Integrating Mental Health and Criminal Justice: the Sequential Intercept Model

1. Integrating Mental Health and Criminal Justice: the Sequential Intercept Model Robert Reitz, Ph.D. Felix T. Vincenz, Ph.D. Department of Mental Health Division of Comprehensive Psychiatric Services

2. The Problem

5. The Nature of the Problem • Too many individuals with a mental illness unnecessarily involved in the criminal justice system • A criminal justice system overwhelmed by people needing mental health care • “Trans-institutionalization”

6. Criminalization of people with mental illnesses is a significant problem “With the decrease in inpatient psychiatric beds and declines in the availability of community mental health services, people with serious mental illnesses frequently go without the treatment and services that they need. When someone experiences a psychiatric crisis or acts out as a result of symptoms of their illness, often police are the first-line responders, and jails and prisons are increasingly used to house and treat these individuals Once incarcerated, people with mental illnesses do not receive the services that they need, are vulnerable to abuse, and have difficulty reconnecting with services on release. The result, for many, is years of cycling through prisons and jails, shelters, and emergency rooms, which is costly for communities, a burden on police and corrections, and tragic for people with mental illnesses.” NAMI

7. Source: Pew Charitable Trusts’ Public Safety Performance Project (2008). “One in 100: Behind Bars in America 2008.” Available at http://www.pewcenteronthestates.org/report_detail.aspx?id=35904.

8. The Adult Corrections Population Source: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics Correctional Surveys (The Annual Probation Survey, National Prisoner Statistics, Survey of Jails, and The Annual Parole Survey) as presented at http://www.ojp.usdoj.gov/bjs/glance/corr2.htm.

9. Trans-Institutionalization of the Mentally Ill

10. Scope of the Problem • Over 14 million arrests each year, involving more than 9 million adults. • Over 1 million arrestees have serious mental illnesses. • 75% of those with serious mental illnesses have co-occurring substance use disorders. • The vast majority will be released to the community.

11. Source: The Center for Mental Health Services’ National GAINS Center (2004). “The Prevalence of Co-occurring Mental and Substance Use Disorders.” Available at: http://gainscenter.samhsa.gov/pdfs/disorders/gainsjailprev.pdf.

12. An Approach to a Solution

13. A systematic approach to thecriminalization problem 􀂄. • There is no single solution to the problem called the “criminalization of people with mental illness” • The problem must be attacked from multiple levels • The “Sequential Filters” Model. Munetz and Griffin conceptualized a series of filters. Each filter provides a point to “catch” an individual with mental illness. Over time, the filter rate should increase earlier in the sequence

14. The Sequential Intercept Model An accessible mental health system: the ultimate intercept Law enforcement and emergency services Postarrest: Initial detention and initial hearings Post-initial hearings: jail, courts, forensic evaluations, and forensic commitments Reentry from jails, state prisons, and forensic hospitalization Community corrections and community support Replica from “Use of the Sequential Intercept Model as an Approach to Decriminalization of People with Serious Mental Illness”, Psychiatric Services, April 2006, Vol. 57 No. 4

15. Sequential Intercept ModelMunetz & Griffin 2006 • The model envisions a series of points of interception at which an intervention can be made to prevent individuals from entering or penetrating deeper into the criminal justice system. • Using the model, a community can develop targeted strategies that evolve over time to increase diversion and linkage to community services

16. Sequential Intercept ModelMunetz & Griffin 2006 • People move through the criminal justice system in predictable ways • Examine this process in your locality to identify ways to “intercept” persons with severe mental illness and co-occurring disorders to ensure: • Prompt access to treatment • Opportunities for diversion • Timely movement through criminal justice system • Linkage to community resources

17. Sequential Intercept ModelMunetz & Griffin 2006

18. Intercept 1 – Pre-Detention • Mobile combined law-enforcement / mental health response teams • Crisis Intervention Training (CIT) • Mental health trained joint communications staff

19. Intercept 2 – Booking and First Appearance • Booking and classification mental health screening • Cross agency information management systems • Medical and mental health assessment • Diversion prior to first appearance • Civil commitment • Diversion into crisis case management

20. Stage 1 Stage 2 Stage 3 Improved Mental Health /Individual Outcomes Identify and Enroll People in Target Group Linkage Comprehensive/ Appropriate Community-Based Services Diversion Improved Public Safety Outcomes Jail Diversion Logic Model

21. Intercept 3 – Jails / Courts • Mental health and Substance Abuse Courts • Specialty jail mental health care and mental health units • Referrals per 552 RSMo. • Pre-trial Evaluation • Competency Restoration

22. Intercept 4 – Re-entry • Jail Discharge planning • Referral and case conferencing • Temporary Housing • Medicaid Memoranda of Understanding • Transportation to shelters or other services • “Meet at the door” re-integration

23. Intercept 5 – Parole / Probation • Transitional Housing • PATH • Forensic Assertive Community Treatment (FACT) • Specialized Case Loads • Evidence Based Practices • DBT • IMR

24. One of the Keys

25. The Boundary Spanner • Understands the frequently conflicting values that both criminal justice and mental health practitioners bring to the table • Recognizes limitations of both systems • Effectively relates to both law enforcement and mental health community

26. Boundary Spanner • Has ligitimate or conferred authority in both systems • Funding can be shared or braided • Has access across the continuum of criminal justice and mental health services

27. Boundary Spanners • Develops Memoranda of Understanding regarding information sharing and disclosure • Leads or involved in coordination councils involving mental health and law enforcement groups • Ensures training opportunities for both law enforcement and mental health staff

28. Local Solutions

29. Missouri’s Experience • Intercept 1: Pre-Booking • CIT • Mental Health Courts • Intercept 2/3: Post-Booking • Drug Courts • Mental Health Courts • Intercept 4: Re-Entry • Mental Health Courts

30. Missouri Mental Health Courts

31. Mental Health Court

32. Mental Health Court (con.)

33. Mental Health Court (con.)

34. Mental Health Court (con.)

35. Mental Health Court (con.)

36. Drug Courts

37. Community Intervention Teams (CIT)

38. A New Initiative – Forensic Assertive Community Treatment (FACT) • FACT - modification of ACT developed by Steve Lamberti in 2004 • Distinguishing Elements from ACT • Goal: Preventing arrest and incarceration • Eligibility: Criminal Justice History • Referrals: Criminal Justice Agencies / Forensic Psychiatric Facilities • Potential to utilize supervised residential treatment facilities

39. Forensic Assertive Community Treatment (con.) • Pilot Site: St. Louis • Involved Providers • Places for People • Conversion of Community Alternatives ACT Team • Referral Sources/Intercepts (Projected Numbers) • Intercepts 1 – 3 • Forensic Case Monitors (1/3) • St. Louis City/County Mental Health Courts (1/6) • Intercept 4 • St. Louis City/County Jail Mental Health Units (1/6) • St. Louis Psychiatric Rehabilitation Center (1/3)

40. Forensic Assertive Community Treatment (con.) • Design • Place 33 patients from SLPRC, closing 16 beds behind them to fund the GR match for 100 FACT slots • Utilize 2 vacant 8 bed cottages on the campus of SLPRC for patients needing secure residential but community based option • Timeline: next 3 to 6 months • If successful, consider implementation in Farmington, St. Joseph/Kansas City

41. Any Questions?