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2007 NAMI North Carolina Decriminalizing Mental Illness Institute The Jericho Project:

2007 NAMI North Carolina Decriminalizing Mental Illness Institute The Jericho Project: Overcoming jail diversion barriers for persons with serious mental illness & serious criminal justice involvement Stephen C. Bush Supervising Attorney/Special Litigation

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2007 NAMI North Carolina Decriminalizing Mental Illness Institute The Jericho Project:

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  1. 2007 NAMI North Carolina Decriminalizing Mental Illness Institute The Jericho Project: Overcoming jail diversion barriers for persons with serious mental illness & serious criminal justice involvement Stephen C. Bush Supervising Attorney/Special Litigation Shelby County Public Defender System 201 Poplar, Suite 2-01 • Memphis, TN 38103 901-545-5835 • Fax 901-545-2527 stephen.bush@shelbycountytn.gov NAMI North Carolina, Raleigh

  2. NAMI North Carolina, Raleigh

  3. “The Jericho experiment sought to create a consumer driven public health jail diversion model based on principles of recovery and resilience, relying on best practice transition planning to access integrated treatment and services, understanding that relationships, peers and community are paramount on the journey to recovery.” SAMHSA Grants 5 H79 SM55058-02 & 1 H79 TI6384-01 A C Wharton, Jr Mayor, Shelby County, Tennessee NAMI North Carolina, Raleigh

  4. High end target population • Serious Mental Illness – Axis I • Bipolar Disorder • Schizophrenia spectrum • Major Depression … • Co-occurring substance use – 74% • Felonies, misdemeanors, kitchen sink • Taps free leverage • With dignity and minimal stigma NAMI North Carolina, Raleigh

  5. Eligibility • Serious mental illness • Stable on medication • Willing to embrace treatment • Seeking to serve persons whose contact with the justice system is related to untreated mental illness NAMI North Carolina, Raleigh

  6. Jail DiversionQuick Reference GuideReference: Sequential Intercept Model • Pre-booking jail diversion • Crisis Intervention Teams – law enforcement • Mobile Crisis Models – mental health • Blended models • Post-booking jail diversion • Fast track supervised release • Mental Health specialty courts • Non-specialty courts - Jericho • Re-entry – from Jails & Corrections NAMI North Carolina, Raleigh

  7. The Sequential Intercept ModelMunetz & Griffin, 2006 • Conceptual framework • Series of points of interception • Prevent deeper penetration of CJS • Organizing tool for systematically addressing decriminalization • Develop targeted strategies to increase diversion & linkage NAMI North Carolina, Raleigh

  8. Systems Barriers • Inadequate community services • Waiting lists for treatment & services • Lack of adequate housing • Fragmentation among MH, SA, housing, social services & health care • Stigma, discrimination, NIMBY NAMI North Carolina, Raleigh

  9. Jericho in a Box • Best Practice Transition Planning • Community Linkage Plans • Conditional Release Strategies • Independent, Layered Supervision • Integrated Treatment • Bridge Case Management • Mainstream Services NAMI North Carolina, Raleigh

  10. Jericho in a Box • Best Practice Transition Planning • Community Linkage Plans • Conditional Release Strategies Free • Independent, Layered Supervision Free • Integrated Treatment • Bridge Case Management • Mainstream Services Free NAMI North Carolina, Raleigh

  11. APIC for Transition PlanningOsher, Steadman & Barr, 2002 • APIC-model best practice transition planning • Assessclinical and social needs • Plan for treatment and services • Identifycommunity programs • Coordinatetransition plan to avoid gaps in care • Key Domains of Services • Developed by Recovery Support Specialists • “Boundary Spanners” per Steadman • Result is the Community Linkage Plan \\Scfntdata1\vol1\PBDF\MyDocuments\stephen.bush\Art & Templates\Jericho sample CLP.doc NAMI North Carolina, Raleigh

  12. Recovery Toolkit • Case management resources • Treatment options • Rental assistance • Transportation resources • Bridge medication resources • Temporary identification • Housing – transitional to permanent NAMI North Carolina, Raleigh

  13. Multiple Referral Streams Confirm Diagnosis & Meds Housing Consumer Input Medications PD Special Litigation Section Pretrial Services Jail Medical Community Providers Jericho Roundtable Benefits Treatment Case Mgt Transportation NAMI North Carolina, Raleigh

  14. Conditional Release Strategies • Many forms of conditional release • Supervised pretrial release • Probation: county, state, private • Avoiding revocation on probation • Supervision is layered over CLP • Independent eyes and ears • Material noncompliance reported NAMI North Carolina, Raleigh

  15. Relationships Relationships Relationships Relationships NAMI North Carolina, Raleigh

  16. Successes • Improved quality of life • Reduced severity of symptoms • Reduced jail days • Reduced arrests • Judges approve over 95% of CLPs NAMI North Carolina, Raleigh

  17. Successes • Referrals from prosecutors • Referrals from judges • High tolerance of relapse • Better, faster dispositions • The branding of Jericho NAMI North Carolina, Raleigh

  18. Outcomes • At 6 months 76% no adverse CJ contact • 25% bump up against the system • 25%, usually new offenses, result in reincarceration • Overall more than half no further arrests • Overall 99 fewer jail days per divertee/year NAMI North Carolina, Raleigh

  19. Systems Impact, n=55 • Jail days dropped from 13,946 in the year preceding linkage to 6,159 in the year following • 7,787 fewer days @$91= $708,617 • $708,617 / 55 = $12,884 per detainee • Overall divertees averaged 99 fewer days per year in jail after linkage NAMI North Carolina, Raleigh

  20. Conditional Release All courts No preset limitations Driven by dynamics of adversarial system Bottom up Mental Health Courts One division Usually nonviolent, low grade offenders Driven by judge Top down Comparision NAMI North Carolina, Raleigh

  21. Looking Forward • Gender-specific, trauma-centered • Targeted resources for homelessness • Consumer Peer Specialists & WRAP • Supportive Employment • Transitional Housing • Gideon – IMS and early intervention NAMI North Carolina, Raleigh

  22. Factors for Success • Interagency collaboration • Active stakeholder involvement • Effective boundary spanner(s) • Strong leader or change agent • Quality transition planning • Incorporate evidence-based practices • Specialized case management services NAMI North Carolina, Raleigh

  23. Values Statement • Recovery is real and possible. • Relationships are important. • Listen to persons with mental illness. They know what what works for them. • Services should be comprehensive, integrated & evidence-based. • Overcome stigma through education and example. • Access to treatment should not compromise due process. • Avoid artificial limits on eligibility. NAMI North Carolina, Raleigh

  24. NAMI North Carolina, Raleigh

  25. Why Jericho? • For 3000 years a place of safety • Food, water, and protection • A safe place in the desert • Metaphor of bringing down walls • Bringing down barriers to recovery NAMI North Carolina, Raleigh

  26. Resources • The National GAINS Center • www.gainscenter.samhsa.gov • Council of State Govts Mental Health Consensus Project Report • www.csg.org • www.consensusproject.org • SAMHSA • www.samhsa.gov • National Registry of Evidence-based Px & Prgms NAMI North Carolina, Raleigh

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