reducing the numbers of people with mental illnesses in ......objective 4: use results of behavioral...

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Reducing the Numbers of People with Mental Illnesses in County Jail

Presentation to Board of Commissioners May 13, 2015

Marilyn Brown Commission President

Paula Brooks Commissioner

John O’Grady Commissioner

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Project History / Approach

Findings

Recommendations

Next Steps

Overview

Council of State Governments Justice Center

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December 9, 2014 federal, state and local leaders, such as Commissioner Brown, discussed their support for reducing the

number of people with mental illnesses in jails.

Franklin County is part of a large national movement to reduce mental illnesses in jails


Federal speakers discussed legislation that supports counties’ efforts to reduce the number of people with mental illnesses in jails

Council of State Governments Justice Center 4

U.S. Sen. Al Franken (left, D-MN) and U.S. Rep. Richard Nugent (above, R-FL)

The Stepping Up Initiative officially launched with a series of events in May 2015


• May 5, Washington DC • May 5, Johnson County, KS • May 6, Miami-Dade County, FL • May 7, Sacramento, CA

National Initiative

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Johnson County KANSAS

Bexar County TEXAS

Franklin County OHIO

Hillsborough County NEW HAMPSHIRE


New York City NEW YORK (5 Counties)

Salt Lake County UTAH

Much innovation already underway in Franklin County

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But Franklin County leaders agree more needs to be done…


Jail Population Declining Nationally


-3.0

-2.0

-1.0

0.0

1.0

2.0

3.0

4.0

5.0

6.0

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

00 01 02 03 04 05 06 07 08 09 10 11 12 13

YEAR

ANNUAL PERCENT CHANGE

NUMBER OF INMATES AT MIDYEAR

Source: Bureau of Justice Statistics, “Jail Inmates at Midyear 2013—Statistical Tables,” 2014.

Inmates confined in local jails at midyear and percent change in the jail population, 2000-2013

What About Persons with Mental Illnesses ?


Source: The City of New York Department of Correction

3,319 4,391

10,257 7,557

2005 2012

M Group Non-M Group

76% 63%

37% 24%

AVERAGE DAILY JAIL POPULATION (ADP) AND ADP WITH MENTAL HEALTH DIAGNOSIS

13,576 Total 11,948

Total

NEW YORK CITY

5% 95% 72% 83% 17% 28%

GENERAL POPULATION JAIL POPULATION

SERIOUS MENTAL ILLNESS

NO SERIOUS MENTAL ILLNESS

SERIOUS MENTAL ILLNESS

NO SERIOUS MENTAL ILLNESS

CO-OCCURRING SUBSTANCE USE DISORDER

NO CO-OCCURRING SUBSTANCE USE DISORDER

Prevalence of Serious Mental Illness and Co-Occurring Disorders in Jail Populations


The Problem: Overrepresentation of Persons with Serious Mental Illnesses


Arrested at disproportionately higher rates • Co-occurrence of SUD • Homelessness

Stay longer in jail and prison

Limited access to health care

Low utilization of EBPs

High recidivism rates

More criminogenic risk factors

– ≠ Crime type

– ≠ Dangerousness

– ≠ Failure to appear

– ≠ Sentence or disposition

– ≠ Custody or security classification level

Recidivism Is Not Simply a Product of Mental Illness: Criminogenic Risk

Risk = How likely is a person to commit a crime or violate the conditions of supervision?


RISK

How do we measure criminogenic risk ?


Dynamic factors Static Factors

Criminal history

- number of arrests

- number of convictions

- type of offenses

Current charges

Age at first arrest

Current age

Gender

History of antisocial behavior

Antisocial personality pattern

Antisocial cognition

Antisocial associates

Family and/or marital factors

Poor school and/or work performance

Few leisure or recreational activities

Substance abuse

Risk-Need-Responsivity Model as a Guide to Best Practices


• Focus resources on high RISK cases

• Target criminogenic NEEDS, such as antisocial behavior,

substance abuse, antisocial attitudes, and criminogenic peers

• RESPONSIVITY – Tailor the intervention to the learning style, motivation, culture, demographics, and abilities of the offender. Address the issues that affect responsivity (e.g., mental illnesses)

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Findings

Recommendations

Next Steps

Overview


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*Included only first bookings and removed cases missing DOB and SSN

