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Office of Justice Programs

National Institute of Justice

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National Institute of JusticeP r o g r a m F o c u s

Maryland’sCommunity CriminalJustice TreatmentProgram

CoordinatingCommunityServices forMentally IllOffenders:

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HighlightsThe number of mentally ill individuals in thecriminal justice system has grown dramati-cally during the past 30 years. Often homelessand suffering from other health-related con-cerns (e.g., substance abuse, HIV infection),these individuals may cycle continuously be-tween the community, where they commitmostly minor offenses, and jail.

Recognizing this pattern and seeking to inter-vene productively, local policymakers haveworked with officials in Maryland’s Depart-ment of Health and Mental Hygiene and withother State officials to establish the MarylandCommunity Criminal Justice Treatment Pro-gram (MCCJTP), a multiagency collabora-tive that provides shelter and treatment servicesto mentally ill offenders in their communities.Created to serve the jailed mentally ill, theprogram now also targets individuals on pro-bation and parole.

MCCJTP operates in 18 of the State’s 24 localjurisdictions and features:

● Local advisory boards composed of localand State decisionmakers who provide on-going leadership.

● Case management services that includecrisis intervention, screening, counseling,discharge planning, and communityfollowup.

● Services for mentally ill offenders who arehomeless or have co-occurring substanceuse disorders.

● Routine training for criminal justice andtreatment professionals.

● Postbooking diversion for qualifying men-tally ill defendants.

The MCCJTP model features strong collabo-ration between State and local providers, acommitment to offering transitional case man-agement services, the provision of long-termhousing support to mentally ill offenders, anda focus on co-occurring substance use disor-

ders. Criminal justice and treatment profes-sionals credit MCCJTP with improving theidentification and treatment of jailed mentallyill individuals, increasing communication be-tween mental health and corrections profes-sionals, improving coordination of in-jail andcommunity-based services for mentally illoffenders and defendants, and reducing dis-ruption in local jails. Case managers and cli-ents report that MCCJTP’s comprehensiveservices have improved the quality of manyclients’ lives.

Independent evaluation of MCCJTP servicedelivery mechanisms and client outcomes isnow under way. The investigation will help indetermining whether providing coordinated,community-based services to mentally ill of-fenders can significantly reduce recidivism,increase residential stability, reduce psychiat-ric hospitalization, and increase voluntaryparticipation in substance abuse treatment.

Coordinating Community Servicesfor Mentally Ill Offenders:Maryland’s Community CriminalJustice Treatment Program

L ooking around his apartment, 45-year-old Ray Carver can hardly believehis good fortune.1 Not long ago, he was living in abandoned buildings and drink-ing cheap whiskey. He had survived like that since he was a teenager, traveling upand down the East Coast, periodically being arrested for shoplifting or vagrancyand spending months at a time in jail. In his early twenties, Ray was diagnosedwith schizophrenia by a psychiatrist in a District of Columbia jail. Since then, hehad taken medication sporadically and had been institutionalized twice for hismental illness. Most of the time, however, he lived on the streets and drank heavily.

by Catherine Conly

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When Ray was arrested for shoplifting inSalisbury, Maryland, he reported to theWicomico County Detention Center’sclassification officer that he had beentaking medication for schizophrenia. Theofficer referred Ray to the mental healthcase manager assigned to the jail by thecounty health department through theMaryland Community Criminal JusticeTreatment Program. With that referral,Ray Carver embarked on a journey thatwould significantly change his life.

Thousands of mentally ill individuals passthrough local correctional facilities eachyear. In 1996, one-quarter of jail inmatesreported that they had been treated at sometime for a mental or emotional problem.2

Nearly 89,000 said that they had taken aprescription medication for those types ofproblems, and more than 51,000 reportedthat they had been admitted to an over-night mental health program.3

The dramatic growth of the population ofjailed mentally ill persons has coincidedwith the policy of deinstitutionalizationthat resulted in the release of thousands ofmentally ill people from psychiatric facili-ties to the community.4 Additional factors,including cuts in public assistance, morestringent civil commitment laws, declinesin the availability of low-income housing,and limited availability of mental healthcare in the community, are thought to haveexacerbated conditions for the mentally illand contributed to their increased involve-ment in the criminal justice system.5 Manymentally ill offenders are charged withrelatively minor offenses (e.g., prostitu-tion, shoplifting, vagrancy),6 but are notdiagnosed or treated while in jail and arereleased back to their communities withno plan for treatment or aftercare.

Finding humane, constitutional, andeffective ways to address the needs ofmentally ill individuals is a challengefor local correctional facilities nation-wide. Crowded, outdated, and designed toensure secure confinement, most jails arenot optimal treatment settings for thementally ill.7 Nonetheless, the nature ofjail populations increasingly demands—and numerous court decisions require—that jails respond to the needs of thementally ill.8

Researchers consistently recommendcorrectional strategies that result in earlyidentification and referral of the jailedmentally ill to the most appropriate treat-ment setting, preferably in the commu-nity.9 However, only a few jails haveachieved this goal.10 Even in jails wherepsychiatric services are models for othersnationwide, a significant proportion ofthe mentally ill can go undetected and/oruntreated.11 In addition, many mentally illindividuals are released with no plan forcommunity-based care.12

Mentally ill offenders are poorly equippedto serve as advocates for their own wel-fare. They often face multiple challenges,including homelessness, unemployment,estrangement from family and friends,substance abuse, and other serious healthconditions such as HIV/AIDS, tuberculo-sis, and hepatitis.13 In turn, community-based providers often find mentally illoffenders challenging to serve becauseof their “coexisting conditions, noncom-pliance, criminal records, unkemptappearance, and clinically difficult andchallenging presentation.”14 Consequently,mentally ill individuals may cycle repeat-edly through the health, mental health,social service, and criminal justice sys-tems, each with its unilateral focus, andnever become stabilized because of a lack

of coordinated care and treatment. This“system cycling” is discouraging to thementally ill offender and costly to thenetwork of community-based providers.

Overview of MCCJTPAfter years of study and discussion, localcorrections officials in Maryland workedwith others in local government, withState officials, and with representativesfrom the private sector to create MCCJTP.In various stages of implementation in 18of the State’s 24 local jurisdictions,15

MCCJTP brings treatment and criminaljustice professionals together to screenmentally ill individuals while they areconfined in local jails, prepare treatmentand aftercare plans for them, and providecommunity followup after their release.The program also offers services to men-tally ill probationers and parolees andprovides enhanced services to mentally illoffenders who are homeless and/or haveco-occurring substance use disorders (see“MCCJTP: At the Forefront of Efforts toAid Mentally Ill Offenders,” page 4).

MCCJTP targets individuals 18 or olderwho have a serious mental illness (i.e.,schizophrenia, major affective disorder,organic mental disorder, or other psy-chotic disorders), with or without a co-occurring substance use disorder. It isfounded on two key principles:

● The target population requires acontinuum of care provided by avariety of service professionals injail and in the community that iscoordinated at both the State andlocal levels. In this regard, agencyparticipants include local mentalhealth and substance abuse treatmentproviders and advocates, local hospitalprofessionals, housing providers,

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services that link detainees, on release, tocommunity services are seldom providedin jails of any size.”c MCCJTP is a clearexception to this trend.

● Long-term housing support for homelessmentally ill offenders. According toSteadman, “Rarely do you see housing asa part of a jail/criminal justice program formentally ill or substance abusing indi-viduals. You may see some use of short-term housing vouchers but not the full-scale commitment Maryland has made.”

● Focus on co-occurring disorders. “Officialsin Maryland,” Steadman noted, “have rec-ognized that co-occurring disorders are thenorm and not the exception.” In his opinion,that awareness and the State’s related pro-grammatic response set MCCJTP apart frommany of its counterparts across the Nation.

Notes

a. GAINS = G–Gathering information,A–Assessing what works, I–Interpreting thefacts, N–Networking with key stakeholders,S–Stimulating change.

b. Steadman, H., and Veysey, B., ProvidingServices for Jail Inmates With Mental Disorders,Research in Brief, Washington, DC: U.S. Depart-ment of Justice, National Institute of Justice, April1997, NCJ 162207, page 1.

c. Ibid, 2.

Efforts to comprehensively address the needsof the jailed mentally ill are still relativelyrare. According to a nationwide survey of jailsconducted by researchers at the NationalGAINSa Center for People With Co-OccurringDisorders in the Justice System (see “Sourcesfor More Information” at the end of this re-port), “most jails have no policies or proce-dures for managing and supervising mentallydisordered detainees.”b

Henry Steadman, one of the study’s authorsand a renowned expert on responses to men-tally ill offenders nationwide, believes thefeatures that set MCCJTP apart from mostother efforts include:

● Strong collaboration between State and lo-cal providers. “Typically, States don’t coor-dinate anything in these efforts,” Steadmanobserved. “In addition, it is very rare for theState to do something that the county isreceptive to without usurping county author-ity. It is usually left to the county to addressthe needs of the jailed mentally ill. Theintegration of funding streams at the differ-ent levels of government and the ongoingcommitment by State officials involved inMCCJTP make the program unique.”

