A Brief Overview of Promising Jail Diversion Programs in Florida

EFFECTIVE ALTERNATIVES A Brief Overview of Promising Jail Diversion Programs in Florida By the Florida Substance Abuse and Mental Health Corporation and Florida Partners in Crisis January 2009

EFFECTIVE ALTERNATIVES A Brief Overview of Promising Jail Diversion Programs in Florida In several counties scattered across Florida, communities have come together to address the challenge of the rising number of people with mental illnesses and substance use disorders entering the criminal justice system. Leaders from local and state government, law enforcement, the courts, treatment agencies and advocacy groups in these communities joined together to plan services and pool resources to tackle this challenge. Borrowing from wellresearched models and/or developing their own innovative approaches, they have initiated costeffective strategies to divert people with mental illnesses and substance use disorders from jails, prisons and state forensic hospitals. Community leaders, often working through task forces or advisory committees, have had to cobble together funding to support these initiatives. Some communities have been awarded federal grants for their jail diversion projects. Others have received funds through the Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant Program, which are matched by county governments, or have received special appropriations from the Legislature. These diversion projects typically involve some or all of the following elements: Crisis Intervention Team training for law enforcement to help prevent the unnecessary arrest of people with mental illnesses; mental health and drug courts that divert appropriate individuals from incarceration into court-monitored treatment; intensive case management to assure people get needed treatment and monitor their progress; crisis stabilization or crisis support care; assistance in obtaining housing and employment; community re-entry services; and monitoring by the courts or other agencies to ensure public safety. The approaches being used in these communities are the kinds of strategies endorsed in a November 2007 report by the Mental Health Subcommittee of the Florida Supreme Court. A sample of these successful projects are described in this report issued jointly by the Florida Substance Abuse & Mental Health Corporation, and Florida Partners in Crisis. A copy of the report can also be downloaded from the following Web sites: www.samhcorp.org www.flpic.org Implementation of similar innovative and costefficient treatment alternatives are at the heart of the Mental Health and Substance Abuse Treatment and Crime Reduction Act legislation filed for action during the 2009 Legislative Session. The limited number of existing programs for mental illnesses and substance use disorders in the criminal justice system are demonstrating that they can: Reduce re-arrest rates. Enhance public safety. Provide effective treatment and rehabilitation services at a lower cost than in a state forensic treatment facility. Divert people from state forensic facilities and improve their chances of recovery. Connect former prison inmates to ongoing treatment and help them obtain training, jobs and housing. Save money for law enforcement agencies and county jails. A Brief Overview of Promising Jail Diversion Programs in Florida 1

Circuit 1 Forensic Mental Health Project Escambia and Santa Rosa Counties Overview The Circuit 1 Forensic Mental Health Project was initiated to provide treatment services to individuals with a mental illness and/or cooccurring substance use disorder who were at high risk of criminal justice system involvement. The project served residents of Escambia and Santa Rosa Counties and was funded by an appropriation of $ 2.5 million from the Legislature. The funds were contracted to Lakeview Center, Inc., which provides mental health and substance abuse services to the two counties. Begun in October 2007, all services were not fully implemented until January 2008. Most progress toward project goals occurred during the last two to three quarters of FY 2007-08. Goals included to reduce the number of individuals admitted to Florida State Hospital forensic units, increase the number of individuals treated under outpatient commitment status, and to reduce the number of individuals with mental illnesses housed in the county jails. These goals were to be accomplished while ensuring public safety. The project also set a goal of serving at least 216 individuals during the year and to keep the average cost per person served to less than $6,000 per year. Individuals with mental illnesses who had been deemed not guilty by reason of insanity, incompetent to stand trial, or who had histories of multiple arrests were the major focus of the project. Participants included people who had committed both misdemeanors and felonies. Many of those whose current offense may have been a misdemeanor had a history of felonies. Those in community competency restoration programs all had current felony charges. The project provided an array of services, including intensive services by a Comprehensive Community Support Team based on the successful