Jail Diversion in North CarolinaFebruary 2009February 2009

919 / 715-2771 or Bob.Kurtz@ncmail.net919 / 715-2771 or Bob.Kurtz@ncmail.net

““What county officials and the public should What county officials and the public should know about the incarcerated mentally ill know about the incarcerated mentally ill population is not just that these individuals population is not just that these individuals will significantly benefit from a system of will significantly benefit from a system of comprehensive services, such as housing, comprehensive services, such as housing, health, and human services, but that such a health, and human services, but that such a strategy would be less expensive and more strategy would be less expensive and more effective in the long-term.” effective in the long-term.”

- - National Association of Counties Report National Association of Counties Report titled: titled: Best practices for diverting mentally Best practices for diverting mentally ill individuals from county jailsill individuals from county jails. - June 2003. - June 2003

Lack of services or Lack of services or barriers to service will barriers to service will increase the likelihood increase the likelihood

that people with that people with mental illness mental illness

will end up in jail.will end up in jail.

Penrose’s Law: There’s an inverse Penrose’s Law: There’s an inverse relationship between Severe & relationship between Severe & Persistent Mental Illness Persistent Mental Illness incarcerated and those in hospitalsincarcerated and those in hospitals

Psychiatric instability often results in legal problems…...

About 20% of people with SMI who have been treated and released from a psychiatric hospital are arrested within one year of discharge - compared to 5% life time arrest rate for the general population. Usually the arrest is for minor crimes…

Trespassing Public Intoxication Disturbing the public order Impeding the flow of traffic Drug related offenses.

According to a recent Duke University study.

High Rates of People with Serious Mental Illness in Jail

Every year, about 800,000 people with severe mental illness are incarcerated in US jails.

More than 16% of people in US jails have a serious mental illness (compared to 5% in general population).

More than 4% of men in jail suffer from Schizophrenia or Bipolar Disorder-manic phase

Women in jail have almost double the rate of serious mental illness as men.

People with mental illness don’t fare well in the criminal justice system

Research shows that people with mental illness -

Are more likely to be arrested - In one study, 47% vs. 26% for non-MI following police encounters.

Face more serious charges - Are often charged with more serious crimes than others for similar behavior.

Stiffer sentences - Are sentenced more severely than other people with similar crimes.

People with mental illness in the criminal justice system continued...

Serve longer in jail and prison - Spend two to five times longer in jail and average 15 months more in prison.

Can’t make bail - Are often detained because they have no income and can’t make bail.

Have more difficulty coping - Experience more fights, infractions, and sanctions in prison

Are more vulnerable - To being exploited or manipulated by other inmates.

In North Carolina jails…...* People with mental illness are often not identified

when they enter jail: There is quick access to emergency mental health

care in jail, but limited access to hospital beds for mentally ill jail detainees:

Policies exist that violate mentally ill detainees’ rights / dignity:

Medications are often changed to a cheaper substitute in jail:

Communication / linkage between jail and community providers varies widely:

* Vaughn & Schyette, 2007, study of mentally ill in NC jails.

Requirements of H.B. 1493 - Section 10.49 (f)

“Within available resources….” A statewide standardized evidence-based screening

instrument shall be used when offenders are booked. LMEs and county sheriffs shall work together to develop all of

the following:a. A designated LME employee who is responsible for

screening the daily jail booking log for known mental health consumers.

b. Protocols for effective communication between the LME and the jail staff including collaborative development of medication management protocols between the jail staff and the mental health providers.

c. Training to help detention officers recognize signals of mental illness.

Goals of Jail Diversion Programs Preventing the inappropriate

incarceration of persons with mental illness and co-occurring disorders.

Reducing jail time for people with mental illness who are inappropriately confined.

Linking detainees to appropriate mental health and community services following their release from jail.

Jail Diversion is Jail Diversion is notnot discharge discharge planning or in-jail treatmentplanning or in-jail treatment

Jail Diversion:Jail Diversion: Is a special program designed to help people with mental illness move from the criminal justice system to appropriate treatment in the mental health system.

In contrast - Discharge / Transition Planning:Discharge / Transition Planning: Is part

of the usual criminal justice process that occurs when the offender would ordinarily leave jail.

