Mental Health 101 for Criminal Justice Professionals David A. D Amora, M.S.

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1 Mental Health 101 for Criminal Justice Professionals David A. D Amora, M.S. Director, National Initiatives, Council of State Governments Justice Center

2 Today s Presentation The Behavioral Health System Mental Health and Substance Use Disorders Effective Treatment 2

3 Objectives } Help criminal justice and behavioral health professionals: 1. Share an understanding of the needs of their common clientele 2. Coordinate treatment with supervision Council of State Governments Justice Center 3

4 Criminal Justice Professionals Must Be Able to Rely on Their Partners in the Behavioral Health System } Conduct comprehensive assessments } Develop treatment plans } Provide necessary services } Oversee behavioral health services in their communities Improve Public Safety Improve Public Health Council of State Governments Justice Center 4

5 What is the Behavioral Health System? } Behavioral Health System } Programs and providers of mental health and/or addiction services. } What do we mean by system? } Where are services provided? } Who provides services? Council of State Governments Justice Center 5

6 Behavioral Health System in Your State } Who is responsible? } State mental health authority provides services for adults with serious mental illnesses and children with serious emotional disturbances } General hospitals, private groups, and solo practitioners provide services to those with private health insurance } In some states, mental health and addiction services are administered by the same agency. Other states have separate agencies for mental health and addiction services. Council of State Governments Justice Center 6

7 Where Are Behavioral Health Services Provided and by Whom? Sector Location Providers Specialty behavioral health General medical/ primary care Human services Voluntary support networks Outpatient setting; acute care in private, state, county hospital settings, outreach to schools, homes, shelters, inreach to jails, prisons Private and community clinics, hospitals, nursing homes Faith-based institutions, public housing facilities 12-step group meetings, drop-in centers Psychiatrists, psychologists, case managers, licensed counselors, certified alcohol and drug counselors, psychiatric nurses, social workers Family practice physicians, internists, pediatricians, nurse practitioners Faith-based, criminal justice and vocational counselors; social workers, child care workers Self-help groups, peer counselors Council of State Governments Justice Center 7

8 How Are Behavioral Health Services Funded? } Large array of sources } Different guidelines for each source } Fiscal years vary by source } Stated purposes vary by funding Council of State Governments Justice Center 8

9 Funding for Behavioral Health Services 120 $ in Billions (in 2003) % 78% Mental Health Services 10% 90% Substance Use Services Private Public U.S. Department of Health and Human Services. National Expenditures for Mental Health Services and Substance Abuse Treatment: , Substance Abuse and Mental Health Services Administration. Maryland, Council of State Governments Justice Center 9

10 What are Mental Illnesses? } What are mental illnesses? } Diagnosable conditions that affect a person s thinking, emotional state, and behavior and disrupt his/her ability to work or carry out other daily activities and engage in satisfying personal relationships Council of State Governments Justice Center 10

11 What Are Mental Illnesses? } Anxiety } Feelings of fear or dread, rapid heart rate, shortness of breath, lightheadedness } Disturbances in perception and thinking } Hallucinations, delusions } Disturbances of cognition } Difficulty organizing, processing, and recalling information } Disturbances of mood } Emotional highs or lows as prominent feature Council of State Governments Justice Center 11

12 When Do Symptoms Cross a Threshold to Become an Illness? } Mental illness and mental health exist on a continuum that is based on the: } Nature and severity of symptoms } Duration of symptoms } Extent to which symptoms interfere with one s ability to carry out daily routines, succeed at work or school, and form and keep meaningful interpersonal relationships Council of State Governments Justice Center 12

13 How Are Mental Disorders Diagnosed? } The Diagnostic and Statistical Manual Text Revision (DSM- IV-TR) of the American Psychiatric Association provides a common language and typology for mental disorders in both children and adults. The DSM-V is due for release in May 2013 Council of State Governments Justice Center 13

14 How Are Disorders Determined and Described? Multiple sources of information Recognizable pattern of symptoms (Syndrome) Meets explicit criteria as described in the DSM-IV-TR Council of State Governments Justice Center 14

15 How Are Disorders Determined and Described? AXES I II all mental disorders, with the exception of those in Axis II e.g., depression, schizophrenia, bipolar disorder personality disorders and mental retardation e.g. paranoid personality disorder, borderline personality disorder III General medical conditions that may affect a behavioral health issue IV Psychosocial and environmental problems or stressors e.g. unemployment, recent death of a loved one V Score on the Global Assessment of Functioning (GAF), a scale from 0 to 100 that rates a person s ability to carry out daily activities and respond to problems Council of State Governments Justice Center 15

16 In a Given Year } 22% of the United States adult population will be diagnosed with a behavioral disorder 16% Meet criteria for mental illness 9% Meet criteria for substance use disorders Council of State Governments Justice Center 16

17 Not all Mental Illnesses are Alike: Mental Illness in the General Population Diagnosable mental disorders 16% Serious mental disorders 5% Severe mental disorders 2.5% 17

