Collaboration at the Interface of Mental Health and Criminal Justice Thursday, June 30, 2011 Council of State Governments Justice Center
Today’s Webinar
Introduction Conversation among JMHCP Grantees
Council of State Governments Justice Center
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Serious Mental Illnesses (SMI): An Issue in Jails and Prisons Nation-wide Serious Mental Illnesses in General Population and Criminal Justice System
Percentage of Population
35
31
30
24
25
Total: female and male
20 15
15
16
Female Male
10 5
5
0 General Population
Jail
State Prison
Source: General Population (Kessler et al. 1996), Jail (Steadman et al, 2009), Prison (Ditton 1999) Council of State Governments Justice Center
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Perceived Root of the Problem “People on the front lines every day believe too many people with mental illness become involved in the criminal justice system because the mental health system has somehow failed. They believe that if many of the people with mental illness received the services they needed, they would not end up under arrest, in jail, or facing charges in court�
Council of State Governments Justice Center
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Arrest is Not Always a “Direct” Product of Mental Illness Reliable raters coded 113 post-booking jail diversion cases: How often were inmates’ offenses considered a result of serious mental illness (SMI) or substance abuse (SA)? Percentage of cases where raters said arrest was “probably” or “definitely” a . . . 100% 80% 60% 40% 20% 0%
19 4
4
17
Direct Indirect Direct Indirect effect of SMI effect of SMI effect of SA effect of SA
Source: Junginger, Claypoole, Laygo, & Cristina (2006) Council of State Governments Justice Center
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Those with Serious Mental Illnesses Often “Fail” Community Supervision Screened 2,934 probationers for mental illness:
13% screened in as mentally ill Followed for average of two years Persons without mental illnesses
Persons with mental illnesses
80% 60% 40% 20% 0% Arrests
No more likely to be arrested… Source:Vidal, Manchak, et al. (2009)
Revocations
. . . But 1.38 times more likely to be revoked See also: Eno Louden & Skeem, 2009; Porporino & Motiuk, 1995
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Criminogenic Risk
Conditions of an individuals behavior that are associated with the risk of committing a crime.
Static factors – Unchanging conditions such as demographics, age of first arrest, and nature of crime
Dynamic factors – Conditions of an individual that change over time and are amenable to treatment interventions such as attitudes, beliefs, thinking patterns, and peer groups.
Council of State Governments Justice Center
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Offenders with Mental Illness Have Significantly More “Central 8” Risk Factors 60 55 **
Persons with mental illnesses
50
Persons without mental illnesses
45 40 LS/CMI Tot
…particularly “Antisocial Pattern”*** ….and these predict recidivism more strongly than risk factors unique to mental illness (i.e., HCR-20 total scores) Source: Skeem, Nicholson, & Kregg (2008) Council of State Governments Justice Center
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Recidivism is Not Simply a Product of Mental Illness: Dynamic Criminogenic Risk Factors Individual Risk Factors for Criminal Recidivism (Andrews, 2006)
Criminogenic Risk Factors History of Antisocial Behavior Antisocial Personality Pattern Antisocial Cognition Antisocial Attitudes Family and/or Marital Discord
Poor school and/or work performance Few leisure or recreation activities
Substance abuse Council of State Governments Justice Center
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Alcohol and Drug Use Disorders: Household vs. Jail vs. State Prison 60 54 %
Percent of Population
50
47 %
53 % 44 %
Alcohol use disorder (Includes alcohol abuse and dependence)
40
30
Drug use disorder (Includes drug abuse and dependence)
20 10
8% 2%
0 Household
Jail
State Prison
Source: Abrams & Teplin, (2010) Council of State Governments Justice Center
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SMI and Co-Occurring Substance Use Disorders (CODs) Co-occurring Substance Use Disorders among Jail Detainees with SMI
28%
72%
■ % With Co-Occurring Substance Use Disorders ■ % Without Co-Occurring Substance Use Disorders Council of State Governments Justice Center
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Incorporating Criminogenic Risk Factors in Sentencing and Supervision Planning Individual Risk Factors for Criminal Recidivism
Risk Factor
Need
History of Antisocial Behavior
Build alternative behaviors
Antisocial Personality Pattern
Problem solving skills, anger management
Antisocial Cognition
Develop less risky thinking
Antisocial Attitudes
Reduce association with criminal others
Family and/or Marital Discord
Reduce conflict, build positive relationships
Poor school and/or work performance
Enhance performance, rewards
Few leisure or recreation activities
Enhance outside involvement
Substance abuse
Reduce use through integrated tx
Source: Andrews, 2006 Council of State Governments Justice Center
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SMIs and CODs are Often Untreated Past Year Mental Health Care and Treatment for Adults Aged 18 or Older with Both Serious Mental Illness and a Substance Use Disorder
Source: NSDUH, 2008 Council of State Governments Justice Center
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Evolving Framework MI-SA-CR I. High-High-High II. Low-High-High III. High-Low-High IV. Low-Low-High V. High-High-Low VI. Low-High-Low VII. High-Low-Low VIII. Low-Low-Low
Council of State Governments Justice Center
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Sequential Intercept Model
Source: Munetz, Griffen, 2005 Council of State Governments Justice Center
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Diversion Logic Model Stage 1
Diversion
Identify and Enroll People in Target Group
Stage 2
Linkage
Comprehensive/ Appropriate Community-Based Services
Stage 3 Improved Mental Health /Individual Outcomes
Improved Public Safety Outcomes Source: Steadman et al., 2007 Council of State Governments Justice Center
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Diversion to What?
Target Population
Comprehensive Effective Community-Based Services
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Effective EBPs for Justice Involved Persons with Behavioral Health Issues EBP Housing Integrated Tx ACT Supported Emp. Illness Mgmt. Trauma Int./Inf CBT Medications
Data for J I ++ ++++ +++ + + ++ ++++ +++++ Council of State Governments Justice Center
Impact +++++ ++++ +++ +++ ++ +++ ++++ +++++ 18
Justice Mental Health Collaboration Program through BJA Map of JMHCP FY2010 Grantees
Council of State Governments Justice Center
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Thank You Fred Osher, M.D. Director Behavioral Health Systems and Services Policy Council of State Governments Justice Center
www.consensusproject.org This material was developed by JLI/PLG Advisory Group for piloting in Springfield, Illinois, on May 3, 2011. Presentations are not externally reviewed for form or content and as such, the statements within reflect the views of the authors and should not be considered the official position of the Justice Center, the members of the Council of State Governments, the American Psychiatric Foundation, or funding agencies supporting the work.
Council of State Governments Justice Center
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