National Findings on Mental Illness and Drug Use by Prisoners and Jail Inmates. Thursday, August 17

National Findings on Mental Illness and Drug Use by Prisoners and Jail Inmates Thursday, August 17

Welcome and Introductions Jennifer Bronson, Ph.D., Bureau of Justice Statistics Statistician Bonnie Sultan, Grantee Technical Assistance Manager, The Council of State Governments Justice Center Sarah Wurzburg, Deputy Program Director, Behavioral Health, The Council of State Governments Justice Center

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 3

Justice and Mental Health Collaboration Program Funding Mentally Ill Offender Treatment and Crime Reduction Act Public Law 108-414 signed into law in 2004 with bipartisan support Authorized JMHCP: $50 million for criminal justice-mental health initiatives Reauthorized for five years in 2008 (Public Law 108-416) December 2016 the 21st Century Cures Act provided funding for JMHCP and MH Courts

Mental Illness and Drug Use by Prisoners and Jail Inmates National Findings on Mental Illness and Drug Use by Prisoners and Jail Inmates Thinking Through How to Use This Information Locally Research and Evaluation Considerations Question & Answer

U.S. Department of Justice Office of Justice Programs Indicators of Mental Health Problems, Drug Use, Dependence and Abuse among Prisoners and Jail Inmates Webinar presentation for Presented by Jennifer Bronson, PhD Statistician Council of State Governments Justice Center August 17, 2017 BUREAU OF JUSTICE STATISTICS

Bureau of Justice Statistics (BJS) Statistical agency of the U.S. Department of Justice. BJS was established on December 27, 1979. Mission à to collect, analyze, publish, and disseminate information on crime, criminal offenders, victims of crime, and the operation of justice systems. BJS does NOT make policies, or provide oversight or monitoring of correctional facility operations. BJS publications, web tools, and data collections are available at www.bjs.gov. www.bjs.gov 7

Mental Health Report Brief Overview Indicators of Mental Health Problems Reported by Prison and Jail Inmates, 2011-12 (NCJ 250612) June 2017 Purpose to present self-reported prevalence estimates of mental heath indicators among inmates Compares prisoners to jail inmates Compares prisoners and jail inmates to the general population Inmate demographics Criminal justice variables (i.e. most serious current offense) Treatment for mental health problems since admission Rule violations while incarcerated. www.bjs.gov 8

Inmate Data Source: National Inmate Survey (NIS) NIS purpose is to collect sexual victimization data, as mandated under the Prison Rape Elimination Act (PREA). NIS-3 was conducted in 2011-12. It is BJS most recent survey of mental health problems among prisoners and jail inmates. Collects self-report data using audio-computer assisted self interview (ACASI) Nationally representative sample of inmates in the U.S. 41,822 adult inmates in 233 state and federal prisons 58,745 adult inmates in 358 jails. www.bjs.gov 9

General Population Data Source: National Survey on Drug Use and Health (NSDUH) NSDUH is collected by SAMHSA. Adults 18+. Data came from the 2009-2012 surveys. NSDUH measures past-30 day serious psychological distress (SPD). NSDUH data were standardized to match the prisoner and jail inmate populations by age, sex, race, and Hispanic origin. Includes an indicator of criminal justice involvement in past 12 months: None Probation or parole Arrested www.bjs.gov 10

BJS Mental Health Indicators Current indicator Serious psychological distress (SPD) in the past 30-days, as measured by a score of 13+ on the K6 Scale (Kessler-6) Lifetime/history of a mental health problem Has a mental health professional ever told you that you have a mental disorder? www.bjs.gov 11

What is the K6? The K6 (Kessler-6) is a general population scale used to identify individuals who likely have a serious mental illness. 6 questions In the 30 days prior to the interview how often did you feel Nervous Hopeless Restless or fidgety So depressed nothing could cheer you up Everything was an effort Worthless Continued www.bjs.gov 12

What is serious psychological distress (SPD)? K6 scores range from 1 (all of the time) to 5 (none of the time). Scores are then recoded to provide a summary score with a range of 0 to 24. A score of 13 or higher indicates the person has SPD. SPD IS NOT A MENTAL DISORDER SPD IS NOT A DIAGNOSIS. SPD IS AN INDICATOR that a person likely has a mental illness and should receive an appropriate assessment. www.bjs.gov 13

