november 27, 2007 nami north carolina, raleigh 2007 nami north carolina decriminalizing mental...

November 27, 2007November 27, 2007 NAMI North Carolina, RaleighNAMI North Carolina, Raleigh

2007 NAMI North Carolina2007 NAMI North Carolina

Decriminalizing Mental Illness InstituteDecriminalizing Mental Illness Institute

The Jericho Project:The Jericho Project:Overcoming jail diversion barriers for persons with

serious mental illness & serious criminal justice involvement

Stephen C. BushStephen C. BushSupervising Attorney/Special LitigationSupervising Attorney/Special LitigationShelby County Public Defender SystemShelby County Public Defender System

201 Poplar, Suite 2-01 201 Poplar, Suite 2-01 • Memphis, TN 38103• Memphis, TN 38103 901-545-5835 • Fax 901-545-2527 901-545-5835 • Fax 901-545-2527 [email protected]@shelbycountytn.gov


“The Jericho experiment sought to create a consumer driven public health jail diversion model based on principles of recovery and resilience, relying on best practice transition planning to access integrated treatment and services, understanding that relationships, peers and community are paramount on the journey to recovery.” SAMHSA Grants 5 H79 SM55058-02 & 1 H79 TI6384-01

A C Wharton, JrMayor, Shelby County, Tennessee


High end target populationHigh end target population

Serious Mental Illness – Axis ISerious Mental Illness – Axis I– Bipolar DisorderBipolar Disorder– Schizophrenia spectrumSchizophrenia spectrum– Major Depression …Major Depression …

Co-occurring substance use – 74%Co-occurring substance use – 74% Felonies, misdemeanors, kitchen sinkFelonies, misdemeanors, kitchen sink

Taps free leverageTaps free leverage With dignity and minimal stigmaWith dignity and minimal stigma


EligibilityEligibility

Serious mental illnessSerious mental illness Stable on medicationStable on medication Willing to embrace treatmentWilling to embrace treatment

Seeking to serve persons whose Seeking to serve persons whose contact with the justice system is contact with the justice system is related to untreated mental illnessrelated to untreated mental illness


Jail DiversionJail DiversionQuick Reference GuideQuick Reference GuideReference: Reference: Sequential Intercept ModelSequential Intercept Model

Pre-booking jail diversionPre-booking jail diversion– Crisis Intervention TeamsCrisis Intervention Teams – – law law

enforcementenforcement– Mobile Crisis Models – Mobile Crisis Models – mental healthmental health – Blended modelsBlended models

Post-booking jail diversionPost-booking jail diversion– Fast track supervised release Fast track supervised release – Mental Health specialty courtsMental Health specialty courts– Non-specialty courts - Non-specialty courts - JerichoJericho

Re-entry – Re-entry – from Jails & Correctionsfrom Jails & Corrections


The Sequential Intercept ModelThe Sequential Intercept Model Munetz & Griffin, 2006Munetz & Griffin, 2006

Conceptual frameworkConceptual framework Series of points of interceptionSeries of points of interception Prevent deeper penetration of CJSPrevent deeper penetration of CJS Organizing tool for systematically Organizing tool for systematically

addressing decriminalizationaddressing decriminalization Develop targeted strategies to Develop targeted strategies to

increase diversion & linkageincrease diversion & linkage


Systems BarriersSystems Barriers

Inadequate community servicesInadequate community services Waiting lists for treatment & Waiting lists for treatment &

servicesservices Lack of adequate housingLack of adequate housing Fragmentation among MH, SA, Fragmentation among MH, SA,

housing, social services & health housing, social services & health carecare

Stigma, discrimination, NIMBYStigma, discrimination, NIMBY


Jericho in a BoxJericho in a Box

1.1. Best Practice Transition PlanningBest Practice Transition Planning

2.2. Community Linkage PlansCommunity Linkage Plans

3.3. Conditional Release StrategiesConditional Release Strategies

4.4. Independent, Layered SupervisionIndependent, Layered Supervision

5.5. Integrated TreatmentIntegrated Treatment

6.6. Bridge Case ManagementBridge Case Management

7.7. Mainstream ServicesMainstream Services


Jericho in a BoxJericho in a Box

1.1. Best Practice Transition PlanningBest Practice Transition Planning

2.2. Community Linkage PlansCommunity Linkage Plans

3.3. Conditional Release Strategies Conditional Release Strategies FreeFree

4.4. Independent, Layered Supervision Independent, Layered Supervision FreeFree

5.5. Integrated TreatmentIntegrated Treatment

6.6. Bridge Case ManagementBridge Case Management

7.7. Mainstream Services Mainstream Services FreeFree


APIC for Transition PlanningAPIC for Transition PlanningOsher, Steadman & Barr, 2002Osher, Steadman & Barr, 2002

APIC-modelAPIC-model best practice best practice transition planningtransition planning– AAssessssess clinical and social needsclinical and social needs– PPlanlan for for treatment and servicestreatment and services– IIdentifydentify community programscommunity programs – CCoordinateoordinate transition plan to avoid gaps in transition plan to avoid gaps in

carecare Key Domains of ServicesKey Domains of Services Developed by Recovery Support Specialists Developed by Recovery Support Specialists

