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Addressing a Na,onal Crisis Too Many People with Mental Illnesses in our Jails Will Engelhardt, Senior Policy Analyst, CSG Jus,ce Center May 20, 2016 | Salt Lake City, UT

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Page 1: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Addressing  a  Na,onal  Crisis  Too  Many  People  with  Mental  Illnesses  in  our  Jails  Will  Engelhardt,  Senior  Policy  Analyst,  CSG  Jus,ce  Center  May  20,  2016  |  Salt  Lake  City,  UT  

Page 2: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

01.  Mental  Illnesses  in  the  Criminal  Jus,ce  System:  How  did  we  get  here?  

   Council  of  State  Governments  Jus,ce  Center  |  2  

Page 3: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Jails  are  Where  the  Volume  is  

 11,605,175    

 553,843      222,565      10,621    

Jail  Admissions   Prison  Admissions  

Annually  

Weekly    

Number  of  Admissions  to  Jail  and  Prison  Weekly  and  Annually,  2012  

Page 4: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

 3,319      4,391    

 10,257    

 7,557    

2005   2012  

M  Group   Non-­‐M  Group  

Jails  Report  Increases  in  the  Numbers  of  People  Mental  with  Illnesses  

Average  Daily  Jail  Popula,on  (ADP)  and  ADP  with  Mental  Health  Diagnoses  

76%  63%  

24%  37%  

13,576    Total   11,948  

Total  

NYC  Jail  Popula,on  (2005-­‐2012)  

Page 5: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Mental  Illnesses:  Overrepresented  in  Our  Jails  

5%   Serious    Mental  Illness  

General  Popula,on   Jail  Popula,on  

17%  Serious    Mental  Illness   72%  Co-­‐Occuring  Substance  Use  Disorder  

Page 6: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

We’ve  All  Experienced  this  Crisis  in  One  Way  or  Another  

County  is  ready,  but  is  it  able  to  deal  with  mentally  ill?  

Mentally  ill  inmates  at  Franklin  County  Jail  stay  longer  

Inmates  with  mental  health  issues  inundate  Pima  County  Jail  

Nearly  a  third  of  county  inmates  require  drugs  for  mental  illness  

Mentally  ill  Mainers  are  s,ll  warehoused,  but  now  it’s  in  jail  

Johnson  County  Sheriff:  Mental  health  is  number  one  problem  

Mental  health  crisis    at  Travis  County  jails  

Jail  violence  increasing  due  to  mental  illnesses  

Page 7: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Factors  Driving  the  Crisis  

Longer  stays  in  jail  and  prison  

Limited  access  to  health  care    

Low  u,liza,on  of  EBPs    

Higher  recidivism  rates    

More  criminogenic  risk  factors    

Dispropor,onately  higher  rates  of  arrest  

Page 8: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Group  3  III-­‐L  

CR:  low  SA:  med/high  

MI:  low  

Group  4  IV-­‐L  

CR:  low  SA:  med/high  MI:  med/high  

Group  1  I-­‐L  

CR:  low  SA:  low  MI:lo  

Group  2  II-­‐L  

CR:  low  SA:  low  

MI:  med/high  

Low  Severity  of  Mental  Illness  (low)  

Serious  Mental  Illness  

(med/high)  

Low  Severity  of  Mental  Illness  (low)  

Serious  Mental  Illness  

(med/high)  

Low  Criminogenic  Risk  (low)  

Substance  Dependence  (med/high)  

Low  Severity  of  Substance  Abuse  

(low)  

A  Framework  for  Priori,zing  Target  Popula,on  

Group  7:  III-­‐H  

CR:  med/high  SA:  med/high  

MI:  low  

Group  8  IV-­‐H  

CR:  med/high  SA:  med/high  MI:  med/high  

Group  5  I-­‐H  

CR:  med/high  SA:  low  MI:  low  

Group  6  II-­‐H  

CR:  med/high  SA:  low  

MI:  med/high  

Medium  to  High  Criminogenic  Risk  (med/high)  

Substance  Dependence    (med/high)  

Low  Severity  of  Substance  Abuse  

(low)  

Low  Severity  of  Mental  Illness  (low)  

Serious  Mental  Illness  

(med/high)  

Low  Severity  of  Mental  Illness  (low)  

Serious  Mental  Illness  

(med/high)  

Page 9: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Coun,es  Na,onwide  are  Stepping  Up  

Over  100  million  people  reside  in  Stepping  Up  counBes  

Page 10: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

50  Coun,es  Aiend  the  Na,onal  Stepping  Up  Summit  

37  states  are  represented  at  the  Summit,  including  Alaska,  Arizona,  California,  Colorado,  Hawaii,  Montana,  Nevada,  New  Mexico,  Oregon,  Washington,  Wyoming  

Page 11: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Na,onal  Stepping  Up  Summit  

State  and  county  behavioral  health  &  criminal  jus,ce  leaders  are  returning  home  with  an  increased  commitment  to  this  issue  

Page 12: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

02.  Coun,es  Step  Up  but  Face  Key  Challenges:  Why  is  it  so  hard  to  fix?  

Page 13: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Key  Challenges  Coun,es  Face:  Observa,ons  from  the  Field  

1.   2.   3.   4.    

