reducing the involvement of persons with mental illness & co-occurring disorders in the criminal...
TRANSCRIPT
Reducing the Involvement of Persons With Mental Illness & Co-Occurring
Disorders in the Criminal Justice System Through Jail Diversion Programs
Henry J. Steadman, Ph.D.
Saks Institute Spring Symposium
April 11, 2013
On June 30, 2005, approximately 7 million people were under correctional supervision in the U.S.
Jail: 747,529
Prison: 1,446,269
Probation: 4,162,536
Parole: 784,408
In 2005, there were 13 million bookings into U.S. jails.
PRA/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%Women – 31%
Steadman, H.J., Osher, F., Robbins, P., 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 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 Disorders
Males Females
Disorder Alcohol Abuse/ Dependence
Drug Abuse/ Dependence
Alcohol Abuse/ Dependence
Drug Abuse/ Dependence
Schizophrenia 59% 42% 56% 60%
Major Depression 56% 26% 37% 57%
Mania 33% 24% 39% 64%
Any Severe Disorder
58% 33% 40% 60%
Detainees with severe mental disorder plus either alcohol or drug abuse/dependence
= 72% = 72%
Adapted 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
CMHS TCE JD: 14 Sites Traumatic Experiences (n=546)
Lifetime Past 12 Months
F M F M
Physical 93.2% 89.8% 67.4% 58.6%
Sexual 77.1% 34.7% 32.1% 27.5%
Repeated Cycles
INCARCERATION
ARREST
PrivateHome
GroupResidence
ShelterStreet
S.A.ResidentialTreatment
MentalHealthInpatient
“Treatment-Resistant” Clients
OR
“Client-Resistant” Services
CO
MM
UN
ITY
Intercept 1Law enforcement
911
Law
En
forc
eme
nt
Intercept 2Initial detention / Initial court hearings
Init
ial
Det
enti
on
Fir
st A
pp
eara
nc
e C
ou
rtArrest
Intercept 3Jails / Courts
Jail
Sp
ecia
lty
Co
urt
Dis
po
siti
on
al
Co
urt
Intercept 4Reentry
Pri
son
/R
een
try
Jail
R
e-en
try
Par
ole C
OM
MU
NIT
Y
Intercept 5Community corrections
Pro
bat
ion
Violation
Violation
Diversion = avoiding or radically reducing jail time by using community-based treatment as an alternative.
“Diversion”
Criminal Justice → Not filing or dropping charges (ATI)
Mental Health → Not filingCondition of bailDeferred prosecution
(stipulate to police report)Deferred sentencingCondition of probation
Diversion
Reduce recidivism
Reduce violence
Reduce jail days
Reduce costs
Public’s Expectations
Diversion Logic Model
Identify and Enroll People in Target Group
Linkage Comprehensive/ Appropriate Community-Based Services
Improved Mental Health /Individual Outcomes
Improved Public Safety Outcomes
Stage 1 Stage 2
Diversion
Stage 3
Mental Health Diversion Options
Pre-Booking
– Police-Based
Post-Booking
– Court-Based
– Jail-Based
– Community Corrections-Based
Dispositions of Cases Handled by Three Types of Police Response at Three Sites
Disposition Birmingham (N=100)
Knoxville (N=100)
Memphis (N=100)
Taken to treatment location 20 42 75
Situation resolved on the scene
64 17 23
Referred to treatment 3 36 0
Arrested 13 5 2
Las Vegas CIT Call Resolution*
485 (74%) Hospitalization
344 (71%) Involuntary
25 (18%) Onsite resolution
6 (4%) Arrest
* Skeem, J., Bibeau, L. (2008). How does violence potential relate to crisis intervention team responses to emergencies? Psychiatric Services 59, 201-204.