Florida Assertive Community Treatment team model, community competency restoration, case management in the jails, community mental health and substance abuse residential treatment services, psychiatric evaluation and medication management services, acute psychiatric crisis services, detoxification services, and traditional mental health and substance abuse outpatient services. Several thousand individuals were screened and of these, the project identified and served 696 individuals who met program criteria. The services provided to the largest number of participants (491) were psychiatric evaluations and medication management, while a much smaller number (96) received more intensive services from the Comprehensive Community Support Team. To accomplish its goals, the project had to address a history of systemic issues, including a lack of coordination between treatment providers, law enforcement, the jails and the courts. The early identification of mental health clients by law enforcement at the time of arrest, by jail personnel at the time of incarceration, and by the courts at the time of first appearance and arraignment all needed to be strengthened. Collaborative relationships were developed between the local mental health and substance abuse services provider (Lakeview Center, Inc.), law enforcement entities in the area (Escambia/Santa Rosa Sheriff Departments, Pensacola/Milton/Gulf Breeze Police Department), probation, the circuit s felony and municipal misdemeanor courts, and the Department of Children and Families Substance Abuse and Mental Health Office. Meetings were held with the various staff of the participating entities to develop working relationships, plan strategy, work through problem areas and monitor progress. The plan also relied heavily on the training of law enforcement, probation officers, and jail personnel in crisis intervention team training (CIT). This initiative was previously underway in the area, but was stepped up as a result of this project. By the end of July 2008, 241 law A Brief Overview of Promising Jail Diversion Programs in Florida 2

enforcement officers had been trained in CIT. Approximately 180 of these officers were trained during FY 2007-2008. This project has had tremendous impact upon the coordination of treatment for individuals with mental illness in Escambia and Santa Rosa Counties, according to the Circuit 1 evaluation of the project completed in September 2008. Among the successes noted were: Incarcerated individuals with mental illnesses are routinely identified and treatment begins inside the jail. Individuals in jail are followed by jail liaisons and case managers and have their care coordinated with immediate access to treatment, including medications, upon release. Outpatient commitments increased from two during the two previous years to 11 outpatient commitments since July 2007. These commitments were considered successful as the individuals remained in treatment during the commitment period and their psychiatric symptoms were relatively stable. 21 individuals were diverted from admission to Florida State Hospital and received their competency restoration services in the community. Prior to this project, all individuals requiring competency restoration treatment to stand trial were admitted to Florida State Hospital. The number of forensic clients admitted to Florida State Hospital from Escambia County 1 in FY 2007-2008 decreased by 10, reversing a trend of increasing admissions over the past several years. The nearly 700 participants spent less time in jail than prior to the project s inception and the re-arrest numbers were very low. Data 2 gathered for a 90-day period from September through November 2007 for inmates served by jail liaisons at the Escambia County Jail showed only 2 of 67 had been rearrested. On average, costs were under $3,600 per individual for community-based treatment. This compares to a cost of $7,358 per month or $41,202 for an average length of stay at Florida State Hospital 3 for competency restoration. Current Status Funds for the project were cut to $550,000 for FY 2008-2009. As a result, staff has been reduced and several specialized services were eliminated. The intensive community support team was cut back to a single forensic case manager. A group home that provided housing to participants was closed. To offset the cutbacks in services, some people have been absorbed into other mental health programs, but services were eliminated for any defendants with misdemeanor charges these had comprised the majority of those served. Instead, the program is serving only those individuals with felony charges who have been deemed incompetent to proceed. Following the cutbacks, admissions of inmates with mental illnesses increased at the Escambia County jail. According to data compiled by the Escambia County Sheriff s Office, admissions of these special risk inmates averaged 253 a month from January through June 2008, but increased to an average of 281.6 a month during July through September 2008 an average increase of nearly 30 inmates per month. 4 Footnotes 1. Commitments by County, Florida Department of Children and Families Mental Health Office, September 2008. 2. Information supplied by Dennis Goodspeed, Director of Community Behavioral Health Services, Lakeview Center, Inc., October 2008. 3. Adult Mental Health Treatment Facilities Cost Per Bed Data FY 2008-2009, September 2008, Florida Department of Children and Families Mental Health Office. 4. Information provided by Capt. Fred Alford, CIRT Commander, Escambia County Sheriff s Office Central Booking and Detention Center. A Brief Overview of Promising Jail Diversion Programs in Florida 3