What do jail diversion staff do?What do jail diversion staff do? Screen - detainees in contact with the criminal

justice system for the presence of a mental illness. Negotiate - with law enforcement, prosecutors,

defense attorneys, and the court to develop community-based mental health treatment dispositions for clients as alternatives to incarceration.

Link - clients to community based mental health services, once the mental health disposition is determined and agreed on by all parties.

Two Categories Of Two Categories Of Jail Diversion InitiativesJail Diversion Initiatives

Pre-booking - Pre-booking - Provide community based alternatives to arrest and incarceration. Most include a 24 hour crisis unit with a no refusal policy for law enforcement.

Post-booking - Post-booking - Following arrest and with the agreement of the court, involvement in treatment in the community.

When law enforcement responds to calls on people with mental illness... The arrest rate is 20% when no specialized

response exists. The arrest rate is 7% when some form of

specialized response exists. The arrest rate for the Memphis CIT

program is just 2%. Percent of incidents resolved on scene = 23% Percent of incidents resulting in the person

being transported to a crisis unit = 75%

Comparisons of pre-booking models Three models were examined to determine

the proportion of police “mental disturbance” calls that resulted in a specialized response.

The results…. Birmingham MH “imbedded” model - 28% Knoxville mobile crisis model - 40% Memphis CIT model - 95%

Steadman, H., et.al, Comparing outcomes of major models of police responses to mental health emergencies. Psychiatric Services, May 2000.

Awards / Recognition for Awards / Recognition for Wake’s CIT programWake’s CIT program

Program of Excellence 2006:

- NC Council of Community Programs Agent of Change Award 2006

- Easter Seals UCP / ASAP Outstanding County Program 2007

- NC Association of County Commissioners CIT is a “Ray of hope in the system”

- News & Observer article quoting Verla Insko - State representative and chairwoman of the House Committee on Mental Health Reform.

Mental Health Courts Are evolving rapidly As yet, no evidence based conclusions Steadman* recommends

A single court docket Courtroom team approach Specific plan manager Assurance of treatment slots Expanded services to avoid displacing others in need of

treatment (I.e., earmark services for the court so other clients aren’t pushed out of service).

Hank Steadman, Ph.D., Director of Policy Research Associates and the TAPA Center, providing technical assistance to SAMHSA funded jail diversion programs.

What we’ve learned about mental What we’ve learned about mental health courts……health courts……

Need to assure that there are expanded numbers of intensive treatment slots for MH Court clients.

Treatment that is court ordered needs to be consistent with what could be accessed without referral to the mental health court.

Referral to the mental health court should be reserved for those consumers who need the oversight of the court to remain compliant.

Should not exclude persons with mental illness who have a committed a violent offense.

Where Diversion Can Occur

R

The earlier the diversion is in the criminal justice process, the better!

Arrest Booking Court ProbationJail orPrison

Release andplanning toreturn tocommunity

Preventionof Arrest

DiversionBeforeBooking

DiversionBeforeAdjudication

MentalHealthCourt

Cost Effectiveness of Intervention

Violation of Rights

Continuum of jail diversion services.Interaction with police

Pre-booking diversion

(to crisis unit or other community service)

JailCourt

Post-booking diversion

Mental health court

Not diverted

Released to community after sentence is served

Core Conceptual Model(Outcomes for jail diversion depend on a comprehensive mental health

service system, and clients being effectively linked to that system)

Jail DiversionComprehensive

Appropriate treatment

Improved Outcomes

Divert from jail to??????

“Successful jail diversion efforts require more than simply diverting an individual with mental illness away from jail. He or she must also be diverted into appropriate and adequate treatment services.”

Jail diversion requires a comprehensive, Jail diversion requires a comprehensive, responsible, & accountable mental health system!responsible, & accountable mental health system!

“Poorly organized jail diversion programs lacking a mental health infrastructure produce short-term results that may harm the client and community.”

Integrated Treatment for People with co-occurring mental illness and substance abuse is particularly important for Jail Diversion clients.

More than 72% of people with severe mental illness who are in jail have a co-occurring substance abuse disorder.

