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NACo WebinarNACo Webinar
Henry J. Steadman, Ph.D.April 29, 2010
• On June 30, 2005, approximately 7 million people were under correctionalmillion people were under correctional supervision in the U.S.
J il 747 529– Jail: 747,529 – Prison: 1,446,269 – Probation: 4,162,536 – Parole: 784,408
I 2005 th 14 illi b kiIn 2005, there were 14 million bookings into U.S. jails.
PRA/CSG Jail Prevalence StudyPRA/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%Prevalence Rates: Men 14.5%Women – 31%
Steadman, H.J., Osher, F., Robbins, P.C., 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 million13 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 DisordersJail Detainees with Severe Mental Disorders
Males Females
Disorder Alcohol Abuse/ D d
Drug Abuse/ D d
Alcohol Abuse/ D d
Drug Abuse/ D dDependence Dependence Dependence Dependence
Schizophrenia 59% 42% 56% 60%
M j D i 56% 26% 37% 57%Major Depression 56% 26% 37% 57%
Mania 33% 24% 39% 64%
Any Severe Di d
58% 33% 40% 60%Disorder
Detainees with severe mental disorder plus
= 72% = 72%
either alcohol or drug abuse/dependence
f “C OAdapted 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
Trauma History Interview Data (n=978)
PercentPercent Experiencing
LifetimePercent Experiencing in Last 12 Months 1
Witness of Violence 65 4% 31 7%Witness of Violence 65.4% 31.7%
Sexual Abuse 55.2% 31.7%
Physical Abuse 90.2% 65.2%y
Any Trauma 94.0% 64.7%
Any Abuse 92.9% 61.1%y buse 9 .9% 6 . %1 – For Those Respondents Experiencing Trauma in Lifetime
Repeated Cycles
INCARCERATION
ARRESTM t l
PrivateHome
MentalHealth
Inpatient
GroupResidence
S.A.Residential
ShelterStreet
Treatment
Basic Goals
• Keep people out who do not need to be there
• Provide constitutionally adequate services whenProvide constitutionally adequate services when
incarcerated
• Link people to services to keep them from coming back because of mental illness
Diversion = avoiding or radically reducing jail time by using community-j y g ybased treatment as an alternative.
“Diversion”Criminal Justice → Not filing or dropping
Diversion
charges (ATI)
fMental Health → Not filingCondition of bailD f d tiDeferred prosecution (stipulate to police report)Deferred sentencingDeferred sentencingCondition of probation
Public’s Expectations
R d idi i
Public’s Expectations
Reduce recidivism
DiversionReduce violence
Reduce jail days
Reduce costs
Diversion Logic ModelDiversion Logic Model
St 1 St 2 St 3
Improved Mental Health
Stage 1 Stage 2 Stage 3
Identify and Enroll People
Linkage Comprehensive/ Appropriate Community-
/Individual Outcomes
Diversion
in Target Group
Based Services
Improved Public Safety Outcomes
Sequential Intercept ModelSequential Intercept Model
Sequential - People move through the criminal justice system in predictable ways
Intercept - Examine this flow and look for ways to intercept persons with mental illness and p poften co-occurring disorders to ensure:
– Prompt access to treatment– Opportunities for diversion
Intercept 1Law
Intercept 2 Intercept 3 Intercept 4 Intercept 5Law enforcement
Initial detention / Initial court hearings
Jails / Courts
urt
Reentry Community corrections
Violation
ITY
911
ent
ion Cou
rt
Spec
ialty
Co
rt
Pris
on/
Ree
ntry
Paro
le
COC
OM
MU
NI
w E
nfor
cem
e
nitia
l Det
enti
App
eara
nce
Arrest
S
sitio
nal C
ou
y
OM
MU
NITY
n
Violation
C
Law In
Firs
t A
Jail
Dis
pos
Jail
Re-
entr
y Y
Prob
atio
n
Now What?Now What?
• List/map what you haveList/map what you have
• Identify biggest gaps/highest need
• Prioritize programs
• Plan, implement and operate
MappingMapping
• Group processGroup process
• All relevant playersy
• Create a picture
Drug Court
Mental Health Court
Intercept 4Reentry
ARD
Job Court
Intercept 1 Law enforcement / Emergency services
Intercept 2Initial detention / Initial court hearings
Lancaster County, PA Sequential Intercepts for Change: Criminal Justice - Mental Health Partnerships June 2009
Intercept 3Jails / Courts
Intercept 5Community corrections/Community support
T F ilg
Reentry Court
PA Board of
Probation & Parole
MU
NIT
Y CO
M
Adult
PA D
ept
Cor
rect
ions
nfor
cem
ent
emen
t jur
isdi
ctio
ns
entio
n C
entr
al H
oldi
ng
gnm
ent
t Jud
ges
Courts
County Wide
Communications
911
Violation
earin
g
To Family
CO
MM
MM
UN
ITY
AdultProbation &
Parole Special
Offender Unit
Pre-Parole Unit
Law
En
30 la
w e
nfor
ce
Initi
al D
ete
Loca
l Hol
ding
Cel
ls o
r C
Prel
imin
ary
Arr
ai 2
0 M
agis
teria
l Dis
tric
t
Lancaster CountyPrison
Primecare MH Services
Drug & Alcohol Education Block Re-entry from Jail
Violation
Arrest
MH Crisis Intervention;
Mobile Outreach
MH Crisis Counselor - Lancaster City Police
Prel
imin
ary
He
Assess
Bail ROR
Community & Faith-Based Services
Re-entry from Jail
State Hospital
Local Hospitals (LGH Behavioral Health Area) Reentry Management
Organization RMO Case
Management White Deer Run D & A Call Center –for Detox
MH/MR In reach
PrimeC
are Alert
Community Supports
NAMI of Lancaster I Can Drop In Center
MH AmericaCharges MH AmericaCHOC
Charges Dismissed Public
Benefits
Gaps/NeedsGaps/Needs
• What is already in place?What is already in place?
• “Frequent flyers”y
• Politically viable
• Biggest community impact
Prioritizing ProgramsPrioritizing Programs
• “Where’s the juice”?Where s the juice ?
• Early successes most probabley– Build political capital
• Leveraging existing programs/services• Leveraging existing programs/services
Plan, Implement and Operatep p1. Designate a lead person
2. Identify the key agencies
3. Meet regularly
4. Identify key positions
5. Specify the pathways of your diversion process
6. Designate specific responsibilities
7 Develop a basic management information system7. Develop a basic management information system
8. Plan for the collection of basic data
9 C i t l l9. Communicate regularly
To download a copy, please visit
www.gainscenter.samhsa.gov
If You Don’t Map?If You Don t Map?
• Keep Sequential Intercept Model picture in mindKeep Sequential Intercept Model picture in mind as a road map
• Don’t build any programs without knowing what• Don t build any programs without knowing what else REALLY is there
• Think systemically; not programatically
Other ResourcesOther Resources
• Munetz, M. & Griffin, P. (2006). A systemic approach to the de-Munetz, M. & Griffin, P. (2006). A systemic approach to the decriminalization of people with serious mental illness: The Sequential Intercept Model. Psychiatric Services, 57, 544-549.
• CMHS National GAINS Center. (2009). Developing a Comprehensive Plan for Mental Health and Criminal Justice Collaboration: The Sequential Intercept Model. Delmar, NY: Author.