Behavioral Health Diversion Interventions

Transcription

1 June 1, 2018 Behavioral Health Diversion Interventions Moving from On-Off Programs to a System-Wide Strategy 2018 The Council of State Governments Justice Center

2 Merrill Rotter, MD Speakers ASSOCIATE CLINICAL PROFESSOR OF PSYCHIATRY, ALBERT EINSTEIN COLLEGE OF MEDICINE Sarah Wurzburg, Deputy Program Director, Behavioral Health THE COUNCIL OF STATE GOVERNMENTS JUSTICE CENTER 2

3 Overview Challenges in the Field What is Diversion? Moving from One-Off Program to a Systems Strategy 3

4 National nonprofit, nonpartisan membership association of state government officials Represents all three branches of state government Provides practical advice informed by the best available evidence 4 4

5 police chiefs consumers pretrial service administrators probation officials state legislators substance abuse providers state corrections directors judges district attorneys families parole board members county executives public defenders crime victims state corrections directors prosecutors mental health advocates court administrators mental health providers researchers jail administrators sheriffs correctional mental health providers state mental health directors victim advocates parole officials Behavioral Health at the CSG Justice Center Criminal Justice / Mental Health Consensus Project Criminal Justice/Mental Health Learning Sites Program Council of State Governments Justice Center 5

6 Mission of the JPLI The Judges and Psychiatrists Leadership Initiative (JPLI) aims to stimulate, support, and enhance efforts by judges and psychiatrists to improve judicial, community, and systemic responses to people with behavioral health needs who are involved in the justice system. Creating a community of judges and psychiatrists Increasing the reach of trainings Developing educational resources Three Judges Guides Subscribe to the JPLI Newsletter 6

7 Resources 7

8 Addressing a National Crisis of Too Many People with Mental Illnesses in Jails

9 An Unprecedented Response More than 430 counties across 43 states, representing 40% of the U.S. population, have resolved to reduce the number of people with mental illnesses in jails. Council of State Governments Justice Center 9

10 The Stepping Up Initiative s Data-Driven Approach to Systems Change Six Questions County Leaders Need to Ask 1. Is your leadership committed? 2. Do you have timely screening and assessment? 3. Do you have baseline data? 4. Have you conducted a comprehensive process analysis and service inventory? 5. Have you prioritized policy, practice, and funding? 6. Do you track progress? 1 Reduce The number of people with SMI booked into jail Strategies Should Focus on Four Key Measures Shorten The average length of stay for people SMI in jails Increase The percentage of connection to care for people with SMI in jail Lower Rates of recidivism Council of State Governments Justice Center 10

11 Framework for Police-Mental Health Collaborations Is our leadership committed to the police-mental health collaboration (PMHC)? Are we following clear protocols to respond to people who have mental illnesses? Are we providing staff with quality mental health and de-escalation training? Do we have the resources and service connections for people who have mental illnesses? Do we collect and analyze data? Do we have a process for reviewing and improving performance? Council of State Governments Justice Center 11

12 Primary Practice-Level Challenges Targeting Interventions Based on BH Needs and Criminogenic Risk Assessing serious mental illnesses, substance use disorders, and criminogenic risk factors in courts and correctional facilities Targeting and tailoring appropriate services and supervision based on level of needs and risk Incorporating Assessment Information into Case Plans Utilizing the assessment information for BOTH behavioral health criminogenic risk in case plans Defining lead case planner at an agency and outlining case conferencing procedures Knowing When to Refer to Which Intervention Taking the assessment information to guide program referral such as cognitive behavioral intervention Council of State Governments Justice Center 12

13 Primary Systems-Level Challenges Quantification of Needs Using Data Systematic identification of people with behavioral health needs by courts and corrections, using validated tools and standard definitions of mental illness and SUDs Accurate data collection and reporting on prevalence, entries, length of stay, and connections to treatment Identifying System Improvements and Treatment Gaps Using Data Selecting strategies and designing programs based on projected impact on key outcome measures Specifying gaps in community-based services and treatment based on data on connections to care Council of State Governments Justice Center 13

14 Use of data to identify and prioritize systems improvements Jurisdiction Metric Finding Action Taken Bexar County, Texas The number of people with mental illnesses in jail County does not know how many people with mental illnesses are in the jail. Bexar County established universal screening for mental illnesses. New York City, New York Length of stay People with mental illnesses stayed in jail 112 days on average as compared to 61 days for those without mental illnesses. New York City implemented early pretrial diversion options to move people with mental illnesses out of jail in a timely way. Franklin County, Ohio Connection to care post- release More than one in three of people who had contact with the behavioral health care system in the year prior to their incarceration did not have contact with the behavioral health care system in the year following their release from jail. The local Alcohol Drug And Mental Health (ADAMH) board established a jail liaison team to provide in-reach service to get follow-up appointments within two weeks of release. Salt Lake County, Utah Recidivism rate One out of three people on pretrial supervision and one out of two people on county probation did not fulfill the requirements of their supervision. Salt Lake County recommendations included establishing intensive supervision caseloads for people who are assessed as being moderate to high risk of reoffending and who are also assessed as having an SMI. 14

15 What does the term diversion mean to you?

16 Behavioral Health Diversion Terms Diversion Jail Diversion Deflection Early Intervention

17 What is Behavioral Health Diversion? Jail diversion is a community-based, collaborative criminal justice mental health response for justice-involved people with mental illnesses where jail time is reduced or avoided, and the individual is linked to comprehensive and appropriate services. Judges Criminal Justice/Mental Health Leadership Initiative. (2010). Judges guide to mental health diversion: A reference for justice system practitioners. Delmar, NY: Policy Research Associates, CMHS National GAINS Center.

