ON THE MOVEON THE MOVEON THE MOVEON THE MOVE

Department of Corrections

GEORGIA

GEORGIA

GEORGIA

GEORGIA

GEORGIA

Stopping the Revolving Door for Mentally Ill Offenders in the Criminal Justice System via Diversion and Re-entry

Programs International Crisis Intervention Training Conference

Eleanor Brown, LPCGeorgia Department of Corrections

Georgia Department of Corrections Statistics

Nationally, 1 in 31 adults is under some form of correctional supervision.

Georgia ranks 1st in the nation with 1 in 13 under some form of correctional control.

Georgia ranks 4th in the nation with an adult incarceration rate of 1 in 70.

GDC currently has approximately 160,000 convicted felons under probation supervision.

Approximately 56,000 inmates in GDC prisons. Approximately 9,000 are classified as having a mental illness

(15.4%). 27% of Day Reporting Centers Participants are classified as

mentally ill.

Increasing high numbers of people with mental illnesses are coming in contact with law enforcement agencies, courts and correctional agencies.

Offenders with mental illnesses have a greater chance of recidivating than the general population offender.

People with mental illness are at an increased risk of developing substance use disorders over the course of their life.

Nearly a third of people who experience homelessness have a serious mental illness and their homelessness makes them highly visible to law enforcement.

People with mental illnesses tend to stay in jail and prison longer and are less likely approved for parole than others charged with similar offenses.

72% of offenders with mental illness have a co-occurring substance abuse disorder.

Justice Center Report “ A Guide to Research-informed Policy Practice”

Best practices which are evidenced based in the delivery of mental health services for the mentally ill under community corrections supervision:

Assertive Community Treatment utilizing a multidisciplinary team of professionals.

Illness Self management and recovery, in which people learn skills to monitor and control their well-being.

Integrated mental health and substance abuse services. Supported employment, in which people with mental illness are

employed in competitive, integrated work setting with follow-along supports.

Psychopharmacology-medications are used to treat mental illness. Family and consumer education, people with mental illness(es) and

their families learn about mental illness, symptom management techniques and stress reduction.

Justice Center Report “ A Guide to Research-informed Policy Practice”

The Revolving Door for the Mentally Ill

Inmate Cost for GDC

• It costs GDC $67 a day to house the mentally ill.• It costs GDC $50.17 a day to house a general

population inmate.• GDC spends approximately five million dollars a

year on Psychotropic medication.• Psychotropic medication accounts for 18% of

GDC’s total pharmacy budget.

Georgia Department of Corrections (GDC) Solutions

Diversionary and Reentry Programs that involve partnering with other State, Local, Law Enforcement, Judicial Systems, and Faith Based Organizations in order to provide wrap-around services to meet all of the offenders’ needs and responsivity issues.

Diversion Day Reporting Centers 13 Day Reporting Centers Non-residential Substance Abuse Programs that use

evidenced-based evaluations and programs to address the underlying problem of the offender.

Mentally ill probationers can be diverted from expensive prison beds if the underlying root of their problem is addressed: mental health compliance, and substance abuse treatment.

Day Reporting Centers

What is a Day Reporting Center (DRC)? A community-based, highly structured, non-

residential sanction for probationers with a history of non-compliant behavior related to substance abuse. Day Reporting Centers provide intensive supervision and behavioral interventions as an alternative to incarceration for probationers who are failing to adhere to standard supervision conditions.

What are some of the Components Substance abuse counseling and programming Rigorous drug testing Cognitive restructuring (changing criminal thinking) Employment preparation, enhancement, and maintenance Adult literacy and GED preparation Intensive supervision (field contact, curfew compliance) 80 hours community service Life skills classes Anger management (some sites) 12 step attendance Family Night participation Six months Aftercare

Why Day Reporting Centers? Georgia has the fourth highest incarceration rate in

the country with one in thirteen Georgians being on some form of correctional supervision. Nationally the rate is one in thirty-one.

Approximately 75% of incarcerated offenders are drug or property offenders, and 72% of those offenders report using drugs prior to their arrest.

In Georgia, 250 – 300 new methamphetamine cases enter the prison system every month.

51% of inmates self-report never having a job 75% without a high school education In CY2011, 21,055 offenders entered the prison

system and 21,390 were released. Of those released, 200 – 300 have mental health issues.

