Stopping the Revolving Door for Mentally Ill Offenders in the Criminal Justice System via Diversion and Re-entry Programs

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1 GEORGIA GEORGIA GEORGIA GEORGIA GEORGIA Department of Corrections ON THE MOVE Stopping the Revolving Door for Mentally Ill Offenders in the Criminal Justice System via Diversion and Re-entry Programs Academic & Health Policy Conference on Correctional Health Eleanor Brown, LPC Georgia Department of Corrections Brian McGregor, Ph.D. Morehouse School of Medicine

2 Georgia Department of Corrections Statistics Nationally, 1 in 31 adults is under some form of correctional supervision. Georgia ranks 1 st in the nation with 1 in 13 under some form of correctional control. Georgia ranks 4 th in the nation with an adult incarceration rate of 1 in 70. GDC currently has approximately 160,000 convicted felons under probation supervision. Approximately 56,000 inmates in GDC prisons. Approximately 9,000 are classified as having a mental illness (15.4%). 27% of Day Reporting Centers Participants are classified as mentally ill.

3 Justice Center Report A Guide to Research-informed Policy Practice Increasing high numbers of people with mental illnesses are coming in contact with law enforcement agencies, courts and correctional agencies. Offenders with mental illnesses have a greater chance of recidivating than the general population offender. People with mental illness are at an increased risk of developing substance use disorders over the course of their life. Nearly a third of people who experience homelessness have a serious mental illness and their homelessness makes them highly visible to law enforcement. People with mental illnesses tend to stay in jail and prison longer and are less likely approved for parole than others charged with similar offenses. 72% of offenders with mental illness have a co-occurring substance abuse disorder.

4 Justice Center Report A Guide to Research-informed Policy Practice Best practices which are evidenced based in the delivery of mental health services for the mentally ill under community corrections supervision: Assertive Community Treatment utilizing a multidisciplinary team of professionals. Illness Self management and recovery, in which people learn skills to monitor and control their well-being. Integrated mental health and substance abuse services. Supported employment, in which people with mental illness are employed in competitive, integrated work setting with follow-along supports. Psychopharmacology-medications are used to treat mental illness. Family and consumer education, people with mental illness(es) and their families learn about mental illness, symptom management techniques and stress reduction.

5 The Revolving Door for the Mentally Ill Homeless Prison Hospital Homeless Jail Probation

6 Inmate Cost for GDC It costs GDC $67 a day to house the mentally ill. It costs GDC $36 a day to house a general population inmate. GDC spends approximately five million dollars a year on Psychotropic medication. Psychotropic medication accounts for 18% of GDC s total pharmacy budget.

7 Georgia Department of Corrections (GDC) Solutions Diversionary and Reentry Programs that involve partnering with other State, Local, Law Enforcement, Judicial Systems, and Faith Based Organizations in order to provide wrap-around services to meet all of the offenders needs and responsivity issues.

8 Diversion Day Reporting Centers 13 Day Reporting Centers Non-residential Substance Abuse Programs that use evidenced-based evaluations and programs to address the underlying problem of the offender. Mentally ill probationers can be diverted from expensive prison beds if the underlying root of their problem is addressed: mental health compliance, and substance abuse treatment.

9 Day Reporting Centers What is a Day Reporting Center (DRC)? A community-based, highly structured, nonresidential sanction for probationers with a history of non-compliant behavior related to substance abuse. Day Reporting Centers provide intensive supervision and behavioral interventions as an alternative to incarceration for probationers who are failing to adhere to standard supervision conditions.

10 What are some of the Components Substance abuse counseling and programming Rigorous drug testing Cognitive restructuring (changing criminal thinking) Employment preparation, enhancement, and maintenance Adult literacy and GED preparation Intensive supervision (field contact, curfew compliance) 80 hours community service Life skills classes Anger management (some sites) 12 step attendance Family Night participation Six months Aftercare

11 Why Day Reporting Centers? Georgia has the fourth highest incarceration rate in the country with one in thirteen Georgians being on some form of correctional supervision. Nationally the rate is one in thirty-one. Approximately 75% of incarcerated offenders are drug or property offenders, and 72% of those offenders report using drugs prior to their arrest. In Georgia, new methamphetamine cases enter the prison system every month. 51% of inmates self-report never having a job 75% without a high school education In CY2011, 21,055 offenders entered the prison system and 21,390 were released. Of those released, have mental health issues.

