Two "Diversion" Models from the US: Police Crisis Intervention Teams & Mental Health Courts

Transcription

1 Two "Diversion" Models from the US: Police Crisis Intervention Teams & Mental Health Courts Amy C Watson University of Illinois at Chicago USA

2 Overview Defining the Problem Strategizing Points of Intervention The Crisis Intervention Team Model Evidence CIT in Chicago Mental Health Courts Evidence Implications and Discussion

3 The Problem Over 1.1 million people with mental illnesses arrested in the US each year (Lyons & Walsh, 2010) Estimates of the prevalence of SMI in jail and prison populations in US range from % for men and % for women (Ditton, 1999; Steadman, et al, 2009) 72% of these individuals have co-morbid substance use problems General population rate SMI 5% (Kessler et al 1996) LA County and Cook County Jails operated the two largest single site psychiatric facilities in the country Persons with SMI tend to spend more time incarcerated pre-trial, serve more of their sentences, and have parole revoked for technical violations more often (Skeem & Louden, 2006)

4 Working toward solutions: The Sequential Intercept Model

5 Diversion from Arrest THE CRISIS INTERVENTION TEAM MODEL (CIT)

6 The Crisis Intervention Team Model (CIT) First Developed in Memphis,TN-1988 Collaboration between law enforcement, mental health, advocates and other stakeholders A pre-booking diversion model, police-based specialized response model Goals Increase safety in encounters for all Increase diversion to MH services or reduce criminalization Link persons in crisis to appropriate care (Cochran, Deane, & Borum, 2000)

7 CIT It s more than just training -Major Sam Cochran Elements of the CIT Model (DuPont, Cochran & Pillsbury, 2007) 40 hours of specialized training (15-20% patrol) Single point of entry to emergency psychiatric services Partnerships with community providers Changes in policies and procedures Most recent estimate is approximately 2700 CIT programs worldwide (most in US) Local, multi-jurisdictional and statewide efforts Some challenges applying model in different size cities, rural areas

8 CIT Elements Training 40 hours specialized training for officers, includes Signs & Symptoms of Mental Illnesses De-escalation techniques Resources & Options Consumer, family member and provider panels Visits to providers in the community Role play exercises Training for Dispatch Advanced CIT training (e.g. juveniles, veterans) Ongoing refresher/in-service training

9 CIT Elements Emergency Psychiatric drop off Designated point of entry to emergency psychiatric services, no refusal, police priority Partnerships & Collaboration Law Enforcement Community Advocacy Community Mental Health Community Policies & Procedures Law enforcement Mental Health

10 CIT in Chicago Began in 2 pilot districts in officers/supervisors per district Training developed in collaboration with community providers & stakeholders Citywide (all 225 districts) implementation began 2006 By CIT officers trained

11 CIT: The Evidence CIT training improves officer knowledge and attitudes (Compton, et al 2006; 2014a) CIT trained officers less likely to endorse use of force as effective response (Compton, et al 2011) CIT trained officers use less force as resistant demeanor increases (Morabito, Kerr & Watson, 2012) CIT implementation associated with: lower arrests rates than in jurisdictions with other models (Steadman, et al 2000) Decreased likelihood of arrest (Compton et al 2014b) Greater confidence in department s response (Borum, et al 1998) More mental disturbance calls identified (Teller, et al 2006) More transports to emergency psychiatric services (Watson et al 2011, Compton et al 2014b) More voluntary transports (Teller et al 2006)

12 Involving people in recovery in the training process: Collaboration with the Thresholds Theatre Arts Program& NAMI-GC

13 CIT in Chicago: Evidence to date Testing a systems level intervention to improve police response to persons with mental illness: CIT in Chicago 2008 NIMH funded Study of CIT in 4 Chicago police districts CIT trained officers directed 18% more call subjects to MH services than non CIT peers Linkage more likely in districts with more MH services CIT officers used less force at higher levels of resistance

14 CIT and Mental Health Service Accessibility in Police Encounters: Impact on Outcomes for Persons with Serious Mental Illnesses Credit where credit is due Co-investigators Michael Compton, MD, MPH George Washington University Jeff Draine, PhD, Temple University Jen Wood, PhD, Temple University Joel Caplan, PhD, Rutgers University Don Hedeker, PhD University of Illinois at Chicago Linda Owens,PhD, University of Illinois at Chicago *work supported by NIMH R01MH096744The contents of this presentation are solely the responsibility of the authors and do not necessarily represent the official views of NIMH