● Transitional case management servicesthat link detainees with community-basedservices. Based on their survey of jails na-tionwide, Steadman and his coauthor, BonitaVeysey, concluded that “case management

members of local law enforcement,and representatives of key State crimi-nal justice, mental health, and sub-stance abuse agencies.

● Local communities are in the bestposition to plan and implementresponses to meet the needs of thementally ill offenders in their juris-dictions. To that end, each participat-ing jurisdiction has developed a localadvisory board to oversee the conductof needs assessments, coordinate pro-gram implementation, monitor servicedelivery, and expand program options.

MCCJTP’s goals are to improve the identi-fication and treatment of mentally ill of-fenders and increase their chances ofsuccessful independent living, therebypreventing their swift return to jail, mentalhospitals, homelessness, or hospital emer-gency rooms. In some locations, MCCJTPalso aims to reduce the period of incarcera-tion (through postbooking diversion) andeven reduce the likelihood of incarcerationaltogether (through prebooking diversion).

According to data maintained by the Mary-land Department of Health and Mental Hy-giene, almost 1,700 mentally ill individualsreceived services through MCCJTP in 1996(see “The Mentally Ill in Maryland Jails,”page 5). Funding for the 18 programs totalsapproximately $4 million annually andcomes from local, State, and Federalsources. In addition, many agencies contrib-ute administrative time and support services(see “MCCJTP Funding,” page 5).16 Thefunding supports the provision of case man-agement services in each jurisdiction andother specialized services such as housing tomeet the needs of mentally ill offenders.

This Program Focus reviews the history ofMCCJTP, describes key program features,

MCCJTP: At the Forefront of Efforts toAid Mentally Ill Offenders

and discusses the benefits of and chal-lenges to program operation.

The Roots of theProgramIn the early 1990s, an estimated 600 to 700mentally ill offenders were confined in localcorrectional facilities throughout Maryland.17

Because they lacked sufficient numbers ofappropriately trained staff to screen and treatthe mentally ill, jails were neither sensitive,nor especially safe, places for most mentallyill individuals. In those days, according toseveral local corrections officials, the spe-cial needs of mentally ill offenders were

generally ignored unless such individualswere suicidal or disruptive. The disruptiveones were usually “locked down,” but notuntil staff had spent considerable time incrisis management, trying to subdue them ornegotiate with mental health agencies foremergency commitments. Lacking mentalhealth training, correctional officers werefrustrated and sometimes insensitive in theirhandling of mentally ill offenders, whichexacerbated an already difficult situation.Adding to the concerns of corrections offi-cials was the high rate of recidivism amongmentally ill offenders (see “Assessing Ser-vice Needs,” page 6). One frustrated formerwarden of a detention facility in southern

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Maryland, who has since become a strongadvocate of MCCJTP, admits having askedpublicly about the mentally ill offenders in hisjail, “Can’t we shoot them up with somethingand just keep them asleep while they’re here?”

In 1991, at the request of the MarylandCorrectional Administrators Association, theGovernor’s Office of Justice Administration(GOJA) formed an interagency State andlocal task force to help define a strategy forresponding to mentally ill offenders in theState. After careful review of available na-tional research and reports on the topic byprevious State task forces (see “Building onResearch,” page 7), the GOJA task forceconcluded that offenders with serious mentalillnesses require a coordinated treatmentapproach that combines the expertise ofcriminal justice and treatment professionals.

The Jail Mental HealthProgram pilotThe State’s Mental Hygiene Administration(MHA), part of the Maryland Departmentof Health and Mental Hygiene, assumed

MCCJTP FundingMCCJTP combines Federal, State, and localfunds to offer a mix of services within localdetention centers and in the community.Current program funding includes:

● $900,000 in annual Mental Hygiene Ad-ministration (MHA) funds to hire MCCJTPcase managers.

● $300,000 in annual Projects for Assis-tance in Transition From Homelessness(PATH)a funds for outreach, case manage-ment, mental health, and substance abuseservices for homeless individuals with se-rious mental illness and/or co-occurringsubstance use disorders, and for paroleesand probationers on intensive supervisioncaseloads.

● $340,922 in Edward Byrne Memorial Stateand Local Law Enforcement AssistanceProgram funds to provide substance abusetreatment services in conjunction withmental health services in seven countydetention centers and in the community.

● $5.5 million from the U.S. Department ofHousing and Urban Development (HUD)to provide Shelter Plus Care housing overa 5-year period (1996–2001).

● $6,557,719 in matching funds and ser-vices from jurisdictions participating inMCCJTP, $5.5 million of which supportsthe Shelter Plus Care housing program.

● Administrative and support servicesfrom participating agencies for which costestimates are not available.

Note

a. PATH is part of the Mental Health Services BlockGrant to the States that is overseen by SubstanceAbuse and Mental Health Services Administration’s(SAMHSA’s) Center for Mental Health Services.PATH provides a variety of treatment formula grantawards to the States for homeless people with mentalillnesses and co-occurring substance abuse prob-lems, including treatment, support services in resi-dential settings, and coordination of services andhousing. See “Sources for More Information” at theend of this report for contact information.

primary responsibility for the design andimplementation of a pilot program toaid local detention centers in creating amultidisciplinary response to the jailedmentally ill. In 1993 and 1994, with$50,000 in seed money from MHA, four

pilot Jail Mental Health Programs (prede-cessors to MCCJTP) were launched inCecil, Charles, Frederick, and Wicomicocounties. The pilots resulted in the creationof a system for providing case managementservices to mentally ill inmates.

According to data main-tained by the MarylandMental Hygiene Adminis-tration, 1,682 jailed men-tally ill individuals re-ceived MCCJTP servicesduring 1996. The averagedaily jail population in theMCCJTP sites ranged froma low of 52 to a high of1,362, with a median popu-lation of 237. The propor-tion of jailed individualswho were mentally ill var-ied considerably across the 18 jurisdictions. Forinstance, in the five jurisdictions visited by theauthor, prevalence estimates ranged from 8 to21 percent.a

The following data from Frederick County,taken during a 1-day census in June 1997,indicate the prevalence of mental illness amongthe jailed population there. Of 341 inmates inthe Frederick County Adult Correctional Cen-ter that day, 71 (21 percent) were diagnosedwith 1 or more mental illnesses. Of those, 36

The Mentally Ill in Maryland Jails

(50 percent) had a co-occurring substance usedisorder.

Note

a. National estimates of the percentage of jailed popu-lations with serious mental illness (e.g., schizophre-nia, bipolar disorder, severe recurrent depression)range from 6 to 15 percent, depending on the study andinstitution. See Torrey, E.F., Editorial: “Jails andPrisons—America’s New Mental Hospitals,” Ameri-can Journal of Public Health 85 (12) (December1995): 1612.

Diagnosis Diagnosed Jail Detainees

Number* Percentage

Depressed or Bipolar Disorder 51 72

Schizophrenic Disorder 5 7

Psychotic Disorder 3 4

Other** 17 23

*Some individuals have multiple diagnoses.

** These include: antisocial personality disorder, attention deficithyperactivity disorder, conduct disorders, dissociative disorders,eating disorders, intermittent explosive disorder, learning disorders,obsessive-compulsive disorder, and personality disorders.

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Assessing Service NeedsFrom 1984 through the early 1990s, local taskforces and MHA staff studied the capacity ofexisting service delivery mechanisms to meetthe needs of mentally ill offenders and discov-ered the following:

● Most detention centers had extremelylimited access to mental health profes-sionals. Jail medical staff were generallynot trained to address both the medical andpsychiatric needs of inmates. If available,psychiatric services were limited to a fewhours per week or month, when only themost severe cases could be evaluated. Jailofficials also experienced considerabledifficulty with the mental health systemwhen trying to relocate individuals whosemental illness appeared to warrant admis-sion to a State mental institution. Both in-jail and community-based services werebeing compromised by the lack of properstaff to screen mentally ill offenders, pro-

vide other supportive services within jail,prepare discharge plans, and offer com-munity-based followup.

● Mentally ill individuals had a high rateof recidivism. Mentally ill offenders ap-peared to return quickly to correctionalsettings at least in part because of the lackof appropriate aftercare planning and ser-vices in the community. In addition, manymentally ill offenders were homelessand/or had co-occurring substance usedisorders that increased the likelihood oftheir return to jail.

