Chester County Report of the Cross Systems Mapping Workshop June 29, 2010

Transcription

1 DREXEL UNIVERSITY & UNIVERSITY OF PITTSBURGH Chester County Report of the Cross Systems Mapping Workshop June 29, 2010 Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System

2 Facilitators Patricia A. Griffin, PhD, Center of Excellence Senior Consultant Mary Gregorio, MA, Southeast Regional Mental Health Services Consultant Other Support Tory Bright, Southeast Regional Mental Health Services Coordinator Paul Butler, Southeast Regional Mental Health Services Forensic Liaison Casey LaDuke, Center of Excellence Research Associate Center of Excellence Staff David DeMatteo, JD, PhD Sarah Dorrell, MSW Sarah Filone, MA Kirk Heilbrun, PhD Edward P. Mulvey, PhD Marcel Schipper Carol Schubert, MPH 2

3 Table of Contents Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System Introduction... 4 Background... 4 About the Workshop... 5 Objectives of the Cross-Systems Mapping Exercise... 5 Keys to Success... 6 Chester County, Pennsylvania Chester County Cross Systems Map... 7 Chester County Cross Systems Narrative... 8 Intercept I: Law Enforcement / Emergency Services...10 Intercept II: Initial Detention / Initial Court Hearing...15 Intercept III: Jails / Courts...17 Intercept IV: Re-Entry...21 Intercept V: Community Corrections / Community Support...24 Chester County Priorities Conclusion Closing List of Appendices Appendix A Participant List...30 Appendix B Chester County Data...41 Appendix C MH/IDD Definition of Serious and Persistent Mental Illness...39 Appendix D Additional Website Resources...40 Appendix E Reources for Specialized Police Response and Law Enforcement/Behavioral Health Collaboration at Intercept Appendix F Resources for Improving Re-Entry...45 Appendix G- Resources for Veterans Involved in the Criminal Justice System Appendix H- Resources for Community Education 48 3

4 Chester County, Pennsylvania Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System Introduction The purpose of this report is to provide a summary of the Pennsylvania Mental Health and Justice Center of Excellence Cross-Systems Mapping workshop held in Chester County, Pennsylvania, on June 29th, conducted by the Pennsylvania Mental Health and Justice Center of Excellence. The workshop was hosted by the Chester County Mental Health/Intellectual and Developmental Disabilities and the Chester County Department of Probation and Parole as part of an ongoing process of developing collaborative systems of support for individuals who have mental illness and who come in contact with criminal justice. This report (and accompanying electronic file) includes: A brief review of the origins and background for the workshop A summary of the information gathered at the workshop A cross-systems intercept map as developed by the group during the workshop A description of each intercept along with identified gaps and opportunities Priorities and next steps determined by the group Background Chester County Office of Mental Health and Intellectual and Developmental Disabilities and the Chester County Department of Probation and Parole requested the Center of Excellence Cross- Systems Mapping workshop to promote progress in addressing criminal justice diversion and treatment needs of adults with mental illness in contact with the criminal justice system. The Cross-Systems Mapping workshop was seen as an opportunity to engage mental health, substance abuse, and criminal systems stakeholders in examining the county s strengths and weaknesses at each Sequential Intercept and identify priorities for change and/or integration. As part of the workshop, they were requested to provide assistance to Chester County with: Creation of a map indicating points of interface among all relevant Chester County systems Identification of resources, gaps, and barriers in the existing systems Development of priorities to promote progress in addressing the criminal justice diversion and treatment needs of adults with mental illness in contact with the criminal justice system. Prior to the workshops, the Center of Excellence gathered information about Chester County through a Community Collaboration Questionnaire, a preliminary meeting by conference call, and documents relevant to the population. The participants in the workshops included 43 individuals representing multiple stakeholder systems including mental health, substance abuse treatment, human services, corrections, advocates, family members, consumers, law enforcement, and the courts. A complete list of participants is available in the Appendix A of this document. Patty Griffin, PhD, Senior Consultant from the Center of Excellence and the CMHS National GAINS Center and Mary M. Gregorio, MA, Consultant for the SE Regional Mental Health Services Coordination Office facilitated the workshop sessions. Tory Bright and Paul Butler of the SE Regional Mental Health 4

5 Services Coordination Office and Casey LaDuke and Sarah Dorrell of the Center of Excellence also provided support. About the Workshop Upon receiving a grant from the Pennsylvania Commission on Crime and Delinquency and the Pennsylvania Department of Public Welfare s Office of Mental Health and Substance Abuse Services, the Pennsylvania Mental Health and Justice Center of Excellence was developed as a collaborative effort by Drexel University and the University of Pittsburgh. The mission of the Center of Excellence is to work with Pennsylvania communities to identify points of interception at which action can be taken to prevent individuals with mental illness from entering and penetrating deeper into the justice system. The Center of Excellence Cross-System Mapping workshop is tailored to each Pennsylvania community. The workshop provides an opportunity for participants to visualize how mental health, substance abuse, and other human services intersect with the criminal justice system. This workshop is unlike other types of consultations or staff development training programs. A key element is the collaborative process. Meaningful cross-system collaboration is required to establish effective and efficient services for people with mental illness and co-occurring substance use disorders involved in the criminal justice system. This makes the composition of the group extremely important. While some workshops involve advertising to the entire provider community, it is essential in the workshops that the organizers gather a group that represents key decision makers and varied levels of staff from the relevant provider systems. Center of Excellence staff work with this group, serving as expert guides to help the group: Create a cross-systems map indicating points of interface among all relevant local systems Identify gaps, opportunities, and barriers in the existing systems Optimize use of local resources Identify and prioritize necessary actions for change Upon completion of the workshops, the Cross-Systems Map included in the report is provided in both print and electronic formats. It is meant to be a starting point. The electronic files can be revised over time to reflect the accomplishments and changes in the planning process. Objectives of the Cross Systems Mapping Exercise The Cross-Systems Mapping Exercise has three primary objectives: 1. Development of a comprehensive picture of how people with mental illness and co-occurring substance use disorders move through the Chester County criminal justice system along five distinct intercept points: Law Enforcement and Emergency Services, Initial Detention/ Initial Court Hearings, Jails and Courts, Re-entry, and Community Corrections/Community Support. 2. Identification of gaps, resources, and opportunities at each intercept for individuals in the target population. 3. Development of priorities for activities designed to improve system and service level responses for individuals in the target population. 5

