Mental Illness and the Criminal Justice System

1. The TAPA Center for Jail Diversion Mental Illness and the Criminal Justice System

2. The TAPA Center for Jail Diversion

3. The TAPA Center for Jail Diversion Overview of Presentation Overview of the Problem (Dr. Fred Osher) The Criminal Justice Perspective (Captain John Caceci) Lessons from the Consensus Project (Dr. Fred Osher) Lessons from the GAINS Center (David Wertheimer) Cost Data (David Wertheimer) Considerations for the Legislature (Dr. Fred Osher / David Wertheimer)

4. The TAPA Center for Jail Diversion Overview of the Problem

5. The TAPA Center for Jail Diversion Skyrocketing Incarceration Rates In 1990 - 1 in every 218 residents In 2000 � 1 in every 142 residents Now over 2 million people incarcerated Nearly 4 million people on parole or probation Nearly 3% of our population under some form of correctional supervision

6. The TAPA Center for Jail Diversion Persons in US Prisons and Jails 1980-1999

7. The TAPA Center for Jail Diversion Six- Month Prevalence of Severe Mental Disorder Among the General Population and Jail Detainees

8. The TAPA Center for Jail Diversion Prevalence of current substance abuse among jail detainees with serious mental disorders

9. The TAPA Center for Jail Diversion Factors Contributing to the High Rates of Persons with Serious Mental Illnesses In the Criminal Justice System

10. The TAPA Center for Jail Diversion Factors Contributing to the High Rates of Persons with Serious Mental Illnesses in the Criminal Justice System

11. The TAPA Center for Jail Diversion The Story We arrest them more often. We stress them while they�re incarcerated. We keep them incarcerated longer. We discharge them without adequate planning. They don�t get access to adequate mental health care. We re-arrest them at higher rates � we have an issue that raises both health and public safety concerns.

12. The TAPA Center for Jail Diversion The Challenge What can criminal justice do differently? What can the mental health / substance abuse treatment system do differently? How can they work together differently?

13. The TAPA Center for Jail Diversion Addressing the Problem:Federal Responses SAMHSA Multi-site jail diversion project Targeted capacity expansion grants GAINS/TAPA Center for Jail Diversion 1-866-518-TAPA Evidence based practice initiative Mental health court legislation leading to demonstration program out of DOJ DOL, DHHS, DOJ $100 million re-entry demonstration program �Mentally Ill Offender Treatment and Crime Reduction Act� (proposed legislation introduced last session)

14. The TAPA Center for Jail Diversion Lessons from the Monroe County Jail

15. The TAPA Center for Jail Diversion

16. The TAPA Center for Jail Diversion Non-profit, non-partisan membership association of state govt. officials Funded largely through state dues Represents all three branches of state government: legislature, judiciary, and executive branch 4 Regional Offices Provides non-partisan setting to discuss controversial criminal justice topics outside of the public spotlight

17. The TAPA Center for Jail Diversion A national initiative to define measures that all stakeholders in the criminal justice and mental health systems agree would improve the response to people with mental illness who are involved in the criminal justice system.

18. The TAPA Center for Jail Diversion

19. The TAPA Center for Jail Diversion Bipartisan: Republican and Democrat co-chairs Cross-system: Includes key stakeholders from mental health, law enforcement, courts, corrections Consensus: Focuses on areas where agreement can be reached

20. The TAPA Center for Jail Diversion

21. The TAPA Center for Jail Diversion

22. The TAPA Center for Jail Diversion Senate Judiciary Committee Hearing

23. The TAPA Center for Jail Diversion

24. The TAPA Center for Jail Diversion Fiscal Implications: General Findings It is significantly more expensive to provide mental health and substance abuse treatment in the criminal justice system than in the community Many of the individuals with mental illness in the justice system are �revolving door� clients Coordinated efforts between criminal justice and mental health systems can ensure a more effective use of resources

25. The TAPA Center for Jail Diversion Measuring Dollars and Sense What are the �price tags� when people with mental illness become involved in the criminal justice system?

