improving outpatient service delivery for criminal offenders with ... · improving outpatient...
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Improving Outpatient Service
Delivery for Criminal
Offenders with Serious
Mental Illness
Lorena Fulton, ABD, LCSW
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The Challenge
SMI + justice problems =
arrest-release-arrest.
Outpatient mental health
services -inconsistent
and lack coordination
with the justice system.
Costs are preventable!
positive correlation between
outpatient mental health services and
reduced recidivism.
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• Successful coexistence in the community.
– less victimization, exploitation, etc.
• Safer Community-less crime.
• Lower costs associated with incarceration and
justice procedures.
• Clinical needs may be addressed with an overall
lower level of care.
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Interagency
Collaboration
Six Steps to
Advocacy
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Improving Outcomes
Macro Level (System)
Advocacy Collaboration
Micro Level (Person)
Advocacy Collaboration
Micro/Individual
Macro/System
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When the justice and
mental health systems work
together to help offenders with
serious mental illness, they are
more likely to avoid or reduce
chronic justice involvement.
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• As a team, we examine input from the
mental health service providers and
justice professionals.
• United approach to improving quality
of life and community safety.
• Aligning priorities and setting team
objectives.
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A range of people who come together to
explore the macro process.
Focus on reducing recidivism
What are positive outcomes of collaboration between the justice and mental health systems, that worked in favor of offenders with mental illness?
Collaboration between systems
What does positive collaboration between these two systems look like?
Constructing and Maintaining
What process constructs and maintains a positive collaboration between the justice and mental health systems?
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• Define effective practice associated with
collaboration between systems.
• Identify risk factors for recidivism that can
be mitigated with professional
collaboration.
• Define roles and responsibilities of the
professionals who help offenders with
serious mental illness.
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A range of people who come
together to explore the macro
process.
Focus on functioning in the community
How can each professional encourage and assist the person in improving functional adaptive behavior in order to improve their quality of life in the communtiy?
Collaboration between professionals
Come to an agreement on strengths and needs. Agree on treatment priorities and outcomes.
Constructing and Maintaining
What creates and maintains a positive collaboration between individual professionals?
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• Smooth transition to the community
for offenders with serious mental
illness.
• Increase functioning
in 8 Dimensions of
Wellness.
• Decrease Criminogenic
thinking and behavior.
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“It is not loving to impose our own grid
onto others. We need to understand
their situation and their needs
accurately, and this comes from
listening to them, not coming in with our
own assumptions.”Matt Perman, What's Best Next: How the Gospel Transforms the Way You Get Things Done
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• Educate ourselves and others
about the disadvantage of
serious mental illness for
offenders.
• Change attitudes and address
misconceptions about the
vulnerability of people with
serious mental illness.
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People with mental illness 11.8
times more likely to be victimized
by violent crime:
• Rape and attempted rape: 22.5x
more
• Sexual assault: 15x more
• Aggravated assault: 13.1x more
• Robbery with injury: 7.3x more
• Theft of property from a person:
140.4x more
Teplin, L.A., McClelland, G.M., Abram, K.M. et al. (2005). Crime victimization in adults with severe mental illness: Comparison with the National Crime Victimization Survey. Archives of General Psychiatry, 62(8), 911-921.
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FRONTLINE-Set Up for
Failure...
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Six Steps Macro Level Micro Level Other
1. Define Barriers and
Needs.
Bureaucracy, Turf Issues,
Funder Expectations, etc.
Lost Support, Secure
Basic Needs, SA, etc.
Staff turnover,
Current Events,
etc.
2. Assess Resources to
Address Barriers and
Needs.
Strong Leaders, Combined
Funds, Community
Support, Outreach
conduits.
Natural Supports, Public
Benefits, Service Hx, etc.
Advocates in
other communities
3. Brainstorm, Outreach,
Education.
Review Case Examples,
Examine solution options.
Communication is key!
Involve natural supports.
Stakeholder
Meetings.
4. Determine a
Collaborative Plan
Consensus, Funding,
Assign Responsibilities
Combine Treatment
Plans
Accountability
Plan
5. Follow the Plan
Through.
Track unintended
consequences, problem-
solve unexpected issues.
Support the person,
Encourage, Be ReliableExpect the
unexpected!
6. Evaluate the
Outcomes/Tweak Plan.
Ongoing quarterly
meetings.
Regular Team Meetings,
Transition out of ServicesHold each other
Accountable.
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• Bureaucracy, Turf Issues, Funder
Expectations, etc.
• Lost Support, Secure Basic Needs, SA,
• Staff turnover, Current Events, etc.
Define Barriers and Needs.
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• Strong Leaders, Combined Funds,
Community Support, Outreach
conduits.
• Natural Supports, Public
Benefits, Service Hx, etc.
• Advocates in other communities
Assess Resources to Address Barriers and Needs
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Brainstorm, Outreach, Education
• Review Case Examples,
• Examine solution options.
• Communication is key!
• Involve natural supports.
• Stakeholder Meetings.
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• Consensus,
• Funding,
• Assign Responsibilities
• Combine Treatment Plans
• Accountability Plan
Determine a Collaborative Plan
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• Track unintended consequences
• Problem-solve unexpected issues.
• Support the person
• Encourage, Be Reliable
• Expect the unexpected!
Follow the Plan Through
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• Ongoing quarterly meetings.
• Regular Team Meetings
• Transition out of Services
• Hold each other Accountable.
Evaluate the Outcomes &Tweak the Plan
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Summary• Improving outcomes for offenders
with serious mental illness
benefits communities and
individuals.
• An effective, community approach
requires combining collaboration
and advocacy.
• The process must be nurtured in
order to be sustained.
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