Being  data  driven  

 

Using  best  prac,ces  

 

Con,nuity  of  care  

 

Measuring  results  

Page 14: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Challenge  1  -­‐  Being  data  driven:    Policymakers  Face  Complex  Systems  with  Limited  Informa,on  

Page 15: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Challenge  1  -­‐  Being  Data  Driven:  Not  Knowing  the  Target  Popula,on  

County  A   County  B   County  C   County  D  

Mental  Health  Assessment   P   P   P-­‐  Substance  Abuse  Assessment   P-­‐  Risk  Assessment     P-­‐  

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Challenge  2  –  Using  Best  Prac,ces:  Addressing  Dynamic  Needs  

Dynamic  Risk  Factor     Need  

History  of  an,social  behavior   Build  alterna,ve  behaviors  

An,social  personality  paiern   Problem  solving  skills,  anger  management  

An,social  cogni,on   Develop  less  risky  thinking  

An,social  associates   Reduce  associa,on  with  criminal  others  

Family  and/or  marital  discord   Reduce  conflict,  build  posi,ve  rela,onships  

Poor  school  and/or  work  performance   Enhance  performance,  rewards  

Few  leisure  or  recrea,on  ac,vi,es   Enhance  outside  involvement  

Substance  abuse   Reduce  use  through  integrated  treatment  

Andrews  (2006)  

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Challenge  2  –  Using  Best  Prac,ces:  The  Science  to  Service  Gaps  

Past  Year  Mental  Health  Care  and  Treatment  for  Adults  18  or  Older  with  Both  SMI  and  Substance  Use  Disorder  

NSDUH  (2008)  

Page 18: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Challenge  3  –  Con,nuity  of  Care  Exis,ng  Services  Only  Reach  a  Small  Frac,on  of  Those  in  Need  

10,523  Individuals  

2,315  People  with  serious  

mental  illness  based  on  naBonal  esBmates  

609  Received  treatment  in  

the  community  

1,706  Did  NOT  receive  treatment  in  the  

Community  

926  LOW    RISK  

1,389  HIGH/  

MOD  RISK  

969    People  with  serious  

mental  illness    

Example  from  Franklin  County,  OH  

Page 19: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Challenge  4  –  Tracking  Progress:    Focusing  County  Leaders  on  Key  Outcomes  Measures  

Outcome  measures  needed  to  evaluate  impact  and  priori,ze  scare  resources  

1.  Reduce    the  number  of  people  with  mental  illness  booked  into  jail  

2.  Shorten    the  length  of  stay  for  people  with  mental  illnesses  in  jails    

3.  Increase    the  percentage  of  people  with  mental  illnesses  in  jail  connected  to  the  right  services  and  supports  

4.  Lower  rates  of  recidivism  

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03.  Effec,ve  Strategic  Plans:  How  do  we  more  forward?  

Page 21: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Overarching  Goal  

There  will  be  fewer  people  with  mental  illnesses  in  our  jails  

tomorrow    than  there  are  today.  

Page 22: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

How  do  We  Know  if  a  County  is  Posi,oned  to  Reduce  Number  of  People  with  Mental  Illness  in  Jail?  

1.   Is  your  leadership  commiied?  

2.  Do  you  have  ,mely  screening  and  assessment?  

3.  Do  you  have  baseline  data?  

4.  Have  you  conducted  a  comprehensive  process  analysis  and  service  inventory?  

5.  Have  you  priori,zed  policy,  prac,ce,  and  funding?  

6.  Do  you  track  progress?  

Six  Key  Ques,ons  

Page 23: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Is  your  Leadership  Commiied?  

Mandate  from  county  elected  officials  ☐  

Representa,ve  planning  team  ☐

Commitment  to  vision,  mission  and    guiding  principles  ☐  

Designated  project  coordinator  and    organized  planning  process  ☐  

Accountability  for  results  ☐  

Page 24: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Do  You  have  Timely  Screening  and  Assessment?  

Mental  illness  

Substance  use  disorders  

Recidivism  

Is  there  are  system-­‐wide  defini,on  of:  ☐

☐

☐

☐

Screening  and  assessment:  ☐

Validated  screening  and  assessment  tools  

An  efficient  screening  and  assessment  process  

☐

☐

Electronically  collected  data  ☐

Page 25: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Do  You  have  Baseline  Data?  

Prevalence  rate  of  mental  illnesses  in  jail  popula,on  

Length  of  ,me  people  with  mental  illness  stay  in  jail    

Connec,ons  to  community-­‐based  treatment,  

services  and  supports  

Recidivism  rates  

Ability  to  measure:  ☐

☐

☐

☐

Electronically  collected  data  ☐  

☐

Page 26: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Have  You  Conducted  a  Comprehensive  Process  Analysis  and  Service  Inventory?  