● Mentally ill offenders tended to cyclethrough a variety of criminal justice andpsychosocial service settings, in part be-cause of the lack of coordination amongservice providers. A survey by MHA staffof 536 individuals housed in detention cen-ters, State psychiatric hospitals, homelessshelters, and substance abuse clinics showed

that during the previous 12 months, 54percent had been in jail, 36 percent hadreceived inpatient hospitalization, 35 per-cent had used an emergency shelter, and33 percent had seen a substance abusecounselor.a Investigators concluded thatbetter service coordination was warrantedto reduce duplication in services, stabilizementally ill offenders in the community,and prevent their return to jail.

These findings strongly suggested the need todesign a program that would increase servicesfor mentally ill offenders, coordinate servicesalready in existence, and support mentally illoffenders in the community.

Note

a. Gillece, J., “An Analysis of Health, CriminalJustice, and Social Service Utilization by Individu-als Hospitalized, Incarcerated, or Homeless,”unpublished doctoral dissertation, College Park:University of Maryland, 1996: 52.

Within a short amount of time, thoseinvolved in the Jail Mental Health Pro-gram began reporting improved identifi-cation of the jailed mentally ill, enhancedcommunication between mental healthand corrections staff, and reduced disrup-tions associated with mentally ill inmates(see “Screening Mentally Ill Offenders inCharles County,” page 8).

Fourteen additional counties have sincedeveloped similar programs to respond tomentally ill offenders. Over time, thefocus of the Jail Mental Health Programhas expanded to include greater use ofcommunity-based services and diversion.In addition, mentally ill probationers andparolees have been added to the clientbase. The program’s title was changed tothe Maryland Community Criminal JusticeTreatment Program in 1994 to reflect itsbroader scope.

Key Features ofMaryland’s Coordi-nated ApproachImmediately after Ray Carver was referredfor a mental health screening, the MCCJTPcase manager reviewed his history of men-tal illness and referred him for medication.

She counseled Ray throughout his stay atthe detention center, and together theydeveloped a treatment and aftercare planfor him that included taking his medica-tion, participating in treatment for alco-holism, reinstating his SupplementalSecurity Income benefits, locating hous-ing, and participating in the day program

Case managers, MCCJTP clients, and other consumers at Go-Getters, Inc., a psychiatricday treatment program in Wicomico County, MD, share free time between classes.

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at Go-Getters, Inc., a local psychiatricrehabilitation center and partner agencyof MCCJTP.

The case manager discussed Ray’s crimi-nal charges with his public defender, theassistant State’s attorney, and the districtcourt judge. Ray pled guilty and wassentenced to a year’s probation. Severalcomponents of the treatment plan, whichhe signed in the presence of the judge,were included as conditions of Ray’sprobation.

Because he was homeless before his incar-ceration and willing to quit drinking andparticipate in daytime activities at Go-Getters, Inc., Ray qualified for housingassistance through the Shelter Plus Caregrant awarded to Maryland’s Departmentof Health and Mental Hygiene by theFederal Department of Housing and Ur-ban Development. Prior to Ray’s release,the MCCJTP case manager helped Raycomplete an application for Shelter PlusCare housing, and a representative fromHudson Health Services, another partneragency of MCCJTP, located an apartmentfor Ray in a relatively low-crime area oftown, just a few blocks from Go-Getters.The furnishings for Ray’s apartment—asofa, bed, table, and chair—were donatedby local church and community organiza-tions and moved to the apartment by twoof the detention center’s work releaseinmates.

On the day he was released from jail,Ray’s MCCJTP case manager spent theday helping him get settled in his newapartment. Together, they stocked Ray’srefrigerator, met with the psychiatrist atthe County Health Center, and visitedGo-Getters, where Ray was assigned acase manager.

During the past decade, a number of re-searchers have recommended strategies forresponding to the needs of the jailed men-tally ill, all of which have been carefullyintegrated into MCCJTP.

Specifically, MCCJTP’s grounding prin-ciple—that communities must provide a con-tinuum of care for mentally ill offenders—isconsistent with 1990 research that concludesthat the mental health needs of inmates mustbe viewed as a community problem requiringthe involvement of an array of service provid-ers in addition to detention center staff.a

Although sites around the Nation differ intheir approach to such service coordination,b

a 1992 review of research and practice recom-mended that the following key elements, whichare central features of MCCJTP, be part of anymultidisciplinary response to the jailed men-tally ill:

● Interagency agreements.

● Consensus on defined goals.

● Delineation of responsibilities.

● Interagency communication.

● Cross-training.

● Ongoing program review.c

In a 1995 discussion of strategies for divertingthe mentally ill out of criminal justice set-tings, researchers called for:

● Integrated services.

● Regular meetings of key agency repre-sentatives.

● “Boundary spanners” (individuals who canfacilitate communication across agenciesand professions) to coordinate policiesand services.

● Strong leadership.

● Early identification of the mentally ill incorrectional settings.

● Distinctive case management services.d

More recently, a 1997 study suggested thattraditional jail-based mental health strate-gies should include court liaison mecha-nisms, pre- and postbooking diversion, andthe use of community mental health ser-

vices (e.g., university resources), especiallyin small jails.e

Some research suggests that services for thejailed mentally ill should also include:

● Screening, classification, and referral.

● Crisis intervention.

● In-jail counseling.

● Discharge planning and communityfollowup.

● Specialized services for subgroups of men-tally ill offenders, such as those who arehomeless and/or have co-occurring sub-stance use disorders).f

Notes

a. Steadman, H.J. Effectively Addressing the MentalHealth Needs of Jail Detainees, Washington, DC:U.S. Department of Justice, National Institute ofJustice, 1990: 3.

b. Ibid., 3.

c. Landsberg, G. “Developing Comprehensive MentalHealth Services in Local Jails and Police Lockups,” inInnovations in Community Mental Health, ed. S.Cooper and T.H. Lentner, Sarasota, FL: ProfessionalResource Press, 1992: 97–123.

d. Steadman, H.J., S.M. Morris, D.L. Dennis, “TheDiversion of Mentally Ill Persons From Jails toCommunity-Based Services: A Profile of Pro-grams,” American Journal of Public Health (De-cember 1995): 1631.

e. Steadman, H.J., and B. Veysey, Providing Servicesfor Jail Inmates With Mental Disorders, Research inBrief, Washington, DC: U.S. Department of Justice,National Institute of Justice, April 1997.

f. Steadman, H.J., D.W. McCarty, and J.P. Morrissey,The Mentally Ill in Jail: Planning for Essential Ser-vices, New York: Guilford Press, 1989; Dvoskin, J.,“Jail-Based Mental Health Services,” in Steadman,Effectively Addressing the Mental Health Needs of JailDetainees, 64–90; Landsberg, G., “Developing Com-prehensive Mental Health Services in Local Jails andPolice Lockups”; Center for Mental Health Services,Double Jeopardy: Persons With Mental Illnesses in theCriminal Justice System, Report to Congress, Wash-ington, D.C.: Substance Abuse and Mental HealthServices Administration, Center for Mental HealthServices, February 1995; Abram, K., and L. Teplin,“Co-Occurring Disorders Among Mentally Ill JailDetainees,” American Psychologist (October 1991):1042–1044.

Building on Research

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Screening MentallyIll Offenders inCharles CountyWhen corrections officials in the CharlesCounty Detention Center met with MHAstaff to begin the county’s Jail Mental HealthProgram pilot, they were confident that onlythree mentally ill individuals were housed inthe jail. But screening by trained mental healthstaff resulted in 17 inmates being diagnosedas seriously mentally ill. Among them was anindividual who was also deaf. Frustrated byhis bizarre behavior, but unaware of his deaf-ness, correctional officers had been speakingloudly to him for days and were becomingincreasingly annoyed by his unresponsive-ness. MHA staff were able to diagnose theinmate and, working with corrections staff,assist in relocating the individual to a securemental health facility.

Months later, when the man again arrived atthe jail, staff were prepared. The protocolthat had been developed through the JailMental Health Program ensured that theinmate was identified quickly, placed onmedication, moved swiftly through the cer-tification process, and transferred to a Statemental hospital.

For the first month after Ray’s release, theMCCJTP case manager checked in on Rayseveral times a week. As Ray became moreinvolved in community-based services, theMCCJTP case manager’s involvementtapered off. She monitors Ray’s progresswith his case manager at Go-Getters andother service providers and is on-call in theevent of a crisis.

As Ray’s experience suggests, MCCJTPincorporates key features listed below anddescribed more fully in the sections thatfollow:

● Local partnerships to aid mentally illoffenders.

● Support from State governmentagencies.

● A broad range of case managementservices for mentally ill offenderswho are incarcerated or living in thecommunity.

● Enhanced services for mentally illoffenders who are homeless and/orhave co-occurring substance usedisorders.

