Essential Elements of the Kalamazoo Community Mental Health Recovery Court Program

1. Essential Elements of the Kalamazoo Community Mental Health Recovery Court Program Presented By: Aki Nearchou, LBSW & Brian Fuller, PH.D. KCMHSAS 418 W. Kalamazoo, MI 49007 269-373-6000

3. Overview • The extent and nature of the concern • Ten Essential Elements of Mental Health Courts (MHC) • Goals of Mental Health Courts • Kalamazoo Mental Health Recovery Court (MHRC) • What are peer support specialists and why they are an integral part of the MHRC team?

4. Extent and Nature of the Concern • 13 million adults booked into U.S. jails each year. • More than 1.3 million people are currently incarcerated in the U.S. • 631,000 people in jail on any given day • 4.6 million under correctional supervision • Over 7% of those inmates suffer from a severe mental illness (SMI). • About 75% of the incarcerated SMI population has co-occurring addictive disorders. Source: Steadman, Osher, Robbins, Case &Samuels, (2009)

5. World Incarceration Rate

6. Why are Persons with Mental Illness Over-Represented in the Criminal Justice System? • Higher arrest rates • “War on Drugs” • 2/3 of inmates in local jails is due to drug law violations • Increased drug related offenses results in increased arrest for those that suffer from a SMI.

7. SMI Over-Representation Cont. • housing of last resort • Affordable housing crisis results in a very visible homeless population that leads to crimes of survival: • Urinating in public • Panhandling • Theft • Etc.

8. SMI Over-Representation Cont. • Longer jail and prison terms • Higher recidivism rate on re-entry as a result of the following: • Inadequate discharge planning • Inadequate resources • No connection to the community • Very little family and social supports • Etc.

9. Specialty Programs that Addresses Over-Representation of persons with SMI involved in the Criminal Justice System • Many communities have adapted the Crisis Intervention Team (CIT) model • Growing number of Mental Health Courts • 10 Mental Health Courts in Michigan (as of 2009)

10. Ten Essential Elements of Mental Health Courts (MHC) • 1. Planning and Administration • 2. Co-Occurring Target Population • 3. Timely Participant Identification & Linkage to Integrated Services • 4.Terms of Participation • 5. Informed Choice • 6. Integrated Treatment Supports and Services • 7. Confidentiality • 8. Court Team • 9. Monitoring Adherence to Court Requirements • 10. Sustainability • Source: Council of State governments, Essential Elements of a MHC, (Third Edition.

11. MHC Planning & Administration • A multidisciplinary planning committee should be charged with designing the MHC. • The planning committee should identify agency leaders and policy makers to serve on an “advisory group”. • Keep the committee informed

12. Co-occurring Target Population • MI related to criminal offense • MHC’s offer options other than arrest and detention • Well defined clinical and criminal eligibility criteria • MHC screening tools

13. Candidate Identification and Linkage to Integrated services. • Identified Participants • MHC Referral sources • Referral Source Training • Expedited referrals

14. Terms of Participation • Minimize the impact of the charges • Individualized for each participant • Successful completion • Dismissal of charge • Reduced fines and cost • Well connected to community resources • MHC is a voluntary program • Option to withdraw

15. Informed Choice • Participants fully understand the requirements of the MHC • Arising competency issue concerns are processed through well established and pre-determined procedures.

16. Integrated Treatment supports & Services. • Mental health court participants require an array of services • MHC participants typically have co-occurring substance abuse disorders • Treatment providers, Mental Health Court Team and the Participants should communicate on a regular basis

17. Confidentiality • Health and legal information is only shared in a way that protects the participants’ confidentiality rights as consumers and their constitutional rights as defendants. • Release forms that adhere to federal and state laws • Participants review releases with their defense counsel and treatment providers • Should not sign release of information forms until competency issues have been resolved

18. The Court Team • Mental health court team works collaboratively to help participants achieve treatment goals by bringing together many of the following staff: • Judicial officer • Integrated Recovery Specialist (case manager) • Prosecutor • Defense attorney • Court liaison • Peer Supports

19. Monitoring Adherence to Court Requirements • stay up-to-date on their progress • The mental health team and case managers regularly discuss the participants’ behavior rather positive or negative • MHC team meets on a regular basis with the judicial team • Regularly scheduled status hearings

20. Sustainability • Performance measures and outcome data is essential. • Data describing the court’s impact on individuals and systems should be collected and analyzed. • MHC team should communicate with key county officers and state legislators. • Attempt to cultivate long-term funding sources early on.