15 Specific Aims: Examine CIT in all Chicago Police Districts in order to= 1. Estimate the impact of CIT training on immediate outcomes of mental healthrelated calls 2. Determine how immediate call outcomes, CIT response, access arrangements, & availability of mental health services affect longer-term outcomes and utilization of services over a period of 12 months 3. Describe process by which officers connect individuals with psychiatric services through both experiences that officers, consumers, and other key individuals have had and the perceptions they hold 4. To explore the geographic associations between MH service accessibility, community characteristics, characteristics of calls and call subjects, call outcomes, and longer-term MH and CJ system outcomes

16 Chicago Police Districts, Designated Drop-offs and MH Agencies

17 Now they are training police to deal with people like us. They don t have to always become forceful with them because all that will do is aggravate the problem, so that makes me feel good. Resources Dupont, R., Cochran, S., & Pillsbury, S. (2007). Crisis Intervention Team core elements Crisis Intervention Team International, Inc.

18 Diversion from incarceration and the revolving door MENTAL HEALTH COURTS

19 Mental Health Courts Emerged in 1990s, now approximately 300 in USA Based on principles of Therapeutic Jurisprudence (TJ) The law can function as a therapeutic (or anti-therapeutic) agent Problem solving court model Goals: to divert offenders with mental illnesses out of the cycle of arrest, incarceration, release and re-arrest by connecting them to treatment and services Assumption that people get into trouble with the law because they are not receiving treatment (or adequate treatment)

20 MHC Model: Common Elements Separate docket or court call Judge plays more hands on role Non-adversarial team approach Voluntary participation participants must waive some procedural rights and agree to follow a prescribed treatment plan May have charges dropped or reduced with successful completion Termination returns case to standard court process

21 Eligibility Criteria MHC Model: Variations Charges (misdemeanor, felony, both, violent offense exclusions, DUIs) Diagnostic criteria (some exclude DD/ID, TBI unless co-occuring) Length of supervision Pre or post plea Availability of services Use of Sanctions/Rewards

22 MENTAL HEALTH COURT PROCESS ARREST Application to MH Court Eligibility Screenig/ Assessment YES Enroll in MH Court program YES GRADUATE: CHARGES DROPPED OR REDUCED NO Comply with Treatment Plan and other conditions for required period of time Sanctions to address noncompliance NO Continue with usual court process Terminate from program

23 Mental Health Court Model and Process Team Judge Attorneys (state, public defender) Probation officers Clinical Coordinator Service providers from community These slides are the intellectual property of Prof. Watson and must not be reproduced Services/Requirements Drug & Alcohol testing (UA and SCRAM) Medication adherence MH and SUD treatment Trauma treatment Housing and employment programs Regular reporting to court and to probation Community service Restitution & fines

24 Mental Health Court Model and Process Rewards for compliance Verbal praise Less frequent monitoring Court appearances Probation reporting Drug and alcohol monitoring Travel passes Gift cards GRADUATION These slides are the intellectual property of Prof. Watson and must not be reproduced Sanctions for noncompliance Verbal admonishment Written assignments More frequent monitoring Court appearances Probation reporting Drug and alcohol monitoring Changes to treatment plan Community Service Hours Jail time TERMINATION

25 Evidence of MHC Effectiveness While MHC participants generally have had some contact with mental health services prior to MHC entry, frequency increases after enrollment (& is greater than comparison group) MHC participants have fewer arrests while under MHC supervision and following program exit than before entrance (and in some cases, comparison groups), and more days to new arrest. Reduction in recidivism largest for MHC completers Being female and white associated with higher likelihood of completing Higher compliance and lower supervision predicts completion Goodale, Callahan and Steadman (2013) conclude MHCs can significantly reduce recidivism rates and incarceration days, improve public safety and increase participation in community-based treatment See also: Boothroyd, et al 2003, 2005; Christy et al 2005; Dirks-Lindhorst and Lindhorst, 2012; Herinckx, et al 2005; Hiday & Ray, 2010; Hiday, Wales & Ray, 2013; Luskin, 2013; Redlich, et al 2010; Steadman et al 2011