6 Keys to Success Existing Cross-Systems Partnerships Chester County s history of collaboration between the criminal justice and behavioral health systems is reflected in a number of existing local efforts that were identified prior to the mapping, including: Mental Health, Recovery, and Drug Courts Chester County Forensic Committee Crisis intervention training for law enforcement Mental Health Probation Protocol Adult Cross Systems Training Dedicated forensic mental health assessment, treatment, case management and housing Collaborative exchange of information among agencies to promote continuity of care, safety, and enhanced services Accelerated Rehabilitative Disposition (ARD) Joint efforts by the Mental Health Office of the County MH/IDDD Department and the Adult Probation Department to pursue grant funding for collaborative initiatives Consumer/Family Involvement in the Workshops Consumers were represented by two Peer Specialists. Consumers added valuable information to the discussion especially about the role of Peer Specialists in the community and in the prison, supports offered through Community Crossroads which is a peer run support center, and ideas about differentiating between crisis and needs that may be urgent but do not rise to the level of crisis. The Chester County National Alliance on Mental Illness (NAMI) was represented by a family member who contributed information and support opportunities available both to families and to law enforcement Representation from Key Decision Makers in the Workshops The workshops included wide cross-system representation and involved many of the key decision makers. Opening remarks by Ruth Kranz-Carl, Human Services Director, and The Honorable William P. Mahon set the stage and established a clear message as to the importance of the workshop. Gary Entrekin, MH/IDD Administrator, welcomed participants and introduced the facilitators. Data Collection Data collected prior to the mapping workshop indicate that the numbers of offenders with serious mental illness in the County prison increased in FY 2010 after years of steady decreases or stable numbers (see Appendix B). 6

7 Chester County Cross Systems Map

8 Chester County Cross Systems Narrative, Gaps, and Opportunities The Cross-Systems Mapping exercise is based on the Sequential Intercept Model developed by Mark Munetz, M.D. and Patty Griffin, Ph.D. 1 in conjunction with the National GAINS Center. In this workshop, participants were guided to identify gaps in services, resources, and opportunities at each of the five distinct intercept points. This narrative reflects information gathered during the Cross-Systems Mapping Workshop. It provides a description of local activities at each intercept point, as well as gaps and opportunities identified at each point. This narrative may be used as a reference in reviewing the Chester County Cross-Systems Map. The cross-systems local task force may choose to revise or expand information gathered in the activity. The gaps and opportunities identified in this report are the result of brain storming during the workshop and include a broad range of input from workshop participants. These points reflect a variety of Bucks County stakeholder opinions, and are therefore subjective rather than a majority consensus. General Description of Services and Cross-System Collaboration Chester County is one of the three original counties of Pennsylvania created by William Penn in The county is located in Southeastern Pennsylvania and has a population of 491,489 across 75 municipalities. It spans 760 square miles, which adds to the complexities of law enforcement and the provision of mental health services alike. The County has been building a continuum of criminal justice and mental health/addiction treatment services that provides a basic foundation for continued growth and reorganization on all levels. There are a number of established links, both formal and informal, between the courts, probation, police departments, corrections and the mental health system that include, but are not limited to: The development of Treatment Court consisting of Mental Health, Recovery and Drug Court tracks. Access to emergency inpatient services, as well as an increasing array of community mental health services Availability of 24-hour crisis response Development of an Intermediate Punishment and Restrictive Punishment (Recovery Court) Sentencing Alternatives for substance dependent offenders Chester County Forensic Committee Mental Health Probation Protocol The Chester County Department of Mental Health/Intellectual and Developmental Disabilities (MH/IDD) administers federal, state, and county funds for mental health, mental retardation, and early intervention services. MH/IDD works closely with the DHS/Office of Managed Behavioral Health and Department of Drug & Alcohol Services to plan and coordinate public mental health 1 Munetz, M. & Griffin, P. (2006). A systemic approach to the de-criminalization of people with serious mental illness: The Sequential Intercept Model. Psychiatric Services, 57,

9 and substance abuse systems development and services that serve 7000 consumers annually. The Office of Mental Health within MH/IDD contracts with 25 mental health agencies for an array of treatments and supports to serve over 1400 consumers annually. The county has four multi-service agencies that are points of entry for adult public mental health care and six similar points of entry for child services. The Chester County Office of Mental Health serves county residents who live with serious and persistent mental illness. With an annual budget of about $16,000,000, the Office uses federal, state, and county funds to provide services to approximately 5000 eligible individuals (including HealthChoices members) each year. Clients typically are county residents who: have serious and persistent mental illness; have no private insurance for mental health care; and are not eligible for Medical Assistance; or require residential or other services that are not HealthChoices billable. The Office of Mental Health works closely with the county s Office of Managed Behavioral Health and managed care contract, Community Care Behavioral Health, which together run the HealthChoices program to coordinate all publicly funded behavioral health services and supports. Many individuals with serious and persistent mental illness qualify for HealthChoices supports as well as county-funded supports. The Office of Mental Health contracts with local agencies throughout the county to provide services. Chester County has four Core Providers for adult services: Fellowship Health Resources (Phoenixville) Holcomb Behavioral Health Systems (Kennett Square) Creative Health Services (Spring City, PA) Human Services, Inc., Downingtown, PA A listing of additional resources for adult services is available at The Court, the Director of Human Services and the Probation Department Director are members of the county Criminal Justice Advisory Board (CJAB) that meets regularly to coordinate and plan criminal justice efforts, many of which involve the human services system. The MH/IDD Administrator participates in monthly meetings of the county human services department heads and the Juvenile Probation Office Chief. Mental Health and Adult Probation officers participate on the Mental Health Court team and work closely with the County Prison, District Attorney, Public Defender, Pretrial Services, and the Coatesville Veterans Affairs Medical Center. The Office of Mental Health has close working relationships with other human services departments including Aging; Drug and Alcohol Services; Children, Youth, and Families; Youth Center, and the Office of Managed Behavioral Health. 9

