Dauphin County MH/ID Mental Health and Forensic Initiatives PRESENTATION TO RCPA SEPTEMBER 29, 2016

Transcription

1 Dauphin County MH/ID Mental Health and Forensic Initiatives PRESENTATION TO RCPA SEPTEMBER 29, 2016

2 Agenda 2 Dauphin County Demographics History of MH and Forensic Efforts in Dauphin County SAMHSA Jail Diversion Grant 2006 BJA Targeted Expansion Grant 2009 Collaboration lessons learned Serving people with challenges lesson learned Sustaining Infrastructure Overview of recent Dauphin County population study Challenging assumptions Treatment and support challenges

3 Dauphin County Demographics 3 271,453 - County Population ~1,100 - Mean Daily Prison Population 72,248 - # of HealthChoices Unique Members FY ,945 - # of HealthChoices Members receiving BH Service FY ,333 - # County Funded MH Program Consumers Served FY 15-16

4 Starting Point: Pre SAMHSA Jail Diversion Grant in Performed a chart review for 32 inmates out of approximately 250 inmates with MH diagnosis (13% Sample) Class of Charge Summary Misdemeanor Felony Parole Violation % 40.63% 18.75% 34.38% Episodes of Incarceration Per Inmate 1 to 3 4 to 6 7 to 9 10 to 15 Over % 25.00% 18.75% 21.88% 12.50%

5 SAMHSA Jail Diversion Grant Data (June 2007 Feb 2010) 5 Referral Source: Magisterial District Judges 31% Pretrial Services 16% Public Defenders & DA 19% Probation / Prison / Police 18% Others 16% Number of Jail Days of Enrollees 7,983 - Mean 50 days Number of Jail Days Saved 39,600 - Mean 249 days

6 Diversion Grant Outcomes + One Year (159 people) 6 Arrests were tracked from two years prior to referral for the program and while in the program, and up to two years after discharge from the program: Number of Arrests 2 Years Prior to Referral Average Number of Arrests 2 Years Prior to Referral Number of Arrests After Enrollment + 2 Years - 97 Average Number of Arrests After Enrollment + 2 Years Data for individuals in the MH Jail Diversion Program who were discharged for 2 years or longer Number of Individuals - 49 Number of Arrests Average Number of Arrests Per Person Number of Individuals Arrested While Enrolled - 11 (22%) Number of Arrests While Enrolled - 15 Average Number of Arrests Per Person While Enrolled Number of Individuals Arrested - 15 (30%) Number of Arrests - 26 Average Number of Arrests Per Person Number of Individuals Not Arrested - 34 (70%)

7 BJA Grant Objectives 7 MH/ID awarded BJA Category II Grant 2009 Sustain core components of existing SAMHSA Jail Diversion Grant for people with SMI Key Components of BJA Grant Develop a Forensic Re-Entry Program for persons with SMI Develop a Mental Health Court Expand Jail Diversion target population to persons with MI and MDJ level court decision Diversion = Substantially reducing # of days in prison MH Courts = Substantially mitigating sentence, enhanced MH treatment and court coordination, reduced parole length, long term success in diminishing criminal antecedents Re-Entry = Substantially increasing community integration options for people not eligible for Diversion or MH Courts either due to nature of crime/length of sentence, prior criminal history, or maxing out of DCP or State Corrections

8 Forensic Overview 2006 to Dauphin County Forensic Program Data 2005 to 2014 MH COURT MH JAIL DIVERSION MH REENTRY Total Number of Participants 119 Total Number of Participants 58 Total Number of Participants 42 Total Number Discharged 62 Total Number Discharged 18 Total Number Discharged 13 Total Number Graduated 51 Total Successful Diversions 38 Total Successfully Reentered 18 Graduation Rate 51/ % Diversion Success Rate: 38/56, 67.8% Re-entry Success Rate 18/31, 58% Individuals Still in Program 5 Ind. Moved to New Program 1 Ind. Moved to New Program 11 **Treatment Works, People Recover** Referrals All Programs Total Accepted (3 Programs)- 219 Total Denied Total Referrals - 569