Eleventh Judicial Circuit Criminal Mental Health Project Overview The Eleventh Judicial Circuit Criminal Mental Health Project (CMHP) in Miami-Dade County grew out of a need to address the large number of people with mental illnesses housed in the county jail. On any given day, there are more than 1,000 detainees with mental illnesses receiving psychotropic medications in the Miami-Dade County jail. The cost to the county just to house these individuals is estimated to be more than $100,000 per day or roughly $40 million per year. In response to the problem, a July 2000 summit of key stakeholders led to a comprehensive plan for diverting people with mental illnesses from the county s criminal justice system and jail into more appropriate community based treatment and services. The CMHP s Jail Diversion Program is designed to serve individuals with serious mental illnesses who are at risk of arrest or who have been arrested for misdemeanor offenses. Approximately 85% of program participants are men. The age range is from 18 to 71 years, with an average age of 41. Roughly 82% of participants are diagnosed with schizophrenia or some other psychotic disorder, 11% are diagnosed with bipolar disorder, and 3% are diagnosed with major depressive disorder. More than half of program participants are homeless at the time of program entry. The goal of the CMHP is to divert these individuals from jail and help them access the treatment and support services essential to their successful rehabilitation and re-entry into the community. The project includes both pre-arrest and post-arrest diversion and a long-term housing component. Since the project s implementation in 2001, a post-booking jail diversion program has been initiated that now serves approximately 300 people a year through a variety of interventions. A pre-booking jail diversion program involving law enforcement officers specially trained in Crisis Intervention Team (CIT) policing has resulted in hundreds, if not thousands, of diversions each year, according to CMHP officials. Although the total number of annual pre-booking diversions across the county is not known, figures reported by the City of Miami Police Department indicate that CIT officers within the city alone respond to roughly 300 mental health related calls per month, or nearly 3,600 calls per year. In 2007, Miami-Dade County received a $1 million, three-year Criminal Justice, Mental Health and Substance Abuse Reinvestment Grant to expand the CMHP s Jail Diversion Program to serve people with serious mental illnesses charged with low-level felony offenses. The grant will provide for a new team of professionals, including case managers and peer specialists, to provide diversion services to individuals who meet program criteria. Key program elements Pre-arrest diversion The project now provides CIT training to all 36 of Miami-Dade County s law enforcement agencies, including university and school-based police officers and county correctional officers. A total of 1,800 individuals have been trained over the past seven years, and more than 850 CIT officers are currently on duty. When appropriate, these specially trained officers transport individuals with mental illness to community mental health facilities for evaluation and treatment instead of making an arrest. Post-booking diversion People with mental illnesses who are charged with misdemeanors are diverted from the jail to community mental health facilities for appropriate treatment within 24-48 hours of their arrest. This diversion is handled through two courts that are not specifically mental health courts, but function similarly to such courts. If the judges in these courts determine that an offender may be suffering from a mental illness, they refer the individual for evaluation by the court psychiatrist within 24 hours. A Brief Overview of Promising Jail Diversion Programs in Florida 4

Those individuals determined to have a serious mental illness are transported to one of six community crisis stabilization units for treatment. Once their illness is stabilized, a discharge summary/case plan outlining appropriate follow up services is developed and sent to the court, which must approve the diversion to community services. Upon release from jail, the Court Mental Health staff follows up to ensure these individuals are linked with case-management services. Core Program Components Assisted Living Facility (ALF) Quality of Care Program The CMHP developed a monitoring program and referral system for ALFs in order to improve the quality of care and access to mental health services at these facilities. Participating ALFs are continuously monitored and evaluated by project staff. These