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DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute On Decriminalizing Mental Illness

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Page 1: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

DeCriminalizing Mental Illness in 2007

Is the Glass Half Full or Half Empty?

Ron Honberg, Director of Policy and Legal Affairs, NAMI-National

NAMI-NC Institute On Decriminalizing Mental Illness

Page 2: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

The National Stats

• Approximately 2,300,000 people incarcerated in jails and prisons at year end 2005.

• 16% of all jail and prison inmates suffer from serious mental illness (conservative estimate).– 368,000 people

• Approximately 550,000 people with serious mental illness on parole or probation.

• By contrast, approximately 70,000 people in hospitals at any given time– In many states, most of these are forensic patients.

Page 3: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

. . . jails and prisons have become the new “psychiatric hospitals”

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Hospitals Jails & Prisons Homeless

Page 4: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

High Costs of Incarceration

• Inmates with severe mental illnesses (SMI) cost more per day to incarcerate.

• E.g. Pa. Dept. of Corrections:– Average per diem cost of incarceration,

inmates with SMI - $140 per day.– Average per diem cost of incarceration, all

inmates - $80 per day.unpublished statistic provided to CJ/MH Consensus Project by John Shaffer, Pa. Department of Corrections.

Page 5: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

Longer Incarceration

• Riker’s Island (NYC)– Average length of incarceration:

• All inmates = 42 days• Inmates with SMI = 215 days

• Pennsylvania Prisons– Inmates with SMI three times more likely

to serve maximum sentences.www.consensusproject.org

Page 6: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

Spending Money in All the Wrong Places!

• Florida spends roughly a quarter of a billion dollars annually to treat 1,700 individuals under forensic commitments.

• Purpose of this treatment is to restore competency to stand trial, not to help people recover.

• Federal Medicaid dollars can’t be used for services provided in correctional settings or forensic hospitals.

• Denying services until people are in crisis is a “penny wise, pound foolish” strategy!

Florida Supreme Court, “Constructing a Comprehensive and Competent Criminal Justice/Mental Health/Substance Abuse Treatment System”, November, 2007, http://www.floridasupremecourt.org/pub_info/documents/11-14-2007_Mental_Health_Report.pdf

Page 7: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

How Did We Get Here?

• Insurance disparities, managed care, and state cuts have made problems worse.

• Treatment is frequently unavailable until a crisis occurs.• Care often is terminated after crisis, with no continuity or

coordination between inpatient and outpatient.• Police relied upon as front line crisis responders• Inadequate hospital beds for people requiring inpatient

treatment• Treatment non-compliance• Punitive society (retribution favored over rehabilitation)

Page 8: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

Innovations from the Criminal Justice Field

• Collaborative efforts have led to progress on jail diversion and reentry.

• Hundreds of CIT programs throughout the country. • At least 150 Mental Health Courts, plus other Court-

based diversion models.• Growing focus on reentry, e.g. Forensic-ACT, expedited

restoration of benefits, etc.• Initiatives to improve treatment of individuals with SMI

who are incarcerated, including correctional training in Indiana and legislation to improve conditions of confinement in NY.

Page 9: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

Does Jail Diversion Work?

• Does It Save Money?

• Does it Reduce Crime?

• Does it Help the People Intended to Benefit?

Page 10: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

Jail/Hospital costs per person

Program # of

Partici-pants

PRIOR to involvement

DURING involvement (plus

program cost)

Cost savings per person

Thresholds Jail

Program (Cook

County, IL)

30 (two years)

$53, 897 $35,024 $18,873

Project Link (Monroe County,

NY)

44 (one year)

$73,878 $34,360 $39,518

Source: Criminal Justice Mental Health Consensus Project

Cost Savings

Page 11: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

Three County Data (Annualized)

12 Months Prior

to Enrollment Since

Enrollment

Days Homeless 205,992 63,764

Days Incarcerated 60,438 9,287

Days Hospitalized 10,906 2,435

Source – National GAINS Center

California’s AB 2034 Program

Page 12: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

Allegheny (Pa) Mental Health Court

• First independent cost-benefit analysis.• Increase in mental health service costs (primarily Medicaid) virtually

offset by decrease in jail costs.– State/local costs probably less since significant proportion of

Medicaid funding is federal.• Over two years, significant reductions in criminal recidivism and

hospitalizations.• No evidence of increased public safety risks.

Rand Corporation, “Justice, Treatment and Cost: An Evaluation of the Fiscal Impact of the Allegheny County Mental Health Court”, 3/1/2007, http://www.rand.org/pubs/technical_reports/2007/RAND_TR439.pdf

Page 13: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

The True Solution Lies In More And Better Mental Health Services

• Evidence based practices, including:– ACT– Integrated mental health/substance abuse treatment.– Supported Employment– Supportive Housing

• Peer services and supports• Acute care beds and/or crisis stabilization

services• As last resort, court ordered inpatient or

outpatient treatment

Page 14: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute
Page 15: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

The National average is a D.• Five states received B’s.• Seventeen states received C’s • Nineteen states received D’s (North

Carolina got a D+)• Eight states received F’s.• Two states received U’s.

Grading the States

Page 16: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute
Page 17: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

North Carolina - Positives• CIT programs are being implemented throughout

the state. • Health insurance parity law passed! • Growing interest in supportive housing (“Housing

400” initiative).• Strong mental health coalition.• New MH leadership, dedicated oversight

committee in legislature.• Alternative to hospitalization programs being

implemented in 4 sites.

Page 18: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

North Carolina - Needs

• Although state has increased MH funding, overall spending is still inadequate.– State ranked 43rd in per capita MH spending in 2006

• Historically, state resources have been spent disproportionately on institutional care, not community services.

• Ongoing concerns about conditions in hospitals.• State needs to invest more resources in

evidence based practices, including ACT and Multi-Systemic Therapy (MST).

Page 19: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

Financial Resources

• Criminal Justice/Mental Health Collaboration grants (U.S. Dept. of Justice – www.ojp.usdoj.gov/BJA)

– $5 million in FY 2007, $10 million in FY 2008• SAMHSA jail diversion grants (www.samhsa.gov).• Byrne Memorial State and Local Law Enforcement

Assistance Grant Program (http://www.ojp.usdoj.gov/BJA/grant/byrne.html).

• More states (e.g. Georgia, Louisiana, Kentucky, Florida, Maine) providing grants for CIT and jail diversion.– Recognition that it is a cost-effective approach.

Page 20: DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute

Websites and Resources• Criminal Justice/Mental Health Consensus Project

– www.consensusproject.org• National GAINS Center

– http://www.gainscenter.samhsa.gov/html/• U.S. Department of Justice, Bureau of Justice

Assistance (Mentally Ill Offender Treatment and Crime Reduction Act, etc.)– http://www.ojp.usdoj.gov/BJA/

• NAMI website, www.nami.org, sections on:– “Criminalization” – “CIT Action Center”