Jail Mental Health Services

Transcription

1 Clients Receiving Mental Health Services in Jail: A Report for San Diego County Mental Health Services Fiscal Year

2 Table of Contents Title Page Table of Contents 1 Introduction 2 Overview and Key Findings 4 Summary 6 References 7 AOAMHS Services Provided FY06 07 to Clients Who Received Jail Services 8 AOAMHS Services Provided to Clients Who Received Jail Services in FY Clients with 30 Days of more Jail Inpatient Services FY Date Revised: 4/2/2009 1

3 Introduction The goal of this report is to explore the use of community based (i.e. non jail) mental health services among adults who receive mental health services in jail for planning purposes for new programs and new collaborative efforts. As shown in Figure 1, 9,768 adults utilized jail based mental health services at some point during FY The implementation of the Mental Health Services Act (MHSA) created an opportunity to transform our public mental health system of care into a wide ranging and inclusive planning process that fosters inter agency cooperation throughout San Diego County. One area of focus has been the development and provision of effective and efficient programs and policies to serve our residents involved in the forensic system and In fiscal year 06 07, 9,768 individuals received mental health services in jail, representing 25.6% of the 38,124 adults who received mental health services and 13.6% of those in jail during the year. Adults Admitted to San Diego County Jails (71,914) Jail and Mental Health Services (9,768) Adults Who Received Mental Health Services (38,124) Figure 1. Adults using both Jail and Mental Health Services protect public safety. One of our County s MHSA initial Community Services and Supports programs built upon the demonstrated successes of the earlier Mentally Ill Offender Crime Reduction (MIOCR) programs provided by the San Diego County Sheriff s Department and the San Diego County Probation Department. This program demonstrated the efficacy and importance of intensive case management to divert mentally ill consumers from the Criminal Justice System and decrease both recidivism and associated costs. Agencies throughout the United States have begun to address the growing awareness of the importance of establishing comprehensive jail diversion and other related programs that result in the right care at the right time in the right place. Many have developed creative and integrated programs that provide mentally ill consumers appropriate services, lessening their involvement Date Revised: 4/2/2009 2

4 with emergency and public safety agencies and decreasing overall costs. As a result of these trends, public policy experts have encouraged the implementation of jail diversion programs to minimize the number of individuals with serious mental illness who are arrested as a primary consequence of their mental illness. The problem of unserved or underserved mentally ill citizens cuts across multiple jurisdictions, multiple municipalities and multiple agencies. Public Safety and Emergency Services throughout the County are impacted, resulting in less than optimal care and inappropriate use of public safety and emergency resources. At its inception, the MHSA recognized these issues and among the key tenets of the Act is a focus on transforming mental health services in California, thus accomplishing a lessening of the involvement of the mentally ill in the Criminal Justice System. Critical to the development of an appropriate response to this problem is having relevant and accurate data upon which to base policy and program decisions. The purposes of this collaborative effort includes augmenting decision making, accurately identifying needs and potential outcomes, documenting the system impact and cost savings, and directing the development of a centralized, collaborative exchange of information. Overview In order to explore the overlap between clients of MHS and those incarcerated through the justice system (see Figure 1), we identified individuals receiving public mental health services in San Diego County jails in fiscal year (FY0607), and summarized their use of mental health services, both in jail and outside of jail, and costs, in FY0506, FY0607, and FY0708. We conducted a similar analysis of services for 30 days pre booking and 30 days post release for individuals receiving services for 30 days or more in a forensics inpatient unit. Date Revised: 4/2/2009 3