facilities have agreed to conform to the court s standard of care. Continuing care A continuing care coordinator monitors the individual s progress for one year and arranges for needed training, housing, treatment, medication, and other services. Currently, 150 clients are receiving continuing care. Court case management specialists These staff members engage program participants at first appearance in court, prepare discharge summaries and arrange for linkages to appropriate community treatment and support services. Peer Specialists Considered essential to jail diversion efforts, peer specialists assist jail diversion participants in re-entering the community and engaging in continuing treatment services. Gap funding Through an Interim Assistance Agreement between Miami-Dade County and the Social Security Administration (SSA), the county provides transitional assistance from the time of the application and approval of SSI/SSDI benefits. Funding is reimbursed to the county by SSA when the individuals begin receiving benefits. SOAR (SSI/SSDI Outreach, Access and Recovery) Miami-Dade is one of the first counties in the state to implement this program in February 2008. Part of a nationwide initiative, the program is a collaborative effort with the Department of Children and Families, the Social Security Administration and the state s Office of Disability Determination. SOAR helps access and expedite disability benefits for Individuals with mental illnesses who are homeless an important step in their recovery. In combination with gap funds, this effort supports diversion to community-based treatment and services upon discharge from jail. Funding The project initially was financed by Miami- Dade County, then received a three-year grant from the Substance Abuse and Mental Health Administration in 2003. The various program elements are now funded through the Department of Children and Families, Miami- Dade County and a Criminal Justice, Mental Health and Substance Abuse Reinvestment Act implementation grant. Based on the most recent semi-annual report1, the Mental Health Court Project appears to be effective in reducing program recidivism. During the 12 months following re-entry to the community, only 22% of participants were rearrested and referred back to the program. Program officials have also found that: The first 60 days appears to be critical for engaging clients in program. Active involvement in psychiatric treatment correlates to better overall outcomes, including reduced recidivism. People who are chronically homeless are at greater risk for poor compliance with program. A Brief Overview of Promising Jail Diversion Programs in Florida 5

Access to Housing: Kiva A Relationship-Based Care Model for Jail Diversion Because half of the people with mental illnesses involved in the CMHP s post-booking jail diversion program are homeless, access to housing is critical to preventing re-arrests and reducing the need for acute care services. To address this need, the court project collaborated with the Dade Homeless Coalition and Citrus Health Network (CHN) to develop the Kiva Program, a post-booking jail diversion program for homeless people with mental illnesses who are involved in the criminal justice system. Approximately half of the people referred by the courts for jail diversion are enrolled in this program. The program is based on Citrus Health s Relationship-Based Care model which has been successful in engaging people with severe mental illnesses who have been resistant to treatment and/or who are difficult to keep engaged in treatment. The model creates ongoing relationships that engage individuals in therapeutic activities and help empower them to take responsibility for their lives. The housing, medication and wrap-around services provided by Kiva cost $65 a day or $23,725 a year. 2 A specialized outreach team contacts individuals within 24 to 48 hours of their referral by the court to establish a relationship, serve as their advocate at the time of their court hearing, and develop an immediate plan of care. Upon release from jail, the team transports the individual to Citrus Health for a full medical and psychiatric assessment, and subsequently to his/her transitional housing placement. Many of the participants reside in assisted living facilities; others may be in short-term residential treatment facilities, supported housing or other types of housing. homelessness, and a significant majority (60.5%) had a diagnosis of schizophrenia. Arrest rates for each participant during a one-year period prior to admission to the diversion program were compared with arrest rates for a one-year period following admission to the program. The evaluation results showed: There were significantly fewer arrests during the year following admission for individuals who remained in the program or had been placed in permanent housing. 58% of all participants were not rearrested. 67% of participants who remained in the program for two months or more were not re-arrested. Compliance with psychiatric treatment contributed to decreased re-arrest rates. The longer individuals remained in the program, the less likely they were to be re-arrested. Those who obtained permanent housing were less likely to be re-arrested. Footnotes 1. Miami-Dade County Criminal Mental Health Project Jail Diversion Program Semi-Annual Report (January June 2008) 2. Information from staff interviews. This figure is based on the average housing costs across all inmates of $114 per day, and does not take into account additional costs associated with medication and other mental health treatment services. 3. A Relationship-Based Care Model for Jail Diversion, Citrus Health Network, March 2008 Kiva A separate study by Citrus Health Network followed 151 individuals served from January 2002 through November 2006 3. Sixty percent of the individuals sampled had a history of chronic A Brief Overview of Promising Jail Diversion Programs in Florida 6

