Addressing a National Crisis Too Many People with Mental Illnesses in our Jails Will Engelhardt, Senior Policy Analyst, CSG Justice Center September 9, 2016 CSG West 69 th Annual meeting
01. Mental Illness in the Criminal Justice System: How did we get here? Council of State Governments Justice Center 2
Jails are Where the Volume is Number of Admissions to Jail and Prison Weekly and Annually, 2012 11,605,175 Annually Weekly 553,843 222,565 10,621 Jail Admissions Prison Admissions
...Jails Report Increases in the Number of People with Mental Illnesses NYC Jail Population (2005 2012) Average Daily Jail Population (ADP) and ADP with Mental Health Diagnoses 13,576 Total 10,257 76% 11,948 Total 7,557 63% 3,319 24% 4,391 37% 2005 2012 M Group Non-M Group
Mental Illnesses: Overrepresented in Our Jails General Population Jail Population 5% Serious Mental Illness 17% Serious Mental Illness 72% Co-Occurring Substance Use Disorder
We ve All Experienced this Crisis in One Way or Another County is ready, but is it able to deal with mentally ill? Mentally ill Mainers are still warehoused, but now it s in jail Mentally ill inmates at Franklin County Jail stay longer Johnson County Sheriff: Mental health is number one problem Inmates with mental health issues inundate Pima County Jail Mental health crisis at Travis County jails Nearly a third of county inmates require drugs for mental illness Jail violence increasing due to mental illnesses
Factors Driving the Crisis Disproportionately higher rates of arrest Longer stays in jail and prison Limited access to health care Higher recidivism rates Low utilization of EBPs More criminogenic risk factors
Incarceration Is Not Always Directly Related to a Person s Mental Illness Number of Crimes 300 250 200 150 100 50 0 7.5% 10.7% 17.2% 64.7% Continuum of Mental Illness Relationship to Crime Completely Direct Mostly Direct Mostly Independent Completely Independent Source: Peterson, Skeem, Kennealy, Bray, and Zvonkovic (2014)
Predicting Future CJ contact: Criminogenic Risk Risk Crime type Dangerousness or violence Failure to appear Sentence or disposition Custody or security classification level Risk = How likely is a person to commit a crime or violate the conditions of supervision?
Criminogenic Risk Factors Static Criminal history - Number of arrests - Number of convictions - Type of offenses Current charges Age at first arrest Current age Gender Dynamic (the Central 8 ) 1. History of antisocial behavior 2. Antisocial personality pattern 3. Antisocial cognition 4. Antisocial associates 5. Family and/or marital discord 6. Poor school and/or work performance 7. Few leisure/recreation outlets 8. Substance use
A Framework for Prioritizing Target Population Low Criminogenic Risk (low) Medium to High Criminogenic Risk (med/high) Low Severity of Substance Abuse (low) Substance Dependence (med/high) Low Severity of Substance Abuse (low) Substance Dependence (med/high) Low Severity of Mental Illness (low) Serious Mental Illness (med/high) Low Severity of Mental Illness (low) Serious Mental Illness (med/high) Low Severity of Mental Illness (low) Serious Mental Illness (med/high) Low Severity of Mental Illness (low) Serious Mental Illness (med/high) Group 1 I-L CR: low SA: low MI:lo Group 2 II-L CR: low SA: low MI: med/high Group 3 III-L CR: low SA: med/high MI: low Group 4 IV-L CR: low SA: med/high MI: med/high Group 5 I-H CR: med/high SA: low MI: low Group 6 II-H CR: med/high SA: low MI: med/high Group 7: III-H CR: med/high SA: med/high MI: low Group 8 IV-H CR: med/high SA: med/high MI: med/high
02. Counties Step Up but Face Key Challenges: Why is it so hard to fix?
A National Initiative to Reduce the Number of People with Mental Illnesses in Jails
Counties and Individuals Join Call to Action Over 100 million people reside in Stepping Up counties
50 Counties Attend the National Stepping Up Summit 37 states were represented at the Summit
National Stepping Up Summit State and county behavioral health & criminal justice leaders are returning home with an increased commitment to this issue
Key Challenges Counties Face: Observations from the Field 1. 2. 3. 4. Being data driven Using best practices Continuity of care Measuring results
Challenge 1 Being Data Driven Policymakers Face Complex Systems with Limited Information
Challenge 1 Being Data Driven Not Knowing the Target Population County A County B County C County D Mental Health - Assessment Substance Abuse Assessment - Risk Assessment -
Challenge 2 Using Best Practices Addressing Dynamic Needs Dynamic Risk Factor History of antisocial behavior Antisocial personality pattern Antisocial cognition Antisocial associates Family and/or marital discord Poor school and/or work performance Few leisure or recreation activities Substance use Need Build alternative behaviors Problem solving skills, anger management Develop less risky thinking Reduce association with criminal others Reduce conflict, build positive relationships Enhance performance, rewards Enhance outside involvement Reduce use through integrated treatment Andrews (2006)
Challenge 2 Using Best Practices The Science-to-Service Gaps Past Year Mental Health Care and Treatment for Adults 18 or Older with Both SMI and Substance Use Disorder NSDUH (2008)
Challenge 3 Continuity of Care Existing Services Only Reach a Small Fraction of Those in Need 10,523 Bookings 969 People with serious mental illness 2,315 People with serious mental illness based on national estimates 609 Received treatment in the community Example from Franklin County, OH 1,706 Did NOT receive treatment in the Community 926 LOW RISK 1,389 HIGH/ MOD RISK
Challenge 4 Tracking Progress Focusing County Leaders on Key Outcomes Measures Outcome measures needed to evaluate impact and prioritize scare resources 1. Reduce the number of people with mental illness booked into jail 2. Shorten the 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
03. Effective Strategic Plans: How do we move forward?
Overarching Goal There will be fewer people with mental illnesses in our jails tomorrow than there are today.