5 Key Findings Type of Service Use in Jail Of the 9,768 individuals described above and referred to in Figure 1, 346 (4%) received services in a forensics inpatient unit, 5,235 (54%) received outpatient (but not inpatient) services in jail, and 4,187 (43%) received only an assessment or forensic evaluation in jail (see highlighted cells, Table 1). Use of Community Based Outpatient Services In FY 06 07, 84% of those who received a mental health service in jail did not receive any outpatient mental health service in the community (16% received outpatient services while outside of jail; see highlighted cell, Table 2). Similarly few individuals received outpatient services in the years prior to or following their jail related services (13% and 16% respectively, see highlighted cells, Table 2). Even among those with more serious conditions requiring inpatient services in jail, over 60% did not receive any outpatient mental health services outside of jail (38% received outpatient services in FY 06 07) with a similar pattern seen for other fiscal years (see highlighted cells Table 2). The data show that persons receiving services in jail do not transition to community based outpatient services when they are released from jail. 84% of those who received a mental health service in jail did not receive any outpatient mental health service in the community. A Revolving Door: Repeat Usage of Jail Mental Health Services Individuals who use mental health services in jail are often repeat users of these services. Nearly one third of individuals who received mental health services in jail in FY also received services in jail in the year prior and year after (32% in FY0506 and 32% in FY0708, see highlighted cells, Table 2). Costs of Mental Health Services for Shared Clients Total costs for mental health services among persons receiving services in jails were $24.6 million in FY0607. The largest component of costs was community based inpatient mental health services. A similar pattern seen in the year prior and year after (see highlighted cells Table 2). These data suggest that inpatient expenditures might be Date Revised: 4/2/2009 4

6 reduced if persons exiting jail were more successfully transitioned to community based outpatient services. Patterns of High Usage Jail Mental Health Services Users One of the purposes of this report is to explore use of community based mental health services among those who are the most severely ill in the jail system. For the purposes of this report, we defined a this group as those receiving 30 or more consecutive days of services from the forensic inpatient unit during FY Among the 53 we identified, 31 (59%) received a mental health service while in a separate jail stay during the 3 months prior to being admitted to the forensic inpatient unit. In the 3 months post release from jail, 8 or 15% were back in jail for a separate stay and received at least one mental health service. Although our sample size is small, the fact that 31 of 53 individuals were not new to the jail system when they received 30 or more days of services from the forensic inpatient unit, and that 8 of the 53 were back in jail and utilizing forensic mental health services within 30 days post release suggests a cyclic pattern of repeat usage that may be costly. Total cost for mental health services were over $206,000 in the 30 days pre booking and over $242,000 in the 30 days post release (see highlighted cells, Table 3). This translates to $2.7 million in annual expenditure, or $51,000 per client per year. 31 of 53 individuals were not new to the jail system when they received 30 or more days of services from the forensic inpatient unit. Date Revised: 4/2/2009 5

7 Summary This report examined the use of community based mental health services among individuals who received mental health services in jail. This report has two main findings: (1) very few individuals who receive services in Very few individuals who receive services in jail ever receive services in the community. jail ever receive services in the community, and (2) individuals who receive services in jail are often repeat users of these services. The concept of a revolving door for justice system services is well known. Baillargeon and colleagues (2009) found that prison inmates with major psychiatric disorders (major depressive disorder, bipolar disorders, schizophrenia, and nonschizophrenic psychotic disorders) had substantially increased risks of multiple incarcerations during a 6 year period. The greatest increase in risk was observed among inmates with bipolar disorders, who were 3.3 times more likely to have had four or more previous incarcerations compared with inmates who had no major psychiatric disorder. Individuals who receive services in jail are often repeat users of these services. Prisons and jails also serve as treatment settings for inmates with mental illness. In a nationwide study of the health and health care of inmates, Wilper and colleagues (2009) found that among inmates in local jails who had ever been treated with a psychiatric medication, only 39% were taking psychiatric medication at the time of admission, but that 46% were restarted on medication as part of their treatment while in jail. Thus, incarceration often results in the resumption of psychiatric treatment. The revolving door of incarceration of individual who are mentally ill, combined with the treatment capacity of prisons and jails, result in a missed opportunities for engagement and retention in treatment. Baillargeon and colleagues (2009) recommend interventions to reduce recidivism among mentally ill inmates, such as continuity of care reentry programs to help mentally ill inmates, as well as a greater role for mental health courts and other diversion strategies. Wilper and colleagues (2009) suggest improvements in correctional health care and in community mental health services that might prevent crime and incarceration. A dual approach would employ transition teams to assist individuals with mental illness as they are being released from jail, as well as prevention efforts aimed at those with a high risk or history of incarceration. In summary, although the current use of community based mental health services is low, and recidivism is high among individuals who receive services in jail, there are also great opportunities for engagement in treatment through a strengthening of current forensic services, increased prevention efforts, and improved linkages to community based services. Date Revised: 4/2/2009 6