– ““Boundary Spanners” per SteadmanBoundary Spanners” per Steadman Result is the Result is the Community Linkage PlanCommunity Linkage Plan

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Recovery ToolkitRecovery Toolkit

Case management resourcesCase management resources Treatment optionsTreatment options Rental assistanceRental assistance Transportation resourcesTransportation resources Bridge medication resourcesBridge medication resources Temporary identificationTemporary identification Housing – transitional to permanentHousing – transitional to permanent


PD Special Litigation SectionPretrial Services

Jail MedicalCommunity Providers

Multiple Referral Streams

Confirm Diagnosis &

Meds

JerichoRoundtable

Housing

Medications

Benefits

Case Mgt

Transportation

Treatment

Consumer Input


Conditional Release Conditional Release StrategiesStrategies

Many forms of conditional releaseMany forms of conditional release– Supervised pretrial releaseSupervised pretrial release– Probation: county, state, privateProbation: county, state, private– Avoiding revocation on probationAvoiding revocation on probation

Supervision is layered over CLPSupervision is layered over CLP Independent eyes and ears Independent eyes and ears Material noncompliance reportedMaterial noncompliance reported


RelationshipsRelationships





SuccessesSuccesses

Improved quality of lifeImproved quality of life Reduced severity of symptomsReduced severity of symptoms Reduced jail daysReduced jail days Reduced arrestsReduced arrests

Judges approve over 95% of CLPsJudges approve over 95% of CLPs


SuccessesSuccesses

Referrals from prosecutorsReferrals from prosecutors Referrals from judgesReferrals from judges High tolerance of relapseHigh tolerance of relapse Better, faster dispositionsBetter, faster dispositions The branding of JerichoThe branding of Jericho


OutcomesOutcomes

At 6 months 76% no adverse CJ contactAt 6 months 76% no adverse CJ contact 25% bump up against the system25% bump up against the system 25%, usually new offenses, result in 25%, usually new offenses, result in

reincarcerationreincarceration Overall more than half no further arrestsOverall more than half no further arrests Overall 99 fewer jail days per Overall 99 fewer jail days per

divertee/yeardivertee/year


Systems ImpactSystems Impact, n=55, n=55

Jail days dropped from 13,946 in the Jail days dropped from 13,946 in the year preceding linkage to 6,159 in year preceding linkage to 6,159 in the year followingthe year following

7,787 fewer days @$91= $708,6177,787 fewer days @$91= $708,617 $708,617 / 55 = $12,884 per $708,617 / 55 = $12,884 per

detaineedetainee Overall divertees averaged 99 fewer Overall divertees averaged 99 fewer

days per year in jail after linkagedays per year in jail after linkage


Comparision Comparision

Conditional Conditional ReleaseRelease– All courtsAll courts– No preset No preset

limitationslimitations

– Driven by Driven by dynamics of dynamics of adversarial systemadversarial system

– Bottom upBottom up

Mental Health Mental Health CourtsCourts– One divisionOne division– Usually nonviolent, Usually nonviolent,

low grade offenderslow grade offenders– Driven by judgeDriven by judge

– Top down Top down


Looking ForwardLooking Forward

Gender-specific, trauma-centeredGender-specific, trauma-centered Targeted resources for homelessnessTargeted resources for homelessness Consumer Peer Specialists & WRAPConsumer Peer Specialists & WRAP Supportive EmploymentSupportive Employment Transitional HousingTransitional Housing Gideon – IMS and early interventionGideon – IMS and early intervention


Factors for SuccessFactors for Success

Interagency collaborationInteragency collaboration Active stakeholder involvementActive stakeholder involvement Effective boundary spanner(s)Effective boundary spanner(s) Strong leader or change agentStrong leader or change agent Quality transition planningQuality transition planning

– Incorporate evidence-based practicesIncorporate evidence-based practices Specialized case management Specialized case management

servicesservices


Values StatementValues Statement

Recovery is real and possible.Recovery is real and possible. Relationships are important.Relationships are important. Listen to persons with mental illness. They Listen to persons with mental illness. They

know what what works for them.know what what works for them. Services should be comprehensive, Services should be comprehensive,

integrated & evidence-based. integrated & evidence-based. Overcome stigma through education and Overcome stigma through education and

example. example. Access to treatment should not compromise Access to treatment should not compromise

due process.due process. Avoid artificial limits on eligibility.Avoid artificial limits on eligibility.


Why Jericho?Why Jericho?

For 3000 years a place of safety For 3000 years a place of safety Food, water, and protection Food, water, and protection A safe place in the desertA safe place in the desert

Metaphor of bringing down wallsMetaphor of bringing down walls Bringing down barriers to Bringing down barriers to

recoveryrecovery


ResourcesResources

The National GAINS CenterThe National GAINS Center– www.gainscenter.samhsa.govwww.gainscenter.samhsa.gov

Council of State Govts Mental Health Council of State Govts Mental Health Consensus Project ReportConsensus Project Report– www.csg.orgwww.csg.org– www.consensusproject.orgwww.consensusproject.org

SAMHSASAMHSA– www.samhsa.govwww.samhsa.gov– National Registry of Evidence-based Px & National Registry of Evidence-based Px &

PrgmsPrgms

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