18 Behavioral Health Diversion Intervention This term includes common name brand programs (like LEAD) and local practices (e.g., court processes that lead to a diversion-related outcome). These programs and practices share the following diversion-related goals: (1) connecting people who have behavioral health needs to treatment and support services, and (2) reducing or eliminating jail time by exploring alternatives to traditional case processing. 18

19 Behavioral Health Diversion Strategy Diversion strategies that address systems enhancements Opportunities for diversion at multiple intercept points Ability to divert eligible individuals at different points in the criminal justice system For those not eligible for diversion providing providing reentry services that include connection to behavioral health services in the community

20 Discussion Questions Do you consider your specialty court diversion? Do you know about other diversion interventions in the court system? Is there a larger strategy across agencies in the criminal justice system for people with BH needs? 20

21 Challenges to Developing Continuum of Diversion Responses No clear common language standards for diversion related terminology Diversion programs and practices constantly evolving No clear strategies on how to build diversion opportunities throughout the criminal justice system

22 Key Questions What is behavioral health diversion? Providing definition for diversion How is a system of diversion developed? Key components needed for strategic development What are options for behavioral health diversion? Describing common BH diversion interventions, programs/practices How do you develop multiple diversion options for your systems? Key components tailored for each subpart of system (law enforcement, pretrial, courts, jails)

23 Overview Challenges in the Field What is Diversion? Moving from One-Off Program to a Systems Strategy 23

24 Agency-Specific Diversion Interventions Programs and practices that are designed to divert people at specific process-oriented phases (i.e., pre-arrest, pre/post-booking, and pre-trial) and implemented by the main agency that has the best opportunity and resources. 24

25 Continuum of BH Diversion Interventions A range of behavioral health diversion programs and practices that span a community s criminal justice system starting from first contact with law enforcement (arrest) through incarceration. 25

26 Behavioral Health Diversion Decision Points

27 Behavioral Health Diversion Options

28 Multiple Behavioral Health Diversion Options Law Enforcement Considerations Pretrial Considerations Court Considerations Jail Considerations Is our leadership committed to the policemental health collaboration (PMHC)? Are we following clear protocols to respond to people who have mental illnesses? Are we providing staff with quality mental health and de-escalation training? Do we have the resources and service connections for people who have mental illnesses? Do we collect and analyze data? Engage stakeholders Identify target population Conduct a comprehensive process analysis and inventory of services Identify and leverage funding streams Information sharing Track progress Engage stakeholders Identify target population Conduct a comprehensive process analysis and inventory of services Identify and leverage funding streams Information sharing Track progress Is our leadership committed? Do we conduct timely screening and assessments? Do we have baseline data? Have we conducted a comprehensive process analysis and inventory of services? Have we prioritized policy, practice, and funding improvements? Do we track progress? Do we have a process for reviewing and improving performance? Specific questions are in development

29 Behavioral Health Diversion Continuum Components Engage stakeholders Identify target population Conduct a comprehensive process analysis and inventory of services Identify and leverage funding streams Information sharing Track progress

30 A Framework for Prioritizing Resources Subgrouping A Low criminogenic risk/ some significant BH treatment needs Subgrouping B High criminogenic risk/ some significant BH treatment needs Divert from criminal justice system without intensive community supervision if connected to appropriate treatment and supports Prioritize for intensive supervision (in lieu of incarceration or as condition of release) coordinated with appropriate treatment and supports 30

31 Collaborative Comprehensive Case Planning 1. Interagency Collaboration and Information-Sharing 2. Staff Training 3. Screening and Assessment 4. Case Conference Procedures 5. Participant Engagement 6. Prioritized Needs and Goals 7. Responsivity 8. Legal Information 9. Participant Strengths 10. Gender Considerations 31

32 Goal of BH Diversion Resources Provide information on diversion Agency-specific information on possible interventions Law enforcement Courts Pretrial Jails Assist jurisdictions to develop, or modify, a continuum of diversion responses for people with behavioral health disorders in the criminal justice system identification of BH issues, alternatives to traditional case processing, reduction or avoidance of jail time, and linkage to comprehensive and appropriate community-based services.

33 Questions and Answers 33

34 CSG Justice Center Developing a Mental Health Court: An Interdisciplinary Curriculum learning.csgjusticecenter.org Developing a Mental Health Court is a free multimedia curriculum for individuals and teams seeking to start, maintain, or just learn about mental health courts or other criminal justice/mental health collaborations.

35 Criminal Justice/Mental Health Learning Sites

36 Contact Information Merrill Rotter, MD, Associate Clinical Professor of Psychiatry, Albert Einstein College of Medicine Sarah Wurzburg Deputy Program Director, Behavioral Health The Council of State Governments Justice Center 36

37 Join our distribution list to receive CSG Justice Center updates and announcements! The presentation was developed by members of The Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of The Council of State Governments Justice Center, the members of The Council of State Governments, or the funding agency supporting the work.