How Do We Know if a County is Positioned to Reduce the Number of People with Mental Illnesses in Jail? 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?
Is Your Leadership Committed? Mandate from county elected officials Representative planning team Commitment to vision, mission, and guiding principles Designated project coordinator and organized planning process Accountability for results
Do You have Timely Screening and Assessment? Is there a system-wide definition of: Mental illness Substance use disorders Recidivism Screening and assessment: Validated screening and assessment tools An efficient screening and assessment process Electronically collected data
Do You have Baseline Data? Four Key Measures Prevalence rate of mental illnesses in jail population Length of time people with mental illnesses stay in jail Connections to community-based treatment, services, and supports Recidivism rates Electronically collected data
Have You Conducted a Comprehensive Process Analysis and Service Inventory? System-wide process review Inventory of services and programming Identified system gaps and challenges Process problems Capacity needs Population projections Evidence Based Practices Identified
Have You Prioritized Policy, Practice, and Funding? A full spectrum of strategies Strategies clearly focus on the four key measures 4 Costs and funding identified $ County investment
Do You Track Progress? Reporting timeline of four key measures 4 Process for progress reporting Ongoing evaluation of program implementation Ongoing evaluation of program impact
04. Opportunities for States to Support Counties
Stepping Up State Projects California Ohio 34
Common Elements of State-level Initiatives Demonstrate state-level support for Stepping Up initiative Conduct a survey of counties Convene a statewide summit Design state policy strategies and a process for providing support to counties Invest in pilot sites within their states Provide a mechanism for communication between counties 35
Example of a Statewide Approach: Ohio Ohio Strengths Clear lessons learned from an indepth technical assistance site (Franklin County, OH) Strong state leaders, including those from Ohio MHAS and former state supreme court justice Strong county leaders and associations Existing grant program at OMHAS Buy-in and interest from many counties statewide Statewide Approach Convened a Stepping Up planning group consisting of county and statewide leaders Survey technical assistance needs and engage in onsite assessment Convened Ohio counties for peer exchanges at statewide Summit Seeks funding from the Governor s office to design and fund policy strategies Provides community innovation grants targeted to Stepping Up Exploring additional investment in intensive pilot sites Created a website at OMHAS that highlights promising practices to spread innovation and catalogues resources: http://mha.ohio.gov/steppingup 36
Example of a Statewide Approach: California California Strengths California State Association of Counties, Chief Probation Officers, Sheriffs, and Behavioral Health Directors associations identify issue as priority for their members Policy changes place increased responsibility at county level for justice and behavioral health decisions and funding History of local interagency collaboration through Community Corrections Partnerships 58 diverse counties Independent state advisory entities that cover mental health/justice intersection Innovative state health care financing policies in place Statewide Approach Stepping Up launch at Capitol in Sacramento (May 2015) Partnerships with state associations of local government officials to Conduct state-wide survey of current practices and gaps/needs Convene California Stepping Up Summit Work with counties to identify diverse innovative approaches Ongoing coordination and consultation with independent advisory groups with long-term planning to set up go-to resources that leverage diverse topical expertise for local leaders
Examples of State Legislative and Programmatic Activity that Support Stepping Up Goals Utah, Connecticut, Oklahoma, & Ohio: Statewide CIT training academies Texas: Statewide requirements &/or contracts for validated screening tools Ohio and New York: Statewide training for Evidence Based Practices Curricula Utah: Regional hubs for telescreening and tele-psychiatry (26 states use tele-psychiatry in correctional facilities)
Examples of State Legislative and Programmatic Activity that Support Stepping Up Goals continued West Virginia Allocated $9 million between FY2014 and FY2016 to expand access to substance use treatment for people on supervision, with county-level grants awarded for treatment services and more. Alabama $12 million over two years for behavioral health treatment for people on supervision. Kansas $5 million added over two years in behavioral health treatment for people on supervision. Wisconsin $10 million over two years to expand community-based recidivism reduction programs including mental health services, substance use treatment, and employment services 39
Next Steps for States to Support Stepping Up What Can States Do? 1. Demonstrate state-level support for Stepping Up 2. Conduct a survey of counties 3. Convene a statewide summit 4. Design strategies to provide support for Stepping Up goals 5. Provide a mechanism for communication between counties
THANK YOU For more information, contact: Will Engelhardt, Senior Policy Analyst, CSG Justice Center Wengelhardt@CSG.org