ATLAS Achieving True Liberty and Success

1. ATLASAchieving True Liberty and Success Mental Health Courts: The Path to Freedom

2. U.S. Criminal Justice Population Now Over 7.2 Million 3.2% of all U.S. Adults Source: Bureau of Justice Statistics (2007)

3. People with Mental Illness areOverrepresented in the Criminal Justice System Source: Council of Governments Consensus Project

4. Most Mentally Ill Offenders have a Co-Occurring Substance Abuse Problem Source: Council of Governments Consensus Project

5. Mentally Ill Men and WomenIncreased Likelihood of Incarceration 4:1 6:1 Source: Council of Governments Consensus Project

6. Most offenders are supervised in the community! 1,492,973/766,010 798,202

7. 2.5 Times as likely to be homeless prior to arrests Source: Council of Governments Consensus Project

8. Mentally Ill Offenders on Probation Offenders with mental illness are twice as likely to fail on probation More likely to fail due to a technical violation Source: Skeem & Louden (2006)

9. The Mentally Ill Offender • Insane? • Competent? • Organically mentally ill? • Drug induced psychosis?

10. What are Mental Health Courts? Mental Health Courts (MHCs) are specialized dockets that link defendants with mental illnesses to court-supervised, community-based treatment in lieu of traditional case processing. Source: The Consensus Project (2008)

11. Objectives: How different responses to mentally ill offenders in the criminal justice system can move an individual from A to Z.

12. What type of offenders do we target for A.T.L.A.S. mental health court?

13. TARGET PRIORITY POPULATION • AXIS I DIAGNOSIS • SCHIZOPHRENIA (.05%-1.5% ADULTS) • BIPOLAR • MAJOR DEPRESSION (10%-25%, WOMEN; 5%-12%, MEN)

14. A.T.L.A.S:“Achieving True Liberty and Success” Mission statement: TO ACHIEVE A COMPREHENSIVE, COORDINATED SYSTEM OF MENTAL HEALTH CARE THROUGH JAIL DIVERSION FOR OFFENDERS WITH SERIOUS MENTAL ILLNESS

15. PROGRAM OVERVIEW Divert felony probationers from the penitentiary Typically lasts to 12 to 18 months ATLAS provides: Temporary Crisis Housing INTENSIVE Case Management Psychiatric Evaluation Medication Management Rehabilitation

16. ATLAS Clients

17. CASE INELIGIBILITY- • Sex Offenders and/or cases involving deviant sexual conduct • Cases involving the death of an individual

18. Clinical Issues? • Antisocial • What is driving behavior? • Criminal thinking? • Mental illness? • Low Functioning • STUCK BW MENTAL HEALTH SYSTEM AND CRIMINAL JUSTICE SYSTEM

19. Why Comprehension Screening and Assessment? • Provide a complete understanding of the participant • Determine the most effective form of treatment, treatment level, and treatment length • Set optimal goals and treatment strategies

20. ONGOING CONCERNS FamilySupport

21. Treatment Responses Increase in treatment Individual/group Decrease in treatment Treatment Contract Release plan if in jail

22. Supervision/PO Response Increased office/home visits Increased surveillance Increased screens/testing Curfew Behavior contract GPS/ELM

23. Judicial Responses Benchmarks Incentives Positive reinforcement Negative reinforcement Sanctions Jail time b/c threat to themselves or community

24. Key Component: JUDICIAL MONITORING Accountability Fear (Loss of Freedom) Praise Positive reinforcement

25. Examining the Effectiveness of ATLAS: A Mental Health Court August 2009 University of North Texas Richard Rogers, PhD Chelsea Fiduccia, BA

26. ATLAS Participants • ATLAS is a “last chance” court for persons with major mental disorders who are on probation for felony convictions, allowing them another opportunity before being revoked. ATLAS clients meeting the following requirements were included in this outcome study: • Intake between February 2006 and December 2008 • Passed probationary period (first 45 days in ATLAS) • Had outcome data for at least 1 year from intake

27. DataCollection • Archival data were collected through Dallas County Community Supervision and Corrections Department and the Department of Public Safety. The outcome data include total new arrest and recidivism one year from • intake. • A match sample (N = 93) was created from other felony probationers with mental disorders who had been on probation within the study time frame. Match participants were chosen based on the following criteria: • Received authorization for mental health services between February 2006 and December 2008 (intake date was identified as earliest service authorization date during this time period). • Control participants were matched to ATLAS participants on several variables (see next slide).