● Diversion strategies.

● Training for criminal justice and treat-ment professionals involved in theprogram.

● A commitment to program evaluation.

Local partnershipsEach MCCJTP program is guided by alocal advisory board that assesses serviceneeds, monitors program implementation,and investigates ways to expand programservices. Although board membershipvaries across the counties, it generally

includes representatives from the localdetention center, as well as health andmental health professionals, alcohol anddrug abuse treatment providers, publicdefenders, assistant State’s attorneys,judges, parole and probation officers,law enforcement personnel, social serviceprofessionals, local hospital staff, housingspecialists, mental health advocates, andconsumers. Additional members are re-cruited as particular service needs (e.g.,for diversion) are identified.

In most counties the advisory boards di-vide their time between reviewing specificcases and setting or refining policy. Inmost jurisdictions local health departmentsor related agencies coordinate MCCJTPand supervise the mental health staff as-signed to the program. Other governmentagencies and private organizations havesigned memorandums of understanding(MOUs) delineating their participation inlocal advisory boards and their willingnessto provide services as appropriate.

These formal agreements are thought to beessential to ensure the smooth execution

Local and State officials convene the monthly meeting of the Task Force on CommunityCriminal Justice Treatment, the advisory council for Wicomico County’s MCCJTP.

of local policies. In addition, workingtogether to handle specific cases hasreportedly been extremely beneficialto solidifying relationships among

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participating agencies andorganizations. As programparticipants have been able tosolve the needs of specificmentally ill offenders, mutualtrust has grown and formalorganizational agreementshave evolved. ShelleyMcVicker, assistant State’sattorney in Frederick County,recalls, “At first we worked outrelationships with others in the[MCCJTP] network on a case-by-case basis. Then we workedon organizational MOUs. TheState’s involvement has helped us cementthe relationships.”

In addition, the willingness of communitytreatment providers to provide honestfeedback to the criminal justice systemabout offenders’ compliance has resultedin support from criminal justice profes-sionals for placing mentally ill offendersin the community. According to McVicker,“My office has a good relationship withWay Station [a local psychiatric rehabilita-tion facility participating in MCCJTP].They share information honestly aboutthose who stay in treatment and thosewho don’t. When necessary, we are ableto work together to define reasonableconsequences.”

Support from StategovernmentA number of State agencies have madestrong commitments to local MCCJTPprograms. In 1994, in an effort to betterserve mentally ill offenders, MHA ex-panded its priority population to includeMCCJTP participants and gave thoseindividuals the same access to MHA-funded services and housing as personsdischarged from MHA inpatient facilities.

Other State agencies, including the Divi-sion of Parole and Probation and the Alco-hol and Drug Abuse Administration, madeformal commitments to ensure the partici-pation of their local representatives inMCCJTP.

MHA’s Division of Specific Populationshas primary responsibility for supportingMCCJTP, providing nearly $1 million inannual funding for the program. In addi-tion, MHA staff have worked coopera-tively with local decisionmakers toprepare grant proposals for other types ofFederal, State, and local funding to en-hance program services and create oppor-tunities for local MCCJTP participants toreceive technical assistance and trainingfrom the National Institute of CorrectionsJails Division and from the NationalGAINS Center for People With Co-Occurring Disorders in the Justice System.18

MHA staff have also been quick to ad-dress issues that cannot be resolved easilyat the local level (e.g., regarding inmateswho require competency hearings oremergency commitment to State mentalhospitals). In addition, MHA staff regu-larly participate in meetings of localMCCJTP advisory boards and the Mary-

land Correctional Adminis-trators Association. Alongwith wardens and other localadvisory board members,MHA staff have met on sev-eral occasions with countycouncils to discuss the meritsof MCCJTP and seek localfunding for program en-hancements.

Case managementservicesEach MCCJTP jurisdiction

employs at least one case manager who isresponsible for screening mentally illindividuals while they are jailed, counsel-ing them while they are detained, helpingthem develop discharge plans, assistingthem in obtaining services in the commu-nity, advocating for them with criminaljustice officials and community-basedservice providers, and monitoring theirprogress following release (even if theircriminal charges are dismissed).

MCCJTP case managers also help linkmentally ill offenders on intensive proba-tion or parole with community-basedservices and monitor their progress fol-lowing release. Although most mentallyill offenders in the program are contactedin detention centers, some are not. Forexample, parolees from the State prisonsystem may be referred to an MCCJTPcase manager by prison or parole officialsvia MHA, or they may refer themselvesfollowing release.

In most jurisdictions, county health de-partments or equivalent government agen-cies receive up to $50,000 per year fromMHA to hire a full-time MCCJTP casemanager who is an experienced mentalhealth professional with an advanced

An MCCJTP case manager assists jail personnel in booking aninmate with potential psychological problems.

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10 National Institute of Justice

degree in counseling. In some jurisdic-tions, a portion of the $50,000 is used toincrease psychiatric treatment time in jail.Administrative support and supervisoryhours are usually contributed by therecipient agency.

According to MHA, the average MCCJTPcaseload is 35 clients, but caseload sizeranges from 10 to 56 depending on thejurisdiction and the number of clientssupervised in the community. In somesettings, following a period of close super-vision by the MCCJTP case manager,community-based case managers from

government or private-sector mental healthorganizations assume primary responsibil-ity for monitoring released individuals,which reduces the supervisory responsibili-ties of the MCCJTP case manager.

Though adaptations are necessary to ac-commodate local needs and service capa-bilities, each participating jurisdictionadheres to the following general casemanagement protocol:

Identification. Preliminary identificationof candidates for program services is madefollowing arrest, after self-referral by the

The warden of the Wicomico County Detention Center meets with the MCCJTP casemanager to discuss legal issues related to an inmate’s care and treatment.

defendant, or as a result of referrals by thearresting officer, the classification officer,jail medical staff, the substance abusecounselor, or other jail personnel.

Screening and needs assessment. TheMCCJTP case manager meets with thecandidates to conduct an in-jail diagnosticinterview and an individual needs assess-ment. If an individual qualifies for pro-gram services, he or she may be referredfor medication.

Counseling and discharge planning.While in jail, the mentally ill defendantmeets with the case manager for counsel-ing and development of an aftercare plan.A typical plan will include mental healthand substance abuse counseling, educa-tional services, recreational activities,employment training, and housing place-ment. Before the individual is released,the MCCJTP case manager and, in somecases, a residential rehabilitation specialistwork to identify suitable housing.

Criminal justice system liaison. TheMCCJTP case manager also meets withassistant State’s attorneys and defensecounsel to advocate for the swift resolu-tion of criminal charges (e.g., throughdiversion or plea negotiation) and for thereturn of the MCCJTP client to the com-munity whenever possible. These negotia-tions usually succeed when criminalcharges are relatively minor because theMCCJTP case manager is able to ensureclose supervision of the mentally ill of-fender in the community and the quick,honest reporting of any problems.

Referral and monitoring in the commu-nity. For those who agree or are requiredto participate in community followup,19

MCCJTP case managers help link clientsto specified services, such as psychiatric

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day treatment, substanceabuse treatment, vocationalrehabilitation, and educationalservices. In addition,MCCJTP case managers meetregularly with community-based providers to monitorclient progress.

MCCJTP’s community-basedpartners are essential to theimplementation of aftercareplans. In some jurisdictions,released individuals are ableto participate in day-treatmentprograms offered by localpsychiatric rehabilitationcenters. These programs offeran array of work opportuni-ties, skills developmentclasses, substance abusecounseling, and housing assis-tance. They may also assigna case manager to work withthe mentally ill offender inthe community. In other loca-tions, a mix of providers offerthese services.

Enhanced servicesState and local MCCJTPparticipants have becomeincreasingly aware of theneed to address certain sub-populations of mentally illoffenders, including homelesspersons and those with co-occurring substance use disorders. Stateand Federal grant funds are being used toenhance the response to individuals inthese groups.

Homeless mentally ill offenders. In 1995,MHA was awarded a $5.5-million ShelterPlus Care grant by HUD to provide rentalassistance for up to 5 years to homeless

mentally ill offenders served by MCCJTP.20

In turn, local service providers participat-ing in MCCJTP have pledged to provideservices such as vocational training, sub-stance abuse treatment, and life-skillstraining to ensure that Shelter Plus Carerecipients have access to meaningful day-time activities.

An MCCJTP case manager helps a jailed inmate develop anaftercare plan.

A case manager and an MCCJTP client review the rules forShelter Plus Care housing.