26 Potential Key Ingredient Research to date has not found direct relationship between treatment received and re-arrest among MHC participants. Several authors point to procedural justice as a potential key ingredient and current evidence suggests MHC process is high on procedural justice According to the procedural justice framework, being treated with respect, dignity and concern and being allowed voice in the process by the judge and MHC team may support self-regulation, desistance from crime, and adherence to the prescribed treatment plan See: Canada & Watson, 2013; Keater, Callahan, Steadman, et al 2013 Poythress, Petrila, McGaha & Boothroyd, 2002 ; Wales, Hiday & Ray, 2010 These slides are the intellectual property of Prof. Watson and must not be reproduced

27 Concerns about Mental Health Courts True voluntariness of participation (Redlich, et al, 2010) MHC as diversion or net widener (Bazelon Center, 2003) Impact on others seeking voluntary services These slides are the intellectual property of Prof. Watson and must not be reproduced

28 CIT and Mental Health Courts As effective interventions for reducing recidivism, improving community safety and improving mental health outcomes? As diversion? As case finders? As net widening mechanisms?

29 Thank you! These slides are the intellectual property of Prof. Watson and must not be reproduced Amy C Watson, PhD Associate Professor University of Illinois at Chicago 1040 W Harrison Street, MC 309 Chicago, IL USA fax acwatson@gmail.com acwatson@uic.edu

30 References Bazelon Center for Mental Health Law (2003). Criminalization of people with mental illnesses: The role of mental health courts in system reform. Jail Suicide/Mental Health Update, 12,1-11. Boothroyd, R. A., Mercado, C. C., Poythress, N. G., Christy, A., & Petrila, J. (2005). Clinical outcomes of defendants in mental health court. Psychiatric Services, 56(7), Boothroyd, R. A., Poythress, N. G., McGaha, A., & Petrila, J. (2003). The broward mental health court: Process, outcomes, and service utilization. International Journal of Law and Psychiatry, 26(1), Canada, K. E., & Watson, A. C. (2013). "'Cause everybody likes to be treated good": Perceptions of procedural justice among mental health court participants. American Behavioral Scientist, 57(2), Christy, A., Poythress, N. G., Boothroyd, R. A., Petrila, J., & Mehra, S. (2005). Evaluating the efficiency and community safety goals of the broward county mental health court. Behavioral Sciences & the Law, 23(2), Cochran, S., Deane, M.W., & Borum, R. (2000). Improving police response to mentally ill people. Psychiatric Services, 51(10),

31 References Compton, M. T., Esterberg, M. L., McGee, R., Kotwicki, R. J., & Oliva, J. R. (2006). Crisis intervention team training: Changes in knowledge, attitudes, and stigma related to schizophrenia. Psychiatric Services, 57(8), Compton MT, Demir Neubert BN, et al (2011): Use of force preferences and perceived effectiveness of actions among Crisis Intervention Team (CIT) police officers and non-cit officers in an escalating psychiatric crisis involving a subject with schizophrenia. Schizophrenia Bulletin 37, 4, Compton, M.T., Bakeman, R., Broussard, B., Hankerson-Dyson, D., Husbands, L., Krishan, S., Stewart-Hutto, T., D Orio, B.M., Oliva, J.R., Thompson, N.J. & Watson, A.C. (2014a online) The Police-Based Crisis Intervention Team (CIT) Model: I. Effects on Officers Knowledge, Attitudes, and Skills. Psychiatric Services. Compton, M. T., Bakeman, R., Broussard,B.,Hankerson-Dyson, D., Husbands, L., Krishan, S., Stewart-Hutto, T., D'Orio, B.M., Oliva, J. R.,Thompson, N. J. & Watson, A C. (2014b online),the Police-Based Crisis Intervention Team (CIT) Model: II. Effects on Level of Force and Resolution, Referral, and Arrest. Psychiatric Services. Dirks-Linhorst, P., & Linhorst, D. M. (2012). Monitoring offenders with mental illness in the community: Guidelines for practice. Best Practices in Mental Health: An International Journal, 8(2), Ditton, P.M. (1999). Mental health and treatment of inmates and probationers. Brueau of Justice Statistics Bulletin. Washington, DC: U.S. Department of Justice. Dupont, R., Cochran, S., & Pillsbury, S. (2007). Crisis Intervention Team core elements. The University of Memphis School of Urban Affairs and Public Policy, Dept. of Criminology and Criminal Justice, CIT Center. Crisis Intervention Team website. Retrieved from These slides are the intellectual property of Prof. Watson and must not be reproduced