10 Intercept I: Law Enforcement / Emergency Services 911 Chester County has a centralized, county-operated 911 system with local dispatch. All calls to 911 have a onebutton connection to local law enforcement dispatch. There are 54 call takers on the Chester County Emergency Service. Individuals can also call a local police department directly. The amount of calls going to either 911 or local departments varies across local jurisdictions (e.g., it was indicated that as many as 99% of calls in West Chester go through the 911 system). Emergency Service call takers will call Valley Creek Crisis Center if the caller is suicidal or indicates a need for mental health crisis services. Local dispatch can also request that Valley Creek Crisis services be involved. If an officer who has been dispatched believes the individual is in need of mental health crisis support, the officer can request support from Valley Creek Crisis Center directly or via dispatch. Valley Creek Crisis Center has mobile service and can respond on site or via phone support. Intercept 1 Law enforcement COMMUNITY 911 Law Enforcement Law Enforcement There are 47 local law enforcement agencies in Chester County including 2 State Police Barracks, Coatesville Veteran s Center campus police, and Lincoln University and West Chester University campus police. 888 police officers serve in the County. As many as 80% of law enforcement agencies in Chester County have fewer than 10 officers. There are typically two State Police officers on duty per night shift. Chief Scott Bohn of the West Chester Police Department is currently President of the County s Chiefs of Police Association. Officers are trained through the Municipal Police Officer Training Curriculum (MPOC). Act 120 training is a requirement for all officers and covers training in Criminal Law and Investigation, Vehicle Code, Accident Investigation, First Aid & CPR, Operation of Patrol Vehicle, Crisis Management, and Defensive Tactics and Firearms. The Crime Victim s Center (Sexual Assault Response Team) has also provided training for police officers in Chester County. Additional training in crisis de-escalation and mental health is offered through Montgomery County Emergency Services but is not required. When intoxicated individuals are arrested, they are frequently detained at the police station and a citation is issued. If the individual is taken to an emergency room, there may be a referral to a non-hospital detoxification provider. A review of 14 months of referrals since the inception of the Mental Health Court suggested that 29 individuals with clear symptoms of mental illness at the time of the arrest could have potentially been referred to crisis services instead of arrest. Of the 29, 16 were successfully diverted to treatment after arrest. 10

11 Valley Creek Crisis Center Valley Creek Crisis Center (VCCC) is a 24/7 crisis center staffed by master s level clinicians, a nurse, and a peer specialist with access to on-call psychiatry. Depending on the time of day there are also 3-5 mobile teams available to go into the community. The highest staffing typically occurs during the 3-11pm shift. Phone support is provided in the event that a mobile team is not available. Valley Creek Crisis Center includes staff fluent in Spanish and in American Sign Language. Valley Creek Crisis Center handles approximately 1000 calls per month, or several hundred calls per week. They can also have dual calls with a dispatcher and a crisis specialist. A minimal number of calls come from law enforcement, approximately 10 to 15 per month. Valley Creek Crisis has an 800 number with two other numbers routed into a single t-line that leads to 23 lines covered by 3-10 call takers. Individuals who call are not put on hold. Valley Creek Crisis Center can identify individuals who have mental health case management or ACT services in order to contact an ICM or ACT staff if an individual is in crisis. Overall VCCC is aware of approximately 700 of these clients. VCCC mobile teams will also go to local hospital emergency rooms when contacted regarding a person in crisis. Valley Creek Crisis Center is not currently set up to be a hospital-based system, or a drop off site, however they will coordinate the services for individuals who walk in; including those who are brought in by police and who can be safely accommodated within the Center. VCCC is not able to serve intoxicated individuals; nor do they prescribe medications, however, they can directly refer individuals to detox after hours. Valley Creek Crisis Center can be reached at (610) or toll-free at (877) Valley Creek Crisis Residential Program Valley Creek Crisis Residential Program is a voluntary program that offers short-term residential treatment to accommodate adult consumers in need of behavioral health services. It is designed to be less restrictive than an inpatient psychiatric hospitalization. Treatment and psychosocial supports are available in the crisis residential program to individuals in acute psychiatric crisis but who are able to remain within the community. Veterans Suicide crisis information for veterans and their families can be obtained from Rebecca Baird of the Coatesville VA Medical Center at x3011. A veteran may contact the Social Work Department at the Coatesville VA Medical Center at x5160 and be matched to talk to someone with similar military service. The Treatment Court has also established a veteran treatment track for those who get involved in the criminal justice system and works closely with the Coatesville VA Medical Center to provide needed mental health and substance abuse treatment services. The national VA Suicide Hotline number is Warm Line Valley Creek Crisis has a consumer-run warm line dedicated to mental health consumers who want to receive peer support and who may need resource information. An important goal of the Warm Line is to proactively support consumers before a crisis develops. The Warm Line handles about 100 calls a month from consumers and family members. 11

12 The Warm Line is open seven days a week, six hours a day: (M-F, 2:00pm to 8:00pm and Sat- Sun, 12:00pm to 6:00pm). The Warm Line is available at (866) Crossroads Peer Support Center Crossroads Peer Support Center provides support for individuals in mental health and addiction recovery, and is currently used by about 27 individuals. Peers are available to support others in their recovery and to assist in preventing problems from becoming crises. Peers are also focused on helping those in the community identify and utilize available resources. Chester County National Alliance on Mental Illness (NAMI) The local chapter of NAMI is located in the same building as the Crossroads Peer Support Center, and often collaborates with Crossroads in crisis situations. NAMI representative, Debbie Thompson, indicated that the local NAMI receives many calls from families whose family member has come in contact with the criminal justice system. The local NAMI created a forensic guide which will be updated and available to both family members and law enforcement. Intensive Case Management (ICM) Approximately 600 individuals in Chester County with serious mental illness receive services through Intensive Case Management. Those individuals will frequently call a case manager rather than crisis services, and the case manager will then contact law enforcement when necessary. Inpatient Hospitalization Brandywine Hospital is the only provider in the county with adult psychiatric inpatient beds. Though not located in Chester County, Pottstown Memorial Medical Center (Montgomery County) is frequently used as a drop off by police officers in the northeastern region of Chester County. The following listing of gaps and opportunities reflect the subjective opinions of the broad range of stakeholders participating in the workshop. There was much discussion and sometimes differing points of view during these brainstorming sections of the workshop. Identified Gaps Law enforcement face a variety of time consuming procedures that present significant barriers to referring individuals to treatment instead of arresting the person, including; emergency room medical clearance, mental health evaluation to determine placement, insurance authorization, bed search, ambulance transport, and hospital requirements for security o Some officers report waiting as much as eight hours Limited data about crisis calls Limited data about law enforcement calls with the target population Multiple challenges for law enforcement agencies when it comes to having officers 12

