Utilizing Evidence Based & Peer Programs as Jail Diversion in

Problem Solving Courts

Judi Evans, Executive DirectorNAMI Florida

Karen Levy, Mental Health AdvocateNami Florida

What are problem - solving courts?(NOT)

Problem solving courts represent a shift in the way the justice system traditionally handles offenders with issues involving substance abuse, mental health or other behavioral health issues. The goal of these courts is to achieve long-term quality recovery and prevent repeat criminal behavior.

The nation's first problem solving court was implemented in 1989, with the

establishment of the first drug court in Miami, Florida. The first mental health

court was established in 1997 in Broward County by Judge Ginger Lerner Wren

Court personnel work with prosecutors, public defenders, probation officers, social workers and other justice system partners

Encourage offenders to stick with treatment programs and abstain from problem behaviors

Supervision and treatment are tailored to the offender groups.

Features of a Problem Solving Court

Judge oversees, provides accountabilityJudge frequently, directly and intimately

involvedDedicated court calendarReferrals from multiple sourcesSpecially trained court personnelDedicated clinical, resource and

supervisory personnel

Features of a Problem Solving Court

Court-based treatment plan and supervisionIntensive services, ACT services, wrap-around

servicesFrequent court appearances/reviewsGraduation and rewards

Jail Diversion

The Jail Diversion Program helps individuals whose legal involvement may be a result of untreated mental illness or co-occurring mental health and substance abuse disorders. This is a short-term program designed to help stabilize and link clients to more traditional treatment methods in order to reduce their incidence and length of incarceration.

Services Include

Face-to-face assessmentstransportationtransitional housingpsychiatric evaluations and treatment plansprescription medication therapyintensive case managementcourt liaison and finding additional

community resources.

The program provides access to community-based health and substance-abuse treatment services.

Clients receive treatment services, case management, housing and medications.

Peer Services – Peer-to-Peer

The Benefits

The cost per day to house an inmate in the Pinellas County Jail is $90. Persons with a mental illness however, generate a higher cost per day than the other inmates in terms of medication, treatment and disruption.

The placement of persons with a mental illness in mental health facilities has resulted in considerable cost savings to the jail.

Long-range benefits include a decrease in recidivism rates and re-offenses.

The Benefits

Perhaps the most important benefit of a jail diversion program is the decriminalizing of mental illness and treatment in an appropriate medical setting.

If the concept of mental health evaluation at the time of booking is shown to be effective, state funding and statutory change requiring this type of intervention could follow.

The benefits to the safety of the community and the resulting impact to the criminal justice system would be substantial.

Jail Diversion Outreach Team(JDOT)

Salt Lake City Utah has a multidisciplinary team that includes:

• a social worker• case manager• nurse• peer mentors• APRN This collaborative effort between Mental Health

Services, Criminal Justice Services, the County jail, housing, and NAMI has been very successful in reducing participants’ jail time.

(JDOT)

The team provides intensive, community-based services to a minimum of 60 criminal-justice involved persons with mental illness. Services emphasize integrated mental health and substance abuse interventions.

As part of the jail diversion services provided in Salt Lake County, JDOT is showing impressive outcomes in keeping individuals with serious and persistent mental illness out of the jail and in the community, with the goal of helping them to be contributing members of society.

(JDOT)Findings from the Salt Lake County 2009 Human Services

Budget Report:Pre JDOT With JDOT

Total Bookings for new office

433 6

Total jail bed days 12,281 103

Average bookings/ person

21 0.3

Average days in jail/person

585 5

Peer Support Practices Are EBPs

• COSP study results confirmed a growing body of evidence that COSPs are evidence-based practices (EBPs):

– Peer support services promote participant well-being. When offered as an adjunct to the treatment of mental illness, they promise mental health consumers recovery of a life in the community.

– Study results have advanced the capacity of researchers, peer providers, and mental health administrators to promote evidence-based peer practices in developing COSPs and to guide quality improvements in mature COSPs

http://www.promoteacceptance.samhsa.gov

Vision

•Instead of more mental health services, the vision is that peer support becomes part of everyday culture and simply good community practice.

Why Integrate Consumers as Staff and Experts in Jail Diversion Programs?

Consumers offer a critical perspective

People who have “been there” can offer the most relevant perspective on how systems fail and what meaningful alternative(s) should be in place.’