Orange County Mental Health Pretrial Release Program Overview Orange County s Mental Health Pretrial Release Program is one outgrowth of the strong crosssystem collaboration that also resulted in creation of the county s Central Receiving Center. The pre-trial diversion program was begun in 1999 and predates the opening of the Central Receiving Center in 2003. The county s jail diversion efforts were enhanced in April 2004, when it received a grant from the federal Substance Abuse and Mental Health Services Administration to create a similar program for jail inmates with non-violent charges who have co-occurring mental health and substance use disorders. These related programs share a common goal of reducing the number of people with mental illnesses and/or co-occurring substance use who are involved in Orange County s criminal justice system. The Mental Health Pretrial Diversion program identifies jail detainees who can be safely supervised in the community while awaiting disposition of their cases. Jail mental health staff and community mental health service providers propose a treatment plan to the court at the defendants first appearance. If the judge, prosecutor, and defense attorney agree on the plan, the defendants are released to the custody of the service provider, typically Lakeside Behavioral Healthcare, which provides case management, medication, treatment, and sometimes housing. Lakeside keeps the court apprised of individuals progress until their cases are disposed of. If participants successfully complete their case plan, charges are usually dropped or the individual is sentenced to time served. Funding The pre-trial release program is primarily funded by Orange County government and the Florida Department of Children and Families, which funds the services of Lakeside Behavioral Healthcare. A retrospective evaluation 1 was conducted of all of the 1,416 individuals referred to the pre-trial release program over an 18-month period. Of the 315 people who choose to participate, 57% (170) successfully completed the program. The study tracked three smaller sample groups for which there was available data. Tracked from the time they were arrested and booked into the jail were: individuals who successfully completed the program (59), individuals who did not successfully complete the program (43), and individuals who did not participate in the program (217). The study concluded that: Those who participated in the program spent an average of 47 days in jail, compared to 119 for unsuccessful participants and 123 for nonparticipants. The cost 2 to the county jail for individuals who successfully completed the program averaged $7,000 per person, compared to $8,454 for nonparticipants. An analysis by the Council of State Governments 3 suggests that increasing the number of individuals who successfully complete the program should decrease what the county spends annually to incarcerate a growing number of people with mental illness. Footnotes 1 and 3. Increasing Collaboration between Corrections and Mental Health Organizations: Orange County Case Study, Council of State Governments Justice Center, New York, NY, 2007 2. Costs were based on the average daily cost of $65 for all inmates. The evaluation noted that people with mental illnesses often require medications and other treatment that are not reflected in this base cost; therefore the savings could be greater. A Brief Overview of Promising Jail Diversion Programs in Florida 7

Hillsborough County Jail Diversion Program Overview Hillsborough County has an extensive jail diversion program for people with mental illnesses and/or co-occurring substance use disorders. The initiative has been expanded in recent years largely through funding from two federal grants. One of these programs intervenes post booking and the other is targeted to individuals re-entering the community from jail or prison. The key element of the Hillsborough County Targeted Capacity Expansion Jail Diversion Program is Forensic Intensive Case Management (FICM) provided by a multidisciplinary team. Based on the Assertive Community Treatment model, the FICM team steps in after booking, providing direct services to participants and serving as a liaison to other community-based service providers. To be admitted to the program, individuals must be at least 18 years old and have two or more misdemeanor offenses in the past 12 months, a diagnosis of probable