28. Control Participants • Variables used for matching: • Age ± 5 years* • Gender • Diagnosis • Race/Ethnicity* • Risk Level ± 1 level** • Intake Date ± 6 months* • Prior Violation Reports • Need Level ± 1 level** **Risk and Need scores were obtained with Texas Case Classification and Risk Assessment Tool (based on Wisconsin Risk/Needs Assessment).

29. Matching *Participants were also matched by risk level.

30. Is Dallas County Safer With ATLAS? Do ATLAS (successful and unsuccessful) and control differ at 1 year? *New arrests are defined as any arrest for a new charge one year following the intake date. **Recidivism is defined as any new arrest or re-incarceration in state jail or prison one year from the intake date.

31. Is Dallas County Safer With ATLAS? *New arrests are defined as any arrest for a new charge one year following their intake date. **Recidivism is defined as any new arrest or re-incarceration in state jail or prison one year from their intake date.

32. Is Dallas County Safer With ATLAS? • Yes! • ATLAS (Successful and Unsuccessful) vs. Control • ATLAS reduced the number of mentally ill offenders with new arrests. • ATLAS reduced new arrests by 42.3%. • ATLAS reduced recidivism by 27.3%. • *Successful ATLAS Clients vs. their Controls • 1. ATLAS reduced the number of mentally ill • offenders with new arrests for successful • clients. • 2. ATLAS reduced new arrests by 70.6% for • successful clients. • 3. ATLAS reduced recidivism 66.7% for • successful clients. *Successful clients include ATLAS graduates and current clients with one year or more of participation in ATLAS.

33. What did Dallas County taxpayersgain from the ATLAS court? • ATLAS court increased public safety and increased savings in tax dollars by decreasing new arrests among mentally ill offenders and diverting mentally ill offenders from prison!

34. Contact Information: Judge Susan hawk 214-653-5872 Shawk@dallascounty.org

35. MENTAL HEALTH AND CRIMINAL JUSTICE ISSUES IN TEXAS SHARED SOLUTIONS SUMMIT JANUARY 9TH-10TH, 2012 AUSTIN, TEXAS

36. Texas Correctional Office on Offenders with Medical or Mental Impairments ( TCOOMMI ) Mission Statement: To provide a formal structure for criminal justice, health and human service, and other affected organizations to communicate and coordinate on policy, legislative, and programmatic issues affecting offenders with special needs* *Special needs include offenders with serious mental illnesses, mental retardation, terminal or serious medical conditions, physical disabilities and those who are elderly.

37. Collaboration: It’s an unnatural act between… …two or more unconsenting adults.

38. State of the State • One of three states with a statutorily mandated coordinating body for offender with special needs. • The only state with continuity of care legislation. • One of a few state with targeted funds for juveniles and adult offenders with special needs. • One of a few states with specialized juvenile and adult probation/parole caseloads. • The most proactive state in regulatory, statutory, procedural and programmatic practices for offenders with special needs.

39. Overview of TCOOMMI Advisory CommitteeTen (10) Gubernatorial Appointees19 State Agencies or Associations consisting of the following: Texas Department of Criminal Justice Correctional Institutions Division Community Justice Assistance Division Parole Division National Alliance for the Mentally Ill Department of State Health Services Texas Commission on Law Enforcement Standards and Education Texas Council of Community MHMRS Department of Aging and Disability Services Texas Juvenile Justice Department The ARC of Texas Mental Health America of Texas Texas Commission on Jail Standards Texas Council for Developmental Disabilities Texas Board of Pardons and Paroles Department of Assistive and Rehabilitative Services Correctional Managed Health Care Committee Texas Commission on Health and Human Services 39

40. TCOOMMI Continuity of Care System & Activities(614.013 – 016, HSC) Juvenile System Arrest  Pre-Trial /Jail Diversion  Probation  CID  Parole 10 – 17 YEARS OF AGE TCLEOSE – Texas Commission on Law Enforcement Officer Standards and Education CIT – Crisis Intervention Team MH/MR – Mental Health/Mental Retardation CJAD – Community Justice Assistance Division NGRI – Not Guilty by Reason of Insanity SS/SSI – Social Security/Supplement Security Income (Mandatory sharing and cross-referencing of offender information throughout the continuum – 614.013-016, HSC)

