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Henry J. Steadman, Ph.D. Saks Institute Spring Symposium April 11, 2013

Reducing the Involvement of Persons With Mental Illness & Co-Occurring Disorders in the Criminal Justice System Through Jail Diversion Programs. Henry J. Steadman, Ph.D. Saks Institute Spring Symposium April 11, 2013.

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Henry J. Steadman, Ph.D. Saks Institute Spring Symposium April 11, 2013

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  1. Reducing the Involvement of Persons With Mental Illness & Co-Occurring Disorders in the Criminal Justice System Through Jail Diversion Programs Henry J. Steadman, Ph.D. Saks Institute Spring Symposium April 11, 2013

  2. On June 30, 2005, approximately 7 million people were under correctional supervision in the U.S. • Jail: 747,529 • Prison: 1,446,269 • Probation: 4,162,536 • Parole: 784,408

  3. In 2005, there were 13 million bookings into U.S. jails.

  4. PRA/CSG Jail Prevalence Study Sites: 5 jails (2 – MD; 3 – NY) Time: 2002 and 2006 Serious Mental Illness: Depression/Bi-Polar/Schophrenia/ Schizo-Affective/Schizophreniform/ Brief Psychotics/Delusional/Psychosis NOS Prevalence: Last month Prevalence Rates: Men – 14.5% Women – 31% Steadman, H.J., Osher, F., Robbins, P., Case, B., Samuels, S. (2009). Prevalence of serious mental illness among jail inmates. Psychiatric Services 60, 761-765.

  5. Admission to U.S. Jails (2005)13 million Proportion of Jail Inmates With Severe Mental DisorderMen = 14.5%Women = 31.0% Number of Annual Admissions to U.S. Jails with Severe Mental Disorder2.1 million

  6. Prevalence of Current Substance Abuse Among Jail Detainees with Severe Mental Disorders Detainees with severe mental disorder plus either alcohol or drug abuse/dependence = 72% = 72% Adapted from: Abram, K.M. and Teplin, L.A. “Co-Occurring Disorders Among Mentally Ill Jail Detainees: Implications for Public Policy.” American Psychologist, 46(10):1036-1045, 1991 and Teplin, L.A. “Personal Communication.”Policy Research Associates, Inc. 6/17/98

  7. CMHS TCE JD: 14 Sites Traumatic Experiences (n=546)

  8. “Treatment-Resistant” Clients OR “Client-Resistant” Services

  9. Intercept 1 Law enforcement Intercept 2 Initial detention / Initial court hearings Intercept 3 Jails / Courts Intercept 4 Reentry Intercept 5 Community corrections Specialty Court Parole Violation Prison/ Reentry 911 Law Enforcement COMMUNITY First Appearance Court COMMUNITY Dispositional Court Initial Detention Arrest Probation Jail Violation Jail Re-entry

  10. Diversion = avoiding or radically reducing jail time by using community-based treatment as an alternative.

  11. “Diversion” Criminal Justice → Not filing or dropping charges (ATI) Mental Health → Not filing Condition of bail Deferred prosecution (stipulate to police report) Deferred sentencing Condition of probation

  12. Public’s Expectations Reduce recidivism Reduce violence Diversion Reduce jail days Reduce costs

  13. 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 Diversion Logic Model

  14. Mental Health Diversion Options • Pre-Booking • Police-Based • Post-Booking • Court-Based • Jail-Based • Community Corrections-Based

  15. Dispositions of Cases Handled by Three Types of Police Response at Three Sites

  16. Las Vegas CIT Call Resolution* • 485 (74%) Hospitalization 344 (71%) Involuntary • 25 (18%) Onsite resolution • 6 (4%) Arrest * Skeem, J., Bibeau, L. (2008). How does violence potential relate to crisis intervention team responses to emergencies? Psychiatric Services 59, 201-204.

  17. Intercept 1 Law enforcement Intercept 2 Initial detention / Initial court hearings Intercept 3 Jails / Courts Intercept 4 Reentry Intercept 5 Community corrections Specialty Court Parole Violation Prison/ Reentry 911 Law Enforcement COMMUNITY First Appearance Court COMMUNITY Dispositional Court Initial Detention Arrest Probation Jail Violation Jail Re-entry

  18. Rikers Island 2008 Bail Statistics(N=48,000) Council of State Governments March, 2013

  19. Rikers Island Average 2008 Length of Stay*(N=48,000) No Identified Mental Illness – 61 Days Identified Mental Illness – 112 Days Council of State Governments March, 2013 *of detainees staying > 3 days

  20. Intercept 1 Law enforcement Intercept 2 Initial detention / Initial court hearings Intercept 3 Jails / Courts Intercept 4 Reentry Intercept 5 Community corrections Specialty Court Parole Violation Prison/ Reentry 911 Law Enforcement COMMUNITY First Appearance Court COMMUNITY Dispositional Court Initial Detention Arrest Probation Jail Violation Jail Re-entry

  21. Nathaniel Project (NYC) N=53

  22. SAMHSA KDA (N=1,185)

  23. CMHS TCE JD: 14 SitesChanges in Arrests and Jail Days

  24. Annualized Number of Arrests – 3 MHCs

  25. Total Incarceration Days Pre and Post 18 Months – 3 MHCs

  26. 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 Diversion Logic Model

  27. Drug & Alcohol Use

  28. Daily Living/Role Functioning Scale

  29. Colorado Symptom Index (CSI)

  30. Year-by-Year CJ Cost

  31. Year-by-Year TxCost

  32. Year-by-Year Total Cost

  33. Is Criminalization An Important Public Policy Concept? Macro View • Transinstitutionalization • % Detainees with MI Different Micro View • Individual more likely in jail than in community-based treatment

  34. More Useful Concepts • Reduce Involvement • Minimize Inappropriate Penetration

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