CIMH Policy Forum: Mental Health

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CIMH Policy ForumMental Health Criminal
Justice

• The Dilemma of Mentally Ill Offenders
• David Meyer, J.D.
• Clinical Professor of Psychiatry and Law
• University of Southern California Keck School of
  Medicine

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Lose-Lose The Dilemma of Mentally Ill Offenders

• The California criminal justice system has more
  than twice the incidence of people who have
  mental illnesses than in the general population
• Incarceration is the worst and least
  cost-effective intervention for mental illness
• Historically, neither the criminal justice nor
  mental health systems willingly take
  responsibility for mentally ill offenders
• The criminal justice system is overwhelmed by
  mentally ill offenders

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Just the Facts

• Incarcerated people who have a mental illness
• 16 nationally
• _at_ 19 of California prisoners
• _at_ 31 of California jail inmates 11 taking meds.
• gt50 of incarcerated people with symptoms of MI
  within12 mos.
• 75 of MI inmates prisoners are also substance
  abusers

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Traditional Criminal Justice Interventions and
Responses

• Incompetency to stand trial (IST)
• Not Guilty by Reason of Insanity (NGRI)
• Guilty but Mentally Ill
• Mitigation of guilt (e.g. diminished capacity)
• Mitigation of sentence
• Post sentence MDO SVP commitments

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Interim Solutions

• Deflection
• Diversion
• Custodial care
• Reentry services and community MH linkages

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Crisis Intervention Training (CIT)

• Train officers to identify symptoms of mental
  illness
• Train and educate officers in verbal
  de-escalation techniques
• Decrease arrests of and use of force with
  mentally ill individuals
• Reduce injuries to officers and mentally ill
  individuals
• Increase officer involvement in the community
• Reducevictimless crime arrests
• Decreased liability for health care issues in the
  jail
• Cost savings

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Police/Mental Health Response Teams

• Mental Evaluation Teams (MET)
• LE Officer and MH clinician work together
• Access to records both criminal history and
  mental health treatment records
• Immediate disposition of contact
• Primary or secondary responder
• Support services for field law enforcement
• Specialized cross-training for officers and
  clinicians

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Urgent Care Partnerships

• Less than emergency situations
• Drop in/Drop off centers
• Little law enforcement processing
• Temporary care 23 hour maximum
• Voluntary, consent-based services

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Court Diversion (traditional)

• Post-filing, pre-trial diversion
• Proceedings delayed by mutual consent and without
  prejudice to either party
• Referral to services
• Behavioral requirements and conditions
• Predetermined success measures
• Flexible rewards
• Punishment resumption of criminal proceedings

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Deferred Entry of Judgment Diversion

• Post-filing, pre-trial
• Plea of guilty required
• Referral to services
• Supervised or unsupervised probation with
  mandatory conditions related to care
• Time constrained
• Reward Dismissal of DEJ charge
• Punishment sentence

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Post Judgment Alternatives

• Alternate services
• Forensic services programs
• Linkages to ACT and community care
• Referrals
• Alternate sentences
• Inpatient and sub-acute custodial care

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Mental Health Courts

• (Universally) voluntary programs
• Problem-Solving or Collaborative Courts
• Protocols and participant roles differ from
  adversarial courts
• Derived from drug courts model
• Developed 1997 in Broward County Florida by Judge
  Ginger Lerner Wren
• Varying participant and treatment models,
  diversion, DEJ and alternate sentencing

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Features of Mental Health Courts

• Judge oversees, provides accountability
• Judge frequently, directly and intimately
  involved
• Dedicated court calendar
• Referrals from multiple sources
• Specially trained court personnel
• Dedicated clinical, resource and supervisory
  personnel

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Features of Mental Health Courts

• Court-based treatment plan and supervision
• Intensive services, PACT services, wrap-around
  services whatever it takes
• Frequent court appearances/reviews
• Graduation and rewards

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Custodial Care

• Constitutional and statutory right to prisoner
  and inmate mental health care
• Limited institutional hospitals and outpatient
  facilities
• Most care provided in general population
  facilities
• Court oversight in many institutions

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Constitutional Requirements for Institutional MH
Care

• Systematic screening and evaluation
• A treatment plan
• Medication, when appropriate, and safeguards
  against dangerous prescribing practices
• Treatment that is more than mere seclusion or
  close supervision
• Services by trained mental health professionals
• Accurate, complete, and confidential records
• A suicide prevention program

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Parole Just the Facts

• 127,000 California state parolees
• 23,378 (_at_19) parolees have MI
• 12,627 (_at_54) parolees who have MI are receiving
  treatment through Parole Outpatient Clinic
  programs
• Parole terminates, sooner or later.

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Reentry

• Techniques and programs targeted at promoting the
  effective reintegration of offenders back to
  communities upon release from prison and jail.
  (cf. parole compliance and supervision)
• Case plan/management
• Integration of services
• Discharge planning
• Treatment
• Training
• Employment
• Housing
• SB 900 and SB 851

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Integrated ApproachSequential Intercept Model

• Mark R. Munetz, M.D. and Patricia A. Griffin,
  Ph.D. based on technical assistance from Henry
  Steadman, Ph.D. at the GAINS Center
• Summit County Ohio
• Framework for systemic approach to mental illness
  in the criminal justice system
• Filters staged to prevent or remove MI people
  from involvement in the criminal justice system

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Sequential Intercept Filters

• Law enforcement and emergency services at
  initial detention and initial hearings
• Jail, courts, forensic evaluations, and forensic
  commitments
• Reentry from jails, state prisons, and forensic
  hospitalization
• Community corrections and community support
  services

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IncentivesIf You Fund It, They Will Come

• Mentally Ill Offender Treatment and Crime
  Reduction Act of 2004 (MIOTCRA)
• California Mentally Ill Offenders Crime Reduction
  Act (MIOCRA)
• NACo Diversion Seed Grants
• MHSA
• SB 900
• SB 851

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Resources

• Council on State Governments Consensus Project
  http//consensusproject.org
• National GAINS Center http//www.gainscenter.samh
  sa.gov/
• MIOCRA Program http//www.cdcr.ca.gov/divisionsbo
  ards/csa/programoverview.htm
• Bazelon Center Criminal Justice Resources
  http//www.bazelon.org/issues/criminalization/

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I can run, but I cant hide

• David Meyer
• Institute of Psychiatry Law [phone]
• Cell phone [phone]
• dmeyer_at_usc.edu