18 Specific Diagnoses: Serious or Severe and Persistent Mental Illnesses } Schizophrenia } Schizoaffective disorder } Bipolar or manic-depressive disorder } Severe forms of major depression and anxiety disorders } Some personality disorders (E.g. schizoid, schizotypal, borderline) Exact definitions of serious mental illness (SMI) vary by state Council of State Governments Justice Center 18

19 What are Co-Occurring Disorders? } If an individual has both mental health and substance use disorders, he/she is typically referred to as having co-occurring disorders. Council of State Governments Justice Center 19

20 What Are Co-Occurring Disorders? } Among the jail population: 83% 17% 30% 70% Serious Mental Illness No Serious Mental Illness Co-Occurring Substance Use Disorder No Co-Occurring Substance Use Disorder Council of State Governments Justice Center 20

21 Systemic Separation between Mental Health and Substance Use } Both substance use disorders and non-addictive disorders are Axis 1 diagnoses in the DSM-IV-TR } However: } Separate administrative structures } Separate programmatic structures } Separate funding mechanisms Council of State Governments Justice Center 21

22 Not all Substance Use Disorders are Alike Abstention Dependence The Substance Abuse Continuum 22

23 What is the Relationship between Mental Illnesses and Substance Use Disorders? } Acute and chronic substance use can produce psychiatric symptoms } Substance withdrawal can cause psychiatric symptoms } Substance use can mask psychiatric symptoms } Psychiatric disorders can mimic symptoms associated with substance use } Acute and chronic substance use can exacerbate recovery process from the addictive disorders Council of State Governments Justice Center 23

24 Co-Occurring Substance Use Disorders and Treatment } Research has consistently demonstrated that integrated treatment is the most effective response to the needs of those with both a mental health and substance use disorder } The integrated treatment model is an evidencebased practice and refers to the integration of mental health and substance abuse treatment in one setting. Council of State Governments Justice Center 24

25 Treatment and Expectations } Treatment works for mental illnesses } Medications, therapies, and support enable people to manage their psychiatric symptoms effectively and many with SMI to lead successful and productive lives } Research indicates that mental illnesses can be managed at levels of effectiveness comparable or superior to the treatment of physical illnesses Council of State Governments Justice Center 25

26 Treatment and Expectations Even in the best-case scenario when an individual is assessed appropriately and linked to high-quality care.. } Recovery can be slow or characterized by relapses } A cure is rarely possible } A cure is not necessarily the objective Council of State Governments Justice Center 26

27 What is the objective of treatment? } Reduce symptoms so that psychiatric and/or substance use disorders minimally affect a person s functioning. Council of State Governments Justice Center 27

28 Principles Associated with Positive Outcomes 1. Consumer centeredness 2. Individualized treatment planning 3. Cultural competency 4. Evidence-based and promising practices 5. Recovery Council of State Governments Justice Center 28

29 1. Consumer Centeredness } Consumers participate in planning, delivering, and evaluating mental health services } A consumer is a person with mental illness receiving mental health services Individuals who have experience with mental illnesses and the criminal justice system can provide valuable input on what is likely to be helpful and effective. Council of State Governments Justice Center 29

30 2. Individualized Treatment Planning } Treatment should be tailored to their individual needs and circumstances Individuals with mental illnesses involved in the criminal justice system differ in their strengths, disabilities, demographics, supports and criminal charges. Council of State Governments Justice Center 30

31 3. Cultural competency } Definition } An acceptance and respect for difference, a continuing selfassessment regarding culture, a regard for and attention to the dynamics of difference engagement in on-going development of cultural knowledge, and resources and flexibility within service models to work toward better meeting the needs of minority populations. Because of their racial, ethnic, and cultural status, some people of color have more limited access to general health care and mental health services than non-minority populations. Council of State Governments Justice Center 31

32 4. Principles Associated with Positive Outcomes } Evidence-based practices (EBP) } Research demonstrates that a particular practice increases the likelihood of positive outcomes There are many services that have not been designated as EBPs but still may be important components of a comprehensive treatment plan. Council of State Governments Justice Center 32

33 5. Recovery } Definition } A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential All people have the potential to recover if given appropriate treatment and supports. Council of State Governments Justice Center 33

34 Identifying Appropriate Services and Supports } Individuals with SMI or co-occurring disorders require } Access to a range of community-based services } Coordinated } High quality } That are matched to their extensive needs } Behavioral health } Social welfare } Availability of resources varies by jurisdiction } Critical to create inventory of services and supports in the community Council of State Governments Justice Center 34

35 Services and Supports Associated with Good Public Health and Safety Outcomes } Case management } E.g. Forensic Intensive Case Management (FICM), Forensic Assertive Community Treatment (FACT), and Assertive Community Treatment (ACT) } Supportive housing } Peer support } Accessible and appropriate medication } Supported employment } Cognitive behavioral interventions targeted to criminogenic risk factors } Integrated Dual Diagnosis Treatment (IDDT) Council of State Governments Justice Center 35

36 Thanks! } Questions? Council of State Governments Justice Center 36

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