Reducing Justice Involvement For People with Mental Illness

Carol Schubert & Amanda Cross

Criminal Justice Advisory Board Conference

October 30, 2013

What we’ll cover today

• Some background regarding justice-involved individuals with mental illness

• What is the PA Mental Health and Justice Center of Excellence?

• Describe our primary functions

• Discuss ways the COE may be of use to you

2

The Context • Adult correctional authorities supervise

nearly 7 million individuals

– Equivalent to 2.9% (1 in 34) adults living the US

3 (Bureau of Justice Statistics, Correctional population in the US, 2011)

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10

57

12

0

10

20

30

40

50

60

Prison Jail Probation Parole

Perc

ent

High rate of mental health disorders among individuals in the CJ system

• 60 - 80% of adults in the CJ system have a substance use problem – Much higher than the general population

• 27% of prison population diagnosed with a mental illness*

• 15% of men and 31% of women in jail settings have a serious mental illness – Rates are 3 – 6 times higher than the general

population

• 70% have both (co-occurring/co-morbid)

4 SAMHSA (2011); Vera Institute, 2013, *Correction Compendium, Summer 2011

“The current situation not only exacts a significant toll on the

lives of people with mental illness, their families, and the community in general, it also threatens to overwhelm the

criminal justice system.”

5 Council of State Governments Criminal Justice/Mental Health Consensus Project, 2002

The Problem

• Often there as the result of nonviolent minor crimes, which are sometimes a consequence of their untreated behavioral disorder.

• Left untreated, co-occurring mental and substance use disorders that can influence and aggravate each other (James and Glaze, 2006)

6

The Problem

• Puts a tremendous strain on scarce public resources and has a huge impact on health care and criminal justice budgets

• Prison/jail environment can aggravate mental health symptoms (e.g. isolation)

• Individuals with mental illness are often detained longer or more likely to “max out”

• Those on probation/parole with MI are at double the risk of failing supervision and more likely to fail due to technical violations (Vidal et al, 2009; Porporino & Motiuk, 1995)

7

Misconceptions Complicate the Issue

• Mental illness is the cause of offending

“If these individuals received

treatment, it would reduce

recidivism”

It’s not that simple

Multiple risk factors for offending and mental illness and they overlap

8

The Problem of Shared Risk

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Low socio-economic status Problematic use of substances

Limited social networks Poor family relationships/abuse

Personal distress/poor coping skills Temperament/misconduct/personality

Mental Illness - Offending - Or Both

Risk Factors Related to Recidivism Central Eight Risk Factors

1. History of Antisocial Behavior

2. Antisocial Personality Pattern

3. Antisocial Cognitions

4. Antisocial Associates

“Big Four” Risk Factors

Most highly correlated with criminal behavior among all other factors

Andrews, Bonta & Wormith, 2006

Central Eight Risk Factors

1. History of Antisocial Behavior

2. Antisocial Personality Pattern

3. Antisocial Cognitions

4. Antisocial Associates

5. Family / Marital Factors

6. School and/or Work

7. Leisure and/or Recreation

8. Substance Abuse

The Role of Mental Illness in Recidivism

• Mental illness (exclusive of SU) is modestly related to recidivism (Bonta, Law &

Hanson, 1998)

• Arrest is rarely a direct product of mental illness, even for mentally ill (Junginger, Claypoole, Laygo & Cristina, 2006)

12

The Role of Mental Illness in Recidivism

• Treating the MI does not necessarily lead to reduced recidivism – particularly in the absence of SU

13

“People involved in the justice system have many needs

deserving treatment, but not all of these needs are

associated with criminal behavior.”

Andrews & Bonta, 2006

The Role of Mental Illness in Recidivism

• Non-criminogenic needs are important to address because they may represent a barrier to effective participation in treatment

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The story in

Pennsylvania….

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Justice Planning Efforts

• Primary responsibilities of PCCD – determine the needs of criminal and juvenile justice

systems,

– develop and implement policies and procedures to improve operations of these systems,

– support all units of government in their efforts to improve these systems.

