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Essential Elements of the Kalamazoo Community Mental Health Recovery Court Program. Presented By: Aki Nearchou, LBSW & Brian Fuller, PH.D. KCMHSAS 418 W. Kalamazoo, MI 49007 269-373-6000. Overview. The extent and nature of the concern - PowerPoint PPT Presentation
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Essential Elements of the Kalamazoo Community Mental Health Recovery
Court ProgramPresented By:
Aki Nearchou, LBSW&
Brian Fuller, PH.D.
KCMHSAS 418 W. Kalamazoo, MI 49007
269-373-6000
Overview
• The extent and nature of the concern• Ten Essential Elements of Mental Health
Courts (MHC)• Goals of Mental Health Courts• Kalamazoo Mental Health Recovery Court
(MHRC)• What are peer support specialists and why
they are an integral part of the MHRC team?
Extent and Nature of the Concern • 13 million adults booked into U.S. jails each year.• More than 1.3 million people are currently
incarcerated in the U.S.• 631,000 people in jail on any given day• 4.6 million under correctional supervision• Over 7% of those inmates suffer from a severe
mental illness (SMI).• About 75% of the incarcerated SMI population has
co-occurring addictive disorders.
Source: Steadman, Osher, Robbins, Case &Samuels, (2009)
World Incarceration Rate
Why are Persons with Mental Illness Over-Represented in the Criminal Justice System?
• Higher arrest rates• “War on Drugs”– 2/3 of inmates in local jails is due to drug law
violations– Increased drug related offenses results in
increased arrest for those that suffer from a SMI.
SMI Over-Representation Cont.
• housing of last resort
• Affordable housing crisis results in a very visible homeless population that leads to crimes of survival:– Urinating in public– Panhandling– Theft– Etc.
SMI Over-Representation Cont.
• Longer jail and prison terms• Higher recidivism rate on re-entry as a result
of the following:– Inadequate discharge planning– Inadequate resources– No connection to the community– Very little family and social supports– Etc.
Specialty Programs that Addresses Over-Representation of persons with SMI involved in the
Criminal Justice System
• Many communities have adapted the Crisis Intervention Team (CIT) model
• Growing number of Mental Health Courts – 10 Mental Health Courts in Michigan (as of 2009)
Ten Essential Elements of Mental Health Courts (MHC) • 1. Planning and Administration• 2. Co-Occurring Target Population• 3. Timely Participant Identification & Linkage to Integrated Services• 4.Terms of Participation• 5. Informed Choice• 6. Integrated Treatment Supports and Services• 7. Confidentiality• 8. Court Team• 9. Monitoring Adherence to Court Requirements•10. Sustainability Source: Council of State governments, Essential Elements of a MHC, (Third Edition.
MHC Planning & Administration
• A multidisciplinary planning committee should be charged with designing the MHC.
• The planning committee should identify agency leaders and policy makers to serve on an “advisory group”.
• Keep the committee informed
Co-occurring Target Population
• MI related to criminal offense• MHC’s offer options other than arrest and
detention• Well defined clinical and criminal eligibility
criteria• MHC screening tools
Candidate Identification and Linkage to Integrated services.
• Identified Participants• MHC Referral sources• Referral Source Training• Expedited referrals
Terms of Participation
• Minimize the impact of the charges• Individualized for each participant• Successful completion– Dismissal of charge– Reduced fines and cost– Well connected to community resources
• MHC is a voluntary program– Option to withdraw
Informed Choice
• Participants fully understand the requirements of the MHC
• Arising competency issue concerns are processed through well established and pre-determined procedures.
Integrated Treatment supports & Services.
• Mental health court participants require an array of services
• MHC participants typically have co-occurring substance abuse disorders
• Treatment providers, Mental Health Court Team and the Participants should communicate on a regular basis
Confidentiality
• Health and legal information is only shared in a way that protects the participants’ confidentiality rights as consumers and their constitutional rights as defendants.– Release forms that adhere to federal and state
laws– Participants review releases with their defense
counsel and treatment providers– Should not sign release of information forms until
competency issues have been resolved
The Court Team
• Mental health court team works collaboratively to help participants achieve treatment goals by bringing together many of the following staff:– Judicial officer– Integrated Recovery Specialist (case manager)– Prosecutor– Defense attorney– Court liaison– Peer Supports
Monitoring Adherence to Court Requirements
• stay up-to-date on their progress• The mental health team and case managers
regularly discuss the participants’ behavior rather positive or negative
• MHC team meets on a regular basis with the judicial team
• Regularly scheduled status hearings
Sustainability
• Performance measures and outcome data is essential.
• Data describing the court’s impact on individuals and systems should be collected and analyzed.
• MHC team should communicate with key county officers and state legislators.
• Attempt to cultivate long-term funding sources early on.