Why Day Reporting Centers? 65% of felons commit additional crimes and return to

prison in their lifetime DRCs apply Evidence Based Principles that are part of the

“What Works” in correctional rehabilitation (cognitive based programming, employment enhancement, substance abuse treatment, and education opportunities)

2010 Study by University of Cincinnati indicated DRC participants recidivated 24% less than non participants.

Public demand for offenders to be punished, while they expect offender rehabilitation

Studies show for every dollar spent on treatment there is upwards of a $7 return

DRC offenders cost per day is $14.78 compared to prison cost of $50.17

DRCs provide a sentencing alternative that is community based in lieu of incarceration

DRC Program Goals Protect the public through intensive supervision and behavioral

interventions Divert offenders from the warrant and revocation processes who

would otherwise be confined to jails, prisons, or other residential facilities

Provide an alternative sentencing option to divert offenders from future criminality

Replace criminal behaviors and attitudes with pro-social alternatives that reduce recidivism

Provide offender opportunity for Restitution, Rehabilitation, and Restoration

Develop a collaborative with law enforcement, state agencies, non-profits and the faith based community to effect accountability of the offender

How long is the Program? The program is six to nine months for Phase I and II,

and six months for Phase III Phase I is the first four to eight weeks of intense

programming Phase II is approximately 2 to 6 months and is

generally when the offender works and attends classes in the evening

Phase III is the aftercare phase and is six months in length

Participants return or transfer back to general probation or parole supervision after Phase II to a 6 month Phase III aftercare program

Athens

Rome

Clayton

Griffin

Macon

Tifton

Columbus

Gainesville

Waycross

CobbDekalb

Albany

Thomasville

Atlanta

Augusta

DRC Sites

Legend

CIP Sites

Future DRC Sites

Mental Health Counselors for DRC, CIP, & Probation Offices

Location of the MH Counselors

Northwest

Probation Offices

Savannah

DRC Female Diagnosis

38%

DRC Male Diagnosis

18%16%

11%

34%

Mental Health Counselors in DRCs

• Four (4) Mental Health Counselors are certified addiction counselors (Atlanta, Athens, Gainesville and Griffin).

• Eight (8) Mental Health Counselors are in the process of obtaining their certification in addiction counseling.

• Three (3) Mental Health Counselors have obtained their Licensed Associate Professional Counselor (LAPC) (Atlanta, Augusta and Clayton), and One (1) has obtained her LMSW (Northwest).

Mental Health Services in Each DRC

A mental health counselor has been placed in each DRC.

The mental health counselor conducts a Mental Health screening on all participants during intake.

The mental health counselor completes a Mental Health Evaluation on all participants identified during intake as possibly needing MH/MR services.

Mental Health Services (cont.)

If a participant is not currently receiving mental health services, the counselor makes an appointment with the local mental health center.

The mental health counselor conducts a minimum of one (1) supportive group per week.

The mental health counselor monitors mental health compliance and reports this to the Probation Officer and/or Center Administrator.

Mental Health Services (cont.)The mental health counselor elicits

community partnerships to address other needs of the participants, such as housing, food, clothing, child care, transportation, crisis stabilization, referrals to vocational rehabilitation programs, and/or assistance with SSI/SSDI applications.

Some mental health counselors attend treatment team meetings at the local mental health center.

Collaborative agreements to meet Offenders Needs

• Department of Behavioral Health and Developmental Disabilities.

• NAMI– Crisis Intervention Team (CIT).

• Georgia Mental Health Consumer Network (GMHCN).

Department of Behavioral Health and Developmental Disabilities

• There are ten (10) DRCs that have the local Community Service Board coming on-site providing initial mental health evaluations the complete intake packet), referrals to the psychiatrist, individual and group therapy (Athens, Augusta, Columbus, Gainesville, Griffin, Macon, Northwest/Dalton, Thomasville, Tifton, and Waycross).

Mental Health Services (cont.)

One (1) more will begin on-site services in the next month (Rome).

These clinicians also conduct mental health groups such as co-occurring disorders, coping skills, DBT, stress management, trauma survivors, and Anger Management.

GMHCN and NAMI

• GMHCN conducts a Double Trouble group at the Atlanta DRC.

• NAMI provides Peer Specialists to conduct groups, provide support and act as a liaison with the local CSB at the Columbus DRC.

