mental health court project
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The Circuit Court of Cook County Honorable Timothy Evans, Chief Judge Honorable Paul Biebel, Presiding Judge, Criminal Division. Mental Health Court Project. The United States is the world leader in incarceration, with a higher proportion of its population behind bars than any other country. - PowerPoint PPT PresentationTRANSCRIPT
The Circuit Court The Circuit Court of Cook Countyof Cook County
Honorable Timothy Evans, Chief JudgeHonorable Timothy Evans, Chief JudgeHonorable Paul Biebel, Presiding Judge, Criminal DivisionHonorable Paul Biebel, Presiding Judge, Criminal Division
Mental Health Court ProjectMental Health Court Project
The United States is the world leader The United States is the world leader in incarceration, with a higher proportion in incarceration, with a higher proportion of its population behind bars than any of its population behind bars than any other country.other country.
5% of world’s population – 25% of world’s jail population5% of world’s population – 25% of world’s jail population
The nation’s prisons and jails held more The nation’s prisons and jails held more than than 2 million2 million inmates for the first time on inmates for the first time on June 30, 2002 (Bureau of Justice). June 30, 2002 (Bureau of Justice).
By the end of 2004, that number reached
2.14 million.
By the end of 2004, that number reached
2.14 million.
~ 7 million people were on probation, ~ 7 million people were on probation, in jail or prison, or on parole in jail or prison, or on parole
~ 3.2% of all U.S. adult residents or ~ 3.2% of all U.S. adult residents or 1 in every 31 adults1 in every 31 adults
(Retrieved 02/17/2006 from: http://www.ojp.usdoj.gov/bjs/correct.htm)
The Mentally Ill IncarceratedThe Mentally Ill Incarcerated
~ 10 million people enter ~ 10 million people enter 3,365 county jails each year3,365 county jails each year
~ 6-15% of these jail ~ 6-15% of these jail detainees suffer from detainees suffer from serious mental illnesses serious mental illnesses compared to the ~ 2%-5% of compared to the ~ 2%-5% of the US population that have the US population that have a serious MIa serious MI
Jails Become Mental InstitutionsJails Become Mental Institutions Daily, ~ 200,000 people behind bars, Daily, ~ 200,000 people behind bars, or more than 1 in 10 inmates, suffer or more than 1 in 10 inmates, suffer from:from: schizophreniaschizophrenia bipolar disorderbipolar disorder major depression major depression
70% of MI population are nonviolent 70% of MI population are nonviolent offendersoffenders
Nearly 90% of inmates with MI have aNearly 90% of inmates with MI have aco-occurring substance abuse problem co-occurring substance abuse problem
(Abram KM, Teplin LA, 1991)(Abram KM, Teplin LA, 1991)
Jails Have Become the Mental Hospitals and Jails Have Become the Mental Hospitals and Social Service Systems of Last ResortSocial Service Systems of Last Resort
Cermak’s Mental Health Services is the Cermak’s Mental Health Services is the largest provider of psychiatric largest provider of psychiatric services in the State of Illinois.services in the State of Illinois.
The Cook County Jail is now, in effect, the largest The Cook County Jail is now, in effect, the largest mental hospital in Illinois. There are more people with mental hospital in Illinois. There are more people with mental illness in our state prisons than in all our public mental illness in our state prisons than in all our public
and private psychiatric institutions combined.and private psychiatric institutions combined.