13 attend trainings on behavioral health issues including size and number of departments, geography, cost, overtime costs, department coverage for small departments, cost/benefit ratio, and perception of the training as not useful if there is no efficient central assessment and disposition option for people in crisis Limited Information about 911 crisis activities; what happens within the County High number of repeat callers to 911 Insufficient awareness of available mental health resources in the community 302 training for law enforcement Little follow up for families/individuals to be connected to MH resources when police have frequent contact/calls Limited notification to the mental health resources that an individual is in need based on police contact No information about HIPPAA to guide police contact with mental health resources when they are on the scene and there is possibility of arrest Inability to identify veterans at time of first contact Limited access to information about veterans in contact with criminal justice and about available VA resources Local criminal charges are pressed by the VA Police Department against a small group of veterans for disruptive behavior on the grounds of the Coatesville VA Medical Center Law enforcement do not have access to historical information about a person in crisis (mental health or drug and alcohol) No access to private insurer information for a person in crisis in contact with the police Little cross-police department sharing of information Minimal use of Crisis as the first response for police Little drug and alcohol services contact with law enforcement concerning these clients until bail setting and sentencing Limited mental health, drug and alcohol, and crisis de-escalation training/resources for police o Municipal Police Officer s Education and Training Commission offers six hours of mental health training o Limited use of training that has been offered in the past by MH providers No central booking in the county Limited psychiatric inpatient beds in county Identified Opportunities Interest in police intervention and consistent/practical training A number of the law enforcement agencies have expressed interest in the Crisis Intervention Training (CIT) model, but see a need to develop a broader system-wide infrastructure to address the crisis system issues Consider ride-alongs as part of training for behavioral health and criminal justice staff and support for greater cross-system collaboration Training, resources and resource materials available from Crossroads Peer Support Center as well as from local NAMI (e.g., NAMI family forensic guide) PA 211 line (for mental health resource information) will be operational later this year Police keep a PREMISE history on some individuals which offers the opportunity to identify an appropriate community resource to assist with that individual Interest in building relationship between Mental Health Crisis and Police response; possibilities for Valley Creek satellite sites Valley Creek Crisis Center keeps track of who has ACT (Assertive Community 13

14 Treatment) or ICM (Intensive Case Management) or is involved with the Mental Health Court Opportunities to create psychiatric advance directives or self disclosure of mental health issues from consumer-based services and supports VA services available to divert veterans who self identify Veterans Affairs has a connection to the National Suicide Hotline for veterans and family/friends of veterans Form used by the Mental Health Court can be enhanced with police information Local, state, and federal funding resources such as the Pennsylvania Commission on Crime and Delinquency planning and implementation grants and federal Bureau of Justice Assistance grants Brandywine Hospital local inpatient facility interested in further development as a local resource 14

15 Intercept II: Initial Detention / Initial Court Hearing Arrest and Initial Detention An individual who is arrested in Chester County is usually detained in the police department of that district. Some police departments share resources and some precincts will house arrestees for other districts. Not all police departments have holding cells or restraint mechanisms and may require that an officer stay with the individual until he or she is transported for arraignment. Preliminary Arraignment There are 19 Magisterial District Judges (MDJ) who handle preliminary arraignment in the County. Preliminary arraignment is done locally on weekdays; individuals are typically transported to another district on evenings and weekends. Constables have been called upon to transport from local police departments to preliminary arraignment sites. Chester County does not have central booking. There is currently little use of video arraignment. Although the technology is in place there are obstacles to implementing its use. Efforts are currently being made by the Court to more broadly implement video arraignment in order to cut costs. Magisterial District Judges are invited to attend Montgomery County Emergency Services (MCES) crisis training programs and some have attended. There is no other formal mechanism for providing mental health training for this group. An earlier criminal justice mental health collaboration including the bail agency and pretrial services in Chester County produced the ADAPT Program. It has since been subsumed into the Mental Health Recovery Court and is generating positive results. See Appendix B for a statistical summary of ADAPT referrals. Veterans Currently, there are approximately 86 identified veterans under the supervision of Bail/Pretrial services of Adult Probation. The following listing of gaps and opportunities reflect the subjective opinions of the broad range of stakeholders participating in the workshop. There was much discussion and sometimes differing points of view during these brainstorming sections of the workshop. Identified Gaps Initially detained at police station; no central booking o High-risk time for suicides; one suicide in recent years o More information is needed about what happens to the target population at this stage Valley Creek Crisis Center doesn t receive calls for support from initial detention or 15

16 preliminary arraignment Secure holding issues Limited mental health training for Magisterial District Justices Little use of video arraignment Limited contact with Crisis services Identified Opportunities Training is available through Montgomery County Emergency Services Use of Brandywine Hospital for access to services Valley Creek Crisis Center can support walk ins 16

17 Intercept III: Jails / Courts Jail The Chester County Prison is fully funded by the county with an approximate budget of $26m. It has a capacity of 1120, and the average census is between 900 and 1000 inmates. Some 30 State prisoners are housed there and 100 beds are contracted for the State population (See Appendix B). Elaine Ziegler, MA, is the Mental Health Manager for the prison. Inmates are screened at the time of intake and referred to the mental health team if needed. If an inmate meets the diagnostic criteria for a serious mental illness there are several possibilities: divert to probation/parole, request Valley Creek Crisis Center do a 302 (involuntary) commitment, refer to Mental Health Court, or request a 402 hearing for competency to stand trial evaluation. The diagnostic categories of those inmates with serious mental illness (SMI) used in the Prison include: Schizophrenia, Psychotic Disorders, Bipolar Disorder, Major Depression and Borderline Personality Disorder. (See Appendix C for the MH/IDD definition of Serious and Persistent Mental Illness.) Under HIPPA rules, Chester County Prison may share information about individuals with serious mental illness with treatment providers, who then can share information regarding medication and treatment. MH/IDD checks the daily list of Prison admissions to identify individuals with histories of county mental health treatment, and shares this information with the Prison. In an average month, the County Prison conducts 30 psychiatric evaluations and identifies 20 new offenders with serious mental illness. These averages have been increasing in FY Intercept 3 Jails / Courts Dr. Robert Davis is the primary psychiatrist at the prison. Dr. Hatti is also available to conduct competency assessments, generally under the auspices of the Mental Health Court and not as a regular supplement to Prison psychiatric services. The prison has tele-psychiatry capability (with Valley Creek Crisis Center) but it is not being used at this time; space and connection issues were noted as barriers to its use and the need has not yet materialized. There are approximately 85 inmates housed in the jail who have serious mental illness. (See Appendix B for more statistical information.) Chester County Prison provides a 59-bed Mental Health Housing Unit for males with severe mental illness. This Unit is located on a dedicated Medium Security Block. Residents of this therapeutic community are provided with weekly wellness checks on the block. Unobtrusive observation by mental health staff is also conducted regularly. Beginning in November, 2009, therapeutic groups were made available to unit residents (Anxiety, Dual Diagnosis, Stress and Anger Management and Life Skills are among the current or planned groups). Addiction services are also available. Future plans for this unit include the implementation of a token economy as well as the expansion of available groups and wellness checks. Jail Specialty Court Dispositional Court 17