41. *Represents all Clients served since 1985, including those whose diagnosis is no longer eligible for MHMR **Schizophrenia, Bipolar, Major Depression ***Do not reflect all persons with serious mental illness, as some may have not been served by community mental system

42. Chapter 614.001, Health & Safety Code (3-a)  "Continuity of care and services" refers to the process of:                    (A)  identifying the medical, psychiatric, or psychological care or treatment needs and educational or rehabilitative service needs of an offender with medical or mental impairments;                    (B)  developing a plan for meeting the treatment, care, and service needs of the offender with medical or mental impairments; and                    (C)  coordinating the provision of treatment, care, and services between the various agencies who provide treatment, care, or services such that they may continue to be provided to the offender at the time of arrest, while charges are pending, during post-adjudication or post-conviction custody or criminal justice supervision, and for pretrial diversion.

43. Continuity of Care – Offenders with Special Needs614.013 - .017, Health and Safety Code Requires state and local criminal justice, mental health, regulatory, law enforcement, health and human services agencies to adopt Memorandum of Understanding (MOU) to define each entities role and responsibility in the continuity of care system for special needs offenders: The MOU shall establish methods for - (1) identifying such offenders in the criminal justice system, and (2) developing interagency rules, policy procedures for the coordination of care and the exchange of information, including electronic transmission.

44. TX Dept of Criminal Justice Board of Pardons & Parole Dept of State Health Services TX Juvenile Probation Comm. TX Youth Commission Dept. of Assistive & Rehab. Services TX Education Agency Comm. On Jail Standards Dept. on Aging & Disability Services TX School for the Blind & Visually Impaired Community corrections & supervision departments Local juvenile probation departments Personal bond pretrial release offices Local jails regulated by Comm. On Jail Standards A municipal or county health departments A hospital district A judge of this state with jurisdiction over juvenile or criminal cases An attorney who is appointed or retained to represent…a juvenile with mental impairment Health & Human Services Comm. Dept. of Information Resources The bureau of ident. & records of the Dept. of Public Safety for the purpose of providing…ident. of individuals in the DSHS client data base Dept. of Family & Protective Services TX Health & Safety Code 614.017 What entities shall exchange continuity of care information? The following entities and individuals, a person with an agency relationship with one of the following entities or individuals, and a person who contracts with one or more of the following entities or individuals

45. Sec. 614.017.  EXCHANGE OF INFORMATION.  (a)  An agency shall:  (1)  accept information relating to a special needs offender that is sent to the agency to serve the purposes of continuity of care and services regardless of whether other state law makes that information confidential; and              (2)  disclose information relating to a special needs offender, including information about the offender's identity, needs, treatment, social, criminal, and vocational history, supervision status and compliance with conditions of supervision, and medical and mental health history, if the disclosure serves the purposes of continuity of care and services.

46. What does the research tell us? • Arrest rarely is a direct product of mental illness; even for offenders who are mentally ill • Mental illness is a modest risk factor for recidivism • Increased services often do no translate into reduced recidivism • Offenders who have low criminogenic risk with high clinical needs have better outcomes in traditional treatment programming • Offenders who have high crimonogenic risk with low clinical needs have better outcomes in traditional treatment programming Source: Skeem, Nicholson, & Kregg (2008)

47. Research Suggest that… • Collaborative partnerships between treatment and supervision officers is key for offenders with high criminogenic risk factors and high clinical need (the hybrid model)

48. TCOOMMI Requirements added to Case Management: • Offender must score high on criminogenic risk factor scales that consider static information such as: • Age of first commitment • Prior commitments • Prior incarcerations • Current conviction • Substance use • Offender must have high clinical needs which is assessed by the Department of State Health Services approved clinical assessment tool (TRAG).

49. Mental Health Criminal Justice Initiative Model • Specialized Mental Health Officer + • Targeted Mental Health Case Manager/Treatment + • Evidenced Based Practices

50. Recidivism Study FY 2009 • For offenders enrolled in the TDCJ-TCOOMMI case management initiative for twelve or more consecutive months, the recidivism rate is 11.8%