reducing the involvement of persons with mental illness & co-occurring disorders in the criminal...
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Reducing the Involvement of Persons With Mental Illness & Co-Occurring
Disorders in the Criminal Justice System Through Jail Diversion Programs
Henry J. Steadman, Ph.D.
Saks Institute Spring Symposium
April 11, 2013
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On June 30, 2005, approximately 7 million people were under correctional supervision in the U.S.
Jail: 747,529
Prison: 1,446,269
Probation: 4,162,536
Parole: 784,408
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In 2005, there were 13 million bookings into U.S. jails.
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PRA/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%Women – 31%
Steadman, H.J., Osher, F., Robbins, P., 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 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 Disorders
Males Females
Disorder Alcohol Abuse/ Dependence
Drug Abuse/ Dependence
Alcohol Abuse/ Dependence
Drug Abuse/ Dependence
Schizophrenia 59% 42% 56% 60%
Major Depression 56% 26% 37% 57%
Mania 33% 24% 39% 64%
Any Severe Disorder
58% 33% 40% 60%
Detainees with severe mental disorder plus either alcohol or drug abuse/dependence
= 72% = 72%
Adapted 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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CMHS TCE JD: 14 Sites Traumatic Experiences (n=546)
Lifetime Past 12 Months
F M F M
Physical 93.2% 89.8% 67.4% 58.6%
Sexual 77.1% 34.7% 32.1% 27.5%
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Repeated Cycles
INCARCERATION
ARREST
PrivateHome
GroupResidence
ShelterStreet
S.A.ResidentialTreatment
MentalHealthInpatient
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“Treatment-Resistant” Clients
OR
“Client-Resistant” Services
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CO
MM
UN
ITY
Intercept 1Law enforcement
911
Law
En
forc
eme
nt
Intercept 2Initial detention / Initial court hearings
Init
ial
Det
enti
on
Fir
st A
pp
eara
nc
e C
ou
rtArrest
Intercept 3Jails / Courts
Jail
Sp
ecia
lty
Co
urt
Dis
po
siti
on
al
Co
urt
Intercept 4Reentry
Pri
son
/R
een
try
Jail
R
e-en
try
Par
ole C
OM
MU
NIT
Y
Intercept 5Community corrections
Pro
bat
ion
Violation
Violation
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Diversion = avoiding or radically reducing jail time by using community-based treatment as an alternative.
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“Diversion”
Criminal Justice → Not filing or dropping charges (ATI)
Mental Health → Not filingCondition of bailDeferred prosecution
(stipulate to police report)Deferred sentencingCondition of probation
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Diversion
Reduce recidivism
Reduce violence
Reduce jail days
Reduce costs
Public’s Expectations
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Diversion Logic Model
Identify and Enroll People in Target Group
Linkage Comprehensive/ Appropriate Community-Based Services
Improved Mental Health /Individual Outcomes
Improved Public Safety Outcomes
Stage 1 Stage 2
Diversion
Stage 3
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Mental Health Diversion Options
Pre-Booking
– Police-Based
Post-Booking
– Court-Based
– Jail-Based
– Community Corrections-Based
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Dispositions of Cases Handled by Three Types of Police Response at Three Sites
Disposition Birmingham (N=100)
Knoxville (N=100)
Memphis (N=100)
Taken to treatment location 20 42 75
Situation resolved on the scene
64 17 23
Referred to treatment 3 36 0
Arrested 13 5 2
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Las Vegas CIT Call Resolution*
485 (74%) Hospitalization
344 (71%) Involuntary
25 (18%) Onsite resolution
6 (4%) Arrest
* Skeem, J., Bibeau, L. (2008). How does violence potential relate to crisis intervention team responses to emergencies? Psychiatric Services 59, 201-204.
