and enable diversion fromsecure correctional facilities and inpatient mental health facilities; and will provide linkages forappropriate aftercare services upon discharge.

Offenders with mental illness typically face these challenges:

1. They have psychiatric illnesses and substance abuse disorders that can helped by theprovision of appropriate treatment and rehabilitation servi are often not connectedwith community based health care service providers

2. They frequently lack basic life skills, such as the abiliing recovery from

aJ . They are commonly disconnected from family the community, forces that

motivate pro-social behavior and provide support when people'sinadequate.

4. They suffer the double-stigma oftraving a mental

relationships with others. Acquiring these skills ismental disorders.

and maintainesffiial

-ft

illness and being a criminal offender.

of Departments of Corrections have aith a mental illness also have a co-

Nationally, approxim ately 160/o of personsserious mental illness; and more thanT5o/ooccurring substance use disorder. The Corrections and Public Healthand Human Services recognize that they often ient base. This joint initiativeseeks to improve outcomes for these shared cli

Successful partnerships depend on relationships individuals. It is crucial, however, thatthe leaders of co ive efforts make an effort td institutionalizetheir partnership, ensuring itslongevity be tenure. To that end, the Department of Corrections and the

f Public Human Services have identified the following key areas to bert: Shared Planning, Shared Communications & Information,

Shared R and S t Methods.

Accomplishments to Date for the period July- Decernber. 2006

The two departments have completed the following:

o Hired a joint FTE - the Behavioral Health Program Facilitator (BHPF)

o Held more than l5 joint meetings with Directors of DOC & DPHHS; andlor DivisionAdministrators of Addictive & Mental Disorders Division (DPHHS), Health, Planning &Information Services (DOC); direct supervisors of Behavioral Health Program Facilitator

o Conducted planning and goal setting discussions for development of this strategic planfor the collaborative effort

r Created a joint program at Montana Chemical y Center (MCDC) to addressthe substance abuse treatment needs of ised on probation and at risk forrevocation to a secure correctional facility. of Understanding (MOU)

beds available were utilizedsigned by both Directors October 1 1,within the first month.

Developed a progrilm overview for STEP (Secure T & Examination Program);designed to serve as a secure treatrnent facility for indiand/or convicted of criminal offenses and sentenced to eiexamination, treatment , incarceration or custody. MOU signed by both departments on

Budget.

Begun planning haining curriculum for Probation and Parole Officers toaddress the with offenders who have a serious mentalillness and/or disorder.

o The Mental Health Oversight Council (subcommittee on Criminal Justice)created a list of for several state agencies. The recommendations forDOC were presented by Chairwoman Waterman to the Corrections Advisory CouncilSepternber 7,2006.

Worked on several individual cases for transition planning

DOC/l\4ontana State Prison (MSP) discharge planner joins Montana State HospitalAdmission, Discharge Review Team (ADRT) meetings & Community Program Officersof AMDD join MSP discharge planning meetings

Panel discussion on Corrections & Mental Health at the Conference on Mental Illnesswith Director Ferriter (DOC), Dr. Schaefer (MSP), Michelle Money, Brian Garrity &Deb Matteucci (BHPF)

have been chargedor DPHHS for

Guidine Principles

offenders with serious mental illness and/or co-occurring substance use disorders.

maximize their potential for living and functioning effectively in the community.

and drug use disorders are a priority.

mental health services.

Lone Term Goals of the Joint lnitiative

GOAL: Joint planning and evaluatiooccurs between the two departrnents

offenders with mental illness

v are se{rmless and wellGOAL: Transitions among progftrms and intointegrated with regard to mental disorder and treafrnent services.

GOAL: the two departrnents is clear, consistent and reachesto all and grams

GOAL: Process have been jointly defined, commissioned,collected and anal alua{ffi impact of services provided by thecollaborating agencies population.