8 REFERENCES J Baillargeon, IA Binswanger, JV Penn, BA Williams, and OJ Murray. Psychiatric Disorders and Repeat Incarcerations: The Revolving Prison Door. Am J Psychiatry : A Wilper, S Woolhandler, JW Boyd, KE Lasser, D McCormick, DH Bor, DU Himmelstein. The Health and Health Care of US Prisoners: Results of a Nationwide Survey. Am J Public Health Jan 15. Date Revised: 4/2/2009 7

9 TABLE 1: AOAMHS Services Provided FY06 07 to Clients Who Received Jail Services *Unique Clients: Inpatient = 346 Outpatient = 5,235 Assess/Eval = 4,187 Overall = 9,768 % of Clients who received any non jail service = 28.2% Total Visits Total Clients Percent Users Outpatient Services Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Case Management 727 2,569 3,397 6, % 1.3% 2.9% 2.2% Outpatient Programs 503 4,706 4,102 9, % 10.5% 9.2% 10.1% Fee for Service 861 2,669 3,192 6, % 5.0% 5.1% 5.3% Full Service Partnership 1,603 1,658 1,295 4, % 1.2% 1.2% 1.6% Total Visits Total Clients Percent Users Emergency Services Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall EPU 422 2, , , , % 20.5% 12.7% 18.3% PERT % 2.3% 1.9% 2.4% Total Days Total Clients Percent Users Mean Days Forensic Services Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Jail 14,490 24,416 6,118 45, ,235 4,187 9, % 100.0% 100.0% 100.0% Total Admissions Total Clients Percent Users Mean Admissions Inpatient Admissions Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall County Hospital % 1.4% 1.1% 1.6% FFS Hospitals % 2.8% 2.8% 3.1% Crisis Residential 228 2,590 2,557 5, % 3.6% 3.4% 3.7% Date Revised: 2/6/2009 8

