Mental Health Court 101 2007 Georgia Drug & DUI Court Conference – Peachtree City, GA

Honorable Kathlene Gosselin, Hall County Superior Court

&

H.E.L.P. Program Team

1955 census included geriatric patients and some patients with MR

21,000 (1/3) of the 70,000 patients in hospitals in 1995 were forensic patients

Does not include community or private hospitals

While the number of patients in psychiatric hospitals has decreased dramatically since 1955...

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1955 1995

Source: Torrey, Out of the Shadows, 1997

. . . jails and prisons have become the new “psychiatric hospitals”

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Hospitals Jails & Prisons Homeless

Non-Traditional Allies

Police, judges, correctional officials have become strong allies of NAMI advocates in many states and communities.

Significant growth of pre and post-booking jail diversion programs, e.g. CIT programs MH Courts.

Enactment of federal legislation (P.L. 108-414).

Mental Health Courts

Treatment is better than jail. For many of these offenders, mental illness

is their primary issue, not criminality – not addressing the primary issue destines the offender to a revolving door at the jail.

Important differences from drug courts. Psychiatric relapse is not a crime.

Drug Courts vs. Mental Health Courts

Similarities Ongoing judicial interaction Use of sanctions/incentives Integration of services with

judicial case processing Non-adversarial approach

of prosecution and defense Use of drug testing Coordinated strategy of

court team Necessary coordination

with community resources

Differences Level and type of sanctions Court atmosphere Intensity of case

management Lack of emphasis on

payment of fees Judicial demeanor Inclusion of mental health

system, consumer and advocacy partners

Focus on medication compliance

Need for treatment specific to co-occurring disorders

Mental Health Program Principles

Divert persons with mental illness from unnecessary and inappropriate incarceration

Improve treatment access and recovery options

Reduce cost and risk for jail and law enforcement

Reduce recidivism and problem behaviors

Benefits of MH Courts

Help people with mental illness who are in the criminal justice system BECAUSE of their illness, out of jails and into treatment and more stable lives in the community.

Better treatment outcomes, reduced recidivism, enhanced public safety.

Provides options for other specialty courts (e.g. drug courts, domestic violence courts).

H.E.L.P Program

A pilot program of the Georgia Department of Corrections in partnership with the Hall County Superior Court

Services provided by MHM Correctional Services, Inc., a national vendor of mental health services to correctional systems and the current vendor to the Georgia Department of Corrections

Background

High recidivism rates for offenders with mental illness (16-18% in HCDC diagnosed MI)

GDOC desired pilot program to prevent the return to prison of offenders with mental illness

GDOC received grant from the Governor’s Criminal Justice Coordinating Council

Hall County selected as pilot site

Coordination

18 months planning and coordination prior to start

Stakeholders attend training conference

Retention of vendor (MHM) Development of service provider team

and program procedures

Mission Statement

It is the mission of the HELP Program to provide alternatives to incarceration for

defendants who are involved in the criminal justice system as a result of their

mental health or mental retardation issues. We accomplish this by linking those individuals to local, community

based treatment resources with the goals of reducing recidivism and helping the participants become stable, productive

members of the community.

Program Objectives

1. Provide offenders with community-based case management and treatment services as an alternative to incarceration

2. Stop the cycle of imprisonment of individuals with serious mental illness

Initial Program Staffing

Project Coordinator (licensed masters level)

Two full-time case managers (licensed masters level)

Half-time clinical psychologist (doctoral level)

Current Program Staffing

Project Clinical Coordinator (licensed masters level)

Clinical Case Manager Community Support Person

Additional Support: Working with Georgia Mountains Community

Service Board – GMCSB Team is similar in make-up Psychiatric Social Worker Community Support Individual Access to psychiatric support and other therapeutic

support

Eligibility Requirements

1. Incarcerated, charged, or on probation/parole in Hall County (Misdemeanor or Felony)

2. Not charged with one of seven serious or violent crimes (prosecutor consent required for enrollment)

3. Hall County residency

4. Voluntary participation

5. Criminal Adult Population

Eligibility Requirements

Mental Health Criteria:a. Severe and Persistent Mental Illness

(psychotic disorders and major mood disorders)

b. Co-occurring Disordersc. Mental Retardationd. Other Axis I disorders that are primary

to their involvement in the criminal justice system

Services

Linkage and close supervision of: Treatment – Inpatient/Outpatient Counseling Medication management Vocational placement assistance Housing placement assistance Transportation linking Length of program: 9 – 18 months or longer

