Partnering with the Justice System to Improve Outcomes in Coordinated Specialty Care

Transcription

1 Partnering with the Justice System to Improve Outcomes in Coordinated Specialty Care Leah Pope, PhD Vera Institute of Justice Jessica Pollard, PhD Yale University School of Medicine Webinar March 5, 2018

2 Disclaimer The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS). 2

3 Who we are Specialized Treatment Early in Psychosis

4 Outline Defining the Problem Criminal Justice Continuum Sequential Intercept Model Roles of Criminal Justice Professionals Potential Outcomes Justice Involvement for FEP Clients Supporting Justice-Involved Clients Building Relationships Q & A

5 Overview: Incarcerated Populations

6 Mental Health Indicators & Criminal Justice Involvement Source: Bureau of Justice Statistics, National Inmate Survey, ; and Substance Abuse and Mental Health Services Administration, National Survey on Drug Use and Health (NSDUH),

7 Psychotic Illnesses and the Criminal Justice System 3-7% men and 4% of women in correctional settings have been diagnosed with a psychotic illness Compared to 1-2% lifetime prevalence estimates in the community Percent of people incarcerated in Psychotic Disorder Symptoms State prison Federal prison Local jail Seena Fazel and John Danesh, Serious Mental Disorder in Prisoners: A Systematic Review of 62 Surveys, The Lancet 359 (2002): ; Doris J. James and Lauren E. Glaze, Mental Health Problems of Prison and Jail Inmates, Bureau of Justice Statistics Special Report (Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, 2006, NCJ ).

8 Why Criminal Justice and First Episode? Exhibiting psychotic symptoms can lead to criminal justice contact Incidence of violence higher during FEP than other phases of illness Higher risk of criminal justice interaction during FEP (14-59% incarcerated before Tx) May be more likely to encounter FEP in justice system than in community CJ contact represents first chance for treatment for significant number of youth w/fep Arrest and incarceration lengthens Duration of Untreated Psychosis (DUP) DUP is one of the strongest predictors of outcomes the shorter, the better e.g. Anderson et al, 2013; Bhui et al, 2015; Broussard et al, 2013; Ford, 2015; Langeveld et al, 2014; Latalova, 2014; Marion-Beyron et al, 2015; Ramsay et al, 2014; Wasser et al, 2017

9 Existing Research on CJ Contact Among FEP Clients Prior to first hospitalization History of criminal offending 29% (Merion-Veyron et al. 2015) History of arrest 70% (Ramsay Wan et al. 2014) History of incarceration 14% (Prince et al. 2007) 59% (Ramsay Wan et al. 2014) History of criminal justice contact leads to worse outcomes (Ramsay Wan et al. 2014) Longer DUP Greater symptom severity Higher likelihood of future CJ contact

10 Sequential Intercept Model

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12 Key Criminal Justice Stakeholders Police Pretrial Services Bail Commissioner Jail Diversion Staff Defenders Prosecutors Judges Corrections Probation Parole

13 Diversion and Sentencing Options Pre-Booking Diversion (Intercept 1) (e.g., law enforcement assisted diversion ) Post-Booking Diversion Pre-Arraignment (Intercept 2) (e.g., specialty probation) Post-Arraignment (Intercept 3) (e.g., mental health court) Probation Alternatives to Incarceration (e.g., sanctions, community service) Incarceration (jail or prison) Also Competency restoration NGRI

14 How might FEP lead to justice involvement? Emergency help seeking (e.g. calling 911) or behaviors considered criminal may lead to interaction w/police, possible charges Clinical Reasons for Justice Involvement Among FEP Clients* Bizarre behavior, loudly responding to internal stimuli (e.g. breach of/disturbing the peace, disorderly conduct) Substance use (e.g. possession, public intoxication) Disorganization (e.g. trespassing, larceny) Paranoia & Persecutory Delusions (e.g. making false reports, harassment) Agitation (e.g. resisting arrest, threatening, property damage) Grandiose & other delusions (e.g. theft, stalking, violation of protective order) Anger spurred by delusions (e.g.assault & other violent crimes) Mania (e.g. engaging police in a pursuit, public indecency, reckless endangerment) *not an exhaustive list