60’s – 60’s – deinstitutionalizadeinstitutionalizationtion
70’s – increase in 70’s – increase in homeless homeless populationspopulations
80’s – “War 80’s – “War Against Drugs”Against Drugs”
Jails Have a Constitutional Jails Have a Constitutional Duty to Provide Duty to Provide Mental Health TreatmentMental Health Treatment
88thth Amendment – prohibits Amendment – prohibits “Cruel and Unusual “Cruel and Unusual Punishment”Punishment”
1414thth Amendment – for pretrial Amendment – for pretrial detainees and juveniles “Due detainees and juveniles “Due Process”Process”
Since 1990’s Over 100 Courts Since 1990’s Over 100 Courts Nationally Have Been DevelopedNationally Have Been Developed
Most are adult criminal courtsMost are adult criminal courts Have a separate docket dedicated to Have a separate docket dedicated to persons with mental illnessespersons with mental illnesses
Divert criminal defendants from Divert criminal defendants from jail into treatment programsjail into treatment programs
Some courts monitor the defendants Some courts monitor the defendants during treatment and have the during treatment and have the ability to impose criminal ability to impose criminal sanctions for failure to complysanctions for failure to comply
Three Basic Critical ProblemsThree Basic Critical Problems
The public safety risk posed The public safety risk posed by the mentally ill offendersby the mentally ill offenders
The difficulties associated The difficulties associated with housing the mentally ill with housing the mentally ill in local jailsin local jails
The inadequacy of the criminal The inadequacy of the criminal justice process in dealing justice process in dealing with the mentally ill with the mentally ill defendants in all mattersdefendants in all matters
The Cook County Model The Cook County Model Target population:Target population:
All voluntary admission to programAll voluntary admission to program Works exclusively with MI felony Works exclusively with MI felony offendersoffenders
24 month probation24 month probation Four phases of treatment, including a Four phases of treatment, including a discharge transition phase (six discharge transition phase (six months) months)
State of Illinois Division of Mental State of Illinois Division of Mental Health open casesHealth open cases
Generally non-violent, non-sex Generally non-violent, non-sex offendersoffenders
Economically disadvantagedEconomically disadvantaged Co-occurring substance use disorderCo-occurring substance use disorder
Unique Program FeaturesUnique Program Features Primary Focus: Primary Focus: Community Case ManagementCommunity Case Management Crisis Intervention Team (CIT) – Chicago Crisis Intervention Team (CIT) – Chicago Police DepartmentPolice Department
Clinical Emphasis-Multidisciplinary Team Clinical Emphasis-Multidisciplinary Team Sanctions-based system that keeps the Sanctions-based system that keeps the mentally ill offender (MIO) out of mentally ill offender (MIO) out of jail/prison and in community servicesjail/prison and in community services
Open state mental health cases: services Open state mental health cases: services are paid through Medicaid and SAMHSA are paid through Medicaid and SAMHSA grantsgrants
Focus on high-risk clients: all felony Focus on high-risk clients: all felony probationers with extensive criminal probationers with extensive criminal justice and mental health backgrounds justice and mental health backgrounds
System-wide Collaboration of State System-wide Collaboration of State and Countyand County (2001-The Process Begins)(2001-The Process Begins)
Cook County Criminal Justice SystemCook County Criminal Justice System LeadershipLeadership
Chief Judge Timothy EvansChief Judge Timothy Evans Presiding Judge Paul BiebelPresiding Judge Paul Biebel Lead Judges – Judge Jay Crane and Judge Thomas Lead Judges – Judge Jay Crane and Judge Thomas V. Gainer, Jr.V. Gainer, Jr.
Adult Mental Health Probation UnitAdult Mental Health Probation Unit Cook County State’s Attorney OfficeCook County State’s Attorney Office Cook County Public Defender’s OfficeCook County Public Defender’s Office
System-wide Collaboration of State System-wide Collaboration of State and Countyand County (2001-The Process Begins)(2001-The Process Begins)
Cermak Health Services of Cook Cermak Health Services of Cook County-Department of Mental Health County-Department of Mental Health Services Services
TASCTASC Illinois Department Human Services, Illinois Department Human Services, Divisions of Mental Health and Divisions of Mental Health and Alcohol Alcohol and Substance Abuse and Substance Abuse
Chicago Police Department – Chicago Police Department – Crisis Intervention TeamsCrisis Intervention Teams
Community Service ProvidersCommunity Service Providers