serious and persistent mental illness and/or cooccurring substance use disorder, and reside in Hillsborough County. The program builds on and expands the county s pre-existing jail diversion activities, which have been in place since 2000. In addition to providing individual and group therapy, the FICM team s clinical case managers serve as community advocates in identifying and networking with landlords, employers, and service providers. A part-time psychiatrist prescribes and monitors medication compliance. A peer specialist provides therapy and life skills training. Wraparound services include transportation, housing assistance, and help in applying for disability payments. The team has a maximum caseload of 30 clients; each can be served for up to a year. To assure continued communication and coordination, an advisory committee meets bimonthly and includes representatives of county government, participating provider agencies, the Department of Children and Families, the Florida Mental Health Institute, the Hillsborough County Sheriff s Office, and area s Public Defender s Office. On alternate months, a jail diversion strategic planning comprised of staff of the various participating agencies meet. The program plans to develop mechanisms for early identification/screening using the sequential intercept model and to create diversion pathways other than to emergency services. A preliminary assessment of the program 1 was done during the period from April 2007 and July 2008, involving 20 of the 39 people who had participated in the program during that time. This early evaluation looked at participants outcomes based on re-arrest rates, alcohol and substance use, housing status and ability to obtain employment. These preliminary findings indicate that the program had been successful in reducing criminal recidivism and mental illness and substance use symptoms as shown by the following: Although all of the participants had been arrested at least twice in the year prior to their admission, 80% were not arrested while enrolled in the program. Additionally, all of the participants reported at admission that they had used alcohol or drugs at some point during their life or in the past 30 days, but 90% reported they did not use alcohol or drugs while enrolled in the program A more in-depth evaluation of an estimated 80 participants over a three-year period will be done by the Department of Mental Health Law and Policy at the Louis de la Parte Florida Mental Health Institute. Re-entering the community Another diversion program operated by Hillsborough County is Looking Ahead, a postrelease program which offers a range of services A Brief Overview of Promising Jail Diversion Programs in Florida 8

to people who are re-entering the community from jail or prison. This umbrella project has a second FICM team as its cornerstone. The program is voluntary and offers varying levels of services and assistance, depending on individual needs. Its focus is ex-offenders with mental illnesses or substance use disorders who have been court-ordered to criminal registration after their release from prison. The goal is to increase linkages to community supports and services and create rapid access to services. Footnotes 1. The Evaluation of a Jail Diversion Program Utilizing Forensic Intensive Case Management, an unpublished paper by Chelsea R. Heinz, the University of South Florida, July 2008. 2. Jan MacLeod, Criminal Justice Liaison, Hillsborough County This program began in November 2007. On average, the program has screened nearly 3,000 people since its inception and sees about 100 per month. About half receive some sort of services at a cost of roughly $820 per person, according to the county s Criminal Justice Liaison. 2 Services range from simple referral to Forensic Intensive Case Management. The average cost of services compares to the estimated $2,800 cost of prosecuting someone who is re-arrested. Funding The pre-booking Forensic Intensive Case Management is financed by a grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA), now in its third year. Funding for the various components of Looking Ahead includes a SAMHSA Justice and Mental Health Collaboration Program grant awarded in 2006, a state Criminal Justice, Mental Health and Substance Abuse Reinvestment Act grant, Department of Children and Families funding and local support. In addition, some services are partly supported by Medicaid and Medicare. No formal evaluation has been done of the postdischarge program, but the Hillsborough County Criminal Justice Liaison reports that no one receiving services has been rearrested since the program began. An evaluation of the program is planned in the future. A Brief Overview of Promising Jail Diversion Programs in Florida 9

