Mental Health & Substance Abuse Re-Entry Efforts

1. Mental Health & Substance Abuse • Re-Entry Efforts Presented by Dean Aufderheide, PhD., Mental Health Service Director, on behalf of Daniel G. Ronay, Chief Deputy Secretary, Florida Dept. of Corrections

2. Just the Facts • United States is about 5% of world population, but incarcerates 25% of world’s inmates • 40% of individuals with serious mental illnesses have been in jail or prison at some time in their lives • Americans with severe mental illnesses are 3 times more likely to be in jail or prison than in a psychiatric hospital • In less than three decades, the percentage of seriously mentally ill prisoners has almost tripled from about 6% in 1983 to 15-20% today

3. Defining the Problem • According to the NAMI report, Florida is 49th in the nation in per capita spending on mental health services • In Florida, a person with serious mental illness is 5 times more likely to be in a jail or prison compared to in a hospital. • There are more inpatient beds in the Florida prison system than the number of involuntary civil commitment beds in Florida’s state hospital system • 18% of the inmates in the Florida DOC have a diagnosed mental disorder that requires mental health treatment 2010 Survey of states by the Treatment Advocacy Center and the National Sheriffs’ Association

4. Florida Mirrors the National Trend in Mentally Ill Population59% Increase, but Has Stabilized Over Past 3 Years at About18%

5. Mental Illness in by Mental Health GradeTotal Inmates 101,767 Florida Department of Corrections - Bureau of Research and Data Analysis - February 14, 2011

6. Increase in the Percentage of Inmates with Severe and Persistent Mental Illness (SPMI) within the Mentally Ill Population (Psychotic Disorders, Bipolar Disorders, Major Depression) Florida Department of Corrections, Date Bureau of Research & Data Analysis

7. Mental Health ReEntry ProgramMeeting the Challenge in Florida Creating an Interagency Agreement between the Department of Corrections and the Department of Children and Families Coordinating with the Social Security Administration to complete SSDI/SSI applications Establishing Community Partnerships with Stakeholders Created a Central Office full-time staff position in mental health to provide oversight and coordinate aftercare services statewide and with stakeholders Created new institutional Mental Health ReEntry Specialist positions solely dedicated to coordinate aftercare services

8. Number of Offenders Eligible for Post-Release Aftercare Planning Annually Florida Department of Corrections; Bureau of Research and Data Analysis; November 30, 2010

9. DCF Office of Disability Determination Agency for Persons with Disabilities Agency for Health Care Administration Potential Stakeholders Veteran’s Administration Agency Workforce Innovation County Sherriff’s Department Florida Institute Legal Services Parole and Probation Office of Homelessness DC/DCF Web-Based Electronic Referral System DC Mainframe Encrypted file transfer DCF Mini-Mainframe Updated Weekly DCF Web Interface DCF staff receives email notice of referral and assigns community provider based on the county of destination DC staff enter referral information into DC Mainframe DC, DCF, CMHC providers have access to aftercare database. DC referral information de-encrypted DCF staff calls provider to establish appointment. DC staff obtains aftercare arrangements from aftercare database / communicates information to inmate.

10. “Seamless Delivery System” Residential Short-term (6 months) Outpatient UA Testing Residential Long-term Therapeutic Community Community Corrections Programs Assessment (if court ordered) Aftercare Upon Admission: CC Upon Admission: IP Post-Release Substance Abuse Transitional Housing In-Prison Programs Screening Upon Release: IP Prevention Support Groups Substance Abuse Transition Centers Motivational Groups Residential Therapeutic Community Intensive Outpatient

11. Type of In-Prison Inmate Treatment2,533 Department Slots • Intensive Outpatient: 1,168 • 14 – Correctional Institutions • Residential Therapeutic Communities: 606 • 5 – Correctional Institutions • 1 –Pre- Release Community-Based • Substance Abuse Transition Centers: 759 • Prevention/Outpatient/Aftercare • 6 – Pre-Release Community-Based

12. In-Prison Substance Abuse Gaps in Services vs. Need FY 2009-10 NEED • 35,810 inmates were provided screening assessments at reception. • ~65% of the total inmate population have consistently been screened to be in need of substance abuse treatment services. • Approximately 19% of those have a co-occurring SA & MH disorder. • 84% of released inmates that needed treatment; did NOT receive it. 65% • Total = 102,232 • As of June 30, 2010 - • 2,533 available department substance abuse treatment slots.