26. The TAPA Center for Jail Diversion Measuring Dollars Saved

27. The TAPA Center for Jail Diversion Measuring Dollar Differentials

28. The TAPA Center for Jail Diversion NY/NY Study Findings (Culhane et al., University of Pennsylvania) Homeless mentally ill are heavy service users (37 % of last 2 years spent in institutional settings) Providing services for homeless mentally ill is expensive ($40,449 per person per year) Providing NY/NY housing for homeless mentally ill reduced costs by 30% ($12,145 in savings per person) 94% of supportive housing costs offset by service reductions

29. The TAPA Center for Jail Diversion Measuring Sense in King County The story of Dan Van Ho (August, 1997) Initial bureaucrat instinct: Run like heck for cover! King County government response: Run towards the crisis, not away Creation of the Mentally Ill Offender Task Force

30. The TAPA Center for Jail Diversion What the King County MIO Task Force Encountered 10% of misdemeanor population used 70% of the misdemeanor jail bed days Persons with mental illnesses were disproportionately over-represented in this group >90% of persons with mental illness booked into jail had co-occurring substance use disorders

31. The TAPA Center for Jail Diversion Lessons from King County�s Mental Health Data Only two significant co-factors to both incarceration and hospitalization for youth, adults and older adults with mental illnesses: Co-occurring substance use disorders Homelessness Integrated treatment and stable housing are ESSENTIAL components to reducing jail and hospital use

32. The TAPA Center for Jail Diversion Budget Impacts in King County >67% of County CX budget expenditures are in the criminal justice system Despite the presence of 2,400+ jail beds, at 5% annual growth rate, new jail would be needed by 2010 One highly promising strategy for cost avoidance: Diversion from jail of low risk offenders with multiple problems

33. The TAPA Center for Jail Diversion MIO Task Force: Promoting Systems Change State level review and adjustment of statutory gaps and barriers Creation of the King County and Seattle Mental Health Courts Creation of Crisis Triage Unit at County Hospital (Harborview Medical Center)

34. The TAPA Center for Jail Diversion State Level Statutory Action Ensuring dangerous individuals exiting criminal justice system are linked to assessment and treatment Attaching resources to mentally ill offenders leaving custody to ensure community-based treatment Creation of pilot projects: Community Transitions Project (SB6002)

35. The TAPA Center for Jail Diversion Creating Mental Health Courts: Key Seattle Findings MHC serves the target population New bookings decreased significantly after MHC involvement Average number of jail days per booking increase if re-booked after MHC involvement (suggests weeding out of more serious offenders)

36. The TAPA Center for Jail Diversion Seattle MHC: Key Findings(Continued) MHC effectively links clients to needed mental health case management, medication, emergency housing and related treatment and support services MHC participation associated with increases in number of treatment episodes received over time

37. The TAPA Center for Jail Diversion Crisis Triage: Another Source of Cost Avoidance Goals of Crisis Triage: Jail diversion Hospital diversion Reduction in use of expensive crisis services (e.g., Hospital ER) Linkage to ongoing services and supports

38. The TAPA Center for Jail Diversion King County Triage Outcomes Triage unit serves 700+ clients per month One-third of referrals come from police Approximately one-quarter are diverted from inpatient hospitalization �Back Door� service promotes successful linkage to community care Significant cost reductions associated with diversion from more expensive resources

39. The TAPA Center for Jail Diversion Key Lessons Learned Cost shifting to criminal justice system is an expensive and losing proposition over the long term Investing in community-based diversion programs saves money and lives Effective diversion requires collaboration and systems integration

40. The TAPA Center for Jail Diversion Key Lessons Learned Systems integration requires sharing of: Information Planning Clients Resources Responsibility

41. The TAPA Center for Jail Diversion Key Lessons Learned Pilot projects represent a modest investment that demonstrate the potential to reduce hemorrhaging of people and dollars from community to institutional settings Spend dollars on what you know works: Evidence-based promising practice models exist and can be replicated

42. The TAPA Center for Jail Diversion What can the Legislature do? Research What programs are effective What implications do cuts to the mental health system have for the criminal justice system Funding (in an era of fiscal crisis) Promote programs found to be effective Reward collaboration between local criminal justice and mental health agencies Foster collaboration (at the state level) Form a statewide commission to improve awareness about the problem and to educate legislators and the public Encourage state agencies to work together

43. The TAPA Center for Jail Diversion For More Information