DRC Graduates FY 2012

10 13 9 5 814

2015

25

1118

7 920

31

4641

20

34

62 66

48

94

52

25 23

0102030405060708090

100 MHNon-MH

DRC MH Graduates by GenderFY 2012

5

12

6

2 2

7

10 10

68

53

5

13 3

67

5 5

10

2

6

10 10

15

02468

10121416

Male

Female

DRC Graduates by DiagnosisFY 2012

21

46

25

1

62

9

010203040506070

Total Graduates: 164

DRC Female Graduatesby Diagnosis FY 2012

83

28

0

10

29

05

101520253035

Total Graduates: 78

DRC Male Graduates by Diagnosis FY 2012

7

33

1

1517

13

0

5

10

15

20

25

30

35

Total Graduates: 86

DRC Mental HealthPhase I Completions

42

33

22

5

19

2

9 9 93 4 3 1

4

05

1015202530354045

Num

ber o

f par

ticip

ants

Time in Weeks

Length of Time to Complete Program

DRC Mental HealthPhase II Completions

14

79

2715 16 10

2 10

102030405060708090

Num

ber o

f par

ticip

ants

Time in Months

Length of Time to Complete Program

DRC Unsuccessful Completions FY 2012

5833

19

49

12

4837 46

3153

2040

58

121

7085

48

81

107

70

139128

757858 51

020406080

100120140

Num

ber o

f Par

ticip

ants

MH Non-MH

MH Discharges: 463

DRC MH ParticipantUnsuccessful Completions FY 2012

735

112

214

172

8820

23

0 20 40 60 80 100

AbscondedPDC/RSAT Treatment Program

DeathFelony Charge (new)

Failure to Comply w/MH ServicesMH Services Terminated

Misdemeanor Charge (new)Probation Sentence Expires

Technical ViolationOther

MedicalSentence Modified/Prob. Ended

Number of Participants

DRC Overall Mental HealthUnsuccessful Completions

3 41

9

36

2724 25

17 1714

9

35

0

5

10

15

20

25

30

35

40

Time in Weeks

Num

ber o

f Par

ticip

ants

Total = 221 Discharges

DRC MH Phase I Unsuccessful Completions

13

0

6

29

1816 17

15

10

14

7

29

0

5

10

15

20

25

30

35

Time in Weeks

Num

ber o

f Par

ticip

ants

Total = 165

DRC MH Phase IIUnsuccessful Completions

21 1

3

7

98 8

2

7

2

6

0123456789

10

Time in Weeks

Num

ber o

f Par

ticip

ants

Total = 56

DRC MH UnsuccessfulCompletions by Diagnosis

DRC MH Unsuccessful Completions by Gender

67

154

0

20

40

60

80

100

120

140

160

180

Females Males

Num

ber o

f Par

ticip

ants

DRC Study

• Morehouse School of Medicine began the outcome study April 17, 2012.

• Dr. Brian McGregor and three (3) interns.

Program Success of Dually Diagnosed Clients in Georgia’s Day Reporting Centers

Core Research QuestionsCore Research Questions

1. Do dually diagnosed participants in the DRC experience program success relative to a matched comparison group of DRC participants with substance abuse only?

2. Are indicators of program success in the DRC such as maintaining sobriety, completing treatment programs, and obtaining employment, different depending on mental health status?

Methodology

Research Design – Observational study, prospective cohort

Participants• Total n = 150• Dually Diagnosed group (n = 25 per site)

– Mental health diagnosis (DSM-IV)• Substance Abuse Only group (n = 25 per site)

– No mental health diagnosis• Matched on demographics

Study Sites• Athens, GA DRC• Griffin, GA DRC• Metro Atlanta DRC

Measurement & OutcomesMeasurement & Outcomes

• Phase completion • Pass/fail on scheduled and random sobriety tests• Substance abuse & mental health counseling• Employment (obtaining a job, length of employment)• Medication management• Number of absconders• Program restarts• Self-efficacy & life satisfaction• Recidivism (i.e., re-arrest [probation/parole violation], re-conviction,

re-incarceration)• Self-report Surveys

– Program satisfaction, readiness to change, self-efficacy, interpersonal supports

SummarySummary

• Program features associated with positive outcomes may need to be strengthened

• May reduce stigma of treatment difficulties with justice-involved individuals with dual diagnoses

• Create impetus for broader evaluation of Georgia DRCs

• Seek collaboration & partnership with other states interested in and successful with justice re-investment

DRC Study Participants By Center

Atlanta Athens Griffin

Co-occurring 16 12 15SA only 29 13 32

05

101520253035

Substance Abuse Only Group

Atlanta Athens GriffinMale 26 12 24Female 3 0 8

0

5

10

15

20

25

30

Co-Occurring Group

Athens Atlanta GriffinMale 9 9 6Female 4 7 9

0

2

4

6

8

10