Mental Health and the Criminal Justice System: Opportunities for Change

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Mental Health and the Criminal Justice System
Opportunities for Change

• Fred C. Osher, M.D.
• April 22, 2005

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What is the Problem?

• People with co-occurring disorders are
  significantly over-represented in the criminal
  justice system

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Case Example Kevin

• 33 y.o. AA male
• Homeless
• Schizophrenia
• Alcohol Dependence
• Cycles in and out of jails for misdemeanors

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Case Example Helen

• 34 y.o. AA Female
• Homeless
• Bipolar Affective Disorder
• Opiate Dependence
• Released from State prison on parole

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Presentation Goals

• What is the Magnitude of the Problem
• What Accounts for the Magnitude
• What Responses are Required

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Skyrocketing Criminal Justice Populations
Bureau of Justice Statistics, 2003
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State and Federal PrisonersPercent of White vs.
Minorities over time (1950 2010)
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Co-Occurring Substance Use Disorders Among Jail
Detainees with Serious Mental Disorders

• With Co-Occurring Substance Use Disorders
• Without Co-Occurring Substance Use Disorders

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What Accounts for the Magnitude of the Problem?

• Arrested at disproportionately higher rates
• Co-occurrence of substance related disorders
• Jails and prisons as housing of last resort
• Longer periods of time incarcerated

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What Accounts for the Magnitude of the Problem?

• Pathogenic nature of incarcerated
  environments
• High recidivism rates on re-entry
• Inadequate Mental Health Services
• Inadequate Access
• Inadequate Quality

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The Story

• We arrest them more often.
• We keep them incarcerated longer.
• We stress them while theyre incarcerated We
  discharge them without adequate planning..
• They dont get access to adequate mental health
  care..
• We re- arrest them at higher rates
• Weve got a need to understand and relate to the
  criminal justice system

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Why should we change?

• Its the right thing to do
• Not changing is costly
• In terms of money
• In terms of public safety
• In terms of public health
• Change can be a win-win-win for all stakeholders

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The Challenge

• What can criminal justice do differently?
• What can the MH/SA/Housing/Health treatment
  systems do differently?
• How can they work together differently?

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Sequential Intercept Model ( Patricia
Griffen)

• People move through the criminal justice system
  in predictable ways
• Examine this process in your locality to identify
  ways to intercept persons with severe mental
  illness and co-occurring disorders to ensure
• Prompt access to treatment
• Opportunities for diversion
• Timely movement through criminal justice system
• Adequate supports upon release

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Points of Contact

• Law Enforcement
• Courts
• Jails
• Prisons
• Community Re-Entry
• Behavioral Health System

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Diversion ProgramsLogic Model
Steadman, Osher, Naples
Stage 1 Stage 2
Identify Target Group
Comprehensive/Appropriate Community Treatment
Diversion
Stage 3 - Outcomes
Improved Public Safety Outcomes
Improved Mental Health Outcomes
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Diversion to What ?
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Addressing the Problem Local Responses

• Law Enforcement
• Police Dispatcher Training
• Police-Based Specialized Responses
• Police Response CIT
• Police-Mental Health Partnership Response
• Courts
• Mental Health Courts
• Drug Courts

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Goals of Specialized Police Responses

• Improved Services to People with Mental Illness
• Improved Efficiency of Law Enforcement Response
• Improved Effectiveness of Law Enforcement
  Response
• Diversion for Criminal Justice System
• Reduction in Officer and Civilian Injuries
• Improved Officer Knowledge About Mental Illness
• Effective Partnerships with the Mental Health
  Community

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Addressing the Problem Local Responses

• Problem Solving Courts
• Drug Courts
• 1200 in operation today and another 600 in
  planning/training phases
• Recognizing the unique challenges of co-occurring
  population
• Mental Health Courts
• First Courts in late 1990s
• BJA Mental Health Courts Program
• 23 jurisdictions in 2002
• 14 jurisdictions in 2003

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Mental Health Court Essential
Elements Council of State Governments,2004

• 1. Coordinated Planning and Administration
• 2. Operate within local Context
• 3. Defined Target Population
• 4. Informed Choice
• 5. Explicit Terms of Participation
• 6. Rapid Processing
• 7. Attention to Confidentiality and
  Information-Sharing
• 8. Integration of Treatment and Community
  Supports
• 9. Outcome Measurement

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Addressing the Problem Local Responses

• Jails
• Innovative Management Information Systems
• Post-Booking Diversion Programs
• Prisons
• Inmate Observation Program in NY
• Oregon DOC Co-occurring Disorders Program
• Community Re-Entry
• APIC Model
• Jails Brad H. Settlement
• Prisons - California Conditional Release Program
• Forensic Assertive Community Treatment Teams

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Addressing the ProblemState Responses

• Council of State Governments Criminal
  Justice/Mental Health Consensus Project
• www.consensusproject.org
• State Flexibility with Federal Programs Bazelon
  Center Report
• Delaware ??

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Addressing the ProblemFederal Responses

• The Presidents New Freedom Commission on Mental
  Health
• The Commission recommends widely adopting adult
  criminal justice and juvenile justice diversion
  and re-entry strategies to avoid the unnecessary
  criminalization and extended incarceration on
  non-violent adult and juvenile offenders with
  mental illnesses.

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Addressing the ProblemFederal Responses

• Legislative Activity The Mentally Ill Offender
  Treatment and Crime Reduction Act (S.B. 1194)
• SAMHSA
• Targeted capacity expansion grants
• GAINS/TAPA technical assistance center 1 800
  311- 4246

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Conclusions

• Continue to build the science base
• Appreciate context of larger societal issues
• Address Stigma and Discrimination
• AND
• Develop meaningful partnerships

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• To the extent that we respond to the health
  needs of the most vulnerable among us, we do the
  most to promote the health of the nation.
• David
  Satcher, M.D.,Ph.D.

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