Transcript Substance Abuse & Mental Health Services

Mental Illness
in Jail
JJ Larson, MS, NCC, NCAC-II
Manager, Psychological Services Division
Greenville County Detention Center
Department of Public Safety, Greenville County
Presented by Kelly Troyer, Executive Director, NAMI Greenville
Bureau of Justice Statistics
Sept 2006
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At midyear 2005 more than half of all prison
and jail inmates had a mental health problem,
including 479,900 in local jails.
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This estimate represented 64% of jail inmates.
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The above findings in this BOJS report were based on data from personal
interviews with State and Federal prisoners in 2004 and local jail inmates in
2002.
SO ?
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Persons with SPMI often slip through the
“judicial” cracks
Largest Psychiatric Facilities in the country
Without planning & community support – can
enter the revolving door
Bureau of Justice Statistics
Sept 2006
MENTAL ILLNESS
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Jail inmates had the highest rate of
symptoms of a mental health
disorder (60%) (compared to federal
or state prisoners)
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Approximately, 24% of jail inmates
reported at least one symptom of a
psychotic disorder.
SUBSTANCE ABUSE
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Among inmates who had a
mental health problem, local
jail inmates had the highest
rate of dependence or abuse
of alcohol or drugs (76%),
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Among inmates without a
mental health problem, 53% in
local jails were dependent on
or abused alcohol or drugs.
Bureau of Justice Statistics
Sept 2006
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Nearly a quarter of jail inmates who had a mental health
problem, compared to a fifth of those without, had served
3 or more prior incarcerations.
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Female inmates had higher rates of mental health
problems than male inmates.
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Local jails: 75% of females, 63% of males
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Over 1 in 6 jail inmates who had a mental health problem
had received treatment since admission
Mental Illness and Substance
Abuse are prevalent problems
amongst today’s criminal
offender population.
Who is housed out the GCDC ?
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Persons who are sentenced to less than 90 days
Persons who are waiting for trial
Persons who are sentenced through family court for child
support
Persons with charges ranging from: disorderly conduct to
assault and battery to burglary to murder and everything in
between
Average daily census = 1400
Book in & Release 100 persons per day (on average)
Annual Booking for 2006 =
22,000 - with 4,000 being repeat offenders in same year
Who is housed out the GCDC ?
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Average inmate – white male mid to late 20’s, charged with A&B
or Burglary 2nd degree
Average mental health inmate – could be any charge from
disorderly conduct to assault & battery with intent to kill
Most often male, most often off medication
Of the 1400 inmates – 33% are on prescribed medication
Of those inmates - 40-50% are on psychotropic medications
Most Common Diagnosis appear to be–
SCHIZOPHRENIA, BIPOLAR, MOOD DISORDERS
TOP 4 Meds in OCT 07:
DEPAKOTE, LEXAPRO, SEROQUEL, & RISPERDAL
What GCDC Has undertaken
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Improving & Enhancing Psychological
Services provided to incarcerated persons
Seeking to enhance community partnerships
for improved pre-release and “discharge”
planning
Partnering with NAMI with Inmate & Family
Support program
Staffing vs. Inmate Population
2000 with average of 855 Inmates –
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1 mental health clinicians
1 psychiatrist, part-time
2007 with average of 1400 Inmates –
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1 mental health administrator
3 mental health clinicians
1 psychiatrist, part-time
1 administrative clerk
Psychological Services
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Mental Health Emergencies
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Mental Illness - Crisis Stabilization
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Inmates who have requested medical services through M360 system.
Seen in their Housing Units; at times seen in Mental Health Office
Substance Abuse Treatment
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Clinician Evaluation/ Assessment of inmates who have active mental health
symptoms needing resolve prior to housing
Recommend and implement plan to bring about stabilization
General Mental Health
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Inmates who have been identified with suicide distress or other crisis level
mental illness symptoms – most often psychosis.
Seen by clinician – may be referred to psychiatrist.
Groups services offered to male and female inmates of detention center. Must
apply and be screened as eligible – by disorders, charges, keep separates,
anticipated length of stay
Psychiatric Services
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Inmates screened by mental health staff and assessed as requiring psychiatric
or pharmacological interventions or adjustments
ZONES for Mental Health
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On-Call Staff
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Inmate Requests
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Respond to requests by officers/ concerned others
May refer inmate to use of Inmate Request system (M360 form)
Case Management
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Responds to requests for services in Zone
First responder for Mental Health Crisis in Zone
Emergent/ Phone-In Concerns
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Weekly rotation – responds to all after hours emergent issues
Conducts Intake Mental Health Triage Care
Troubleshoot medication verification
Assist with discharge planning on inmate request
Coordinate pre-release planning based on needs assessment
Mental Health & Suicide Observation
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Monitor inmates on these protocols, monitor stabilization,
recommend appropriate possessions and housing as needed
Maintain mindfulness of safety –of self, of staff, of inmates
Staff Challenges
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Medication- verification & compliance
Housing Issues
Dual Diagnosis & AOD
Discharge/ Pre-release planning
Inpatient Commitment/ Placement
Specialty Field –
“correctional mental health”
Security Issues / Behavior
Malingering
Commitment to Quality Care
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Estelle v. Gambel defined “Adequate Healthcare” for
Correctional Facilities at a National Level.
In 1976, the Supreme Court of the United States found in the
Eighth Amendment to the Constitution that inmates had a
constitutional right to medical care. The Court noted that an
individual in custody is unable to seek medical care and is
totally dependent on the employees of the institution for their
health care. Therefore, failure to provide that care would be
considered “cruel and unusual punishment.”
http://www.health.state.mn.us/divs/cfh/ophp/resources/docs/correctional_health_2006.pdf
Commitment to Ongoing Quality Care
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Jails & Detention Facilities have become the largest
psychiatric hospitals in the nation
Inmate acuity (aka – amount of time it takes to
manage an inmate’s psychiatric needs) will continue
to increase as the population grows/ages
More Psychiatric Needs = More Staffing Needs
Provision of recidivism reducing treatment
Inmates Seen
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2006 –
5319 inmates seen by mental health
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2007 –
3945 inmates seen for 1:1
530 inmates seen in group sessions
4475
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84% of 2006 total – in just 1st six months of this year
Other Challenges
Lack of Jail Diversion:
Pre-Booking
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Occurs at at the point of contact with law enforcement officers and relies
heavily on effective interactions between police band mental health/
substance abuse agencies.
Most entail: specialized training by police and a no-refusal crisis drop-off
center
Our county lacks crisis drop-off center
Post-Booking
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Mental Health court referrals which entail collaborations with judicial and mental
health or dual diagnosis treatment
-- Can’t meet all demands –
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Transition Planning prior to release from Jail is evolving. Not yet a complete
“Post-Booking” program; needs to be part of a community collaboration and
recidivist reduction effort
Contact for more information:
Ms. Jennifer “JJ” Larson
[email protected]
Main office number: 864-467-2359
 Kelly Troyer
[email protected]
NAMI Greenville 864-331-3300
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