Table and Figure Notes *Comparison group. **Difference with the comparison group is significant at the 95% confidence level. - Standard errors for all presented data are available in the full reports (www.bjs.gov). www.bjs.gov 14

www.bjs.gov

Report Limitations Self-report data and not verified by medical records, clinical interviews, etc. We do not know the time period, or setting, in which an inmate was told they had a mental disorder. The lifetime measure is conflated with access to health care and treatment-seeking behavior. We have limited information about the relationship of either mental health indicator in relation to the current offense or current incarceration. Causation or correlation between one s mental health status and incarceration cannot be assumed with this data. National level data only Trends could not be produced The K6 scale was not included on past BJS inmate surveys Mode differences (ACASI versus CAPI). www.bjs.gov 26

Summary of Findings Prisoners were 3 times more likely to have SPD than the total adult general population (GP). Jail inmates were 5 times more likely to have SPD than the total adult GP. Female prisoners and jail inmates were more likely than males to have an indicator of a mental health problem. More white prisoners and jail inmates had SPD than black or Hispanic inmates. Prisoners incarcerated for a violent crime or property crime were equally as likely to have SPD or a history of a mental health problem. There was no difference among prisoners or jail inmates with SPD and sentence length. Prisoners and jail inmates with an indicator of a mental health problem were more likely to have a rule violation than inmates without an indicator. www.bjs.gov 27

Illicit Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-09 (NCJ 250546) By: Jennifer Bronson (BJS), Jessica Stroop (BJS), Stephanie Zimmer (RTI), and Marcus Berzofksy (RTI) www.bjs.gov

Drug Use Report Brief Overview Prevalence data on the percentage of state prisoners and sentenced jail inmates who met the Diagnostic and Statistical Manual, 4 th Edition (DSM-IV) criteria for drug dependence or abuse. Illicit drug use estimates for 8 types Lifetime drug use (ever used) Regular drug use (used drugs at least once a week for at least a month). At time of the offense Month before the offense Committed the offense to get money for drugs or drugs. Comparisons to the general population. Drug use and drug use disorder presented by demographics. Drug use changes over time (2002-04 to 2007-09). Drug treatment while incarcerated. www.bjs.gov 29

Inmate Data Source: National Inmate Survey (NIS) 1 and 2 NIS-1 was conducted in 2007, NIS-2 was conducted in 2008-09. Survey years were combined for analysis (2007-09). BJS most recent survey of useable drug use data among prisoners and jail inmates. Self-report data using ACASI. Nationally representative sample of inmates in the U.S. NIS-1 à 22,943 state prisoners and 45,414 jail inmates NIS-2 à 28,749 state prisoners and 48,066 jail inmates. www.bjs.gov 30

General Population Data Source: National Survey on Drug Use and Health (NSDUH) NSDUH is collected by SAMHSA. Adults 18+. Data came from the 2007-2009 surveys. DSM-IV criteria for dependence or abuse; drug use in month before; regular drug use NSDUH data were standardized to match the prisoner and jail inmate populations by age, sex, race, and Hispanic origin. Includes an indicator of criminal justice involvement in past 12 months: None Probation or parole Arrested www.bjs.gov 31

Measurement of Drug Dependence 1. Tolerance 2. Withdrawal symptoms or drug taken to relieve withdrawal 3. Drug taken in larger amounts for longer periods than intended 4. Persistent desire or unsuccessful attempts to cut down or control drug use 5. A lot of time is spent obtaining drugs, using them, or recovering from its effects 6. A reduction in or absence from social, occupational, or recreational activities 7. Continued use despite adverse consequences. www.bjs.gov 32

Measurement of Drug Abuse 1. Recurrent drug use resulting in a failure to fulfill major role obligations 2. Recurrent drug use in which it is physically hazardous 3. Recurrent drug-related legal problems 4. Continued drug use despite having persistent or recurrent drug-related social problems. www.bjs.gov 33

www.bjs.gov

Table 1. State prisoners and sentenced jail inmates who ever used drugs, by drug type, 2002, 2004, and 2007-2009 www.bjs.gov

Table 2. State prisoners and sentenced jail inmates who regularly used drugs, by drug type, 2002, 2004, and 2007-2009 www.bjs.gov

Table 3. www.bjs.gov

Table 4. www.bjs.gov

Demographic differences Drug use in the month before offense State prisoners Females (47%) more likely than males (38%). Whites (42%) more likely than blacks (36%) or Hispanics (37%). Drug use significantly decreased by age. Violent offenders (34%) were less likely to have used drugs in the month before the offense, than those incarcerated for a property crime (47%), drug offense (47%), or public order offense (44%). Sentenced jail inmates Females (60%) more likely than males (54%). Whites (59%) more likely than blacks (55%) or Hispanics (45%). Drug use significantly decreased by age. Violent offenders (54%) were less likely to have used drugs in the month before compared to property offenders (63%), or drug offenders (67%).

