NCJA Conference. Focusing on the Mentally Ill: Pre-Trial Diversion, Assessment and Treatment

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1 NCJA Conference Focusing on the Mentally Ill: Pre-Trial Diversion, Assessment and Treatment

2 PCCD: Who we are Established by law in 1978, the Pennsylvania Commission on Crime and Delinquency (PCCD) serves as the justice planning and policymaking agency for the Commonwealth by bringing together diverse and talented stakeholders from local and state criminal and juvenile justice agencies. Members include: judges, prosecutors, law enforcement officers, probation officers, corrections officers, treatment providers, educators, victim service providers, legislators and community members.

3 Commission s Goals To ensure that the Commonwealth s communities are safe. To reduce the impact of crime on victims. To serve as a criminal and juvenile justice center of excellence by providing research, policy, planning, training, technology, and other special outreach and support services.

4 PCCD Allocates State and Federal Monies PCCD allocates and oversees over $100 million in federal and state funds to victims, victim service providers, criminal and juvenile justice agencies, and nonprofit organizations to help communities improve the administration of justice.

5 Criminal Justice Planning One of the primary responsibilities of PCCD is to determine the needs of the criminal and juvenile justice systems, develop and implement policies and procedures to improve the operations of these systems, and support all units of government in their efforts to improve these systems. In order to achieve this goal, PCCD works with local governments in developing plans to address problems dealing with crime and delinquency. PCCD also provides support to counties to develop and implement a team approach to problem solving involving the collaborative efforts of key decision-makers, who possess the authority and responsibility for using and managing county and municipal criminal justice resources.

6 An Identified Problem Police officers, judges, prosecutors, and defense attorneys are seeing increasing numbers of defendants who have serious untreated mental illnesses charged with committing low-level crimes. Traditional court processes do little to improve outcomes for many of these people. They cycle again and again through jail, courtrooms, and our city streets. As of December 31, 2011, the Pennsylvania Department of Corrections housed 51,319 inmates; of those, 48,603 were male inmates and of that number 20.7% were on the mental health roster with 2.2% of them being considered seriously mentally ill. The female population, as of the same date, was 2,716 of which 46.7% were on the mental health roster and 11.4% of those considered seriously mentally ill. County wardens are reporting an even higher percentage of individuals with mental illness coming into their jails.

7 Mental Health and Justice Systems Advisory Committee (MHJAC) In the summer of 2009, the Pennsylvania Commission on Crime and Delinquency (PCCD) and the PA Department of Public Welfare (DPW) established the Mental Health and Justice Advisory Committee (MHJAC). The formation of this multi-disciplinary committee was the Commissions answer to criminal justice and community leaders who asked PCCD to help them address the special needs of repeat offenders diagnosed with mental health disorders. MHJAC works to improve the criminal justice system s response to mentally ill offenders. Reducing recidivism, providing for jail diversionary efforts and improving re-entry programs for individuals diagnosed with mental illness are among MHJAC s priorities. Since its inception, MHJAC serves as a statewide resource, providing insight, funding and expertise to help create effective programs for mentally ill offenders.

8 Mental Health and Justice Systems Advisory Committee (MHJAC) The committee, chaired by Judge Zotolla of Allegheny County, is a true partnership and collaborative effort between state, and local gov t officials, and various associations and advocate groups representing individuals with mental illness. State agencies include: PCCD, DPW, DOC, PBPP, PSP, Supreme Court, JCJC, DOH, AOPC, VA, Victim Advocate, and PCS. Local agencies include: Adult and Juvenile Probation, Common Pleas Court Judges, Wardens, Mental Health Providers, Drug & Alcohol Providers, Reentry Coordinators, Prosecutors, and Local Law Enforcement. Associations and advocacy groups include: NAMI, County Drug and Alcohol Administrators, Housing Alliance, Community Providers, Disability Rights Network, Mental Health Consumers, National Alliance of Mental Illness, Pennsylvania Psychiatric Society, County Commissioners Association, and the Mental Health Association of Pennsylvania.