13. Community CorrectionsSubstance Abuse and Mental Health Resources 775Short – term – 73% 286 Long – term – 27%

14. Community Corrections Substance Abuse: Gap vs Need FY2009-10 Need Total • On 6/30/10, 152,928 offenders were on active supervision. • Approximately 55.8% (85,341) offenders supervised are potentially in need of substance abuse treatment. Statistics compiled by the Bureau of Research & Data Analysis

15. Special Collaborative Re-Entry Project • At Century Correctional Institution the Department of Children and Families is funding a Reentry Case Manager position that provides case management and follow up services to inmates with substance abuse problems released from Century CI to the Escambia County area. Services include: • Family connectivity • Housing Referrals • Substance Abuse referrals/follow up • Mental Health referrals/follow up • Case management

16. Seeking New Funding Opportunities and Partnerships • Partnering with two community-based treatment providers the Department submitted a 2nd Chance Grant application for Adult Offenders with Co-occurring Disorders in June of 2011 . • The program, if funded, would target inmates with co-occurring substance abuse and mental health disorders located in the Department’s Therapeutic Community Program at Jefferson Correctional Institution who are returning to the Circuit 2 vicinity. • Post –release re-entry services include mental health and substance abuse aftercare and case management services, follow-up psychiatric care, and medication management. Based on individual needs, housing, transportation and employment skill training will be provided. .

17. Circuit 17 Program Targets Severely and Persistent Mentally Ill • In 2006, based on legislative appropriation, the Department partnered with Henderson Mental Health Center to develop a pilot program that provides intensive, specialized re-entry rehabilitation and support services to probationers and released inmates who have a severe and persistent mental illness. This program continues today. • Program Goals include successful re-entry by preventing unnecessary psychiatric hospitalization(s), incarceration(s) or crises.

18. Prison Diversion • Currently, Circuit 13 has the only pilot prison diversion program (PDP) • Offenders are sentenced to the program in lieu of prison. Program provides varying levels of care. • Individuals in need of mental health services receive services through the provider’s psychiatrist or referred to an outside provider. • Offenders in need of substance abuse treatment receive services through the program.

19. Probation Officers work with Mental Health Courts • Circuit 15- Mental Health Court • Circuit 17-Mental Health Court • Circuit 12-Sarasota County Mental Health Court was established in the 1990’s.  • Circuit 13-Pre Trial Intervention Mental Health Court • Circuit 20-Lee and Collier counties have Mental Health Courts • Circuit 8 –Alachua County Mental Health Court • Circuit 2 – Mental Health Court

20. Veterans Dorm Program • Over 6,700 self-reported Military Service personnel • Identified Dorms • 6 dorms sites • Inmate relocation in process • Curriculum development in process • Identify programming • Thinking for a Change, staff trained • Establishment of community partnersand stakeholders

21. Veteran Inmates Requiring Post-Release Mental Health/Substance Abuse Treatment In 2002/2003, an estimated 1.2 million male veterans were identified as suffering from serious mental illnesses. Approximately 340,000 of these individuals had co-occurring substance abuse disorders(1). Inmates referred to DCF/VA for Post-Release Mental Health/Substance Abuse Treatment in 2007 The Florida Department of Corrections, Bureau of Research and Data Analysis, Inmate Data Section, January 29, 2008; (1) National Survey on Drug Use and Health, “Male Users with Co-Occurring Serious Mental Illness and a Substance Use Disorder,"  Nov.11, 2004,  http://www.oas.samhsa.gov/2k4/vetsDualDX/vetsDualDX.htm ;

22. Recidivism Reduction Initiatives and Priorities

23. Recidivism Reduction Initiatives and Priorities

24. Recidivism Reduction Initiatives and Priorities

25. Recovery Health Network Discount Prescription Drug Cards

26. The Importance of Collaborative Leadership to the Right Thing, the Right Way for the Right Reasonsin Our Mental Health and Substance Abuse Programs

27. When They Succeed, We Succeed!