naco webinarnaco webinar · probation & parole m unity com adult pa dept corrections n...
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NACo WebinarNACo Webinar
Henry J. Steadman, Ph.D.April 29, 2010
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• 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
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I 2005 th 14 illi b kiIn 2005, there were 14 million bookings into U.S. jails.
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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.
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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
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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
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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
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Repeated Cycles
INCARCERATION
ARRESTM t l
PrivateHome
MentalHealth
Inpatient
GroupResidence
S.A.Residential
ShelterStreet
Treatment
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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
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Diversion = avoiding or radically reducing jail time by using community-j y g ybased treatment as an alternative.
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“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
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Public’s Expectations
R d idi i
Public’s Expectations
Reduce recidivism
DiversionReduce violence
Reduce jail days
Reduce costs
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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
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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
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Intercept 1Law
Intercept 2 Intercept 3 Intercept 4 Intercept 5Law enforcement
Initial detention / Initial court hearings
Jails / Courts
urt
Reentry Community corrections
Violation
ITY
911
ent
ion Cou
rt
Spec
ialty
Co
rt
Pris
on/
Ree
ntry
Paro
le
COC
OM
MU
NI
w E
nfor
cem
e
nitia
l Det
enti
App
eara
nce
Arrest
S
sitio
nal C
ou
y
OM
MU
NITY
n
Violation
C
Law In
Firs
t A
Jail
Dis
pos
Jail
Re-
entr
y Y
Prob
atio
n
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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
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MappingMapping
• Group processGroup process
• All relevant playersy
• Create a picture
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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
M
Adult
PA D
ept
Cor
rect
ions
nfor
cem
ent
emen
t jur
isdi
ctio
ns
entio
n C
entr
al H
oldi
ng
gnm
ent
t Jud
ges
Courts
County Wide
Communications
911
Violation
earin
g
To Family
CO
MM
MM
UN
ITY
AdultProbation &
Parole Special
Offender Unit
Pre-Parole Unit
Law
En
30 la
w e
nfor
ce
Initi
al D
ete
Loca
l Hol
ding
Cel
ls o
r C
Prel
imin
ary
Arr
ai 2
0 M
agis
teria
l Dis
tric
t
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
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Gaps/NeedsGaps/Needs
• What is already in place?What is already in place?
• “Frequent flyers”y
• Politically viable
• Biggest community impact
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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
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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
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To download a copy, please visit
www.gainscenter.samhsa.gov
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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
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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.