Passport to Success: Community Treatment for Ex-Offenders with Mental Illnesses in Hillsborough, Pasco and Pinellas Counties Overview Passport to Success is a re-entry and community treatment program for ex-offenders with mental illnesses. It is operated in Hillsborough, Pasco and Pinellas Counties by Gulf Coast Community Care via a $650,000 annual contract with the Florida Department of Corrections. The program serves ex-offenders returning to the community from prison or on probation one of the most difficult groups of individuals to reintegrate into society. In addition to the issues associated with a criminal record, including the effects of institutionalization, these individuals tend to be highly transient and many have never held a job. Through marshalling community resources, the program works to help ex-offenders achieve stability in terms of their mental illness and their day-to-day lives. Services include mental health treatment and medications, help in applying for disability benefits, assistance finding housing and employment, job training or completing a GED, funds to buy work clothes and tools, transportation, and other community services. The program expects to serve 250 people during FY 2008-2009. Each ex-offender is assigned a life coach who sets up a case plan designed for the individual's needs. Life coaches are located in each of the participating counties and work with the exoffenders released to that county. Participants also meet with an employment specialist, a mental health counselor and a psychiatrist who determines if medication is needed. Participants are considered to have successfully completed the program if they have met their immediate needs for re-entry into the community, are employed and have stable housing. three to six months. Once the individual completes the program, follow-up occurs every 30 days for a three-month period to check on the ex-offender's progress. Participants who need further help after completing the program are encouraged to contact Passport staff for assistance or guidance. An independent evaluation 1 of the 155 individuals admitted during the program s first 10 months of operation (August, 2006 through May 2007) showed that: In spite of dealing with a particularly difficult population, Passport to Success is reaching or exceeding the targets set for it, and promises to continue to be a definite asset to the participants, the criminal justice system and the community. Specific outcomes are: 78.7% (107) of the non-disabled clients entering the program were either working or in training programs, exceeding the 75% target. 46.2% the program s 155 participants had obtained employment and were still on the job 90 days later, nearing the goal of 50%. Participants average wage of $9.00/hour was considerably higher than the $7.00 wage earned during the first few months of the project. 100% of participants were linked to psychiatric services, including medication management, compared to a goal of 75% Footnote 1. Independent evaluation by William R. Blount, Ph.D., W. R. Blount and Associates, Inc., Tampa, former chair of the Department of Criminology, University of South Florida, July 2007. The average time spent in the program is from A Brief Overview of Promising Jail Diversion Programs in Florida 10

Eighth Judicial Circuit Mental Health Court Alachua County Overview The Eighth Circuit Mental Health Court Program is a partnership between the circuit court, Department of Children and Families, the Public Defender s Office, State Attorney s Office, Alachua County Court Services, Veteran s Administration and treatment providers. Originated in the fall of 2001, it is a pretrial diversion program for defendants arrested for misdemeanor offenses who have a mental illness or development disability. It is one of only a handful of mental health courts in Florida. The program is designed to divert participants from jail and expedite legal case processing through the criminal justice system by providing access to the least restrictive treatment, training, and support services necessary to reduce recidivism and ensure public safety. After an initial screening to determine if the defendant meets program criteria, a case plan is developed by the defendant, case managers, and pre-trial counselor. The case plan, which is closely monitored by the Mental Health Court team, includes goals, services, and discharge requirements. The Mental Health Court Program is a voluntary program. Participants spend an average of eight months in the program. Upon successful completion of the program, the charges are dismissed, the criminal case closed and, as needed, the individual continues the treatment plan. Defendants who do not comply with their treatment plans return to criminal court for sentencing. savings to the county jail during a seven-year period beginning in FY 2001-2002. Including current participants, there have been 233 individuals court ordered into the program since its inception. Of that total, 143 (61%) successfully completed the program. Following are some of the key statistics collected on those individuals who successfully completed the program since its inception 1 : 128 of 143 people have had no jail days since completion. Those who had served an average of 49.26 days in jail in the 5 years prior to participation in Mental Health Court served only 4.92 days while participating and 4.59 after completing the program. Based on an average daily jail bed day cost of $63.06, the mental health court s impact on reducing jail time resulted in a savings of $276,485 over the sevenyear period. The average time in jail for the 67 individuals who were dropped from the program for noncompliance increased from 20 to 24.76 after they left the program. 54 of the 67 have had no jail days since termination. Footnote 1. Report on Data Collection for Mental Health Court Participants, prepared by Circuits 3 and 8 Substance Abuse and Mental Health Program Office, September, 2008 Data collected by the Circuit 8 Substance Abuse and Mental Health Program show the Mental Health Court has led to a significant decrease in the amount of time spent in jail by participants. This reduction in jail time has resulted in a A Brief Overview of Promising Jail Diversion Programs in Florida 11