Shelter Plus Care applicants areeligible to receive the equiva-lent of the fair market rate forrent and utilities in the jurisdic-tion where they live, providedtheir incomes do not exceed thepredetermined ceiling for thecounty of residence, they agreeto pay up to one-third of theirincomes in rent, and they par-ticipate in fulfilling the com-ponents of their MCCJTPtreatment plans. Shelter PlusCare recipients may live aloneor with a roommate. In situa-tions involving families, thespouse and/or children are alsoeligible for housing as long asthe adult receiving the assis-tance will aid in the care andsupport of the children and thefamily’s income does not ex-ceed the ceiling for the county.

The MCCJTP case managerand/or other case managersavailable through community-based service providers areresponsible for developingtreatment plans, gathering docu-mentation of homelessness, andfiling paperwork with the appro-priate county and State mentalhealth offices. In some jurisdic-tions, case managers are alsoresponsible for locating housing.In others, such as Calvert,Frederick, Prince Georges, and

Wicomico counties, where MCCJTP partneragencies work with local realtors, commu-nity-based organizations assume substantialresponsibility for locating housing. Rentalagreements can be made with the tenants orsponsor based, which means that a crediblethird party vouches for the tenant andsigns the lease.

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12 National Institute of Justice

Case managers are responsible for moni-toring tenants to ensure their compliancewith housing agreements and participationin the daily activities outlined in treatmentplans. To assist in this process, each ser-vice provider submits monthly documen-tation of the services clients receive to theMCCJTP case manager.

Program implementation has been remark-ably smooth. By all accounts, landlordshave responded favorably to the program.They appreciate that it guarantees thatrents will be paid and that tenants will besupervised closely. In addition, there hasbeen no community opposition, probablybecause Shelter Plus Care clients arehoused throughout the community insingle- or double-occupancy dwellings,and because close supervision by casemanagers helps to ensure that client prob-lems are addressed swiftly. Bureaucraticissues such as creating tracking forms,training staff, and developing protocolsfor timely rental payments by State andcounty government agencies have arisen,but are now mostly resolved.

Other issues have emerged as well. First,rental assistance does not cover the costsof such household necessities as furniture,linens, dishes, and utensils. Althoughthese items are often donated by localcharitable organizations, they must bemoved to the housing locations. InWicomico County, detention centerinmates on work release help transportfurnishings, which has proven a cost-effective way to reduce the burden on theMCCJTP case manager. Second, housingis not always located near public transpor-tation. This is especially true in ruralcounties where transportation to daytimeactivities is generally limited. In somelocations, community-based participants

in MCCJTP provide transportation forprogram clients. Third, it is not alwayseasy to guarantee that affordable housingwill be located in relatively crime-freeneighborhoods, though that is certainly thegoal. Finally, in locations where sponsor-based lease agreements are required, someclients’ reputations make it difficult toidentify an organization willing to signtheir lease agreements. Some counties,such as Frederick, have addressed thisconcern by involving multiple sponsorsin the program.

According to MHA, 216 individualsand/or families were placed in Maryland’sShelter Plus Care Housing Program in thefirst 2 years of operation (April 1996 toApril 1998). At the end of the period,nearly 90 percent remained in permanenthousing. Eleven individuals had beenevicted; 7 were rearrested; and 9 left theprogram.

Mentally ill offenders with co-occurringsubstance use disorders. In 1996 MHAreceived nearly $350,000 in EdwardByrne Memorial State and Local LawEnforcement Assistance Program fundsfrom the U.S. Department of Justice’sBureau of Justice Assistance to hire sub-stance abuse and mental health case man-agers to aid dually diagnosed offenders inseven MCCJTP jurisdictions.21 Thesefunds are being used in a variety of ways.For example, Frederick County has hired acase manager who provides treatmentplanning to mentally ill offenders with co-occurring substance use disorders whilethey are confined in the Frederick CountyAdult Detention Center and communityfollowup after they are released. The casemanager also coordinates mental healthservices at the detention center with medi-cal, inmate classification, substance abuse

program, and security staff. In DorchesterCounty, a full-time case manager is in-volved in treatment of dually diagnosedinmates; Kent County uses its funds forcommunity followup of dually diagnosedclients.

Other counties that do not receive Byrnefunding have taken steps to ensure thatmental health services are coordinatedwith their jails’ substance abuse treatmentproviders. Substance abuse treatmentprofessionals in the jails report that, as aresult of MCCJTP, mentally ill offenders,who often went undiagnosed or untreatedin the past, can now benefit more fullyfrom substance abuse services and areless disruptive in substance abuse treat-ment settings.

DiversionIn a number of jurisdictions, diversion isincluded among the MCCJTP’s objectives.Hoping to reduce the length of confine-ment for mentally ill individuals who arearrested for nonviolent offenses,Wicomico County added postbookingdiversion to its bank of program servicessoon after implementing MCCJTP.According to the county’s guidelines,diversion candidates must demonstrate awillingness to participate in the program,and community-based services must beavailable to meet participants’ needs.Individuals with a history of violence orarson are not eligible for the program.

In a typical situation, the MCCJTP casemanager works with a diversion candidateto develop a treatment plan. The treatmentplan is then discussed with the assistantState’s attorney, the public defender, andthe judge assigned to the case. When allparties agree that diversion is appropriate,

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the judge places the case on the “stet”docket, which leaves it open for 1 year.The defendant is then released to the com-munity to complete his or her treatmentplan. Knowing that released individualswill be supervised closely by the MCCJTPcase manager, judges have reportedly beenactive and enthusiastic participants in thediversion program.

More recently, Wicomico’s MCCJTPadvisory board has focused its attentionon prearrest diversion. In 1996 theWicomico County Detention Center, incollaboration with the county health de-partment, received Edward Byrne Memo-rial State and Local Law EnforcementAssistance Program funds to establish amobile crisis unit. With assistance fromthe GAINS Center, county planners vis-ited mobile crisis programs in Birming-ham, Alabama, and Albany, New York. “Icame back really enthused,” says M. KirkDaugherty, Chief Deputy in the WicomicoCounty Sheriff’s Office, about his visit toAlbany. “It’s always nice to hear from aguy who’s done a program already. Westarted our unit in October of 1997 and it’sbeen very beneficial.”

Staffed by a deputy sheriff and two casemanagers (one on call 24 hours a day; oneworking 2–10 p.m.), Wicomico’s mobilecrisis unit is always available to help thesheriff’s office identify the most appropri-ate placement for mentally ill individuals.If law enforcement officers responding toan incident involving a mentally ill persondetermine that criminal charges do not needto be filed, other options (e.g., for shelter oremergency room evaluation) are pursued.The case manager accompanies the men-tally ill individual to the agreed-upon desti-nation, thereby relieving law enforcementofficers of time-consuming interactionswith the health and mental health systems

Participants in an art class at Go-Getters, Inc., a psychiatric day treatment program inWicomico County, MD.

and ensuring that the mentally ill individualhas a mental health advocate at his orher side.

Commenting on the kinds of situationsthat prompt calls to the mobile crisis unit,Daugherty says, “Down here, citizens callthe police for everything—marriage coun-seling—the whole gamut. In situationsinvolving the mentally ill, there may notbe a crime, but an emergency petition [tothe court to send someone to a State men-tal health facility] probably won’t workeither. For instance, one time we had aguy who wasn’t taking his meds and wasvery depressed, but there was nothing wecould do. The hospital wouldn’t take him.So we called mobile crisis and they re-lieved our people and surely made thefamily feel a whole lot better. I like it[mobile crisis] as a safety net. It gives ourpeople more confidence that the [mentallyill] person won’t do anything crazy whenwe’re gone. It’s a very valuable tool.”

TrainingProviding training for both criminal jus-tice and mental health professionals isa key objective of most local advisoryboards and MHA. With assistance fromthe GAINS Center and the VirginiaAddictions Technology Transfer Center,MHA offers regional cross-trainings forprofessionals involved in the criminaljustice, mental health, and substanceabuse treatment systems. The aim ofthese trainings is to have professionalsfrom the three disciplines learn eachother’s terminology and understand eachother’s job duties, roles, and responsibili-ties. Individual counties have also partici-pated in training and technical assistanceoffered by the GAINS Center and theNational Institute of Corrections JailsDivision. In addition, some counties havedeveloped their own training modules.

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14 National Institute of Justice

Program evaluationDuring the past 4 years, State and localplanners have concentrated on programdevelopment; with funding from twoFederal grants, they are now able to focusattention on evaluating service deliveryand client outcomes.

Creating a client tracking system andresearch database. Eight pilot jurisdic-tions are working with MHA staff andresearchers at the University of Marylandat Baltimore to develop a client-trackingsystem that will assess service provisionand individual client outcomes.22 Afterhelping to create a uniform data-collectioninstrument, MCCJTP case managers ateach pilot site began entering data in April1998. The database will include intake,aftercare planning, and community follow-up information on each MCCJTP client.23

It will provide data on the characteristicsof clients who receive MCCJTP services;the types and amounts of services MCCJTPclients actually use, both in jail and in thecommunity; the costs of services; andchanges in client circumstances within thejail and in the community (e.g., regardinghousing, employment, psychiatric hospi-talization, arrest, or substance abusetreatment).

