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

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

In 2005, there were 13 million bookings into U.S. jails.

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.

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

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

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%

Repeated Cycles

INCARCERATION

ARREST

PrivateHome

GroupResidence

ShelterStreet

S.A.ResidentialTreatment

MentalHealthInpatient

“Treatment-Resistant” Clients

OR

“Client-Resistant” Services

CO

MM

UN

ITY

Intercept 1Law enforcement

911

Law

Enf

orce

men

t

Intercept 2Initial detention / Initial court hearings

Initi

al D

eten

tion

Firs

t App

eara

nce

Cou

rtArrest

Intercept 3Jails / Courts

Jail

Spec

ialty

Cou

rt

Dis

posi

tiona

l Cou

rt

Intercept 4Reentry

Pris

on/

Ree

ntry

Jail

Re-

entr

y

Paro

le

CO

MM

UN

ITYIntercept 5Community corrections

Prob

atio

n

Violation

Violation

Diversion = avoiding or radically reducing jail time by using community-based treatment as an alternative.

“Diversion”Criminal Justice → Not filing or dropping

charges (ATI)

Mental Health → Not filingCondition of bailDeferred prosecution

(stipulate to police report)Deferred sentencingCondition of probation

Diversion

Reduce recidivism

Reduce violence

Reduce jail days

Reduce costs

Public’s Expectations

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

Mental Health Diversion Options

Pre-Booking – Police-Based

Post-Booking – Court-Based

– Jail-Based

– Community Corrections-Based

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

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.

CO

MM

UN

ITY

Intercept 1Law enforcement

911

Law

Enf

orce

men

t

Intercept 2Initial detention / Initial court hearings

Initi

al D

eten

tion

Firs

t App

eara

nce

Cou

rtArrest

Intercept 3Jails / Courts

Jail

Spec

ialty

Cou

rt

Dis

posi

tiona

l Cou

rt

Intercept 4Reentry

Pris

on/

Ree

ntry

Jail

Re-

entr

y

Paro

le

CO

MM

UN

ITYIntercept 5Community corrections

Prob

atio

n

Violation

Violation

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

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

CO

MM

UN

ITY

Intercept 1Law enforcement

911

Law

Enf

orce

men

t

Intercept 2Initial detention / Initial court hearings

Initi

al D

eten

tion

Firs

t App

eara

nce

Cou

rtArrest

Intercept 3Jails / Courts

Jail

Spec

ialty

Cou

rt

Dis

posi

tiona

l Cou

rt

Intercept 4Reentry

Pris

on/

Ree

ntry

Jail

Re-

entr

y

Paro

le

CO

MM

UN

ITYIntercept 5Community corrections

Prob

atio

n

Violation

Violation

Nathaniel Project (NYC) N=53

Prior Year Current Year

Number of Arrests

101 7

Misd. 35 5

Felonies 66 2

SAMHSA KDA (N=1,185)

Diverted Non-Diverted

Community days 303 245

# Arrests 1.03 1.20

Arrests/mo. .11 .15

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

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%

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%

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

Drug & Alcohol UseNumber 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

Daily Living/Role Functioning Scale

NMean Score

(Range: 0 to 4)1Mean 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

Colorado Symptom Index (CSI)

NMean Score

(Range: 0 to 60)1Mean 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

Year-by-Year CJ Cost

1 2 3 4 5 60

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

MHC TAU

Year-by-Year Tx Cost

1 2 3 4 5 60

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

MHC TAU

Year-by-Year Total Cost

1 2 3 4 5 60

2000

4000

6000

8000

10000

12000

14000

16000

18000

20000

MHC TAU

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

Reduce Involvement

Minimize Inappropriate Penetration

More Useful Concepts