Sources of Data

SHERIFF’S OFFICE

ADAMH Board

Community Shelter Board

Matched to SMI Services Flags

1,554

Accessed the Shelter System One Year Prior to Booking

1,168


2010 Jail Bookings

32,638

Unique Individuals Booked* 21,966

2011 Jail

Bookings

2012 Jail

Bookings

2013 Jail

Bookings

Study Cohort Used for re-booking recidivism analysis

2009 Jail

Bookings

2008 Jail

Bookings

Used to develop risk proxy

56% 49%

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More than half of all adults re-enter jail within 3 years of release

Misdemeanor N=14,198

PERCENT REBOOKED IN 3 YEARS

Felony N=5,643

* Analysis of first Franklin County jail bookings in 2010


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People with serious mental illnesses return more frequently

* Analysis of first Franklin County jail bookings in 2010 ** SMI identified using match to behavioral health service utilization data

51%

60%

Non-SMI Flag SMI

PERCENT RE-INCARCERATED IN THREE YEARS

N = 20,412 N = 1,554


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People with serious mental illnesses stay longer in jail


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SMI

Non-SMI

AVERAGE LENGTH OF STAY IN JAIL (DAYS)

N = 20,412

N = 1,554


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People with serious mental illnesses are slightly higher risk


46%

30%

24%

41%

29% 30%

Low Risk Med Risk High Risk

RISK DISTRIBUTION

Non-SMI

SMI


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How Does the Population Identified with SMI Differ from Those Not Identified as Having SMI?


No significant differences in charge level

Similar proportion booked pretrial vs. sentenced

Different ALOS regardless of risk level* Risk factors include prior jail bookings, age, charge level, and offense type


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Individuals with serious mental illnesses who experienced homelessness prior to jail booking have higher recidivism rates

*Analysis of first Franklin County jail bookings in 2010; SMI identified using match to behavioral health service utilization data; ** Shelter flag defined as accessing shelter one year prior to jail booking

N = 20,412 N = 1,554


45%

56% 63%

76%

Non-SMI flag SMI flag

PERCENT RE-BOOKED IN THREE YEARS

No shelter contact Shelter contact 1 yr prior to booking

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Information on risk is not systematically collected to inform decision-making

Pretrial Risk

• Risk of failure to appear in court

• Risk of re-arrest during pretrial period

Decisions Regarding Community Supervision

• Municipal Probation • Class 1 Misdemeanants only

• Common Pleas Adult Probation (felony probationers)

?

(OR

AS)


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Information on needs is not systematically collected to inform decision-making

People Booked into Franklin County Jail*

21,966

Bookings with ALOS > 3 Days

10,523

Actual Number of People with SMI Entering Jails is

UKNOWN

Matched to ADAMH Data and Identified as SMI Prior to Booking

National Estimates** of SMI Population in Jail After 3 Days

9%

22%

**Extrapolated from national data on jail populations.

* Analysis of first Franklin County jail bookings in 2010


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Many people with serious mental illnesses released from jail are not receiving the treatment and supports they need in the community

Bookings with ALOS > 3 Days

10,523

Actual Number of People with SMI Entering Jails is

UKNOWN

Matched to ADAMH Data and Identified as SMI Prior to Booking*

National Estimates of SMI Population in Jail After 3 Days**

969 People with SMI

2,315 People with SMI

**Extrapolated from national data on jail populations * Analysis of first Franklin County jail bookings in 2010


609 Received treatment from ADAMH funded provider within a year of release

360

Did NOT receive treatment from ADAMH funded providers within a year of release

KNOWN GAP

Treatment following release

609 Received treatment from ADAMH funded provider within a year of release

1,706 As many as 1,706 did NOT receive treatment from ADAMH funded providers within a year of release

POTENTIAL GAP

LOW RISK 40%

HIGH/ MOD RISK

60%

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Findings

Recommendations

Next Steps

Overview


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Objective 1: Increase access to crisis services and alternatives to incarceration for law enforcement

Recommendation A: Charge ADAMH with providing a resource guide for people with mental illnesses and family members who don’t know what services are available 24/7. Recommendation B: Expand the capacity of NETCARE and other crisis service options to allow for diversion of individuals with mental illnesses that are not a risk to public safety.


Objective 2: Improve response by local law enforcement to people with mental illness

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15%

85%

Crisis Intervention Training in 2015

CIT Trained Officers Non-CIT Trained Officers

25%

75%

Potential goal for % of CIT Trained Officers

CIT Trained Officers Non-CIT Trained Officers


Objective 3: Use the results of a validated pretrial risk assessment to inform decisions about pretrial release and detention

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Recommendation A: Charge the judges of the Municipal and Common Pleas Courts, with the support of the Probation Department directors, to design of a process that ensures timely and effective pretrial decision-making.