32 These slides are the intellectual property of Prof. Watson and must not be reproduced References Goodale, G., Callahan, L., & Steadman, H.J. (2013). What Can We Say About Mental Health Courts Today? Psychiatric Services, 64(4), Herinckx, H. A., Swart, S. C., Ama, S. M., Dolezal, C. D., & King, S. (2005). Rearrest and linkage to mental health services among clients of the clark county mental health court program. Psychiatric Services, 56(7), Hiday, V. A., & Ray, B. (2010). Arrests two years after exiting a well-established mental health court. Psychiatric Services, 61(5), Hiday, V. A., Wales, H. W., & Ray, B. (2013). Effectiveness of a short-term mental health court: Criminal recidivism one year postexit. Law and Human Behavior, 37(6), Keator, K. J., Callahan, L., Steadman, H. J., & Vesselinov, R. (2013). The impact of treatment on the public safety outcomes of mental health court participants. American Behavioral Scientist, 57(2), Kessler RC, Berglund PA, Zhao S, et al. The 12-month prevalence and correlates of serious mental illness, In Manderscheid RW, Sonnenschein MA, eds. Mental health, United States, Washington, DC: US Government Printing Office; DHHS publication no. (SMA) Kopelovich, S., Yanos, P., Pratt, C., & Koerner, J. (2013). Procedural justice in mental health courts: Judicial practices, participant perceptions, and outcomes related to mental health recovery. International Journal of Law & Psychiatry, 36(2), Luskin, M. L. (2013). More of the same? treatment in mental health courts. Law and Human Behavior, 37(4),

33 These slides are the intellectual property of Prof. Watson and must not be reproduced References Lyons, S. & Walsh, N. (2010). Money well spent: How positive social investments reduce incarceration rates, improve public safety, and promote the well-being of communities. Washington, DC:Justice Policy Institute. Retrieved from Morabito, MS, Kerr, AN, Watson, AC, Draine, J, Angell, B (2012). Crisis Intervention Teams and People with Mental Illness: Exploring the Factors that Influence the Use of Force. Crime & Delinquency, 58 (1) Poythress, N. G., Petrila, J., McGaha, A., & Boothroyd, R. (2002). Perceived coercion and procedural justice in the broward mental health court. International Journal of Law and Psychiatry, 25(5), Redlich, A. D. & Han, W. (2013). Examining the links between therapeutic jurisprudence and mental health court completion. Law & Human Behavior. Advance online publication. Redlich, A. D., Hoover, S., Summers, A., & Steadman, H. J. (2010). Enrollment in mental health courts: Voluntariness, knowingness, and adjudicative competence. Law and Human Behavior, 34(2), Redlich, A. D., Steadman, H. J., Monahan, J., Petrila, J., & Griffin, P. A. (2005). The second generation of mental health courts. Psychology, Public Policy, and Law, 11(4), Skeem, J.L., & Eno Louden, J. (2006). Toward Evidence-Based Practice for Probationers and Parolees Mandated to Mental Health Treatment. Psychiatric Services, 57(3), Steadman HJ, Deane MW, Borum R, et al (2000): Comparing outcomes of major models of police responses to mental health emergencies. Psychiatric Services 51:

34 These slides are the intellectual property of Prof. Watson and must not be reproduced References Steadman, H. J., Osher, F. C., Robbins, P. C., Case, B., & Samuels, S. (2009). Prevalence of serious mental illness among jail inmates. Psychiatric Services, 60(6), Steadman, H. J., Redlich, A., Callahan, L., Robbins, P. C., & Vesselinov, R. (2011). Effect of mental health courts on arrests and jail days: A multisite study. Archives of General Psychiatry, 68(2), Teller JLS, Munetz MR, Gil KM, et al: Crisis intervention team training for police officers responding to mental disturbance calls. Psychiatric Services 57: , 2006 Tyler, T. R. (2009). Procedural justice, identity and deference to the law: What shapes rule-following in a period of transition? Australian Journal of Psychology, 61(1), Tyler, T. R., & Lind, E. A. (1992). A relational model of authority in groups. In M. Zanna (Ed.), Advances in experimental social psychology (Vol. 25, pp ). New York: Academic Press. Wales, H.W., Hiday, V. A., & Ray, B. (2010). Procedural justice and the mental health court judge's role in reducing recidivism. International Journal of Law and Psychiatry, 33(4), Watson, A.C., Ottati, V.C., Draine, J.N., Morabito, M. (2011) CIT in context: The Impact of mental health resource availability and district saturation on call outcomes. International Journal of Law and Psychiatry, 34 (4)