System-­‐wide  process  review  ☐  

Inventory  of  services  and  programming  ☐

Iden,fied  system  gaps  and  challenges  ☐  

Process  problems  

Capacity  needs  

Popula,on  projec,ons  

☐

☐

☐

Evidence  Based  Prac,ces  Iden,fied  ☐  

Page 27: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Have  You  Priori,zed  Policy,  Prac,ce  and  Funding?  

A  full  spectrum  of  strategies  ☐  

Costs  and  funding  iden,fied  ☐

Strategies  clearly  focus  on  the  four  key  measures  ☐  

County  investment  ☐  

4

$

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Do  You  Track  Progress?  

Repor,ng  ,meline  of  four  key  measures  ☐  

Process  for  progress  repor,ng  ☐

Ongoing  evalua,on  of  program    implementa,on  ☐  

Ongoing  evalua,on  of  program  impact  ☐  

4

Page 29: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

04.  Support  for  Coun,es:  What  can  states  do?  

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4  Ways  the  State  and  Coun,es  Can  Partner  Right  Away  

1. Work  with  county  associa,ons  in  your  state  to  convert  “six  ques,ons”  into  a  tool  for  your  state  

 2.  Survey  coun,es  across  the  state  vis  a  vis  these  ques,ons    3.Convene  a  statewide  summit    4.  Use  the  survey  and  summit  to  design  a  plan  to  support  coun,es  across  the  state  

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Next  Step:    Medicaid  Eligibility  Status  and  Enrollment  

Determine Enrollment and

Eligibility  Status  

Initiate and Complete

Application for Eligible Individuals  

Not Already Enrolled but

Eligible  

Already Enrolled  

Maintain  Enrollment if

Possible  

Reinstate Upon Release  

Enroll in Benefits  

Track Progress  

Con

nect

to C

over

ed C

omm

unity

Tr

eatm

ent B

ased

on

Beha

vior

al

Hea

lth a

nd R

isk

Asse

ssm

ents  

Are  people  screened  for  eligibility  and  enrollment  status  at  jail?  If  people  are  enrolled,  are  they  staying  enrolled  while  in  jail?  (suspension  vs.  termina,on)  If  people  are  not  enrolled,  are  they  gesng  enrolled  in  jail  in  order  to  access  benefits  upon  release?  

☐  ☐  

☐  

Page 32: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

Next  Step:      Treatments  and  Services  that  are  Medicaid  Reimbursable    

Psychiatric  medica,on  upon  release  CBT  interven,ons,  based  on  criminogenic  risk  Case  management  Integrated  MH  and  SUD  

services  

Review  which  BH  treatment  services  are  currently  covered  by  Medicaid.    Services  could  include:  ☐

☐

☐

Determine  what  changes  can  be  made  to  Medicaid  plans  to  cover  these  services  (state  plan  amendments  and  waivers)  ☐

Iden,fy  addi,onal  resources  to  address  gaps  in  Medicaid  coverage  for  these  services  ☐

☐☐

Medica,on-­‐assisted  therapy  Supported  employment  Suppor,ve  housing  In-­‐reach  services  Peer  support  services  

☐  ☐  ☐  ☐  ☐  

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Next  Steps:  State  Innova,on  Grants  Cover  Gaps  in  Medicaid  

California:  $17.1  million  for  3  years,  star,ng  in  2015  for  services  for  people  with  mental  illnesses  in  the  criminal  jus,ce  system  

Ohio:  $3  million  in  grants  in  2016  to  connect  offenders  to  treatment  

Michigan:  $3.15  million  in  grants  staring  in  2015  for  jail  diversion  programs  in  8  coun,es  

Indiana:  $30  million  in  grants  star,ng  in  2015  for  treatment  services  for  the  criminal  jus,ce  popula,on  without  insurance  coverage  

Massachuse]s:  $1.9  million  in  grants  star,ng  in  2015  for  pre-­‐arrest  law  enforcement  based  jail  diversion  programs  in  13  police  departments  

Florida:  In  2015  coun,es  could  apply  for  1  or  3  year  grants  for  ini,a,ves  that  serve  people  with  behavioral  health  disorders  in  the  criminal  jus,ce  system  

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Next  Steps:  Increase  Capacity  and  Support  for  Rural  Coun,es  

Texas  and  North  Carolina:  Statewide  requirements  &/or  contracts  for  validated  screening  tools  

Ohio  and  New  York:  Statewide  training  for  Evidence  Based  Prac,ces  Curricula  

Utah:  Regional  hubs  for  tele-­‐screening  and  tele-­‐psychiatry  (26  states  use  tele-­‐psychiatry  in  correc,onal  facili,es)  

Utah,  ConnecBcut,  Oklahoma,  &  Ohio:  Statewide  CIT  training  academies  

Page 35: Addressing)aNaonal)Crisis) · 2016-05-31 · Addressing)aNaonal)Crisis) Too)Many)People)with)Mental)Illnesses)in)our)Jails) Will)Engelhardt,)Senior)Policy)Analyst,)CSG)Jus,ce)Center)

THANK  YOU  For  more  informa,on,  contact:    Will  Engelhardt,  Senior  Policy  Analyst,  CSG  Jus,ce  Center  –  [email protected]    


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