9 Commission Advisory Committees PA Commission on Crime and Delinquency Established by law in 1978, the Commission on Crime and Delinquency serves as the justice planning and policy making agency for the Commonwealth by bringing together diverse and talented stakeholders from state and local criminal and juvenile justice agencies including; judges, prosecutors, law enforcement officers, probation officers, correction officers, treatment providers, educators, victim service providers, legislators and community members. Mental Health and Justice Advisory Committee (MHJAC) Chair: Honorable John Zottola Criminal Justice Advisory Committee (CJAC) Chair: Mr. Philip Damiani Juvenile Justice and Delinquency Prevention Committee (JJDPC) The Constables & Deputy Sheriffs' Education and Training Boards Victims Services Advisory Committee (VSAC) Research, Evaluation, Data Collection, and Analysis Advisory Committee (REDAAC)

10 PA Center of Excellence (COE)

11 CoE Cross-Systems Mapping Workshops The CoE offers two-day Cross Systems Mapping Workshops to assist county teams in identifying areas where individuals with mental illness may be diverted from or avoid further penetration into the criminal justice system. The underlying benefit of these workshops is that criminal justice and behavioral health practitioners work together to explore the challenges and resources that exist in each of their systems. Though this collaborative process, mutual respect and stronger working relationships are developed. This trust and understanding becomes the foundation for on-going discussions that identify resources, gaps, and system improvement strategies for their local criminal justice and behavioral health systems. To date, the CoE has successfully completed 26 Cross Systems Mapping Workshops and six additional workshops are scheduled across the Commonwealth. PCCD s MHJSAC oversees local grant programs that support initiatives resulting from this planning process.

12 Sequential Intercept Model I. Law Enforcement/Emergency Services II. Post-Arrest: Initial Detention/Initial Hearings III. Post-Initial Hearings: Jail/Prison, Courts, Forensic Evaluations & Forensic Commitments IV. Re-Entry From Jails, State Prisons, & Forensic Hospitalization Munetz & Griffin: V. Community Corrections & Community Support

13 PA Center of Excellence

14 PA Center of Excellence

15 Results of the Cross System Mapping As a result of the cross system mapping effort, counties teams identified the following gaps in services: 1) diversionary programs such as mental health courts, 2) permanent housing, and 3) specialized training for law enforcement officers responding to incidents involving individuals with mental illness. Members of the enforcement for MHJSAC Advisory Committee also indentified Forensic Peer Support Training and Mental Health Procedures Act Training as additional gaps in services. JAG, JAG Stimulus, State Funding from the Department of Public Welfare, and Funding from Philanthropic Organizations has been used to support these initiatives.

16 First Responders Training The CIT model, first developed and implemented by the Memphis Police Department, emphasizes building partnerships among law enforcement, consumers, mental health care providers, family members, and members of the community. This model emphasizes de-escalating tensions at the scene to reduce the need for use of force during these types of encounters. Mental Health First Aid is another option for first responders. This is offered in the form of an interactive 12-hour course that presents an overview of mental illness and substance use disorders in the U.S. and introduces participants to risk factors and warning signs of mental health problems, builds understanding of their impact, overviews common treatments, and provides an Action Plan to address behavioral health challenges. Due to the vast difference in training hours and topics between CIT and MHFA and the diversity of the Commonwealth s training needs, the CoE is assisting PCCD in developing a statewide training deployment strategy.

17 Statewide Forensic Peer Support Program Forensic Peer Support provides peer support to individuals who have been, are in, or are at risk of being in the criminal justice system. The overarching goal of the Forensic Peer Support Program is to reduce the number of individuals with mental illness and/or co-occurring substance use disorders in the criminal justice system in a manner that incorporates recovery oriented principles, values, and practices. This reduction is achieved through the use of welltrained forensic peer support specialists. The CoE developed a Forensic Peer Support Curriculum for statewide implementation. Specialists learned how to assist offenders at various stages in the criminal justice process described by the Sequential Intercept Model, ranging from initial contact with law enforcement authorities through re-entry in the community following incarceration. Throughout this 18-month initiative, 162 individuals received forensic per support training and an additional 43 trainers and five advanced-level facilitators completed training as well.

18 Pennsylvania Department of Corrections (PADOC) Certified Peer Specialist Initiative The PADOC commenced Certified Peer Support (CPS) Specialist training program in six (6) State Correctional Institutions (SCI s) in August All six SCIs completed CPS training by December 2011 resulting in 89 inmates obtaining CPS credentials. DOC staff have reported that since CPS began employment, there have been recognizable decreases among the inmate population diagnosed with mental illness in needing to be placed on psychiatric observation and inmates have become more amenable since having a CPS on the unit. Inmates housed in units with CPS have become more willing to participate in therapy; they are less combative and specifically seek the CPS out to work through issues they are faced with. Inmates that are currently employed as a CPS have demonstrated a strong commitment to provide the best possible assistance they can offer to their peers. They have verbalized having found a new purpose in their lives and through training have come to recognize their own worthiness and value. The PADOC is one of the first state corrections agencies to formally implement a CPS program; accordingly, project staff have visited CPS pilot sites to gather information on what works, best practices sharing, implementation design, and future needs.