Studying the prebooking diversion ofmentally ill women offenders. In July1998 Wicomico County launched an ex-perimental prearrest diversion program forwomen with co-occurring severe mentalillness and substance use disorders whoface arrest for a misdemeanor or nonvio-lent felony offense. The program is one ofnine research programs funded nationallyby SAMHSA’s Center for SubstanceAbuse Treatment and Center for MentalHealth Services. Called the Phoenix

Project, Wicomico County’s programbuilds on MCCJTP networks to offer 24-hour mobile crisis services, secure crisishousing for women and their children, anintegrated outpatient treatment program,case management services with client-to-staff ratios of 20 to 1, and transitionalhousing for women and their children.

Participants in the study are being as-signed randomly to the prebookingintervention or to the standard MCCJTP(postbooking) services available throughthe Wicomico County Detention Center.Women in the intervention group arebeing recruited into the program prior toarrest but after determination by law en-forcement officers that a complaint ischargeable as a misdemeanor or nonvio-lent felony. Interview data on women inthe intervention group will be comparedwith similar data collected from womeninvolved in the county’s postbookingMCCJTP program. Both process andoutcome data will be analyzed to evaluateservice provision and client-level out-comes (i.e., recidivism, use of treatmentand support services, residential stability,time spent with children, psychiatricsymptomology, and level of substanceuse). Additional analyses involving thepre- and postbooking samples will focuson individual recovery processes, costs,and child outcomes (i.e., social and behav-ioral functioning and self-concept).

Sustaining Funding:An Ongoing ChallengeWith its substantial base of State and Fed-eral funding and with matching funds andin-kind services from many local provid-ers, MCCJTP has been able to serve a

large number of mentally ill offenders injail and in the community. But sustainingfinancial support is an ever-presentchallenge.

A key concern is whether local govern-ments will, in the future, assume responsi-bility for funding services that are nowprovided with Federal grant monies. Inthis regard, some MCCJTP advisory boardmembers believe that program evaluationwill be essential in persuading local legis-lators to make a financial commitment toMCCJTP.

A second concern is that MCCJTP fundsfrom MHA have remained capped at$50,000 per site since the Jail MentalHealth Program pilots were launched in1993. Yet with increased costs due toinflation, and with improved identificationof mentally ill offenders, those fundscover less of the actual program expenseseach year, resulting in increased adminis-trative burdens for participating agencies.Thus far, those agencies have determinedthat the increases in efficiency and theimproved care provided by MCCJTPoffset any additional operating expensesit creates.

Finally, like many other States, Marylandhas adopted a managed public mentalhealth care system. Prior to its implemen-tation in July 1997, some State and localMCCJTP participants expressed concernthat indigent clients might be “lost” in thenew fee-for-service system and that com-pensation might not be adequate to allowproviders to respond to the diverse—andoften extreme—needs of mentally ill of-fenders. Some feared that if services weresubstantially reduced, mentally ill offend-ers would be sent back into local detentioncenters and mental institutions.

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So far, there is reason for optimism.Because MHA has continued to providegrant funds for MCCJTP, which offerssupport services that are not covered undermanaged care (i.e., screening and casemanagement services for jailed mentallyill inmates and community followup forreleased offenders), mentally ill offendersdo not experience interruptions in treat-ment. When mentally ill offenders arereleased from jail, they are linked immedi-ately with community-based mental healthcare providers, ensuring a smooth transi-tion to the managed care system. MCCJTPcase managers and other providers in-volved in the program then continue towork together to provide mentally illoffenders with the full complement ofcommunity-based services they require.

Tallying theAccomplishmentsRay Carver smiles as he prepares a pot ofspaghetti in his apartment. He is proudthat he has food in his refrigerator and asafe place to live. Out of jail for 6 months,Ray now works in the kitchen at Go-Gettersand participates in life- and social-skillsclasses there. He is also preparing for hisgeneral equivalency diploma. He attendsAlcoholics Anonymous meetings nightlyand has regular appointments with a psy-chiatrist at the county health center. Hereports monthly to his probation officer.Ray appreciates the support that he hasreceived from his MCCJTP case managerand other program participants, saying,“In 45 years, this is the only time thatpeople have really cared—have helpedme, believed in me, and really supportedme. I was tired of the life I was living, but

before this, I had no one to turn to for realhelp.”

When the MCCJTP pilot programs werelaunched in 1993, program planners hadseveral goals. By improving the treatmentof mentally ill offenders in jails and in thecommunity, they hoped to improve thequality of care those offenders received,decrease the disruption mentally ill of-fenders created in correctional and com-munity settings, reduce “system cycling”by coordinating services, and help men-tally ill offenders live productively in thecommunity. Five years later, through thededication of local advisory boards, thecommitment of case managers and com-munity-based service providers, and thesupport of MHA, jurisdictions throughoutMaryland have constructed a frameworkfor achieving these goals. The result, assummarized by Charlie Messmer, a sub-stance abuse counselor in WashingtonCounty, is that “treatment of mentally illoffenders has become an ‘our’ problemrather than ‘mine’ or ‘yours.’ ”

Perhaps the most dramatic changes haveoccurred in detention centers around theState. Local corrections professionalsreport that early identification and treat-ment have reduced inmates’ disruptivebehavior, training has improved the abilityof correctional officers to identify andrefer mentally ill inmates for screening,and correctional officers now feel sup-ported by treatment professionals in thejail. According to Barry Stanton, Wardenof the Frederick County Detention Center,“These changes have made me feel awhole lot more relaxed. Mentally ill of-fenders are no longer the primary issue onmy desk.”

Other criminal justice professionals havealso benefited from MCCJTP. Judges andassistant State’s attorneys have the assur-ance that treatment plans will be closelymonitored in the community and can relyon case managers for careful assessmentsof community placements and individualperformance. Defense counsels are reas-sured that clients who are confined inlocal detention centers receive better careand treatment than in the past and thatMCCJTP case managers are able to pro-vide information helpful to making deci-sions regarding diversion, pretrial release,and case disposition. Probation and paroleofficers receive support from MCCJTPcase managers, who monitor and report onthe progress of mentally ill clients in ful-filling their aftercare and treatment plans.

MCCJTP appears also to have dramati-cally changed the lives of individual cli-ents. Although only careful evaluation ofservice delivery and case outcomes willdemonstrate whether MCCJTP servicessignificantly reduce recidivism, case man-agers around the State report that someMCCJTP clients have made substantialprogress in improving the quality of theirlives and contributing to the communitiesin which they live. As Maureen Plunkert,a case manager in Wicomico County,remarked, “Amazing personalities arerevealed as these men and women startgetting well.”

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16 National Institute of Justice

Sources for More InformationThe Maryland Department of Health andMental Hygiene’s Division of SpecificPopulations fosters the development of in-novative programs for recipients of mentalhealth services with special needs, such asindividuals with psychiatric disabilities whoare homeless, are in jail but could be appro-priately served in the community, have co-occurring substance abuse disorders, and/orare deaf. The Division of Specific Popula-tions sponsors MCCJTP. For more informa-tion, contact:

Joan GilleceAssistant DirectorDivision of Specific Populations, MentalHygiene Administration201 West Preston StreetBaltimore, MD 21201Telephone: 410–767–6603TTY: 410–767–6539 Fax: 410–333–5402

The National Institute of Justice (NIJ) isthe principal research, evaluation, and devel-opment agency of the U.S. Department ofJustice (DOJ). For information about NIJ’sefforts in corrections and program develop-ment, contact:

Marilyn C. MosesProgram AnalystNational Institute of Justice810 Seventh Street N.W., 7th FloorWashington, DC 20531Telephone: 202–514–6205Fax: 202–307–6256E-mail: moses@ojp.usdoj.gov

The National Criminal Justice ReferenceService (NCJRS) was established by NIJ in1972. It serves as the national and interna-tional clearinghouse for the exchange of crimi-nal justice information. For more informationabout topical searches, bibliographies, cus-tom searches, and other available services,contact:

NCJRSP.O. Box 6000Rockville, MD 20849–6000Telephone: 800–851–3420 (8:30 a.m. to 7p.m. Eastern time, Monday through Friday)E-mail: askncjrs@ncjrs.org

The Bureau of Justice Assistance (BJA), acomponent of DOJ’s Office of Justice Pro-grams, supports innovative programs thatstrengthen the Nation’s criminal justice sys-tem by assisting State and local governmentsin combating violent crime and drug abuse.