• To achieve these goals, PCCD – works with local governments in developing plans to

address problems dealing with crime and delinquency

– provides support to counties to develop and implement a team approach to problem solving involving the collaborative efforts of key decision-makers, who possess the authority and responsibility for using and managing county and municipal criminal justice resources

Office of Mental Health and Substance Abuse Services (OMHSAS)

Justice Related Goals

• Divert people from the criminal justice system whenever possible

• Ensure timely and appropriate assessment and treatment for people who are incarcerated

• Provide comprehensive planning and support services to people returning from incarceration to ensure successful return to her or his community and prevent recidivism

OMHSAS Partnership/Collaboration with PCCD Strategic Plan and Accomplishments

• Statewide Strategic Plan to improve Pennsylvania’s Response to People with Mental illness Involved with the Criminal Justice System from 2009

– Formulation of the Mental Health and Justice Advisory Committee

– Creation of the PA Mental Health & Justice Center or Excellence

• Other accomplishments

– Mental Health Procedures Act Training

– Statewide Forensic Peer Support Initiative

– Housing Supports

Mental Health & Justice Advisory Committee (MHJAC)

• Established in 2009 by PCCD and the PA Department of Public Welfare (DPW)

• MHJAC priorities

– Reducing recidivism

– providing for jail diversionary efforts

– improve re-entry programs for individuals diagnosed with mental illness.

• MHJAC serves as a statewide resource, providing insight, funding and guidance to help create effective programs for mentally ill offenders.

Mental Health & Justice Advisory Committee (MHJAC)

• Chaired by Judge Zotolla of Allegheny County, is a true partnership and collaborative effort. Over 40 members regularly participate in advisory committee meetings.

• Membership includes local and state government officials from the following organizations: – DOC, PEPP, PCCD, DPW, AOPC, DOH, AOFC, VA, Justice of Supreme Court,

Victim Advocates, PCS, JCJC, County probation. County judges, County Warden, Mental Health, County Drug & Alcohol, County Re-entry Coordinators, Prosecutors, and Local Law Enforcement

• Membership also includes representatives from numerous associations and advocacy groups including:

– NAMI, Association of County Drug & Alcohol Administrators, Housing Alliance, Community Providers, Disability Rights Network, Mental Health Consumers’ Association, PA Psychiatric Society, County Commissioners Association, and the Mental Health Association of Pennsylvania

So what is the CoE and how does it fit into all of this?

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Collaborative effort: • Drexel University

• University of Pittsburgh (Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center)

Funded by: • Pennsylvania Commission on Crime and Delinquency

(PCCD)

• Department of Public Welfare Office of Mental Health and Substance Abuse Services (OMHSAS)

• Oversight by the Mental Health and Justice Advisory Committee (MHJAC) of PCCD

Center of Excellence Personnel • Co-Directors

Kirk Heilbrun, Ph.D.

Professor and Head, Department of Psychology, Drexel University

Edward P. Mulvey, Ph.D. Professor of Psychiatry, University of Pittsburgh School of Medicine

• Senior Consultants David DeMatteo, J.D., Ph.D.

Assistant Professor, Department of Psychology, Drexel University Co-Director, JD/PhD Program in Law and Psychology, Drexel University

Patricia A. Griffin, Ph.D. Consultant for a variety of agencies and organizations including the CMHS National

GAINS Center & TAPA Center for Jail Diversion, the Philadelphia Dept. of Behavioral Health, and the Montgomery Dept. of Behavioral Health

Carol A. Schubert, M.P.H.