Jail diversion programs

may benefit counties by…. Helping to alleviate jail over-crowding Reducing costs of incarceration and unnecessary

prosecution Helping consumers get access to appropriate

services Providing support and incentives for staying in

treatment Helping end the cycle of repeated incarcerations

and crisis care

CIT in North Carolina – February 2009

AlamanceAlexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Buncombe

Burke

Cabarrus

Caldwell

Camden

Carteret

Caswell

Catawba Chatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Currituck

DareDavidson

Davie

Duplin

Durham

Edgecombe

ForsythFranklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

Macon

MadisonMartin

McDowell

Mecklenburg

Mitchell

Montgomery

Moore

Nash

NewHanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Tyrrell

Union

Vance

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

Yancey

NC counties where CIT trainings have been held.

Post-booking Jail Diversion In North Carolina by 2009

AlamanceAlexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Buncombe

Burke

Cabarrus

Caldwell

Camden

Carteret

Caswell

Catawba Chatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Currituck

DareDavidson

Davie

Duplin

Durham

Edgecombe

ForsythFranklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

Macon

MadisonMartin

McDowell

Mecklenburg

Mitchell

Montgomery

Moore

Nash

NewHanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Tyrrell

Union

Vance

Wake

Warren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

Yancey

Intensive Case Mgt

Mental Health Court

North Carolina Jail Diversion DataNorth Carolina Jail Diversion Data

Estimates by case managers in five jail Estimates by case managers in five jail diversion programs indicated an average diversion programs indicated an average of 3,174 jail days reduced per year per jail of 3,174 jail days reduced per year per jail diversion program. diversion program.

These data suggest an average of 8.7 These data suggest an average of 8.7 fewer inmates in jail per year in those fewer inmates in jail per year in those areas where jail diversion programs exist. areas where jail diversion programs exist.

Outcome data on clients in Outcome data on clients in North Carolina jail diversion programs for North Carolina jail diversion programs for

one year show…one year show…

Higher global assessment of functioning scores. Report lower rates of substance abuse. Lower rates of homelessness. Greater satisfaction with housing. Movement to more independent housing. Higher rates of employment.

But rates of re-arrest and psychiatric hospitalization and inpt treatment

for substance abuse were not reduced during that first year.

Collaboration between Mental Health &

Justice Systems is complicated by their differences

Different Interests

Mental Health Providers: Concerned with client’s emotional and psychiatric well being.

Jail: Concerned with safety. Group vs. Individual focus.

Defense Attorney: Often concerned with short term legal (instead of long term “best”) interests of client.

Judges: Concerned with community safety.

Different Constituencies

ActorActor

Police----------------------- Prosecutor----------------- Defense Attorney-------- Judge----------------------- Sheriff----------------------

Mental Health staff------

ConstituencyConstituency

Local Community Government Defendant The Law (and electorate) The wider community and

sometimes federal judge The client, family, advocates,

local community, and state.

DIFFERENT LANGUAGE -including different definitions of diversion*

Justice system definition of diversion: To divert the criminal case out of the justice system and off the court docket. Judge’s may view this type of diversion as a criminal’s attempt to “get out of jail free.”

Mental health system definition of diversion: To divert the client from jail to the community mental health system. Deferred prosecution, continued court oversight, and (perhaps) mandatory treatment are included in this definition.

*To a judge, deferred prosecution is not diversion.

“The most effective way to improve your relationship with the justice

system is to increase your understanding of it.” Learn the “language” of the justice

system Know how the justice system functions

in your community Understand the culture of your law

enforcement officers and jails. Beware of the many challenges faced

by those working in the justice system.

The Benefits of Working Together Reduce jail days, reduces overcrowding, reduces

overcrowded court dockets. Reduces jail service expenses. Reconnects people to services. Coordinates services - reduces waste. Gives people structure, allowing them to focus on

recovery. Increases Federal share of treatment cost.

For More Information about Jail DiversionFor More Information about Jail Diversion

The Tapa Center is the organization contracted by SAMSHA to provide technical assistance to jail diversion programs. Contact them at: www.tapacenter.org or (866) 518-8272

The GAINS Center is a national organization that collects and disseminates information about effective services for people with co-occurring disorders in contact with the justice system. Access them at: www.gainsctr.com

The Consensus Project is an national effort to provide information, research and support to organizations attempting to help people with mental illness in the criminal justice system. It is sponsored by the Council of State Governments. They may be reached and their report downloaded at: www.consensusproject.org

Or Bob.Kurtz@ncmail.net or 919 / 715-2771