18 Women also receive treatment, though they do not have a separate treatment unit and instead are treated within their individual units throughout the Prison. There is a case manager on staff to help with court protocols and forms. Within the last year, if an inmate has been involved with mental health case management in the community, the case manager goes to the prison to revise the service plan. The revised service plans includes the development of a plan, as appropriate, for continued case management contact during County incarceration. Approximately individuals from Chester County are housed in the Norristown State Hospital Forensic Unit. The prison case manager has some contact with the Forensic Unit, but lately this has been inconsistent. Peer Specialist, Kenneth Miller, provides in-reach into the prison on a weekly basis to meet with inmates and review life plans and offer support. Mr. Miller also attends Mental Health Court. Currently, there are approximately 65 veterans incarcerated at the Chester County Prison. The Veteran Justice Outreach Specialist from the Coatesville VA Medical Center Administration also does in-reach into the prison. Correctional officers received Suicide Prevention training through Montgomery County Emergency Services in The Family Training and Advocacy Center has also provided training. The first Hearing Distressing Voices training was conducted in July 2010 with more than 60 staff members in attendance. There are plans to provide training on trauma in the future. Courts Adult Drug Court was established in 1997 (presided over by Judge William Mahon) and currently has a caseload of 150. The Court is diversion only (Section 118 disposition without conviction) and includes all non-mandatory drug charges and first offense DUI s with drug charges. As of March 2010, 721 individuals have graduated from Drug Court. Recovery Court was established in 2007 (presided over by Judge William Mahon) and is a postconviction Adult Drug Court for Level 3 & 4 offenders (PA sentencing guidelines) with drug and alcohol issues and co-occurring disorders. The current caseload is approximately 98 offenders. Recovery Court is operated with funding by the Pennsylvania Commission on Crime and Delinquency for Drug and Alcohol Restrictive Intermediate Punishment. The Mental Health Recovery Court was established in 2008, through cooperative planning by the Court, Office of Mental Health, Probation Department, District Attorney, Public Defender, County Prison, Pretrial Services, and Crime Victim Services. It was developed to address the needs of offenders with serious and chronic mental illness. Participants are offered a treatment based sentence, which utilizes judicial oversight as a component of the program. The MHRC coordinates an array of services designed to address the many needs of this population. Cases referred to MHC may initially receive services through bail modification and may ultimately be disposed of by pre-plea diversion (ARD) or post-plea diversion with reduced or no jail time. The goals of the Mental Health Recovery Court are to: Preserve public safety Divert offenders with mental illness from incarceration and into community treatment Maintain treatment, housing, benefits, & community support services for offenders with mental illness 18

19 Reduce repeated criminal activity by offenders with mental illness Support effective communication between the criminal justice and mental health systems MHRC staff screen for eligibility and develop an initial service plan. The defendant may be released on bail under court supervision to begin treatment in the community. The MHC decides if the case is legally and clinically eligible. With the advice of counsel, the defendant/consumer voluntarily decides whether to participate in MHRC. The Mental Health Recovery Court is presided over by Judge William Mahon with approximately 80 individuals on the caseload. All criminal charges are considered on a case by case basis. There are currently 45 pretrial diversion, 22 post conviction, 7 violations of probation/parole, and 4 bail modification cases. Erik Walschburger, Assistant District Attorney, and Sarah Whatley, Assistant Public Defender, are assigned to the court full time. There is also a Pretrial Services position to work with veterans (20-25 person caseload within specialty courts; 40 have been screened, 6 funneled to court, 6 paroled with specialized re-entry services) The Veterans Justice Outreach Specialist from the Coatesville VA Medical Center also provides support and linkage to Veterans Affairs services for eligible veterans under the supervision of the Mental Health Recovery Court. Currently there are approximately 20 identified Veterans in the 3 combined treatment courts. The Court receives ARRA funding from the Pennsylvania Commission on Crime and Delinquency. The following listing of gaps and opportunities reflect the subjective opinions of the broad range of stakeholders participating in the workshop. There was much discussion and sometimes differing points of view during these brainstorming sections of the workshop. Identified Gaps Concern that jail becomes a magnet because of the quality of services offered High cost of jail mental health services No social workers in the public defender s office Liaison with Norristown State Hospital Forensic Unit is inconsistent Limited affordable housing Consistency of case management at prison contacting forensics Core group of individuals with severe mental illness housed in jail (about 85 have been screened) o Criminal charges makes them ineligible for diversion programs o o No place to put them Perception by criminal justice system that there are not sufficient community mental health facilities to serve this population Identified Opportunities Use NY State Suicide screen Tele-psychiatry capacity to work in the prison Training is available and prison staff are willing to participate Training on trauma will be provided in the prison in the future Jail has a contract for 100 Pennsylvania DOC inmates Jail identifies medications at admission but this is not verified by community psychiatrists 19

20 Jail MH Manager (County employee) is key Jail unit for men with severe mental illness with treatment groups Treatment efforts supported by the Warden Recent funding to hire a Pretrial Services officer for Veterans diversion Valley Creek Crisis comes into the prison to do 302 and 402 assessments (Mental Health Court initiates competency evaluations) Holcomb Forensic Peer Specialist does in-reach into the jail Coatesville VA Medical Center does in-reach into the jail 20

21 Intercept IV: Re Entry General Description of Services and Cross-System Collaboration Re-entry Parole planning begins six weeks prior to release. Two staff are dedicated to the Re-entry Unit. They develop home plans, arrange risk and needs assessment, and make drug & alcohol and mental health appointments. Intensive supervision is set for the first 90 days. Assessment and referral to the community Base Service Unit, case management, and mental health providers may be a condition of parole. The prison provides 5-days of medication or a prescription for 30 days when a psychiatric appointment has been set up. It takes about days for reactivation of Medical Assistance benefits. The prison starts the application process and it is then followed by community caseworkers (e.g., Holcomb, Mental Health Court). There is no formal process for the jail to consistently provide notification to the Social Security Administration about admissions. The Prison social worker or Mental Health Recovery Court case manager makes referrals to community case management (Holcomb, Fellowship) and those case managers come into the jail to begin reentry planning. The Assertive Community Treatment team (ACT) typically has 3-4 persons with forensic histories among their cases Intercept 4 Reentry Prison/ Reentry Jail Re-entry Problem solving and decision-making classes are offered through the Delaware Community College. Additionally, LEAP (Leading Everyone to Achieve Potential) vocational training is available for Treatment Court population. REDI Services (ARRA funded) provide employment services. Peer Specialist and the Veterans Justice Outreach Specialist of the Coatesville VA Medical Center provide in-reach to assist with re-entry planning. Crossroads Peer Support Center is available for individuals after release and is typically a place for people to go during the day. They offer supports with life management, healthy lifestyles, food, and other services. Crossroads does not target the forensic population but serves a number of individuals with forensic histories. The Pennsylvania Department of Corrections provides information to the SE Regional Mental Health Coordination Office regarding upcoming release dates of state inmates reaching their maximum sentence; i.e., max outs. Paul Butler, Regional Forensic Liaison, works with Candy Craig of MH/IDD to coordinate with the Dept. of Corrections and others to establish housing and services. Ideally the DOC list is generated 16 months in advance of release, but is often 6 months to a year prior to release. The Regional Forensic Liaison also assists with max outs from Norristown State Hospital. Forensic Administrative Case Management is available for several groups of individuals: those who do not qualify for a higher level of case management (Blended, Resource coordination), 21