15 What Supports do Justice-Involved Clients Need? Be a proactive clinician - get involved Consider Justice System part of Coordinated Specialty Care Make part of community relationship building Huge stressor for clients; having a knowledgeable clinician who can problem solve, access resources, educate may really help! Get thorough history on clients legal involvement Clients may be unsure; get collateral, access to databases/lookups? Working w/pre-trial Services, Jail Diversion or Specialty Courts if arrests occur Assist in accessing these mechanisms if necessary Insuring treatment continuity if incarcerated Coordinating w/probation or Community Monitoring Educating families re: requesting CIT

16 Can we adhere to CSC principles? Not all CSC Programs accept those mandated to treatment When can accept, allow clients choice of CSC as treatment option Learn & follow elements of Procedural Justice Having a voice/feeling heard, respect, dignity, involvement in decision-making, fairness, transparency, & absence of coercion Procedural Justice relevant component of experiences of people w/ SMI in interactions with MH professionals in involuntary commitment & mandated treatment (e.g. O'Donoghue et al, 2011; Galon & Wineman, 2010) Clarify roles, boundaries, & conditions Reiterate as necessary Know your clients rights & laws regarding confidentiality Seek supervision/consultation any time unsure

17 Building Relationships with Local Justice Professionals Why should CSC programs outreach to Justice Professionals? Shorten DUP/Early Detection opportunities Coordination Who? CIT/CIT social worker; police departments Jail Diversion MH/Specialty Courts Public Defender s Office Bail Commissioners Jail administrators Probation/Juvenile Probation Re-entry programs

18 Detailing & Outreach Strategies Capitalize on existing relationships from coordination efforts E.g., ask your client s probation officer what referral materials and trainings might be useful, best format for delivery of information, what meetings can attend E.g., when working w/police officers on crisis call, ask what they need Offer to be a resource (even w/lots of ineligible referrals) Visit regularly (when/where appropriate) Workshops, In-service education Materials & tchotchkes Keep information clear, succinct, layperson terms

19 Detailing & Outreach Strategies mindmap youtube video

20 Example Scenarios Terrence: paranoid delusions confrontations in community w/multiple police interactions ED CSC, jail diversion CSC Clinician engages, offers CSC as treatment option, clarifies role is to support Terrence in fulfilling his agreement w/court along w/meeting other treatment goals he identifies, discusses what information to be shared, collaborates w/diversion staff regarding communication w/judge (e.g. normalizes challenges w/engagement for FEP) Works w/terrence as w/any other CSC client; justice involvement included as one element of coordination Nancy: trespassing charges related to delusion probation CSC Clinician discovers at intake that Nancy is on probation, gets permission to reach out to her PO, provides info on Program, education on FEP, learns about Nancy s terms of probation, supports Nancy in avoiding violations, clarifies role is to help not enforce, works w/po to develop feasible plans

21 Additional resources NASMHPD Early Intervention in Psychosis Virtual Resource Center Information Brief: First-Episode Psychosis: Considerations for the Criminal Justice System Information Brief: Outreach for First Episode Psychosis Guidance Manual: Educating Communities to Identify and Engage Youth in the Early Phases of an Initial Psychosis Pollard, Fisk & Srihari (2017). First-Episode Psychosis and the Criminal Justice System: Using a Sequential Intercept Framework to Highlight Risks and Opportunities. Psychiatric Services, 68:

22 Questions? Comments?

23 Contact Information Leah Pope, PhD Director, Substance Use and Mental Health Program Vera Institute of Justice Jessica Pollard, PhD Assistant Professor, Psychiatry Yale University School of Medicine Clinical Director, STEP THANK YOU!