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CO
MM
UN
ITY
Intercept 1Law enforcement
911
Law
En
forc
eme
nt
Intercept 2Initial detention / Initial court hearings
Init
ial
Det
enti
on
Fir
st A
pp
eara
nc
e C
ou
rtArrest
Intercept 3Jails / Courts
Jail
Sp
ecia
lty
Co
urt
Dis
po
siti
on
al
Co
urt
Intercept 4Reentry
Pri
son
/R
een
try
Jail
R
e-en
try
Par
ole C
OM
MU
NIT
Y
Intercept 5Community corrections
Pro
bat
ion
Violation
Violation
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Rikers Island 2008 Bail Statistics(N=48,000)
No Mental Illness
Mental Illness
Make Bail 21% 12%
Days to Make Bail 9 48
Council of State Governments March, 2013
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Rikers Island Average 2008 Length of Stay*(N=48,000)
Council of State Governments March, 2013
No Identified Mental Illness – 61 Days
Identified Mental Illness – 112 Days
* of detainees staying > 3 days
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CO
MM
UN
ITY
Intercept 1Law enforcement
911
Law
En
forc
eme
nt
Intercept 2Initial detention / Initial court hearings
Init
ial
Det
enti
on
Fir
st A
pp
eara
nc
e C
ou
rtArrest
Intercept 3Jails / Courts
Jail
Sp
ecia
lty
Co
urt
Dis
po
siti
on
al
Co
urt
Intercept 4Reentry
Pri
son
/R
een
try
Jail
R
e-en
try
Par
ole C
OM
MU
NIT
Y
Intercept 5Community corrections
Pro
bat
ion
Violation
Violation
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Nathaniel Project (NYC) N=53
Prior Year Current Year
Number of Arrests
101 7
Misd. 35 5
Felonies 66 2
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SAMHSA KDA (N=1,185)
Diverted Non-Diverted
Community days 303 245
# Arrests 1.03 1.20
Arrests/mo. .11 .15
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CMHS TCE JD: 14 SitesChanges in Arrests and Jail Days
Pre-Enrollment(1 year)
Post-Enrollment(1 year)
n % n %
Any Arrests 579 100.0 293 50.6
Arrests (Mean) 2.3 1.0
Violent Arrests (Mean) .23 .1
Jail Days (Mean) 49 33
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Annualized Number of Arrests – 3 MHCs
Pre 18 Months
Post 18 Months
% Reduction
MHC Mean(N)
2.2(436)
1.4(436)
37%
TAU Mean(N)
2.6(597)
2.0(586)
23%
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Total Incarceration Days Pre and Post 18 Months – 3 MHCs
MHCNEW Pre 18 Months
Post 18 Months
% Increase
MHC Mean(N)
75(436)
84(436)
12%
TAU Mean(N)
75(597)
152(597)
101%
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Diversion Logic Model
Identify and Enroll People in Target Group
Linkage Comprehensive/ Appropriate Community-Based Services
Improved Mental Health /Individual Outcomes
Improved Public Safety Outcomes
Stage 1 Stage 2
Diversion
Stage 3
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Drug & Alcohol Use
Number Cases
Reporting Use
Percent of Cases
Reporting Use
Mean Number
of Days of Use
Median Number
of Days of Use
Any alcohol -Last 30 Days
Baseline 576 59.1% 13.1 8
6 Months 169 28.4% 5.8 3
12 Months 105 30.1% 6.6 3
Alcohol to Intoxication -Last 30 Days
Baseline 372 38.2% 12.9 8
6 Months 76 12.8% 5.2 2
12 Months 45 12.9% 7.3 4
Illegal drugs - Last 30 Days
Baseline 568 58.3% 17.8 20
6 Months 101 17.0% 9.5 5
12 Months 55 15.7% 10.0 5
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Daily Living/Role Functioning Scale
NMean Score
(Range: 0 to 4)1
Mean Difference From Baseline 2
Baseline 977 2.01 --
6 Months 594 1.31 -0.70
12 Months 349 1.17 -0.84
1 – Where 0 = No Difficulty and 4 = Extreme Difficulty2 – Calculations based on those individuals having both interviews completed
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Colorado Symptom Index (CSI)
NMean Score
(Range: 0 to 60)1
Mean Difference From Baseline 2
Baseline 968 31.5 --
6 Months 590 22.3 -9.2
12 Months 346 21.4 -10.1
1 – Where 0 = Low Symptoms/High Well-Being and 60 = High Symptom/Low Well-Being2 – Calculations based on those individuals having both interviews completed
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Year-by-Year CJ Cost
1 2 3 4 5 60
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
MHC TAU
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Year-by-Year Tx Cost
1 2 3 4 5 60
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
MHC TAU
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Year-by-Year Total Cost
1 2 3 4 5 60
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
MHC TAU
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Is Criminalization An Important Public Policy Concept?
Macro View Transinstitutionalization
% Detainees with MI Different
Micro View Individual more likely in jail than in community-
based treatment
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Reduce Involvement
Minimize Inappropriate Penetration
More Useful Concepts