BJA primarily makes funding availablethrough the Edward Byrne Memorial Stateand Local Law Enforcement Assistance Pro-gram. Under this program, BJA is authorizedto make formula grants to States and territo-ries, which award subgrants to local units ofgovernment. States are required to contributea 25-percent cash match toward overall fund-ing. For more information, contact:

Mary SantonastassoDirector, State and Local Assistance DivisionBureau of Justice Assistance810 Seventh Street N.W., 4th FloorWashington, DC 20531Telephone: 202–305–2088Fax: 202–514–5956E-mail: santonas@ojp.usdoj.gov

The American Jail Association (AJA) pro-vides regional training seminars, onsite tech-nical assistance, and training materials re-lated to inmate programming, direct supervi-sion, and other corrections topics for a modestfee. The Association also sponsors an AnnualTraining Conference & Jail Expo. Contact:

Stephen J. IngleyExecutive DirectorAmerican Jail Association2053 Day Road, Suite 100Hagerstown, MD 21740–9795Telephone: 301–790–3930Fax: 301–790–2941E-mail: aja@corrections.comWorld Wide Web site: http://www.corrections.com/aja

The National Institute of Corrections (NIC)Jails Division coordinates services to im-prove the management and operation of jailsystems throughout the United States and itscommonwealths and territories. Technicalassistance, training, and information are pro-vided in many areas, including medical andmental health services and suicide preven-tion. For more information on technical assis-tance and training activities, contact:

NIC Jails Division1960 Industrial Circle, Suite ALongmont, CO 80501Telephone: 800–995–6429Fax: 303–682–0469

HUD’s Shelter Plus Care program pro-vides rental assistance in connection withsupport services from other providers tohomeless people with disabilities. The pro-gram allows for a variety of housing choices,such as group homes or individual units,

coupled with a range of supportive servicesfunded by other sources. Grantees must matchthe rental assistance with supportive servicesthat are at least equal in value to the amount ofHUD’s rental assistance. States, local gov-ernments, and public housing agencies mayapply. HUD awards Shelter Plus Care fundsas annual competitive grants. For more infor-mation, contact:

Allison ManningU.S. Department of Housing and UrbanDevelopmentOffice of Community Planning andDevelopmentOffice of Special Needs Assistance Programs451 Seventh Street S.W.Washington, DC 20410Telephone: 202–708–0614, ext. 4497

The Substance Abuse and Mental HealthServices Administration (SAMHSA) is partof the U.S. Department of Health and Hu-man Services. Its mission is to improve thequality and availability of prevention, treat-ment, and rehabilitation services to reducethe illness, death, disability, and cost to soci-ety that result from substance abuse and men-tal illness. SAMHSA comprises the Centerfor Mental Health Services (CMHS), the Cen-ter for Substance Abuse Prevention (CSAP),and the Center for Substance Abuse Treat-ment (CSAT). The Phoenix Project, whichinvolves the pre-arrest diversion of mentallyill women offenders in Wicomico County,MD, is funded jointly by CMHS and CSATunder the Federal Knowledge Developmentand Application Program. For more infor-mation on that program, contact:

Susan SalasinDirector of Mental Health and CriminalJustice ProgramsCenter for Mental Health Services5600 Fishers Lane, Room 11C–26Rockville, MD 20857Telephone: 301–443–6127Fax: 301–443–0541E-mail: ssalasin@samhsa.gov

CSAT Office of Communications andExternal Liaison5600 Fishers Lane, 6th FloorRockville, MD 20857Telephone: 301–443–5052Fax: 301–443–7801

Established in 1995, the National GAINSCenter for People With Co-OccurringDisorders in the Justice System serves asa national locus for the collection and

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dissemination of information about effectivemental health and substance abuse servicesfor people with co-occurring disorders whocome in contact with the justice system. TheGAINS Center is a Federal partnership be-tween NIC and the Office of Justice Programswithin the U.S. Department of Justice andCSAT and CMHS within the U.S. Depart-ment of Health and Human Services. TheGAINS Center is operated by Policy Re-search, Inc., through a cooperative agreementwith the Federal partners that is administeredby NIC. For more information, contact:

The GAINS CenterPolicy Research, Inc.262 Delaware AvenueDelmar, NY 12054Telephone: 800–311–GAINFax: 518–439–7612

Projects for Assistance in Transition fromHomelessness (PATH) is part of the MentalHealth Services Block Grant to the States thatis overseen by SAMHSA’s CMHS. PATHprovides a variety of treatment formula grantawards to States for homeless people withmental illnesses and co-occurring substanceuse problems. Services covered includetreatment, support services in residential set-tings, and coordination of services and hous-ing. For more information, contact:

Center for Mental Health ServicesHomeless Programs Branch5600 Fishers Lane, Room 11C–05Rockville, MD 20857Telephone: 301–443–3706Fax: 301–443–0256

Funded by SAMHSA, the Virginia AddictionTechnology Transfer Center has developed a1-week cross-training curriculum on offenderswith co-occurring disorders. Offered to correc-tions officers, substance abuse counselors, andmental health treatment counselors, the trainingconsists of 15 modules that may be used sepa-rately or in conjunction with each other asneeded. For more information, contact:

Scott ReinerCriminal Justice CoordinatorVirginia Addiction TechnologyTransfer CenterDivision of Substance Abuse MedicineMedical College of Virginia1112 East Clay StreetP.O. Box 980205Richmond, VA 23298–0205Telephone: 800–828–8323Fax: 804–828–9906

NIJ Publications onOffender Health Careand TransitionalServicesThe National Institute of Justice has spon-sored a number of publications related tothe issue of offender health care and tran-sitional services. To get a free copy ofthese publications, write the NationalCriminal Justice Reference Service, P.O.Box 6000, Rockville, MD 20849–6000;call them at 800–851–3420; or send e-mailto askncjrs@ncjrs.org.

Case Management in the Criminal JusticeSystem, Research in Action, 1999 (NCJ173409).

The Women’s Prison Association: Support-ing Women Offenders and Their Families,Program Focus, 1998 (NCJ 172858).

The Delaware Department of CorrectionLife Skills Program. Program Focus, 1998(NCJ 169589).

Chicago’s Safer Foundation: A Road Backfor Ex-Offenders, Program Focus, 1998(NCJ 167575).

Texas’ Project RIO (Re-Integration ofOffenders), Program Focus, 1998 (NCJ168637).

Successful Job Placement for Ex-Offend-ers: The Center for Employment Opportu-nities, Program Focus, 1998 (NCJ 168102).

Providing Services for Jail Inmates WithMental Disorders, Research in Brief, 1997(NCJ 162207).

The Orange County, Florida, Jail Educa-tional and Vocational Programs, ProgramFocus, 1997 (NCJ 166820)

The Effectiveness of Treatment for DrugAbusers Under Criminal Justice Supervi-sion, Research Report, 1995 (NCJ157642).

Evaluation of Drug Treatment in LocalCorrections, Research Report, 1997(NCJ 159313).

The Americans With Disabilities Act andCriminal Justice: Mental Disabilities andCorrections, Research in Action, 1995(NCJ 155061).

Managing Mentally Ill Offenders in theCommunity: Milwaukee’s CommunitySupport Program, Program Focus, 1994(NCJ 145330).

Notes1. Ray Carver’s history is a composite of those

reported to the author in interviews with 14Maryland Community Criminal JusticeTreatment Program participants.

2. Harlow, C.W., Profile of Jail Inmates 1996,Bureau of Justice Statistics Special Report,Washington, DC: U.S. Department of Jus-tice, Bureau of Justice Statistics, April 1998,NCJ 164620. In 1996, there were 507,026jail inmates. Men were less likely thanwomen to have ever been treated for a mentalor emotional problem. The author notes that24 percent of male inmates and 36 percent offemale inmates reported having receivedmental health services.

3. Ibid., 12.

4. Palermo, G.B., M.B. Smith, F.J. Liska, “JailsVersus Mental Hospitals: A Social Di-lemma,” International Journal of OffenderTherapy and Comparative Criminology 35(2) (Summer 1991): 97–106; Judiscak,Daniel L., “Why Are the Mentally Ill inJail?” American Jails (November–December1995): 11–15.

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18 National Institute of Justice

5. National Coalition for Jail Reform, Removingthe Chronically Mentally Ill From Jail: CaseStudies of Collaboration Between LocalCriminal Justice and Mental Health Systems,Rockville, MD: U.S. Department of Healthand Human Services, National Institute ofMental Health, 1984; Janik, J., “DealingWith Mentally Ill Offenders,” Law Enforce-ment Bulletin 61 (7) (July 1992): 22–26.