Process

Referral: by police, attorney, DA, courts, probation, self-referral

Screening conducted by licensed staff

Assessment conducted for placement

Determination of suitability for program

Referral to HELP case management or declined services

Initiation of case management services

Court involvement

If not appropriate for Program – will be linked to services in community when possible to do so

Referral Sources

Hall County Public Defender Office 24% Hall County Detention Center 23% Private Attorneys 14% Probation/Pretrial 13% District Attorney/Solicitor 12% Family/Self Referred 3% Judicial 3% Other 8%

(Defense Attorneys account for 37% of referrals)

Hall County, GeorgiaHELP Program Participants

Active 24 Graduated 30 Terminated 35 Opted Out 8 Enrolled (since inception) 97

Hall County, GeorgiaHELP Program - Jail Days

97 Participants: Jail Days in 18 months prior to entry

7183 AVG 74

Jail Days while in Program 1333 AVG 14

Jail Days for 30 Graduates (in 18 months) 9 Jail Days for 30 Grads (prior 18 months) 1759

AVG 59

Hall County, GeorgiaHELP Program – Cost Benefit

These 92 persons spent 7183 days incarcerated in the 18 months prior to program entry, costing $359,150 in jail costs alone (does not include costs associated with officers dealing with issues these offenders caused while incarcerated, medical staff costs, transportation costs, or other jail related costs other than standard cost for an offender per day of $50)

Hall County, GeorgiaHELP Program – Cost Benefit

Jail Costs for participants in 18 months

immediately prior to entry $ 359,150 Active participants have spent 1333

days in jail while active in program $ 66,650 30 Graduates have spent 9 days in jail $ 450

Program has been operational for 30 months and first graduation was 12/2005

Participants

65% of women have been victims of trauma Childhood physical/sexual abuse and/or

adult abuse Co-occurring

Nearly 60% have co-occurring substance abuse issues in conjunction with their mental illness diagnosis

50% Female – Male

William M.

Hall County Arrest Record: Drunk in Public - 1996 Convicted – Armed Robbery in 1998 - GDC from 6/11/98

until 3/23/05 Committed Simple Assault 6/13/05 (1 day in jail);

Probation Warrant 7/8/05 (7 days in jail) Entered HELP 7/15/05 1 day in jail during program Graduated 6/29/06 – 0 days incarcerated since graduation Jail Days in 18 months prior to entry 447 Jail Days in Program 1 Jail Days since Graduation (9+ months) 0

Christie M.

Keys toSuccessful Diversion Programs

Fixed Point of Accountability Sufficient Case Management

Resources 24/7 Staffing, On Call and On Site Low Patient-to-Staff Ratios Access to Full Range of MH/SA

Services

Keys toSuccessful Diversion Programs

Safe, transitional housing Job placement opportunities Supportive law enforcement

community Focus on recovery Certain discretionary resources

Governor’s Mental Health Diversion ProgramConceptual Model for Comprehensive Hall County

Program

Hall CountyJail – Mental Health Care

Local Hospitalsand Health

Sector,Housing and Job

Resources,Community Agencies

Law EnforcementProbation

Parole

Corrections,Transition and Aftercare for

Probationers and Parolees(TAPP)

Community Service Board,

MHSA Forensic Services,

State Hospitals

CIT Program

Diversion Intensive Case Management

(Currently HELP)

Hall County Courts and Treatment Services

Funded through and managedby Hall County Superior Court

Key Program Supports

Successes and Challenges

Successes to-date

On-going challenges

Future of the program

Mental Health Court IssuesThe Great Unknowns

The issue of perception The effect of medications Learned helplessness Identifying target behaviors “½ the sanctions and twice the

patience”

It Just Makes Sense97 Participants: Jail Days in 18 months prior to entry

7183(AVG. 74)

Jail Days while in Program 1333(AVG.

14) Jail Days for 30 Graduates (in 18 months) 9 Jail Days for 30 Grads (prior 18 months) 1759

(AVG. 59)

Jail Costs for participants in 18 months immediately prior to entry $ 359,150

Active participants have spent 1333 days in jail while active in program $ 66,650

30 Graduates have spent 9 days in jail $ 450

Questions