CO
MM
UN
ITY
Intercept 1Law enforcement
911
Law
En
forc
eme
nt
Intercept 2Initial detention / Initial court hearings
Init
ial
Det
enti
on
Fir
st A
pp
eara
nc
e C
ou
rtArrest
Intercept 3Jails / Courts
Jail
Sp
ecia
lty
Co
urt
Dis
po
siti
on
al
Co
urt
Intercept 4Reentry
Pri
son
/R
een
try
Jail
R
e-en
try
Par
ole C
OM
MU
NIT
Y
Intercept 5Community corrections
Pro
bat
ion
Violation
Violation
Rikers Island 2008 Bail Statistics(N=48,000)
No Mental Illness
Mental Illness
Make Bail 21% 12%
Days to Make Bail 9 48
Council of State Governments March, 2013
Rikers Island Average 2008 Length of Stay*(N=48,000)
Council of State Governments March, 2013
No Identified Mental Illness – 61 Days
Identified Mental Illness – 112 Days
* of detainees staying > 3 days
CO
MM
UN
ITY
Intercept 1Law enforcement
911
Law
En
forc
eme
nt
Intercept 2Initial detention / Initial court hearings
Init
ial
Det
enti
on
Fir
st A
pp
eara
nc
e C
ou
rtArrest
Intercept 3Jails / Courts
Jail
Sp
ecia
lty
Co
urt
Dis
po
siti
on
al
Co
urt
Intercept 4Reentry
Pri
son
/R
een
try
Jail
R
e-en
try
Par
ole C
OM
MU
NIT
Y
Intercept 5Community corrections
Pro
bat
ion
Violation
Violation
Nathaniel Project (NYC) N=53
Prior Year Current Year
Number of Arrests
101 7
Misd. 35 5
Felonies 66 2
SAMHSA KDA (N=1,185)
Diverted Non-Diverted
Community days 303 245
# Arrests 1.03 1.20
Arrests/mo. .11 .15
CMHS TCE JD: 14 SitesChanges in Arrests and Jail Days
Pre-Enrollment(1 year)
Post-Enrollment(1 year)
n % n %
Any Arrests 579 100.0 293 50.6
Arrests (Mean) 2.3 1.0
Violent Arrests (Mean) .23 .1
Jail Days (Mean) 49 33
Annualized Number of Arrests – 3 MHCs
Pre 18 Months
Post 18 Months
% Reduction
MHC Mean(N)
2.2(436)
1.4(436)
37%
TAU Mean(N)
2.6(597)
2.0(586)
23%
Total Incarceration Days Pre and Post 18 Months – 3 MHCs
MHCNEW Pre 18 Months
Post 18 Months
% Increase
MHC Mean(N)
75(436)
84(436)
12%
TAU Mean(N)
75(597)
152(597)
101%
Diversion Logic Model
Identify and Enroll People in Target Group
Linkage Comprehensive/ Appropriate Community-Based Services
Improved Mental Health /Individual Outcomes
Improved Public Safety Outcomes
Stage 1 Stage 2
Diversion
Stage 3
Drug & Alcohol Use
Number Cases
Reporting Use
Percent of Cases
Reporting Use
Mean Number
of Days of Use
Median Number
of Days of Use
Any alcohol -Last 30 Days
Baseline 576 59.1% 13.1 8
6 Months 169 28.4% 5.8 3
12 Months 105 30.1% 6.6 3
Alcohol to Intoxication -Last 30 Days
Baseline 372 38.2% 12.9 8
6 Months 76 12.8% 5.2 2
12 Months 45 12.9% 7.3 4
Illegal drugs - Last 30 Days
Baseline 568 58.3% 17.8 20
6 Months 101 17.0% 9.5 5
12 Months 55 15.7% 10.0 5
Daily Living/Role Functioning Scale
NMean Score
(Range: 0 to 4)1
Mean Difference From Baseline 2
Baseline 977 2.01 --
6 Months 594 1.31 -0.70
12 Months 349 1.17 -0.84
1 – Where 0 = No Difficulty and 4 = Extreme Difficulty2 – Calculations based on those individuals having both interviews completed
Colorado Symptom Index (CSI)
NMean Score
(Range: 0 to 60)1
Mean Difference From Baseline 2
Baseline 968 31.5 --
6 Months 590 22.3 -9.2
12 Months 346 21.4 -10.1
1 – Where 0 = Low Symptoms/High Well-Being and 60 = High Symptom/Low Well-Being2 – Calculations based on those individuals having both interviews completed
Year-by-Year CJ Cost
1 2 3 4 5 60
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
MHC TAU
Year-by-Year Tx Cost
1 2 3 4 5 60
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
MHC TAU
Year-by-Year Total Cost
1 2 3 4 5 60
2000
4000
6000
8000
10000
12000
14000
16000
18000
20000
MHC TAU
Is Criminalization An Important Public Policy Concept?
Macro View Transinstitutionalization
% Detainees with MI Different
Micro View Individual more likely in jail than in community-
based treatment
Reduce Involvement
Minimize Inappropriate Penetration
More Useful Concepts