Transcript Creating Appropriate Responses for Justice

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
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
In 2005, there were 13 million bookings
into U.S. jails.
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.
Admission to U.S. Jails (2005)
13 million
Proportion of Jail Inmates With Severe Mental Disorder
Men = 14.5%
Women = 31.0%
Number of Annual Admissions to U.S. Jails with Severe Mental
Disorder
2.1 million
Prevalence of Current Substance Abuse Among
Jail Detainees with Severe Mental Disorders
Males
Disorder
Alcohol Abuse/
Dependence
Drug Abuse/
Dependence
Females
Alcohol Abuse/
Dependence
Drug Abuse/
Dependence
Schizophrenia
59%
42%
56%
60%
Major Depression
56%
26%
37%
57%
Mania
33%
24%
39%
64%
Any Severe
Disorder
58%
33%
40%
60%
Detainees with severe
mental disorder plus
either alcohol or drug
abuse/dependence
= 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
= 72%
CMHS TCE JD: 14 Sites Traumatic
Experiences (n=546)
Lifetime
Past 12 Months
F
M
F
M
Physical
93.2%
89.8%
67.4%
58.6%
Sexual
77.1%
34.7%
32.1%
27.5%
Repeated Cycles
INCARCERATION
ARREST
Mental
Health
Inpatient
Private
Home
Group
Residence
S.A.
Residential
Treatment
Shelter
Street
“Treatment-Resistant”
Clients
OR
“Client-Resistant”
Services
Intercept 5
Community
corrections
Prison/
Reentry
Parole
Violation
Probation
Violation
Jail
Re-entry
Dispositional Court
First Appearance Court
Initial Detention
Law Enforcement
Arrest
Intercept 4
Reentry
COMMUNITY
COMMUNITY
911
Intercept 3
Jails / Courts
Specialty Court
Intercept 2
Initial detention /
Initial court
hearings
Jail
Intercept 1
Law
enforcement
Diversion = avoiding or radically reducing
jail time by using communitybased treatment as an
alternative.
“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
Public’s Expectations
Reduce recidivism
Reduce violence
Diversion
Reduce jail days
Reduce costs
Diversion Logic Model
Stage 1
Stage 2
Stage 3
Improved
Mental Health
/Individual
Outcomes
Diversion
Identify and
Enroll People
in Target
Group
Linkage
Comprehensive/
Appropriate CommunityBased Services
Improved
Public Safety
Outcomes
Mental Health Diversion Options

Pre-Booking
–

Police-Based
Post-Booking
–
Court-Based
–
Jail-Based
–
Community Corrections-Based
Dispositions of Cases Handled by Three
Types of Police Response at Three Sites
Birmingham
(N=100)
Knoxville
(N=100)
Memphis
(N=100)
Taken to treatment location
20
42
75
Situation resolved on the
scene
64
17
23
Referred to treatment
3
36
0
Arrested
13
5
2
Disposition
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.
Intercept 5
Community
corrections
Prison/
Reentry
Parole
Violation
Probation
Violation
Jail
Re-entry
Dispositional Court
First Appearance Court
Initial Detention
Law Enforcement
Arrest
Intercept 4
Reentry
COMMUNITY
COMMUNITY
911
Intercept 3
Jails / Courts
Specialty Court
Intercept 2
Initial detention /
Initial court
hearings
Jail
Intercept 1
Law
enforcement
Rikers Island 2008 Bail Statistics
(N=48,000)
Mental Illness
Make Bail
No Mental
Illness
21%
Days to Make Bail
9
48
Council of State Governments March, 2013
12%
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
Intercept 5
Community
corrections
Prison/
Reentry
Parole
Violation
Probation
Violation
Jail
Re-entry
Dispositional Court
First Appearance Court
Initial Detention
Law Enforcement
Arrest
Intercept 4
Reentry
COMMUNITY
COMMUNITY
911
Intercept 3
Jails / Courts
Specialty Court
Intercept 2
Initial detention /
Initial court
hearings
Jail
Intercept 1
Law
enforcement
Nathaniel Project (NYC) N=53
Prior Year
Current Year
101
7
Misd.
35
5
Felonies
66
2
Number of
Arrests
SAMHSA KDA (N=1,185)
Diverted
Non-Diverted
Community days
303
245
# Arrests
1.03
1.20
.11
.15
Arrests/mo.
CMHS TCE JD: 14 Sites
Changes in Arrests and Jail Days
Pre-Enrollment Post-Enrollment
(1 year)
(1 year)
Any Arrests
n
%
n
%
579
100.0
293
50.6
Arrests (Mean)
2.3
1.0
Violent Arrests (Mean)
.23
.1
Jail Days (Mean)
49
33
Annualized Number of Arrests – 3 MHCs
Pre 18
Months
Post 18
Months
%
Reduction
MHC Mean
(N)
2.2
(436)
1.4
(436)
37%
TAU
2.6
(597)
2.0
(586)
23%
Mean
(N)
Total Incarceration Days
Pre and Post 18 Months – 3 MHCs
MHCNEW
Pre 18
Months
Post 18
Months
%
Increase
MHC Mean
(N)
75
(436)
84
(436)
12%
TAU Mean
(N)
75
(597)
152
(597)
101%
Diversion Logic Model
Stage 1
Stage 2
Stage 3
Improved
Mental Health
/Individual
Outcomes
Diversion
Identify and
Enroll People
in Target
Group
Linkage
Comprehensive/
Appropriate CommunityBased Services
Improved
Public Safety
Outcomes
Drug & Alcohol Use
Any alcohol Last 30 Days
Alcohol to
Intoxication Last 30 Days
Illegal drugs Last 30 Days
Number
Cases
Reporting
Use
Percent of
Cases
Reporting
Use
Mean
Number
of Days of
Use
Median
Number
of Days of
Use
Baseline
576
59.1%
13.1
8
6 Months
169
28.4%
5.8
3
12 Months
105
30.1%
6.6
3
Baseline
372
38.2%
12.9
8
6 Months
76
12.8%
5.2
2
12 Months
45
12.9%
7.3
4
Baseline
568
58.3%
17.8
20
6 Months
101
17.0%
9.5
5
12 Months
55
15.7%
10.0
5
Daily Living/Role Functioning Scale
N
Mean Score
(Range: 0 to 4)1
Mean Difference
From Baseline 2
Baseline
977
2.01
--
6 Months
594
1.31
-0.70
12 Months
349
1.17
-0.84
1 – Where 0 = No Difficulty and 4 = Extreme Difficulty
2 – Calculations based on those individuals having both interviews completed
Colorado Symptom Index (CSI)
N
Mean Score
Mean Difference
(Range: 0 to 60)1 From Baseline 2
Baseline
968
31.5
--
6 Months
590
22.3
-9.2
12 Months
346
21.4
-10.1
1 – Where 0 = Low Symptoms/High Well-Being and 60 = High Symptom/Low Well-Being
2 – Calculations based on those individuals having both interviews completed
Year-by-Year CJ Cost
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
1
2
3
MHC
4
TAU
5
6
Year-by-Year Tx Cost
10000
9000
8000
7000
6000
5000
4000
3000
2000
1000
0
1
2
3
MHC
4
TAU
5
6
Year-by-Year Total Cost
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
1
2
3
MHC
4
TAU
5
6
Is Criminalization An Important Public
Policy Concept?
Macro View

Transinstitutionalization

% Detainees with MI Different
Micro View

Individual more likely in jail than in communitybased treatment
More Useful Concepts
 Reduce
Involvement
 Minimize
Inappropriate Penetration