• Staffing • Timing • Risk assessment tools • Information sharing • Training


Objective 4: Use results of behavioral health risk screening and assessment to inform treatment and supervision plans

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The Franklin County Sheriff’s Office will implement universal screening for mental illnesses and substance use disorders Assessment results inform jail interventions and connections to community-based treatment and supervision. This effort should address the following:

• Staffing • Timing • Behavioral health screening tools • Information sharing • Training


Objective 5: Use risk and behavioral health information to develop comprehensive community-based supervision plans

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Low Criminogenic Risk (low)

Medium to High Criminogenic Risk (med/high)

Low Severity of Substance Abuse

(low)

Substance Dependence (med/high)

Low Severity of Substance Abuse

(low)

Substance Dependence (med/high)

Low Severity of

Mental Illness (low)

Serious Mental Illness

(med/high)

Low Severity of



(med/high)

Low Severity of



(med/high)

Low Severity of



(med/high)

Group 1 I – L CR: low SA: low MH: low

Group 2 II – L CR: low SA: low MH: med/high

Group 3 III – L CR: low SA: med/high MH: low

Group 4 IV – L CR: low SA: med/high MH: med/high

Group 5 V – H CR: med/high SA: low MH: low

Group 6 VI – H CR: med/high SA: low MH: med/high

Group 7 VII – H CR: med/high SA: med/high MH: low

Group 8 VIII – H CR: med/high SA: med/high MH: med/high


Objective 6: Ensure people are connected to community-based behavioral health care services prior to release

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Recommendation A: Charge the Franklin County Sherriff’s Office and ADAMH with developing a plan that connects people who qualify for the following services:

• ADAMH agencies • Veteran’s services • Ohio Benefits Bank for connections to healthcare


Objective 7: Ensure availability of community based behavioral health services

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Recommendation A: Increase availability of case management: ACT Teams with forensic expertise; additional peer support positions Recommendation B: Train and incentivize providers to deliver services that address the behaviors associated with recidivism Recommendation C: Improve access to housing and support services to reduce rates of homelessness


Objective 8: Track progress

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Recommendation A: Generate bi-annual reports that provide the County Commissioners the following measures:

• Prevalence of mental illness of those booked into the jail • Prevalence of substance use disorders of those booked into

the jail • Profile of risk of those booked into the jail • Of those released how many are connected to services • Of those released with high risk and high need how many

connected to services


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Findings

Recommendations

Overview


Next Steps

Opportunities

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1. Increase Public Safety There are likely 1000+ people with SMI released from jail in need of treatment who are at moderate/high risk of re-offense 2. Maximize impact of resources People with SMI stay almost twice as long in jail as the non-SMI population and cost significantly more to detain

3. Improve health outcomes There are significant gaps in the continuum of care that could be improved with increased treatment capacity and better cross-systems coordination


Goal 1: Divert additional people from arrest

Increase alternatives to incarceration


Increase crisis services

Goal 2: Increase the number of individuals connected to services

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*Numbers extrapolated from national estimates

2,300 SMI individuals

released from jail*

Target group who should receive

community mental health services

600 received

treatment from

ADAMH funded

provider*


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Goal 3: Lower recidivism rates


51%

60%

Non-SMI Flag SMI

PERCENT RE-BOOKED IN THREE YEARS

N = 20,412 N = 1,554


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Goal 4: Reduce length of stay

* Analysis of first Franklin County jail bookings in 2010 ** SMI and AOD identified using match to behavioral health service utilization data


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SMI

Non-SMI

AVERAGE LENGTH OF STAY IN JAIL (DAYS)

N = 20,412

N = 1,554

Next Steps

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CHARGE a single entity with responsibility for achieving these goals


COMMISSION periodic reports highlighting progress toward goals

REQUIRE regular written updates reviewing status of implementation of recommendations

Thank you!

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Michael Thompson Director, CSG Justice Center

Fred Osher, M.D. Director of Health Systems and Services Policy,

CSG Justice Center

www.csgjusticecenter.org

The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect

the views of the authors, and should not be considered the official position of the Justice Center, the members of the Council of State Governments, or the funding agency supporting the work.


Please contact Kati Habert at [email protected] with any questions.

http://www.csgjusticecenter.org/

mailto:[email protected]

reducing the numbers of people with mental illnesses in ......objective 4: use results of behavioral...

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