Figure 2. www.bjs.gov

Figure 3. www.bjs.gov

Table 5. www.bjs.gov

Table 6. www.bjs.gov

Table 7. www.bjs.gov

Table 8. www.bjs.gov

Summary of Findings 58% of state prisoners and 63% of sentenced jail inmates met the DSM-IV criteria for dependence or abuse. This compared to about 5% of the total general population. The percentage of inmates who met the DSM-IV criteria was higher for property offenders compared to violent offenders or public order offenders. A larger percentage of females than males used drugs in the month before the offense. A larger percentage of whites compared to blacks regularly used cocaine/crack, heroin/opiates, or methamphetamine. Among those inmates who met the DSM-IV criteria for dependence or abuse, 28% of prisoners and 22% of jail inmates participated in a drug treatment program since admission. www.bjs.gov 46

Thank you! Both reports are available at www.bjs.gov For questions or comments: Jennifer.Bronson@usdoj.gov 202-598-7774 (work) www.bjs.gov

How to Use National Information For comparison purposes and as a point of reference The National Survey of Drug Use and Health (NSDUH) was used in these analysis The Substance Abuse and Mental Health Services Administration provides a Behavioral Health Barometer with state level data Volume 4 utilizes 2016 NSDUH data

What Information Is Being Collecting? Is there a standard process for screening in the jail or prison facility? Does your jurisdiction know: The number of people with mental illness The number of people with substance use disorders Demographic information by gender and race

383 Counties Have Passed Resolutions

To Reduce the Number of People With Mental Illnesses in Jails, County Leaders Should Ask These Questions Six Key Questions 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? 3

Reminder: Four Key Measures To Track Progress of Stepping Up Efforts 1. Reduce the number of people with mental illness booked into jail 2. Shorten the average length of stay for people with mental illnesses in jails 3. Increase the percentage of people with mental illnesses in jail connected to the right services and supports 4. Lower rates of recidivism 4

þ Question 2: Do You Have Timely Screening and Assessment? System-wide definition of mental illness þ System-wide definition of substance use disorders þ Validated screening and assessment tools for mental illness and substance use þ Efficient screening and assessment process þ Validated assessment for pretrial risk þ Mechanisms for information sharing 6

Research and Evaluation Considerations How will data be collected? Will people be surveyed? Will data be accessed from case files or MIS systems? What information sharing agreements should be in place in order to collect the information you need?

Research and Evaluation Considerations Who is collecting the data? How are staff trained to obtained this information? Do evaluators have the needed access to the population and records? What training is needed for staff to do this work? Interview training Data entry Data analysis How do staff get feedback and coaching about this work?

Research and Evaluation Considerations What happens after the evaluation? How do evaluation partners share findings with program and institutional staff? How can this research help us learn more about our population? How can the evaluation help to identify service gaps? What training and education can help staff better serve the population? How can evaluation partners participating in planning for new work?

Research and Evaluation Considerations Next Steps and New Partnerships Is leadership onboard? What partners will take part in initiative planning? What programs can be implemented to be responsive to the needs of the population? How can we develop partnerships in the community to transfer care for people returning home? How can we develop practices to ensure programs are implemented to fidelity? What tools can evaluators share to help map out your work? What is the long term evaluation plan?

Contact Information Jennifer Bronson, Ph.D., Bureau of Justice Statistics Statistician, Jennifer.Bronson@usdoj.gov Bonnie Sultan, Grantee Technical Assistance Manager, The Council of State Governments Justice Center, bsultan@csg.org Sarah Wurzburg, Deputy Program Director, Behavioral Health, The Council of State Governments Justice Center, swurzburg@csg.org

Thank You Join our distribution list to receive CSG Justice Center project updates! csgjusticecenter.org/subscribe For more information, contact Olivia Randi, orandi@csg.org. The presentation was developed by members of the Council of State Governments (CSG) Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the CSG Justice Center, the members of The Council of State Governments, or the funding agencies supporting our work.