10 TABLE 2: AOAMHS Services Provided to Clients Who Received Jail Services in FY06 07 *Unique Clients FY06 07 Inpatient = 346 Outpatient = 5,235 Assess/Eval = 4,187 Overall = 9,768 FY0506 Percent Users FY0607 Percent Users FY0708 Percent Users Outpatient Services Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Case Management 7.8% 1.2% 2.6% 2.0% 8.4% 1.3% 2.9% 2.2% 6.9% 1.5% 2.8% 2.2% Outpatient Programs 16.5% 8.5% 7.9% 8.5% 16.5% 10.5% 9.2% 10.1% 11.3% 10.6% 9.0% 9.9% Fee for Service 14.7% 5.2% 5.1% 5.5% 14.2% 5.0% 5.1% 5.3% 12.7% 4.3% 4.8% 4.8% Full Service Partnership 0.0% 0.0% 0.0% 0.0% 12.1% 1.2% 1.2% 1.6% 17.6% 1.9% 1.8% 2.4% Any Outpatient Services 28.9% 12.5% 13.0% 13.3% 38.2% 14.8% 14.8% 15.6% 39.0% 15.1% 14.9% 15.9% Emergency Services Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall EPU 36.4% 11.7% 9.8% 11.8% 52.9% 20.5% 12.7% 18.3% 25.7% 11.7% 9.1% 11.1% PERT 13.9% 3.2% 2.2% 3.2% 9.8% 2.3% 1.9% 2.4% 9.2% 2.1% 2.2% 2.4% Any Emergency Services 39.0% 13.4% 10.9% 13.2% 54.9% 21.5% 13.5% 19.3% 29.2% 12.8% 10.2% 12.3% Forensic Services Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Jail 49.7% 38.8% 23.0% 32.4% 100.0% 100.0% 100.0% 100.0% 51.7% 35.2% 25.7% 31.7% Inpatient Admissions Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall County Hospital 6.1% 1.1% 0.9% 1.2% 9.5% 1.4% 1.1% 1.6% 7.2% 1.1% 0.9% 1.2% FFS Hospitals 11.6% 2.7% 2.8% 3.0% 11.3% 2.8% 2.8% 3.1% 9.0% 2.1% 1.8% 2.3% Crisis Residential 6.4% 3.0% 2.5% 2.9% 7.8% 3.6% 3.4% 3.7% 5.5% 3.0% 2.6% 2.9% Any Inpatient Admissions 20.8% 5.4% 4.8% 5.7% 24.0% 6.4% 5.8% 6.8% 18.2% 5.1% 4.3% 5.2% FY0506 Costs FY0607 Costs FY0708 Costs Service Type Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Inpatient Outpatient Assess/Eval Overall Outpatient Services $324,632 $1,341,473 $1,522,566 $3,188,670 $488,621 $1,746,887 $1,753,750 $3,989,258 $730,036 $2,549,680 $2,035,837 $5,315,553 Emergency Services $476,462 $1,867,182 $945,742 $3,289,385 $619,756 $2,083,353 $1,157,476 $3,860,584 $288,173 $1,182,153 $840,382 $2,310,708 Inpatient Admissions $1,134,343 $2,557,519 $2,618,933 $6,310,795 $1,766,324 $3,677,304 $3,191,879 $8,635,507 $1,394,840 $3,018,958 $2,289,098 $6,702,896 Subtotal Non Jail $1,935,436 $5,766,174 $5,087,240 $12,788,850 $2,874,701 $7,507,544 $6,103,105 $16,485,350 $2,413,049 $6,750,791 $5,165,317 $14,329,157 Jail $1,319,897 $1,634,591 $653,637 $3,608,126 $4,961,390 $2,232,002 $985,737 $8,179,129 $800,592 $1,432,465 $2,028,852 $4,261,909 Grand Total $3,255,333 $7,400,765 $5,740,877 $16,396,976 $7,836,091 $9,739,546 $7,088,841 $24,664,479 $3,213,641 $8,183,256 $7,194,169 $18,591,066 Date Revised: 2/6/2009 9

11 TABLE 3: Clients with 30 Days or more Jail Inpatient Services FY06 07 Unique Clients 53 3 months Pre Booking 3 months Post Release Outpatient Services Total Visits Total Clients Percent Users Total Visits Total Clients Percent Users Case Management % % 6.7 Outpatient Programs % % 4.0 Fee for Service % % 3.7 Full Service Partnership % % 36.4 Emergency Services Total Visits Total Clients Percent Users Total Visits Total Clients Percent Users EPU % % 1.1 PERT % % 1.5 Forensic Services Total Days Total Clients Percent Users Total Days Total Clients Percent Users Jail % % 7.0 Inpatient Admissions Total Admissions Total Clients Percent Users Total Admissions Total Clients Percent Users County Hospital % % 1.0 FFS Hospitals % % 1.0 Crisis Residential % % 1.0 Service Type 3 months Pre Booking Costs 3 months Post Release Costs Outpatient Services $9,540 $49,788 Emergency Services $45,134 $10,353 Inpatient Admissions $109,330 $166,453 Subtotal Non Jail $164,004 $226,594 Jail $42,129 $15,807 Grand Total $206,133 $242,401 Date Revised: 2/6/