22 those needing short-term transitional case management to connect to community treatment and support services including community-based forensic blended case management, and men housed in the Forensic House, (a program of Human Services, Inc., funded through Shelter Plus Care funds). Forensic Blended Case Managers at two of the Core Providers (Fellowship Health Resources and Holcomb Behavioral Health) provided Blended community case management services. These ARRA grant funded positions will support approximately 50 individuals in MH Court or after re-entry from prison. The following listing of gaps and opportunities reflect the subjective opinions of the broad range of stakeholders participating in the workshop. There was much discussion and sometimes differing points of view during these brainstorming sections of the workshop. Identified Gaps Turnover in the County Assistance Office; need a point person to facilitate Medical Assistance applications Need state suspending of Medical Assistance rather than automatic termination Not clear when jail reports to Social Security Administration affects termination and suspension of Medical Assistance and Social Security benefits Re-entry Unit cannot pick up planning for releases of inmates with bench paroles (which happen very quickly) and those individuals might not be able to get needed aftercare medications Minimal permanent housing; limited space and beds Timeliness for individual to be reconnected to benefits Timeliness of setting up a re-entry plan for accessing services and setting up the mental health and benefits appointments Delays in access to psychiatric care in the community No social worker in the Public Defender s office Limited transportation to community resources for services Limited housing availability is a major issue Lack of an address makes it difficult to access some services Appropriate treatment resources; psychiatric partial hospitalization is available, but there may be a need for more structured, intensive programs Need more employment opportunities o Easier to engage landlords than employers Need more cross training on mental health/criminal justice issues Identified Opportunities Probation Re-entry collaboration with Behavioral Health Goal of jail is that everyone has a re-entry plan Jail case manager 2 of 4 short-term emergency beds prioritized for MH Recovery Court clients; 7/1 MH base funding Adult Probation has a re-entry unit with 2 fulltime officers to coordinate parole and supervise the first 90 days, expedite process REDI works with criminal justice offenders for employment New PCCD ARRA grant for two new forensic case managers for Mental Health Recovery Court and across the intercepts Fellowship Health resources can do an intake within 5 days and an appointment with the doctor within 10 days Built relationship with MA office; Diane Robertson invite to a meeting Motivational interviewing 22

23 Level of acuity clinical home model with a forensic case management SE Regional Forensic Coordinator assists with State prison re-entry and with NSH clients Crossroads can help with transportation SAMHSA Drug and Alcohol grant GED, basic remediation assessment, and vocational training available Problem-solving classes with Community College Many permanent low-income housing opportunities exist, but often inmates/consumers do not want to live in those geographic areas 23

24 Intercept V: Community Corrections / Community Support Probation The Chester County Adult Probation and Parole Department provides services for the Courts and community-based supervision of offenders. With 49 Probation and Parole Officers and an active caseload of 9,567 offenders, the Department offers a broad range of services including several specialized units and support to treatment courts. The Probation Department staff is trained in evidence-based principles---including motivational interviewing---as one effort to reduce recidivism. The Probation Department is the lead agency in the county s Treatment Court, which includes both Drug Court and Mental Health Recovery Court. Two specialized probation officers, each with a caseload of 75, oversee Mental Health Protocol supervision. There is no distinction between probation and parole. Intercept 5 Community corrections Violation Violation Mental Health Protocol is a post-sentence program to provide mental health screenings, case consultation, intensive supervision, treatment and medication monitoring for clients with serious mental illness placed on probation or parole. Compliance with a mental health treatment plan is a condition of probation or parole. This program is a collaborative effort among Adult Probation, the MHIDD Department, the MH/IDD Advisory Board, and community treatment providers. The MH Protocol can be added at any point when a person is on probation or parole. There is one full-time probation officer that supervises all offenders placed in any level of Mental Health Court whose current caseload is 75. The Probation Department also employs the MH Recovery Court Coordinator, who processes all new referrals and acts as the boundary spanner between the CJ and MH systems. Parole Probation COMMUNITY Community Treatment and Support Services Day treatment programs with forensic expertise are available through Holcomb Behavioral Health Services, Fellowship Health Resources. Several providers have developed dual competencies in mental health and substance abuse treatment to support individuals with cooccurring disorders. Holcomb offers Dialectical Behavioral Therapy (DBT), an evidence-based practice. The Crossroads Peer Support Center is staffed by peers and certified peer specialists and provides support to all persons in recovery. 24

25 Housing and Homelessness Mental Health Housing Coordinator, Rebecca Piorko-Shelly, supports the forensic population to find housing. The Valley Creek Crisis Residence has ten crisis beds. The following listing of gaps and opportunities reflect the subjective opinions of the broad range of stakeholders participating in the workshop. There was much discussion and sometimes differing points of view during these brainstorming sections of the workshop. Identified Gaps Limited resources for individuals requiring medium and long-term hospitalization and community treatment and support alternatives for this level of care Limited affordable housing o Not enough permanent housing o Little turnover in transitional housing Need cross training for housing and mental health regarding specific forensic issues Stigma by consumers and providers regarding certain towns; single room units are available in some communities but providers object to distance Need reality-based and more optimistic conversation re affordable housing options Too much focus on direct link between criminal behavior and mental illness ; Need understanding that mental illness must be addressed if criminogenic issues are to be addressed More acute and less motivated individuals would benefit from multiple treatment tracks that offer a wide range of treatment approaches, individualized services, and vary in intensity VA does not offer the same range of mental health services offered in the community Need more employment and supported employment options Identified Opportunities Integration of drug and alcohol providers with psychiatric treatment to address those with co-occurring disorders; big progress here in the last year o Co-occurring Disorders Treatment certification o Recruiting policies o Retraining therapists o Collaborating with Drug & Alcohol providers (regular meetings) o Dually-licensed rehab providers MISA services for those with co-occurring disorders are now being offered by the mental health and D&A outpatient providers and training is occurring More expertise available and collaboration is occurring Department of Community Development provides housing and has resources available for low-income individuals; willing to overlook criminal records. Crossroads Peer Center is near the Court building Forensic housing funded through OMH and HUD Administrative case managers: provide groups, effective with probation Some housing options could be more fully utilized MH Probation Protocol with resources for evaluation and case management Assertive Community Treatment Team (ACT) has 3 or 4 clients from Mental Health Court; some team members have forensic expertise ACT comes into the Crisis Res The evidence-based treatment modality of DBT being offered at Holcomb and Fellowship 25