SharedResources ;

GOAL: Programs for offenders with mental illness are designed to utilize sharedassets between the two departments and provide for efficient use of limited resources

GOAL: A formal inventory exists of all services available to the target population,including those outside the scope of the collaborative initiative. Partner agencieshave coordinated their response to gaps in service capacity and identifiedopportunities to guide the initiative with current services or supports

Shared Treatment Methods

GOAL: To create consistent, evidence based treatment methods across systemsbetween the Department of Corrections and the Department of Public Health andHuman Services

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[fi ENTAL HEATTH OVERSIGHT AE}VI$QRYc0uNclL

PARTNERS 'N PTANN'NG FOR A RECOVERY.BASED MENTAL HEALTH SYSIEMTHROUGHOUT MONTANA

Mignon Waterman,Chair

Barbara HoggVice-Chair

PO Box 202905Helena. MT 59620-2905

August 2T,2006

Joan MilesDirector, Department of Public Health and Human Services

Senator John CobbChairperson, Legislative Finance Committee

We, the members of the Mental Health Oversight and Advisory Council have beenstudying the criminal justice system as it pertains to the mental health care of people inMontana. The Council recentlyranked the criminal justice system as one of their topthree priorities. We have identified some disturbing trends, problems, and needs. Werealize that the criminal justice system has been put under significant stress by our currentsocietal problems and we believe that those who serve in this system are doing the bestthey can with limited resources.

We are also impressed and heartened by the high priority this administration, you andyour staff has placed on mental health. Please understand that the recotlmendations arenot meant as criticism of the outstanding public service those within your division andwithin the criminal justice systern provide. Rather, we present these recommendations aspart of our stafutory duty to o'review and advocate for persons with mental illness." Insome cases, we believe our recoflrmendations may prevent some individual from enteringthe criminal justice system.

We respectfully request that you make the appropriate administrators aware of theCouncil's concems and recommendations. The concerns are listed categorically underorganizations, associations, or individuals thatmay be able to respond.

L Department of Public Health and Human Services

1. The Council applauds Addictive and Mental Disorders Division's(AMDD) commitment to work with the Department of Corrections in thedevelopment of the Behavioral Health Program Facilitator position. Weunderstand that the position is designed to serve as a liaison between theDeparbnent of Public Health and Human Services and the Department of

ATTACHMENT C

Criminal Justice Task Force Recommendations 2006

Corrections. Furthermore, the Council is excited about the recent hiring ofDeb Matteucci as the Behavioral Health Program Facilitator. The Councilrecorlmends that this position be responsible for developing betterservices for seriously mentally ill individuals under the Departrnent ofCorrections, developing altemative placernent for non-violent offenderswho are seriously mentally ill, developing a pre-release center forseriously mentally ill offenders, and developing more community servicesfor the seriously mentally ill offender who is being released. The Councilrecommends that this position serve as the chairperson of the BuildingBridges committee.

The Council applauds AMDD and other department employees in thesupport of a Special Needs Offender Unit at Montana State Hospital. TheCouncil recommends that this Unit be developed quicklybased on theLegislature's directive to the Department of Corrections and appropriationof firnds. The Council recommends that the unit specifically serveseriously mentally ill individuals in the correctional system. The Councilrecommends adequate professional staffing patterns with a fullcommitment to treating those with serious mental illness.

The Council applauds the Department's consideration of a comprehensivestate wide crisis evaluation and stabilization system. The Councilrecommends that this system account for the needs for the seriouslymentally ill individual who is being investigated, apprehended, or detainedby law enforcement professionals. ln keeping with the Crisis InterventionTeam/Mernphis Model, the Council recommends that the crisis systeminclude regional facilities where teams could place seriously mentally illindividuals who have violated the law or created a disturbance. Theplacement would be a diversion from county jail with a focus onassessment and treatment of the mental illness. The Council alsorecommends that the crisis system include services to those in countyjails, which are often challenged to obtain adequate crisis interventionservices.

The Council has identified an increasing need to develop a system toidentifu seriously mentally ill offenders who are going to jail, are in jail, orare leaving jail. The Council recommends the development of an earlywarning system with the intention of providing for mental health treatrnentneeds, which may in tum prevent relapse and enhance recovery.