19 Mental Health Procedures Act of 1978 (MHPA) The CoE lead a multi-agency effort to offer a statewide training curriculum on Pennsylvania s Mental Health Procedures Act of 1976 (MHPA). This training contributes to the Commonwealth's ongoing jail diversion efforts and promotes uniformity throughout the Commonwealth in terms of the MHPA. Four training sessions were conducted in 2011 in the following areas: Pittsburgh, Philadelphia, Scranton and Harrisburg.

20 Mental Health Symposium Under the judge s guidance, Mental Health Courts use a team approach consisting of prosecutors, defense attorneys, and mental health service providers to connect eligible defendants with community-based mental health treatment in lieu of incarceration PCCD and DPW/OMHSAS held a one-day symposium on mental health courts and related services in the Commonwealth in Approximately 200 people were in attendance. Two existing mental health courts that were currently operating were highlighted. A session addressing the critical issue of housing for people with mental illness who are also involved in the criminal justice system was offered.

21 Mental Health Courts The availability of $1 million in federal and state funds for the implementation of Mental Health Courts was announced at this conference. The COE provided TA to the award recipients in the establishment of their MHC. As a result of these efforts and on-going education and outreach by the MHJSAC, the courts, and the COE, there are 16 Mental Health Courts operating in Pennsylvania. The AOPC has established an accreditation process for these courts and are also in the process of building a case management/tracking system.

22 Veterans Courts Pennsylvania has the fifth highest population of veterans of any state or commonwealth in the country, with a total population of approximately one million. Currently there are 13 Veterans Courts in operation in Pennsylvania with another six courts in the planning stages. Veterans' Treatment Courts use the drug court model to serve veterans struggling with addiction, mental illness and/or co-occurring disorders. These courts promote sobriety, recovery, and stability through a coordinated response that involves cooperation and collaboration with the traditional partners found in Drug and Mental Health Courts, with the addition of the U.S. Department of Veterans Affairs, and the Veterans' Benefits Administration. Unique to Veterans Courts is the volunteer veteran mentor. The Administrative Office of Pennsylvania Courts (AOPC) in partnership with Robert Morris University, developed an on-line training program for Volunteer Veteran Mentors.

23 Housing Symposium To address the lack of suitable and available housing for individuals with mental illness following incarceration, PCCD and DPW/OMSAS hosted a Housing Symposium, in conjunction with the Housing Alliance of Pennsylvania annual Homes Within Reach Conference. This conference afforded PCCD the opportunity to educate potential partners and foster collaborations between landlords and the criminal and behavioral health professionals. The conference had a record attendance of over 700 participants. As a result of the Housing Symposium held in 2011, the Housing Alliance of Pennsylvania is a member of PCCD s MHJAC and are part of the ongoing work and discussion to address homelessness of veterans and help PCCD enhance our reentry strategies for individuals leaving our jails and state prisons and re-entering our communities. PCCD and DPW/OMHSAS staff are currently planning the 2012 conference that will take place in Harrisburg, PA on December 2-5, 2012 and PCCD s portion of the conference will focus on re-entry and homelessness and the difficult to place populations. PCCD, also issued a joint funding announcement with DPW/OMHSAS, and awarded five Housing Initiatives grants in Pennsylvania in June 2012 totaling an excess of $700k.

24 Case Studies/Grantees Allegheny County Mental Health Court Allegheny County Veterans Court Philadelphia County Mental Health Court

25 Allegheny County Mental Health & Veterans Court Goal: The goal of the Allegheny County Mental Health and Veterans Courts are to provide a countywide, community-based integrated system of treatment and care for individuals with mental disabilities and veterans who are involved in the criminal justice system while ensuring public safety. Objectives: To establish effective collaboration, communication and functioning between the court system and the behavioral health system. To create a balance between ensuring public safety and providing community based treatment options for the offender with mental disabilities or the veteran. To ensure good legal representation, timely processing and appropriate sentencing for the offender with mental disabilities or the veteran.