6. Haddad, J., “Managing the Special Needs ofMentally Ill Inmates,” American Jails 7 (1)(March-April 1993): 62–65; National Coali-tion for Jail Reform, Removing the Chroni-cally Mentally Ill From Jail: Case Studies ofCollaboration Between Local CriminalJustice and Mental Health Systems; TheCenter on Crime, Communities and Culture,Mental Illness in U.S. Jails: Diverting theNonviolent, Low-Level Offender, ResearchBrief, Occasional Paper Series, No.1, NewYork: The Center on Crime, Communitiesand Culture, November 1996.

7. Wilberg, J.K., K. Matyniak, and A. Cohen,“Milwaukee County Task Force on theIncarceration of Mentally Ill Persons,”American Jails (Summer 1989): 20–26; Snow,W.H., and K.H. Briar, “The Convergence ofthe Mentally Disordered and the Jail Popula-tion,” in The Clinical Treatment of the CriminalOffender in Outpatient Mental Health Settings,ed. N.J. Palone and S. Chaneles, New York:The Haworth Press, 1990: 147–162; Torrey,E.F., J. Stieber, J. Ezekiel, S.M. Wolfe, J.Sharfstein, J.H. Noble, and L.M. Flynn,Criminalizing the Seriously Mentally Ill: TheAbuse of Jails as Mental Hospitals, Washing-ton, DC: Public Citizen’s Health ResearchGroup, 1992; Landsberg, G. “DevelopingComprehensive Mental Health Services inLocal Jails and Police Lockups,” in Innovationsin Community Mental Health, ed. S. Cooperand T.H. Lentner, Sarasota, FL: ProfessionalResource Press, 1992: 97–123.

8. See for example, Estelle v. Gamble, 429 U.S.97 (1976); Bell v. Wolfish, 441 U.S. 535,

n.16, 545 (1979); Bowring v. Godwin, 551F.2d 44 (4th Cir 1977).

9. Snow, W.H., and K.H. Briar, “The Conver-gence of the Mentally Disordered and the JailPopulation”; Steadman, H.J., S.M. Morris,D.L. Dennis, “The Diversion of MentallyIll Persons From Jails to Community-BasedServices: A Profile of Programs,” AmericanJournal of Public Health 85 (12) (December1995): 1630–1635. For more information onexisting models for screening and linkingmentally ill jail detainees with community-based services, see Veysey, B.M., H.J.Steadman, J.P. Morrissey, and M. Johnson,“In Search of the Missing Linkages: Continu-ity of Care in U.S. Jails,” Behavioral Sci-ences and the Law 15 (1997): 383–397, inwhich the authors discuss program strategiesin seven city and county jails.

10. Steadman, H., and B. Veysey, ProvidingServices for Jail Inmates With Mental Disor-ders, Research in Brief, Washington, DC:U.S. Department of Justice, National Instituteof Justice, April 1997, NCJ 162207;Muzekari, L.H., E.E. Morissey, and A.Young, “Community Mental Health Centersand County Jails: Divergent Perspectives?”American Jails XI (1) (March–April 1997):50–52.

11. Teplin, L.A., K.M. Abram, and G.M.McClelland, “Mentally Disordered Womenin Jail: Who Receives Services?” AmericanJournal of Public Health 87 (4) (1997):604–609.

12. Steadman and Vesey, Providing Services forJail Inmates With Mental Disorders, 5.

13. Correctional Association of New York,Insane and in Jail: The Need for TreatmentOptions for the Mentally Ill in New York’sCounty Jails, New York: Correctional Asso-ciation of New York, October, 1989; Abram,K., and L. Teplin, “Co-Occurring DisordersAmong Mentally Ill Jail Detainees,” Ameri-can Psychologist 46 (10) (October 1991):

1036–1045; Peters, R.H., W.D. Kearns, M.R.Murrin, and A.S. Donente, “Psychopathol-ogy and Mental Health Needs Among Drug-Involved Inmates,” Journal of Prison andJail Health 11 (1) (Summer 1992): 3–25;Martell, D.A., R. Rosner, and R.B.I. Harmon,“Base-Rate Estimates of Criminal Behaviorby Homeless Mentally Ill Persons in NewYork City,” Psychiatric Services 46 (6) (June1995): 596–601; Gillece, J., “An Analysis ofHealth, Criminal Justice, and Social ServiceUtilization by Individuals Hospitalized,Incarcerated, or Homeless,” unpublisheddoctoral dissertation, College Park: Univer-sity of Maryland, 1996: 2–42.

14. Gillece, J., “An Analysis of Health, CriminalJustice, and Social Service Utilization byIndividuals Hospitalized, Incarcerated, orHomeless,” 4.

15. The following counties participate inMCCJTP: Allegany, Anne Arundel, Balti-more, Calvert, Caroline, Carroll, Cecil,Charles, Dorchester, Frederick, Harford,Kent, Prince Georges, Queen Annes, St.Marys, Washington, Wicomico, and Worces-ter. Several of these commenced programplanning in February 1997.

16. Precise administrative cost figures are notavailable. In each jurisdiction, a portion ofsupervisory, fiscal, and secretarial staff hoursare contributed to support MCCJTP staff.These costs are thought to vary considerablyacross jurisdictions because of variation inpay scales and in the complexity of MCCJTPprograms.

17. Governor’s Office of Justice Administration,Report of the State/Local Criminal Justice/Mental Health Task Force, Baltimore, MD:Governor’s Office of Justice Administration,January 1995: 12.

18. The GAINS Center is run by PolicyResearch, Inc., a not-for-profit branch ofPolicy Research Associates in Delmar, NY,a research firm studying issues in mental

Program Focus 19

PROGRAM FOCUS

health, substance abuse, criminal justice, andhomelessness.

19. As might be expected, not all mentally illindividuals who are counseled in detentioncenters agree to take part in community-based followup. Case managers report thatsome individuals participate only after theyfail repeatedly to make it on their own.

20. To ensure sufficient numbers of participants,the target population was subsequentlyexpanded to include parolees and probation-ers on intensive supervision caseloads andparticipants in PATH, a Federal formulagrant program that funds outreach, casemanagement, mental health, and substanceabuse services for homeless individuals withserious mental illness and/or co-occurringsubstance use disorders.

21. These include Baltimore, Calvert, Caroline,Dorchester, Frederick, Kent, and QueenAnnes counties. The counties provide a25-percent cash match.

22. Seven of the counties—Baltimore, Calvert,Caroline, Kent, Queen Annes, Dorchester,and Frederick—receive Edward ByrneMemorial State and Local Law Enforce-ment Assistance Program funds to aiddually diagnosed offenders. That fundingalso supports the 3-year database develop-ment and research effort. In addition,Wicomico County has been included amongthe pilot sites. Data collection in that countywill aid in the evaluation of the PhoenixProject.

23. The tracking database has three modules. TheIntake Module includes information on eachclient’s demographic characteristics, currentliving situation, family history, employment

and finances, prior alcohol and drug use,alcohol and drug treatment history, priorpsychiatric treatment, medical treatment, andlegal circumstances. Two standardized in-struments—the Multnomah County Commu-nity Abilities Scale, which assesses a client’slevel of social functioning across multiple lifedomains and the Lehman Quality of LifeInterview (TL–30S), which includes objec-tive and subjective measures of quality of lifeacross eight life domains—are also includedin the intake data module. The Service En-counter Module includes information on thetype, amount, and duration of services pro-vided to jail-based clients. This module willsupport analysis of level of services andservice costs. The Aftercare Module includesdata on the aftercare service plan, clientcontacts with referral agencies, and self-reported changes in client circumstances(e.g., in residence, employment, psychiatrichospitalization, arrests, and substance abusetreatment).

About this studyThis Program Focus was written by Catherine Conly, Associate at Abt AssociatesInc. In preparing the report, Ms. Conly met at length with Joan Gillece and otherstaff of Maryland’s Mental Hygiene Administration. She also interviewed officialswho participate in the MCCJTP programs in Allegany, Charles, Frederick, Wash-ington, and Wicomico counties; observed local advisory board meetings; and inter-viewed MCCJTP clients both in jails and in the community. In addition, Ms. Conlyparticipated in a 3-day, multisite cross-training for mental health, substance abuse,and corrections professionals involved in the MCCJTP.

Findings and conclusions of the research reported here are those of the author and do notnecessarily reflect the official position or policies of the U.S. Department of Justice.

All photos courtesy of Gary Marine Photography, Inc., Delmar, MD.

The National Institute of Justice is a compo-nent of the Office of Justice Programs, whichalso includes the Bureau of Justice Assistance,the Bureau of Justice Statistics, the Office ofJuvenile Justice and Delinquency Prevention,and the Office for Victims of Crime.

NCJ 175046 April 1999

This and other NIJ publications can befound at and downloaded from the NIJWeb site (http://www.ojp.usdoj.gov/nij).