Bazelon Center for Mental Health Law (2003)

President’s New Freedom CommissionReport on Mental Health (July 2003)

Goal 2 Mental health care is consumer and family driven

Consumers working as providers help expand the range and availability of services and supports that professionals offer

Consumer providers bring different attitudes, motivations, insights, and behavioral qualities to the treatment encounter

When it’s about the individual…

•No one else has to change.•We pre-determine outcomes.•We lose sight of our learning.•We lose sight of the relational dynamic.

Benefits of Peer Provided Services To individuals receiving them

Improved social functioningImproved self-esteem and social supportImproved quality of lifeReduced use of hospitalization and/or crisis services

(Solomon, 2004)(2004)Strengthening Self-AdvocacyWellness Recovery Action Plan (WRAP)Access to self help resources (Mead, et.al, 2001)Peer to Peer

Benefits of Peer Provided Services

To service delivery system CostCost-savings due to decreased hospitalization/shorter

hospital stays Improves negative attitudes of service providers Provide mechanism for offering services to people in need of

services who are alienated from the traditional mental health system (e.g. people who are homeless)

Improve the effectiveness of the traditional mental health delivery system (Solomon, 2004)

Greater optimism among professional staff about clients’’chances of recovery (Felton, et al, 1995)

Roles for Consumers in Jail Diversion & Re Entry Programs

Peers hired as direct service staffJail diversion program planning & oversightFocus groups, planning committees, dialogue groups Participation in Boards of Directors and Advisory/Steering

CommitteesResearch and evaluationHire peers as research assistantsConsumer satisfaction surveysHire as observers/monitors in court and jail setting to ensure

clients rights are protectedDelivery of Peer Support programs in jail & communityProvider TrainersAdvocacy e.g. Re Entry And Beyond (RAB)

Why NAMI ??

What is NAMI’s Peer-to-Peer Program?Peer-to-Peer is a unique, experiential learning program for people with any

serious mental illness who are interested in establishing and

maintaining their wellness and recovery.

Why NAMI ??

What does the course include? Peer-to-Peer consists of ten two-hour units and is taught by a team of

two trained “Mentors” and a volunteer support person who are personally experienced at living well with mental illness.

Mentors are trained in an intensive three day training session and are supplied with teaching manuals.

Participants come away from the course with a binder of hand-out materials, as well as many other tangible resources: an advance directive; a “relapse prevention plan” to help identify tell-tale feelings, thoughts, behavior, or events that may warn of impending relapse and to organize for intervention; mindfulness exercises to help focus and calm thinking; and survival skills for working with providers and the general public.

"Peer to Peer has given me a sense of who I am. I understand what is going on with me and I am able to cope. I have gained employment and committed to my recovery. I've come a long way since I've started.“

"I am now able to look at myself in more depth with less fear. I can try to build bridges with the relationships that were interrupted by my illness.”

"Peer to Peer has allowed me to take the focus off my illness and learn to balance it with the rest of my life.. By engaging in recovery I am able to be more relaxed and productive."

NAMI Connection is a weekly recovery support group for people living with mental

illness in which people learn from each others’ experiences, share coping strategies,

and offer each other encouragement and understanding.

The vision is that every person in this country who lives with a mental illness

will have, within reasonable driving distance, a NAMI Connection Recovery

Support Group to attend.

"For so long my illness has been a disability. Now I can see how my experience enables me to help others. It makes what I went through worth while". Connecticut"When I was in crisis, a dear friend said, "Don't worry, we will be your life preserver, we won't let you sink!"With my friends, family and NAMI I built a support safety net. I feel with the NAMI Connection program that my support net has gotten stronger. Look at all the support I am now connected to!"

Why NAMI ??

What is NAMI’s Family-to-Family Program?

The NAMI Family-to-Family Education Program is a free, 12-week course for family caregivers of individuals with severe mental illnesses.

The course is taught by trained family members All instruction and course materials are free to

class participants Over 115,000 family members have graduated

from this national program

"I have a greater understanding of mental illness and also how to deal with the many issues I deal with on a daily basis with my ill family member.”

"It has been extremely helpful to me in my job with the LPD (Lakeland Police Department). I can better relate to families when called to a situation where mental illness is involved. All law enforcement officers and firemen, etc. should have to take this course.”

"Sometimes I felt as if nobody understood, but this course helped in every area I was interested in and gives me hope for my relative and me!”

"Family members who take the Family-to Family course are better equipped to work with mental health clinicians and other professionals in a collaborative manner... It will help you learn to cope successfully with a major challenge in your life, and that, in turn, will help your loved one as he or she works towards recovery.“

--Peter Weiden, M.D., author of Breakthroughs in Antipsychotic Medications