Chicago PoliceChicago PoliceCrisis Intervention TeamCrisis Intervention Team Voluntary program of specially trained Voluntary program of specially trained officersofficers
Mental health crisis responseMental health crisis response Coordinated tactical responseCoordinated tactical response Collaborative trainingCollaborative training Linkage to the mental health service systemLinkage to the mental health service system
TrainingTraining
40 hour State Certification 40 hour State Certification coursecourse
Mental Health Court trainingMental Health Court training Office of Emergency Communication Office of Emergency Communication call taker trainingcall taker training
Mental Health Service System Mental Health Service System trainingtraining
Focus groupsFocus groups
Chicago PoliceChicago PoliceCrisis Intervention TeamCrisis Intervention TeamProgram goals:Program goals: Enhance outcomesEnhance outcomes Officer safetyOfficer safety De-escalationDe-escalation DiversionDiversion Crisis preventionCrisis prevention
Chicago PoliceChicago PoliceCrisis Intervention TeamCrisis Intervention TeamProgram goals:Program goals:
Identify mental health callsIdentify mental health calls Quantify mental health callsQuantify mental health calls Identify best practice methodsIdentify best practice methods
The Beginning ProcessThe Beginning Process(What we thought the reality was)(What we thought the reality was)
Ongoing evaluationOngoing evaluation Program modifications Program modifications ExpansionExpansion
TimelineTimeline
April 5, 2004 – screening process beganApril 5, 2004 – screening process began May 12, 2004 – first cases admittedMay 12, 2004 – first cases admitted October, 2005 – program funding: SAMHSA October, 2005 – program funding: SAMHSA jail diversion grant for program jail diversion grant for program expansion & increased community expansion & increased community programmingprogramming
May 25, 2006 – first graduationMay 25, 2006 – first graduation Six semi-annual graduations to date; Six semi-annual graduations to date; 11/13/08 to have the most graduates to 11/13/08 to have the most graduates to date (18), bringing total of successful date (18), bringing total of successful graduates to 43graduates to 43
The Process as of NowThe Process as of Now(What we are finding reality to be)(What we are finding reality to be)
The program individuals have:The program individuals have: Much more extensive criminal Much more extensive criminal backgroundsbackgrounds(compared to a 9 year review of Cook (compared to a 9 year review of Cook County drug court participants)County drug court participants)
Much more extensive psychiatric Much more extensive psychiatric histories (including major Axis II histories (including major Axis II Personality Disorders)Personality Disorders)
Few, if any, community resources with Few, if any, community resources with adequate funding to service the level adequate funding to service the level of of care neededcare needed
Stabilization became a priority prior to Stabilization became a priority prior to being released from the jailbeing released from the jail
Most identified individuals have had long Most identified individuals have had long histories with addiction/dependency issueshistories with addiction/dependency issues
Housing needs became essential, leading to Housing needs became essential, leading to
a collaboration with the Chicago a collaboration with the Chicago Department Department of Housingof Housing
Many individuals have minimal, if any, Many individuals have minimal, if any, benefits in placebenefits in place
The Process as of NowThe Process as of Now(What we are finding reality to be)(What we are finding reality to be)
Criminal Justice History of Program Criminal Justice History of Program Participants at Admission Participants at Admission
0
5
10
15
20
25
30
35
Average TotalArrests
Average FelonyArrests
Average TotalConvictions
Average FelonyConvictions
AveragePrison/Probation
(Years)
Males
Females
Total
Program ImpactProgram Impact
Decreased criminal activityDecreased criminal activity Decreased hospitalizationsDecreased hospitalizations Decreased incarceration Decreased incarceration Decreased county cost Decreased county cost expendituresexpenditures
Improved quality of lifeImproved quality of life
Reduction of Criminal Activity Reduction of Criminal Activity While in ProgramWhile in Program
0
10
20
30
40
50
60
70
80
90
100
% never held incustody
% no newarrests
% no newfelony arrests
% no newconvictions
% no newfelony
convictions
Criminal Activity Criminal Activity Pre- and Post-AdmissionPre- and Post-Admission
0
0.5
1
1.5
2
2.5
3
3.5
Average arrests 1year prior toadmission
Averageconvictions 1 yearprior to admission
Average arrests 1year afteradmission
Averageconvictions 1 yearafter admission
Males
Females
Total
In Custody Days and CostsIn Custody Days and Costs
0
20
40
60
80
100
120