The Council recommends that the Montana State Hospital reconsider theappropriateness of transferring patients from the hospital to the prisonwhen they are perceived to have received the fullbenefit from thehospital's services. The Council is concerned about the detrimentalimpact of the prison environment andthe potential for relapse. TheCouncil recommends that hospital and prison administrators develop

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altemative placernents that protect the mental health of these patients,possibly in the soon to be developed Special Needs Offenders Unit.

II. Deparhnent of Corrections1 . The Council applauds the Department of Correction's commitment to

developing the Behavioral Health Program Facilitator position. Weunderstand that the position is designed to serve as a liaison between theDepartment of Public Health and Human Services and the Department ofCorrections. Furthermore, the Council is excited about the recent hiring ofDeb Matteucci as the Behavioral Health Program Facilitator. The Councilrecommends that this position be responsible for developing betterservices for seriously mentally ill individuals under the Department ofCorrections, developing altemative placement for non-violent offenderswho are seriously mortally ill, developing a pre-release center forseriously mentally ill offenders, and developing more communityservices for the seriously mentally ill offender who is being released. TheCouncil recommends that this position serve as the chairperson of theBuilding Bridges committee.

The Council applauds the Departrnent of Corrections' commitment todevelop a Special Needs Offender Unit at Montana State Hospital. TheCouncil recommends that this Unit be developed quickly based on theLegislature's directive and appropriation of funds. The Councilrecommends that the unit specifically serve seriously mentally illindividuals in the correctional system. The Council recommends adequateprofessional staffing pattems with a full commitrnent to treating those withserious mental illness. If the Unit cannot be placed on the Montana StateHospital campu$, we recommend that the Department quickly develop analternative site, possibly close to a city with professional resources.

The Council has identified a need to improve mental health staffingpatterns and services in all DOC facilities in order to meet the standards ofcare developed by the National Commission on Correctional Health Care.The Council recommends obtaining legislative approval to hire or contractfor more direct care mental health professionals at the Montana StatePrison, Montana Women's Prisons, and the regional prisons. The Councilrecommends improving the mental health staffing patterns at contractedprisons by developing contracts that specifically require minimal mentalhealth staffing pattems and services.

The Council supports the Department's application for the federal grantunder the Mentally Ill Offender Treatment and Crime Reduction Act. TheCouncil believes the focus of this initiative, and the money, may help theDepartment divert seriously mentally ill offenders from the prison system.

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The Council has identified a need for offenders with a serious mentalillness to be given the same opportunities as those without mental illnessto participate in a pre-release center. The Council recommends that theDepartrnent consider designating a certain number of beds in a pre-releasefor offenders with a serious mental illness. The Council recommends thatthis pre-release have the appropriate number of professional mental healthstaff to help meet these needs. It would also be beneficial to have a mentalhealth case manager assigned to these individuals. For personsaccepted into this placement, participation in communitymental healthprograms and reasonable accommodation regarding fulltime work shouldbe available.

The Council respectfully requests an annual report from the Department ofCorrection specifying the following:

Current populations by facilityCurrent mental health staffing by facility

-number and tlpes of professionals-number who are licensed

Current caseload of seriously mentally ill offenders by facility-total number-number in each major diagnostic category-number on psychotropic medicine-number on which major categories of psychotropicmedicine

Current types of mental health treatment available by facilityNumber of suicides in the prior year by facilityNumber of mental health related lawsuits in the prior year.A course description and outline of the mental health trainingprovided to correctional and support staff by facility.Current health care or correctional organization/associationcertifications.

i. Detailed plan to improve the mental health services provided tooffenders in the next year.

The Council is aware that the Department of Corrections serves apopulation with a high rate of both mental illness and chemicaldependency. The Council invites the Department of Corrections to jointhe Department of Public Health and Human Services in adopting co-occurring model of care. Department of Corrections staff members areeligible for training offered by the Department of Health and HumanServices.

The Council recommends that the Department of Corrections develop aspecialized pre-service and in-service training program for correctional,parole, and probation officers who supervise seriously mentally illoffenders in institutions or in the communitv.

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9. The Council recommends that the Department of Corrections attempt tocollaborate more with the county jails in order to obtain crucial mentalhealth care information, identiff o'at-risk" individuals, and coordinatecontinuity of mental health care.