26 Allegheny County Mental Health & Veterans Court Objectives (cont d): To aid the Court in diagnostic and evaluation services as a means to render appropriate sentencing and disposition options. To establish a cost efficient and accelerated adjudication process when indicated for the offender with mental disabilities or the veteran. To sustain effective community supervision, treatment and support through a collaborative strategy involving both the court division and the behavioral health system via the establishment of mental health community based individualized Service Plan to satisfy the mental health mandate of the sentencing disposition. To lower the recidivism rates of the offender with mental disabilities or the veteran promoting stability and quality of life through treatment compliance and the utilization of community based mental health services. To reduce overcrowding in jail facilities.

27 Some Key Successes of Allegheny County MHC through 2011 Court worked with and supported stakeholders to streamline procedures and expand dedicated court time to expand services to a greater number of participants resulting in a MHC three year expansion from 85 participants to well over 400 participants yearly, and VC having served approximately 150 veterans to date. Court worked with and supported the prosecutor to enable the acceptance of more serious felony cases into MHC and VC based on the Rand Corporation Study indicating: * Court and stakeholder resources more wisely utilized * More appropriate and more serious offenders are better served over the long term * Greater tax dollar savings when participants who are charged with more serious crimes receive long term treatment and intensive supervision.

28 Key Successes of Allegheny County MHC Substantially lower recidivism rate as defined by the Rand Corporation Study of Allegheny County Mental Health Court: 14% for MHC versus 65% for general population. The Court has developed and implemented a peer support program for Veterans Court and has worked to establish a peer support program for Mental Health Court. The program includes appropriate peer/mentor training, guidelines and expectations, and the filming of a court simulation video for instructional purposes for potential peer mentors.

29 Challenges Staff and budgetary constraints, as courts grow so do needs. Do more with less. Maintaining trust and collaboration among team members. Easier over time because of court successes and quarterly out of court discussion sessions. Placement issues for treatment and for housing. Continued public education regarding effectiveness and need for problem solving approaches on criminal justice.

30 Philadelphia Mental Health Court

31 Mental Illness in the Philadelphia Prison System The critical demand for mental health services in Philadelphia extends to criminal justice settings. A 2007 study of 240 inmates housed in the jail s most intensive mental health units illustrated a high demand for behavioral health treatment of inmates with serious mental illness diagnosis. Currently, 27.6% of the inmates in PPS are on the Behavioral Health case load. (a 7.6% increase from 2011) Currently, 17.5% have been diagnosed as Seriously Mentally Ill (SMI); suffering from schizophrenia, bi-polar disorder or major depressive disorder. (a 2.5% increase from 2011) Approximately 80% of inmates listed on the mental health caseload have a SMI diagnosis and/or a co-occurring diagnosis.

32 Project Design & Implementation The Philadelphia Mental Health Court employs a multidisciplinary, collaborative approach that combines intensive wrap-around treatment and individualized probation supervision. The Phila MHC identifies individuals who are willing to accept a higher level of supervision in exchange for being placed in treatment facilities outside the Philadelphia Prison System. Participants are monitored throughout the re-entry process by providing a continuum of care through the Department of Behavioral Health/Intellectual Disabilities Targeted Case Management Unit.

33 Program Goals To facilitate the re-entry of offenders with mental illness from incarceration into supervised community treatment settings. To provide treatment, housing, benefits, and community support services for defendants with mental illness. To reduce recidivism by defendants with mental illness. To support effective communication between the criminal justice and mental health systems. To preserve public safety.

34 Stakeholders & Justice Partners Supervising Judge Woods-Skipper Department of Behavioral Health and Intellectual Disabilities Philadelphia Public Defender Association Philadelphia District Attorney Adult Probation & Parole Department Philadelphia Prison System First Judicial District Administrative Staff Case Management & Treatment Teams

35 Challenges Housing Systems resources Confidentiality between systems Consumer independence to make medical and/or psychiatric decisions Court priorities versus treatment priorities Family involvement Sustainability Staffing shortages with justice partners Budgeting issues

36 Key Successes & Results Reduced recidivism Expanded court Successful graduate is now a program director who provides the court with updates of defendants within FJDMHC Since July 2009, MHC has saved 20, 878 Incarceration Days, which is a savings total of $2,131,985.20

37 Questions Through the initiatives of MHJAC, numerous counties including Philadelphia and Allegheny have, have made tremendous strides in implementing programs to reduce recidivism, improve jail-diversion efforts and assist offenders with reentering their community. Linda Rosenberg, Executive Director PA Commission on Crime and Delinquency

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