The Goals of MHC are:The primary goal of MHC courts is to
reduce recidivism and enhance access to & engagement in community treatment
1. To preserve public safety2. To divert offenders with mental illness & co-occurring disorders3. To maintain treatment, housing, insurance benefits and community
support services for participants with mental illness4. To reduce repeated criminal activity5. To decrease the utilization of high cost system services
Inside a Mental Health Court
Video is Courtesy of PBS and Frontline
Kalamazoo Mental Health Recovery Court (MHRC)
• Founded in fall of 2008• State and Federal Grants• MHRC Team:– 8th District Court Judge– Kalamazoo Community Mental Health &Substance
Abuse Services staff.– Defense Counsel– Prosecuting Attorney
Nature and Scope of Concern in Kalamazoo County
• Undersized jail • Large number of bookings and jail housing
cost• High utilization of services for SMI population• Strain on budgets
Program Description• Misdemeanors • Recovery focused• Participants must have staff who will come to court• 2 clinical staff and 2 Forensic Peer Support Specialists• Year long program• Two phases• Will take persons who have MI/DD, co-occurring and
Personality Disorders• Provide Crisis Intervention Team Training (CIT) for Law
Enforcement
Who is eligible to Participate in the Kalamazoo Mental Health Recovery Court?1. Must be charged with a misdemeanor2. At least 17-years-old3. Has a diagnosis of mental illness or is dually diagnosed
with a developmental illness and substance abuse disorder and is in need of or assigned to case management services.
4. Is a Kalamazoo County Resident5. No pattern of violent behavior6. No more than one prior assault/battery7. No more than two prior felony conviction of any kind8. No violence at the time of arrest
The Referral Process
MHRC accepts referrals from: Police Officers, District Judges, Defense
Attorneys, Prosecuting Attorneys, Probation Officers, Kalamazoo County Jail staff, Family Members, KCMHSAS staff, Provider Agencies and Members of the public.
What Happens to an Accepted Case?
• Agree to comply• Determine and assign team• Attend scheduled court hearings• Graduated incentives and sanctions
Incentives and Sanctions
Incentives
• Praise from the Judge• Positive report by case mgr/PO• Clapping• See judge less often• Less judicial supervision
requirements• Reduced or waived court cost
/fees
Sanctions
• Lecture from Judge • Report to MD, PhD, PO more
often• Jail • Move back to phase I• Daily report to CMH• community service• Increase AA/NA, etc.
Performance Measure Criteria
• Decrease in jail admissions, jail days, and psychiatric admissions among successful participants
• Number served in MHRC• Outside researcher evaluation results• CIT training
Outcomes for MHRC Participants* (N=37)
8.8
0.51.1 1.5
3.4
16.7
0
10
20
30
Before MHRC During MHRC After MHRC*
Hospital Days
Jail Days
*Only those completing MHRC(N=37) (N=37) (N=20)
*Those completing MHRC or still participating in MHRC
72.6%
BOTH new offense & jail
11.3%
Jail only
12.9%
New offense
only
3.2%
Nei
ther
Before MHRC*% with Criminal Justice Involvement (N=62)
*In 12 months prior to enrollment
96.8%
Criminal Justice-Involved
35.5%
BOTH crisis contact & hospitalization
6.5%
Hosp only
46.8%
Crisis contact
only
11.3%
Neither
Before MHRC*% with Mental Health Crisis (N=62)
*In 12 months prior to enrollment
88.7%
Mental Health Crisis
Felony-level Offenses (N=62)
28.0%21.7%
0.0%
20.0%13.5%
21.6%
BeforeMHRC
DuringMHRC
After MHRC
TerminatedCompleted/Still
*statistically significant difference
*
Limitations of the MHRC
• The impact of the program is limited to those charged with misdemeanors.
• Integrated recovery specialist (case managers) are required to attend court with individuals they serve, but have no specific criminal justice training.
• Number of participants and length of the program.
Role of Forensic Peer Specialist within Criminal Justice System
What is a Peer Support Specialist?• Individuals willing to provide history of disability and recovery with people
in earlier stages of recovery
The stages of change are:1.Precontemplation
2.Contemplation 3.Preparation/Determination 4.Action/Willpower 5.Maintenance 6.Relapse
• Forensic peer support involves trained peer specialist with histories of mental illness and criminal justice involvement helping those with similar histories
Role of Peer Support Specialists within the MHRC Program
• Participate in all status meetings, court sessions, etc.
• Meet one on one with potential participates to determine recovery eligibility
• Facilitate a 16 hour Wellness Recovery Action Plan (WRAP) training.
• Meet with participants prior, during and after court sessions as needed.
MHRC Participant Outcomes
• MHRC successful and unsuccessful participant outcomes
Questions?
Thank You
Kalamazoo Community Mental Health & Substance Abuse Services
Brian Fuller&
Aki Nearchou