10. The Council recommends that the Department of Corrections considermethods for managing offenders who need to be segregated in a mannerthat will reduce the probability of mental health problems. A recent reportcompleted by prison monitoring expert Dr. Harr offers some helpfulsuggestions.

Chief Law Enforcement OfficeMontana Law Enforcernent Academy

l. The Council has identified a significant need for improvement in thetraining of police, detention, and correctional officers in the identificationand appropriate management of persons with serious mental illness. TheCouncil recommends initial and comprehensive training at the MLEA aswell as on-going in-service training. The Council would like theopportunity to review the training curriculum and offer suggestions.

2. The Council recommends that Montana develop Crisis Intervention Teams(CIT) based on the Memphis model in order to more appropriatelyrespond to persons with serious mental illness who have disturbed thepeace or violated the law. This model focuses on developing teams madeup of mental health crisis workers and police officers, designed to reducethe risk to officers as well as the individual being apprehended. AMDD,NAMI-Helena, and the Board of Crime Control have funded and led twotraining sessions at the Montana Law Enforcement Academy.

Attorney General's OfficeCounty Attorney OfficesPublic Defender's Office

l. The Council acknowledges the research that has identified a disturbingtrend towards the criminalizationof individuals with mental illness whohave violated the law. The Council recommends that individuals withmental illness be diverted from incarceration into treatment. Federal grantmoney may assist with this goal (Mentally Ill Offender Treatment andCrime Reduction Act).

2. The Council recommends a systematic haining program designed toimprove awareness and identification of serious mental illness in thosebeing charged with legal offenses. The Council recommends offering thistraining to county sheriffs, county attorneys, judges, public defenders, and

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others with a need to know this information in order to consideralternatives to incarceration.

3. The Council recommends that Montana establish more treatment courts.These treatment courts can develop plans that protect the public while alsoproviding co-occurring treatment to the offender. The Councilrecommends consideration of community based services and sentencesthat promote recovery from co-occurring disorders.

V. Sheriffs and Peace Officers AssociationMontana Association of CountiesCounty Jail Administrators

l. The Council is concerned about the increasing number of seriouslymentally ill individuals being incarcerated in county jails. The Councilrecommends the pursuit of funding in order to hire professional mentalhealth staff to address the needs of this population. The Council isparticularly concerned with meeting the standards of care for jails asdetermined by the National Commission on Correctional Health Care.These standards call for routine mental health services, not just crisisservices. Routine screening, assessment, and treatment are essentialservices for those in county jail. The Council is particularly concernedwith the high suicide rate in county jails and recommends that each jailhave a comprehensive suicide prevention program based on NCCHCstandards. The National Institute of Corrections and National Associationon Mental Illness may help provide educational and financial resourcestowards these goals.

2. The Council recommends that each county jail have a program to increasethe awareness of serious mental illness among detainees. This shouldinclude specific training in the identification of signs of mental illness andsuicide risk.

3. The Council is concerned about the practices of those prescribingpsychohopic medicines to individuals in county jails, where the potentialfor abuse of medicine is high, and the call for "chemical restraints" mayseem attractive. The Council recofilmends that those who prescribepsychotropic medicine in countyjails be required to attend $ainingprovided Dr. Ken Minkoffor a similarly qualified professional. Thistraining has been sponsored by the Department of Public Health andHuman Services and is designed to enhance sensitivity to co-occurringdisorders and promote recovery for those with mental health and substanceabuse problerns.

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Governor's Office

1. The Council recommends that you consider amending the me,ntal healthcode so that the Mental Disabilities Board of Visitor's "powers andduties" include the responsibility and authority to review the treatrnent ofpeople with mental illnesses who are inmates in state correctionalfacilities. The Council would encourage additional staff to provide thisadditional oversight.

Our Council stands ready to discuss these recommendations or to assist anyone inimplementing them. Thank you for your consideration.

Respectfully,

Mignon WatermanChairpersonMental Health Oversight and Advisory Council

C: Anna Whiting-Sonel

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