Research Program Administrator, Law and Psychiatry Program, Western Psychiatric Institute and Clinic

• Staff

Amanda Cross, Ph.D., Senior Research Associate

Katy Winckworth-Prejsnar, B.A., Project Coordinator

Center of Excellence Goals

• Promote diversion of mentally ill individuals from the criminal justice system

o Cross Systems Mapping and Action Planning Workshops

o Technical Assistance

• Educate providers and policy makers about possible innovations and improvements

o Website

o Presentations

o Consultation

Sequential Intercept Model

as our Organizing Tool

Sequential Intercept Model: Objectives

• Prevent initial involvement in the criminal justice system for appropriate crimes

– Not everyone can be diverted

• Decrease admissions to jail

• Engage individuals in treatment

– Timely, effective and ongoing

• Minimize time spent moving through the CJ system

• Link individuals to community-based treatment

• Decrease return to the CJ system 27

What is the Sequential Intercept Model?

• Principles • People with behavioral health problems who

commit crimes with criminal intent that is unrelated to their symptoms of behavioral health problems SHOULD be held accountable

BUT

• They shouldn’t be arrested/jailed because of their disorder or lack of access to appropriate care

• Shouldn’t be detained longer due to their illness

• Shouldn’t be repeatedly shifted between systems 28

• Identifies

o Existing local services and systems

o Issues considered important to local stakeholders o Data

o Diagnosis

o Strengths on which to build

• Helps everyone see “big picture” & how they fit

o Helps diverse groups from various systems understand where/how everything fits

o Intercepts provide “manageable” venues and opportunities for systems interventions

Sequential Intercept Model:

Organizing Tool for Systems

Mappings

Five Key Points of Interception

1. Law enforcement / Emergency services

2. Booking / Initial court hearings

3. Jails / Courts

4. Re-entry

5. Community corrections / Community support

Sequential Intercepts Best Clinical Practices: The Ultimate Intercept

I. Law Enforcement/Emergency Services

II. Post-Arrest: Initial Detention/Initial Hearings

III. Post-Initial Hearings: Jail/Prison, Courts, Forensic Evaluations and Commitments

IV. Re-Entry From Jails, State Prisons, & Forensic Hospitalization

V. Community

Corrections & Community Support

Munetz & Griffin (2006)

Psychiatric Services 57:

544–549

What does the COE Do?

Examples of Current Projects:

Cross –systems Mapping Workshops

Cross-Systems Mapping Workshops

Cross-systems Mapping Workshop Goals

• Nurture cross-system collaboration

• Map the local system

• Inventory current resources, gaps, and opportunities

• Agree on priorities

• Build an Action Plan

Common County Priorities

Training at Intercept One

Formalized detoxification procedure

o Reduce strain on hospitals, jails, and law enforcement

Continuity of care from local jails to community

o Re-activation of benefits

o Psychiatric Appointments

Housing

Information sharing

What does the COE Do?

Examples of Current Projects:

Web-based Resource Center

Web-based Resource Center

Dynamic

Links to relevant and important information

oPractical tools

o Funding announcements

oData collection/management tools

County-specific information

o Links to census and crime data

oProgram information

Forum for cross-county communication

www.pacenterofexcellence.pitt.edu

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Number of Visits to the CoE Website January 2011- August 2013

0

500

1000

1500

2000

2500

Jan

-11

Mar

-11

May

-11

Jul-

11

Sep

-11

No

v-1

1

Jan

-12

Mar

-12

May

-12

Jul-

12

Sep

-12

No

v-1

2

Jan

-13

Mar

-13

May

-13

Jul-

13

Technical Assistance

• Issues facing counties or programs – Follow up after mapping activities – Specific requests

• Plan evaluations • Read proposals • Information about model programs

• Issues identified by MHJAC – Reactions and actions from the mapping exercises – Overview documents

• Specialized Police Response • Intellectual Disabilities

– Survey of county practices – Survey of surrounding states – Analyses of DOC data

Future Activities

• Continue mappings for counties

• Expand individual TA projects

• Examine additional projects identified by MHJAC

• Learn from other states and disseminate that information

• Expand collaboration with the Department of Corrections

For more information

www.pacenterofexcellence.pitt.edu

Contact:

Katy Winckworth-Prejsnar

Coordinator

kw494@drexel.edu