9 Collaboration Lessons Learned 9 Establish Key Partnerships- President Judge, MDJs, District Attorney, Public Defender, Prison, Adult Probation, Pre-Trial Services, Court Administration, Law Enforcement, MH Agencies, and Community Agencies Police Training Programs (CIT and MH First Aid) Boundary Spanner MH Forensic Coordinator housed in Pretrial Services Mental health system and providers improve forensic system knowledge Establish credibility with courts and criminal justice system Stratifying forensic collaboration Criminal history eligibility Voluntary treatment participation Developing and maintaining strategies for offenders not eligible for diversion

10 Challenging Population to Serve 10 Develop Forensic Expertise Forensic ICM /Blended ACT Forensic Residential Program Co-Occurring (MH and D&A) Disorder Strategies Trauma Informed Treatment Approaches Seeking Safety DBT Trauma CBT RECOVERY: Treatment, Housing, Employment, Peers, Positive Interactions

11 Sustaining Infrastructure 11 Monitor programs, processes, collaboration participation Big group of people that have to maintain strategies and focus on this population Not always the priority of the criminal justice system or the courts Provider staff turnover.train, retrain, retrain and retrain again Maintain strong partnerships especially with Pretrial Services and Adult Probation HealthChoices funding for Housing Support funds Expanding Co-Occurring treatment options Using diversion CRR programs effectively

12 Intercept Graphic 12

13 Challenges Ahead 13 Research now says Criminogenic Risk and Mental Illness Simple Logic Model: Not So Simple Mental Health Symptoms lead to criminalization Expand Mental Health Services Criminalization of persons with Mental Illness will Decrease BUT. more mental health services do not necessarily decrease the percentage of persons with mental illness in jail (Fisher 2000) Steadman 2013; Rotter, 2015 Criminogenic Risk Factors: The Risk-Need-Responsivity Paradigm Risk Factor History of antisocial behavior Antisocial personality pattern Antisocial cognition Antisocial attitudes Family and/or marital discord Poor school and/or work performance Few leisure or recreation activities Substance abuse Source: Andrews (2006)

14 Recent Dauphin County Prison Study 14 Dec. 15 Jan. 16 Feb 16 Total % DCP Admissions Open Base Service Unit (BSU) BSU Closed Within 3 Years Not Registered NATIONAL DATA OVERVIEW Gen Pub State Prison Jail Probation/Parole Serious Mental Disorders 5.4% 16% 17% 7 9%

15 CRIMINAL CHARGE PROFILE OPEN AND CLOSED Open # Open % Closed# Closed % Violent 22 39% 33 28% Non Violent 34 61% 83 72% Total Felony Subtotal 24 43% 60 52% Misdemeanor Subtotal 30 54% 50 43% Other 2 3% 6 5% Total LENGTH OF STAY* OPEN AND CLOSED Open # Open % Closed # Closed % < 30 days % % 30 to 60 Days % % > 60 days % % MEDIAN * Maximum length of stay for this report is 122 days based on earliest admission 12/1/15 and data cut off 3/31/16

16 Recidivism Population 16 Open % Closed % No Prior Arrest 3 5.4% 7 6.0% Prior not within 2 years % % Prior within 2 years % % # of Priors within 2 Years % % 3 2.6% % 6 5.2% % % % % % % % % Total % %

17 Meeting the Challenge 17 Address the underlying trauma that can result in adults with antisocial thinking and behavior, poor relationships, lack of community engagement Increase employment skills, housing stability, treatment engagement Address co-occurring disorders Explore how to Use an integrated approach consistent with effective practice to provide services that address individuals behavioral health and criminogenic needs, and targets those needs that are most likely leading to criminal justice involvement (e.g., cognitive behavioral treatment, or CBT, targeted to criminogenic risks, such as Reasoning and Rehabilitation and Thinking for a Change) Alex M Blandford, MHP CHES, Fred Osher, MD

18 Questions / Comments 18 Daniel E. Eisenhauer, Administrator Dauphin County MH/ID Program 100 Chestnut Street, 1 st Floor Harrisburg, PA deisenhauer@dauphinc.org (717)