140
Average dayscustody yearprior to adm
Average totaldays custody
year afteradm
Average dayscustody yearafter adm,following anew arrest
$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
$16,000
Average jailcosts year
prior to adm
Average totaljail costsyear after
adm
Average jailcosts yearafter adm,following anew arrest
Average Days in Custody Average Jail Costs
Cook County, IllinoisCook County, IllinoisMental Health Court (MHC) ReportMental Health Court (MHC) Report
April 4, 2004 – November 1, 2008April 4, 2004 – November 1, 2008
Cook County MHC ReportCook County MHC Report Referrals – 281 Referrals – 281
– Sources of Referral:Sources of Referral: Cermak Health Services - 178 Cermak Health Services - 178 Other – 103Other – 103
Active clients – 78 (of 159 total Active clients – 78 (of 159 total admissions) admissions) – 37 Females 37 Females – 41 Males– 41 Males
Pending cases – 8 Pending cases – 8 – 4 Female 4 Female – 4 Male– 4 Male
Other dispositions – 114 Other dispositions – 114
Current ChargesCurrent Charges
(reflect multiple charges against some participants)(reflect multiple charges against some participants) Prostitution – 1 Prostitution – 1 Possession of a controlled substance Possession of a controlled substance (PCS) – 62(PCS) – 62
Retail theft – 24 Retail theft – 24 Theft/labor or service – 4 Theft/labor or service – 4 Aggravated battery – 3 Aggravated battery – 3 Burglary – 7 Burglary – 7 Unlawful use of a weapon – 1 Unlawful use of a weapon – 1 Criminal damage to property > $300 – 1 Criminal damage to property > $300 – 1
Data on Clients Admitted to Data on Clients Admitted to Cook County MHCCook County MHC
Age range of female clients: 24 Age range of female clients: 24 - 60- 60
Average age of female client: Average age of female client: 39.039.0
Age range of male clients: 20 – Age range of male clients: 20 – 5656
Average age of male client: Average age of male client: 38.738.7
Data on Clients Admitted to Data on Clients Admitted to Cook County MHCCook County MHC VOP’s – 191 VOP’s – 191
– Filed against 106 clientsFiled against 106 clients Probation terminated unsuccessful (PTU) Probation terminated unsuccessful (PTU) – 7 – 7
New arrests – 123 New arrests – 123 – 75 misdemeanors, 48 felonies 75 misdemeanors, 48 felonies – Filed against 23 participantsFiled against 23 participants
Clients with no new arrest – 60%Clients with no new arrest – 60% Active clients terminated from program – Active clients terminated from program – 8181
Successful Graduates (PTS), as of Successful Graduates (PTS), as of 11/13/08 - 43 11/13/08 - 43
Active Warrant Status – 10 Active Warrant Status – 10 Cook County Department of Corrections – Cook County Department of Corrections – 1010
Death of client - 2 Death of client - 2
Mental and Health Issues Mental and Health Issues Affecting ClientsAffecting Clients (many participants with (many participants with more than one diagnosis)more than one diagnosis)
Schizophrenia – 18 Schizophrenia – 18 Schizoaffective Schizoaffective Disorder – 17Disorder – 17
Bipolar Disorder – 28 Bipolar Disorder – 28 Major Depression – 25 Major Depression – 25 Dysthymia – 1 Dysthymia – 1 Psychotic Disorder Psychotic Disorder NOS – 6 NOS – 6
Substance Abuse Substance Abuse Disorders – 74 Disorders – 74
Mood Disorder NOS - 6Mood Disorder NOS - 6
Impulse/Explosive Impulse/Explosive Disorder – 2 Disorder – 2
Post-traumatic Post-traumatic Stress Syndrome – Stress Syndrome – 64 64
Anti-social Anti-social Personality Personality Disorder – 0 Disorder – 0
HIV+ – 1 HIV+ – 1 Developmentally Developmentally Delayed – 2 Delayed – 2
Hepatitis C – 4Hepatitis C – 4 Pancreatitus - 1 Pancreatitus - 1
Types of Facilities Currently in UseTypes of Facilities Currently in Use
Residential treatment facility – 67Residential treatment facility – 67 Psychosocial rehabilitation (PSR) day program – 16 Psychosocial rehabilitation (PSR) day program – 16 Nursing home – 10 Nursing home – 10 Inpatient psychiatric unit – 1 Inpatient psychiatric unit – 1 Receiving ACT services – 29 Receiving ACT services – 29 Employed – 3 Employed – 3 Substance abuse treatment groups only – 0 Substance abuse treatment groups only – 0 Recovery/halfway house – 17 Recovery/halfway house – 17 Individual housing (alone or with family) – 29Individual housing (alone or with family) – 29 Enrolled in educational program – 3 Enrolled in educational program – 3 Enrolled in methadone/suboxone treatment - 2Enrolled in methadone/suboxone treatment - 2
Vignette of Male Client from Vignette of Male Client from Cook County Mental Health CourtCook County Mental Health Court
Family backgroundFamily background HistoryHistory Circumstances at time of arrestCircumstances at time of arrest Arrest and mental health court Arrest and mental health court referralreferral
Mental health court outcomesMental health court outcomes