Alachua County Forensic Specialist Jail Diversion Team Overview Alachua County began in 1998 to focus on ways to address the criminalization of individuals with mental illnesses and substance use disorders by developing specialized, therapeutic mental health and drug courts, Crisis Intervention Team training and community and jail-based competency restoration services. In 2006, based on recommendations of a special Mental Illness Work Group, the county funded a Forensic Specialist Team. This special diversion team serves people charged with misdemeanors as well as those adjudicated incompetent to proceed under F.S. 916. In 2008, a Forensic Diversion Team was added, supported by a Criminal Justice, Mental Health, and Substance Abuse Reinvestment Act implementation grant. The grant will provide $1 million over a threeyear period, to be matched by Alachua County. The Forensic Diversion Team is operated by Meridian Behavioral Health, a nonprofit organization serving Alachua and several other counties. The project is overseen by an appointed advisory group with Meridian as the lead agency working with the Alachua County Sheriff s Office, the courts, the Department of Children and Families Substance Abuse and Mental Health Program Office, the Office of Court Services and the Housing Authority. An evaluation of the project will be conducted by the Louis de la Parte Florida Mental Health Institute. The program serves as a treatment home, providing team-based services and case management for difficult to treat individuals who have serious mental illnesses or substance use disorders or both, coupled with a history of recidivism. The program adopts features from the Assertive Community Treatment (ACT) team model that emphasize engagement, integrated team approach, and intensive service delivery, including on-call staff. The majority of individuals served have been charged with felonies. The original Forensic Specialist team continues to serve people with fewer treatment attempts, or somewhat less serious co-occurring conditions. The team offers basic outreach services to engage the individual and make appropriate referrals. Those individuals with more complex illnesses and/or co-occurring disorders served by the specialists receive more intensive case management services. Most of those enrolled are referred to area providers regular service programs. Participants who meet program criteria are referred to the team at their first court appearance and spend little time in custody. Those who successfully complete their treatment plans generally have their charges dropped or are sentenced to time served. Both teams coordinate services to enhance participants opportunities for appropriate judicial disposition and assure access to the comprehensive services necessary to their successful recovery. These services include case management, psychiatric services, vocational services, benefits coordination and housing assistance. From July 2007 June 2008, the Forensic Specialist Team project served 426 clients, according to an August 2008 report to Alachua County commissioners by Meridian Behavioral Health President and CEO Maggie Labarta, Ph.D. Clients are served while in jail, and while living in the community. The team also follows up on individuals who have been committed to Northeast Florida State Hospital for treatment. Meridian Behavioral Health has collected baseline data for 130 clients for the period from January through June 2007 and a full year of post-admission data from June 2007 through July 2008. Following are highlights from Meridian s analysis: Those participants receiving outreach services served an average of 14.65 fewer days in jail. Those who received case management and other intervention services served 52.45 fewer days in jail. A Brief Overview of Promising Jail Diversion Programs in Florida 12

84% of participants in the program kept their medication appointments, an important step in recovery. The cost for the jail diversion services provided by Meridian was $780 for each client served. The per client cost of $7.23 per day compared to the current base jail cost of $67 per day or an adjusted cost of $125 per day based on estimates for serving inmates with mental health care needs. The project saved Alachua County from $193,161 to $360,375 (adjusted rate) in jail costs for the 130 clients. Extrapolated to the 400 clients expected to be served this year, the estimated savings in jail costs ranges from $646,008 to $1.2 million. A Brief Overview of Promising Jail Diversion Programs in Florida 13