12 Why Day Reporting Centers? 65% of felons commit additional crimes and return to prison in their lifetime DRCs apply Evidence Based Principles that are part of the What Works in correctional rehabilitation (cognitive based programming, employment enhancement, substance abuse treatment, and education opportunities) 2010 Study by University of Cincinnati indicated DRC participants recidivated 24% less than non participants. Public demand for offenders to be punished, while they expect offender rehabilitation Studies show for every dollar spent on treatment there is upwards of a $7 return DRC offenders cost per day is $14.78 compared to prison cost of $50.17 DRCs provide a sentencing alternative that is community based in lieu of incarceration

13 DRC Program Goals Protect the public through intensive supervision and behavioral interventions Divert offenders from the warrant and revocation processes who would otherwise be confined to jails, prisons, or other residential facilities Provide an alternative sentencing option to divert offenders from future criminality Replace criminal behaviors and attitudes with pro-social alternatives that reduce recidivism Provide offender opportunity for Restitution, Rehabilitation, and Restoration Develop a collaborative with law enforcement, state agencies, non-profits and the faith based community to effect accountability of the offender

14 How long is the Program? The program is six to nine months for Phase I and II, and six months for Phase III Phase I is the first four to eight weeks of intense programming Phase II is approximately 2 to 6 months and is generally when the offender works and attends classes in the evening Phase III is the aftercare phase and is six months in length Participants return or transfer back to general probation or parole supervision after Phase II to a 6 month Phase III aftercare program

15 Mental Health Counselors for DRC, CIP, & Probation Offices Northwest Legend DRC Sites Location of the MH Counselors Rome Cobb Gainesville Athens Dekalb Atlanta CIP Sites Future DRC Sites Probation Offices Clayton Griffin Augusta Macon Columbus Savannah Albany Tifton Waycross Thomasville

16 DRC Female Diagnosis 38%

17 DRC Male Diagnosis 16% 18% 34% 11%

18 Mental Health Services in Each DRC: A mental health counselor has been placed in each DRC. The mental health counselor conducts a Mental Health screening on all participants during intake. The mental health counselor completes a Mental Health Evaluation on all participants identified during intake as possibly needing MH/MR services.

19 Mental Health Services (cont.) If a participant is not currently receiving mental health services, the counselor makes an appointment with the local mental health center. The mental health counselor conducts a minimum of one (1) supportive group per week. The mental health counselor monitors mental health compliance and reports this to the Probation Officer and/or Center Administrator.

20 Mental Health Services (cont.) The mental health counselor elicits community partnerships to address other needs of the participants, such as housing, food, clothing, child care, transportation, crisis stabilization, referrals to vocational rehabilitation programs, and/or assistance with SSI/SSDI applications. Some mental health counselors attend treatment team meetings at the local mental health center.

21 Mental Health Services (cont.) The centers in Athens, Griffin, Macon, and Northwest have a licensed clinician from the local mental health center who comes on-site to conduct initial assessments and to make referrals to the psychiatrist. These clinicians also conduct mental health groups such as co-occurring disorders, coping skills, DBT, stress management, trauma survivors, and Anger Management.

22 DRC Graduates FY 2012

23 DRC MH Graduates by Gender FY Male Female Athens Atlanta Augusta Clayton Columbus Gainesville Griffin Macon Northwest Rome Rouse/Waycross Tifton Thomasville

24 DRC Graduates by Diagnosis FY 2012

25 DRC Female Graduates by Diagnosis FY 2012 None Total Graduates: 37

26 DRC Male Graduates by Diagnosis FY 2012 Total Graduates: 49

27 DRC Mental Health Phase I Completions

28 DRC Mental Health Phase II Completions

29 DRC Unsuccessful Completions FY 2012

30 DRC MH Participant Unsuccessful Completions FY 2012

31 Number of Participants DRC Overall Mental Health Unsuccessful Completions to 8 9 to to to to to to to to Time in Weeks Total = 221 Discharges

32 Number of Participants DRC MH Phase I Unsuccessful Completions to 8 9 to to to to to to to to Time in Weeks Total = 165

33 Number of Participants DRC MH Phase II Unsuccessful Completions to 8 9 to to to to to to to to Time in Weeks Total = 56

34 DRC MH Unsuccessful Completions by Diagnosis

35 DRC MH Unsuccessful Completions by Gender

36 Program Success of Dually Diagnosed Clients in Georgia s Day Reporting Centers Core Research Questions 1. Do dually diagnosed participants in the DRC experience program success relative to a matched comparison group of DRC participants with substance abuse only? 2. Are indicators of program success in the DRC such as maintaining sobriety, completing treatment programs, and obtaining employment, different depending on mental health status?

37 Methodology Research Design Observational study, prospective cohort Participants Total n = 150 Dually Diagnosed group (n = 25 per site) Mental health diagnosis (DSM-IV) Substance Abuse Only group (n = 25 per site) No mental health diagnosis Matched on demographics Study Sites Athens, GA DRC Griffin, GA DRC Metro Atlanta DRC

38 Measurement & Outcomes Phase completion Pass/fail on scheduled and random sobriety tests Substance abuse & mental health counseling Employment (obtaining a job, length of employment) Medication management Number of absconders Program restarts Self-efficacy & life satisfaction Recidivism (i.e., re-arrest [probation/parole violation], re-conviction, re-incarceration) Self-report Surveys Program satisfaction, readiness to change, self-efficacy, interpersonal supports

39 Summary Program features associated with positive outcomes may need to be strengthened May reduce stigma of treatment difficulties with justiceinvolved individuals with dual diagnoses Create impetus for broader evaluation of Georgia DRCs Seek collaboration & partnership with other states interested in and successful with justice re-investment

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