26 Chester County Priorities Subsequent to the completion of the Cross-Systems Mapping exercise, the assembled stakeholders began to define specific areas of activity that could be mobilized to address the gaps and opportunities identified in the group discussion about the cross-systems map. Listed below are the priority areas identified by the workshop participants for future consideration. Top Priorities Intercept 1: Law Enforcement/911/Crisis Services Develop training for all components of justice-related response system (police, 911, dispatch, judicial, etc.) Research and implement strategies for improved information exchange: o Police access to mental health information o Notification to providers of individuals in need of services o Ability to red flag frequent 911 callers for possible follow up with crisis services and mental health resources o Police Premise form to provide mental health information about individuals living at that premise Address crisis availability and efficiency Consider potential for centralized and secure crisis services Explore relationship with Brandywine Hospital o Invite Caln Police Department and Probation to existing Brandywine/MH provider meetings Re-entry from jail to community Improve connection to County Assistance Office in order to expedite access to Medical Assistance and other public benefits Expand connections to services, medications, housing and vocational supports Veteran s Issues Engage Veterans Affairs Justice Outreach Services early in the criminal justice process Community Public Education Educate about mental health resources and diversion Build on NAMI interest in: o Educating families about the purpose and use of the Police Premise form o Working with families across all intercepts to develop information exchange toward supporting prevention and intervention o Modifying Family to Family guide for forensic issues o Developing community public education for young adults prior to Intercept I While Action Planning was not part of this one day Cross-Systems Mapping workshop, some participants volunteered to pursue a variety of next steps in support of the identified priorities: 1. Gary Entrekin of MH/IDD will contact EMS to identify a point person for future training --- Completed 26

27 2. Gary Entrekin will set up a meeting with the County Assistance Office---Completed 3. Debbie Thompson of NAMI will introduce the Family to Family curriculum and provide NAMI information to local police jurisdictions 4. Leslie Lipson will coordinate with the Brandywine/MH provider meeting to add the recommended new persons 5. A core group of stakeholders will be established to begin working on the identified priorities 27

28 Conclusion Chester County, PA Mental Health and Justice Center of Excellence Report, June 2010 Considerable work has already been undertaken in Chester County to improve services for the target population of people with severe mental illness and often co-occurring substance use disorders involved in the criminal justice system. The success of various programs located within Intercept 3 (jails and courts) highlight a number of positive outcomes that have been gained through sustained interest and collaboration, including expanded treatment services at the Chester County Prison, Adult Drug Court, and Mental Health Recovery Court. Additional innovative programs throughout Intercepts 4 (reentry) and 5 (community corrections and community support) include forensic clients carried on the caseload of the local Assertive Community Treatment (ACT) team, MH/IDD forensic case managers, Mental Health Probation Protocol, probation support of the treatment courts, and the Restrictive Intermediate Punishment program. In addition, there have been a number of efforts to identify veterans in the local criminal justice system, link them to Veterans Affairs services, and provide community alternatives to incarceration. Although there was some frustration and differing points of view expressed during the workshop, there was clear interest in building on the successes described above to better improve programming and relationship building between law enforcement and crisis services in Intercept 1. Given the challenges in implementing more timely and effective crisis responses for people with severe mental illness and often co-occurring substance use disorders, the Cross- Systems Mapping workshop is an important first step in tackling these obstacles in Chester County. During the workshop, it was proposed that a core group of stakeholders from both behavioral health and criminal justice systems be developed to lead and coordinate the work addressing the identified priorities. Other counties have shown success in having a similar core group meet on a regular basis with more frequent meetings early in the process, such as bi-weekly or monthly, and then quarterly as the process shows progress. A number of Pennsylvania counties have formalized this core group as a subcommittee of their Criminal Justice Advisory Board. The expansion of the larger workshop group to address the priorities established during the Cross-Systems Mapping workshop is another essential step in a true systems change process. It will be important to create effective working relationships with other groups that did not attend the workshop, including police jurisdictions not represented, county Emergency Services, Social Security Administration, County Assistance Office, and others. It will also be important to continue to incorporate consumers and family members in the planning process. The consumers and family members attending the workshop were knowledgeable, experienced, committed, and had many thoughtful ideas about ways services can be improved in Chester County. Regular meetings should be held by this larger group to facilitate information sharing, planning, networking, development and coordination of resources, and problem solving. Closing Congratulations to Chester County on its successful federal Bureau of Justice Assistance grant proposal. Earlier this year, Chester County MH/IDD in conjunction with Chester County Adult Probation and other stakeholders applied for a planning grant from the federal Bureau of Justice Assistance s Mental Health and Justice Collaboration initiative. Shortly after the workshop, Chester County was notified that their proposal was approved. The grant funding will be used to support a mental health/criminal justice expert consultant to provide technical assistance and to facilitate and guide a planning process around Intercept 1, and also to fund site visits from or 28

29 to exemplary programs addressing the efforts prioritized for action. The Cross-Systems Mapping workshop is a first step in that much needed planning process. Chester County is fortunate to have a wide range of stakeholders across the mental health, substance abuse, and criminal justice systems that have made significant efforts to understand and support the challenging issues discussed in this workshop. The Cross-Systems Mapping workshop participants displayed genuine interest in improving the continuum of criminal justice/behavioral health services in Chester County by developing a coordinated strategy to move forward with the identified priorities. By reconvening and supporting the work of the group in coming months, it will be possible to maintain the momentum created during the Cross-Systems Mapping workshop and build on the commitment and drive of key local stakeholders. A variety of resources tailored to the priorities identified by group during the workshop are included in the appendices. The Pennsylvania Mental Health and Justice Center of Excellence hopes to continue its relationship with Chester County and to observe its progress. Please visit the Pennsylvania Mental Health and Justice Center of Excellence website for more information, 29