21. The Goals of MHC are: The primary goal of MHC courts is to reduce recidivism and enhance access to & engagement in community treatment • To preserve public safety • To divert offenders with mental illness & co-occurring disorders • To maintain treatment, housing, insurance benefits and community support services for participants with mental illness • To reduce repeated criminal activity • To decrease the utilization of high cost system services

22. Inside a Mental Health Court Video is Courtesy of PBS and Frontline

23. Kalamazoo Mental Health Recovery Court (MHRC) • Founded in fall of 2008 • State and Federal Grants • MHRC Team: • 8th District Court Judge • Kalamazoo Community Mental Health &Substance Abuse Services staff. • Defense Counsel • Prosecuting Attorney

24. Nature and Scope of Concern in Kalamazoo County • Undersized jail • Large number of bookings and jail housing cost • High utilization of services for SMI population • Strain on budgets

25. Program Description • Misdemeanors • Recovery focused • Participants must have staff who will come to court • 2 clinical staff and 2 Forensic Peer Support Specialists • Year long program • Two phases • Will take persons who have MI/DD, co-occurring and Personality Disorders • Provide Crisis Intervention Team Training (CIT) for Law Enforcement

26. Who is eligible to Participate in the Kalamazoo Mental Health Recovery Court? • Must be charged with a misdemeanor • At least 17-years-old • Has a diagnosis of mental illness or is dually diagnosed with a developmental illness and substance abuse disorder and is in need of or assigned to case management services. • Is a Kalamazoo County Resident • No pattern of violent behavior • No more than one prior assault/battery • No more than two prior felony conviction of any kind • No violence at the time of arrest

27. The Referral Process MHRC accepts referrals from: Police Officers, District Judges, Defense Attorneys, Prosecuting Attorneys, Probation Officers, Kalamazoo County Jail staff, Family Members, KCMHSAS staff, Provider Agencies and Members of the public.

28. What Happens to an Accepted Case? • Agree to comply • Determine and assign team • Attend scheduled court hearings • Graduated incentives and sanctions

29. Incentives and Sanctions Incentives Sanctions Lecture from Judge Report to MD, PhD, PO more often Jail Move back to phase I Daily report to CMH community service Increase AA/NA, etc. • Praise from the Judge • Positive report by case mgr/PO • Clapping • See judge less often • Less judicial supervision requirements • Reduced or waived court cost /fees

30. Performance Measure Criteria • Decrease in jail admissions, jail days, and psychiatric admissions among successful participants • Number served in MHRC • Outside researcher evaluation results • CIT training

31. Outcomes for MHRC Participants* (N=37) Jail Days Hospital Days (N=37) (N=20) (N=37) *Only those completing MHRC *Those completing MHRC or still participating in MHRC

32. Before MHRC*% with Criminal Justice Involvement (N=62) 72.6% BOTH new offense & jail 11.3% Jail only 12.9% New offense only 3.2% Neither 96.8% Criminal Justice-Involved *In 12 months prior to enrollment

33. Before MHRC*% with Mental Health Crisis (N=62) 46.8% Crisis contact only 35.5% BOTH crisis contact & hospitalization 6.5% Hosp only 11.3% Neither 88.7% Mental Health Crisis *In 12 months prior to enrollment

34. Felony-level Offenses (N=62) * *statistically significant difference

35. Limitations of the MHRC • The impact of the program is limited to those charged with misdemeanors. • Integrated recovery specialist (case managers) are required to attend court with individuals they serve, but have no specific criminal justice training. • Number of participants and length of the program.

36. Role of Forensic Peer Specialist within Criminal Justice System

37. What is a Peer Support Specialist? • Individuals willing to provide history of disability and recovery with people in earlier stages of recovery The stages of change are: 1.Precontemplation 2.Contemplation 3.Preparation/Determination 4.Action/Willpower 5.Maintenance 6.Relapse • Forensic peer support involves trained peer specialist with histories of mental illness and criminal justice involvement helping those with similar histories

38. Role of Peer Support Specialists within the MHRC Program • Participate in all status meetings, court sessions, etc. • Meet one on one with potential participates to determine recovery eligibility • Facilitate a 16 hour Wellness Recovery Action Plan (WRAP) training. • Meet with participants prior, during and after court sessions as needed.

39. MHRC Participant Outcomes • MHRC successful and unsuccessful participant outcomes

40. Questions?

41. Thank You Kalamazoo Community Mental Health & Substance Abuse Services Brian Fuller & Aki Nearchou