30 Appendix A Participant List Scott Bohn, Chief West Chester Police Department sbohn@west-chester.com Kim Bowman, Director Department of Drug and Alcohol Services kbowman@chesco.org Betty Brennan Chester County Hospital Emergency Department bbrennan@cchosp.com Brian Byerly, Chief Cain Police Department bbyerly@calntownship.org Candy Craig, Clinical Services Coordinator Office of Mental Health ccraig@chesco.org Patrick Davis, Law Enforcement Liaison District Attorney s Office Nicholas DeSantis Peer Support Center Nick.desantis@hhinc.org Barbara Diehl Department of Human Services CSP Kevin Kirby, Director of Case Management Services MH Adult Core Provider-HSI kkirby@hsi-cmhs.org Ruth Kranz-Carl, Director Department of Human Services rkranzcarl@chesco.org Leslie Lipson, Director MH Crisis Intervention-HBHS llipson@holcombbhs.org Jen Lopez, Deputy Director Adult Probation jlopez@chesco.org The Honorable William P. Mahon, Presiding Judge, Mental Health Recovery Court wmahon@chesco.org Nancy Marquette, MH Court Coordinator Adult Probation nmarquette@chesco.org Nancy McDonald, Quality Director Department of Managed Behavioral Health nmcdonald@chesco.org D. Edward McFadden Chester County Prison Cliff Downward Bail and Pretrial Services cdownward@chesco.org Kenneth Miller, Forensic Peer Specialist MH Recovery Court Team/HBHS kenzmil@aol.com Cliff Downward Bail and Pretrial Services 30

31 Gary Entrekin, Administrator Department of MH/IDD Brooke Hedderick, Managing Supervisor Crime Victims Services Ryan Murtogh Parkesburg Police Department Roger Osmun, Supervisor Holcomb Behavioral Health Services Torrie Osterholm, MSS, LCSW, VA Justice Outreach Specialist Coatesville VA Medical Center Coatesville, PA ext Rebecca Piorko-Shelly, MH Housing Coordinator Chester County Department of Community Development Donna Primera Coatesville VA Medical Center John Morton Adult Probation David Moser, Board Member Brandywine Hospital Janet Stanley, Regional Director MH Adult Core Provider-FHR Sharon Stewart, Forensic Case Manager Holcomb Behavioral Health Services Debbie Thompson Chester County NAMI Eric Walschburger, Assistant DA District Attorney s Office ewalschburger@chesco.org Sara Whatley, Assistant PD Office of the Public Defender swhatley@chesco.org Marc Rothman, MD Brandywine Hospital Marc_rothman@chs.net Reid Willis, Knowledge and Resource Manager Chester County MH/IDD rwillis@chesco.org Nathan Schenker, Public Defender Public Defenders Office nschenker@chesco.org Elaine Ziegler, Mental Health Manager Chester County Prison eziegler@chesco.org 31

32 Caroline Smith, Deputy Administrator Office of Mental Health 32

33 Tory Bright Mental Health Services Coordinator SE Regional MH Services Coordination Office Norristown State Hospital Bldg 2 Rm 185 Sterigere Street Norristown, PA Phone: Fax: regional.mh@verizon.net Paul Butler Regional Forensic Liaison SE Regional MH Services Coordination Office Norristown State Hospital Building 2, Room Sterigere Street Norristown, PA Phone: Fax: E_mail: pbutler@pmhcc.org Mary Gregorio Consultant SE Regional MH Services Coordination Office Norristown State Hospital Bldg 2 Rm Sterigere Street Norristown, PA Phone: gregorio.consulting@gmail.com Patty Griffin, Ph.D. Senior Consultant Pennsylvania Mental Health and Justice Center of Excellence 8503 Flourtown Avenue Wyndmoor, PA Phone: (215) pgriffin@navpoint.com Sarah Dorrell, MSW Project Coordinator Pennsylvania Mental Health and Justice Center of Excellence Department of Psychology Drexel University MS 626, 245 N. 15th Street Philadelphia, PA tel (215) fax (215) sad85@drexel.edu Casey LaDuke, Research Associate Pennsylvania Mental Health and Justice Center of Excellence 123 South Broad Street, 22 nd floor Philadelphia, PA Phone: (215) x3320 casey.laduke@drexel.edu 33

34 Appendix B Chester County Data Information provided by Reid Willis, Chester County MH/IDD Chester County MH/MR Persons Identified with Serious Mental Illness at Chester County Prison FY 01 FY 02 FY 03 Average Monthly Adult SMI Average Monthly New SMI Source: Monthly Prison Social Work reports FY 01= 6 m. of data, FY 02-04= 9 m. of data, FY 05= 10 m. of data, FY 06=1m. of data, FY 07=6 m. of data, FY 08= 7 m. of data, FY 09= 9 m. of data FY 04 FY 05 FY 06 FY 07 FY 08 FY 09 FY 10 34

35 Source: MH/IDD Daily Prison Admissions Tally 35

36 Profile of Identified SMI at Chester County Prison Note: CCP reports 19 new admits since this profile report SMI List distributed 2/29/08 Inmate Status Serving Sentence Awaiting Ct Action* Other TOTAL Released Death 1 1 Violent Questionable 4 4 Non-Violent TOTAL * 2 of the 23 are waiting for Inpatient evaluation Of the 23 awaiting Court action: - 12 are homeless, 7 lost their housing due to incarceration - 9 of the 23 are already in the MH Protocol, 3 more on Probation Of the 14 Non-violent & Questionable Awaiting Court: - 8 are in the MH Protocol and 2 on Probation ADAPT Diversion Experience - 27 months, 10/05-1/08 Total Referrals 126 Denials 87 69% Accepted 43 34% Denial Reasons DA -legal reason 25 29% DA -no reason known 18 21% 50% Client/Attorney withdrew 11 13% Clinical -not SMI 19 22% Denial Reason Unknown 14 16% TOTAL % 36

37 Forensic Consultant & Diversion Simulation (2004) During a 40-day study of CCP admissions (4/12/04-5/21/04), 6-7% had a history of public MH treatment, and 3-4% appeared to be SMI. During a 9-month study of CCP admissions (7/2003-3/2004) there were 145 admissions an average of SMI admissions/month: 50% had VOP, 26% felonies, 21% misdemeanors, 3% summaries. Of the 145, 41% had no public MH history, 32% were open with public MH services, 27% had a public MH service history. 37

38 Chester County MH/MR Persons Identified with Serious Mental Illness at Chester County Prison Note: "SMI" includes persons self-identified at admission, or whose behavior during prison stay warrants MH attention. 38