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Mental Health Court 101 2007 Georgia Drug & DUI Court Conference – Peachtree City, GA
Honorable Kathlene Gosselin, Hall County Superior Court
&
H.E.L.P. Program Team
1955 census included geriatric patients and some patients with MR
21,000 (1/3) of the 70,000 patients in hospitals in 1995 were forensic patients
Does not include community or private hospitals
While the number of patients in psychiatric hospitals has decreased dramatically since 1955...
0
100,000
200,000
300,000
400,000
500,000
600,000
Pa
tie
nts
in P
ub
lic P
sy
ch
iatr
ic H
os
pit
als
1955 1995
Source: Torrey, Out of the Shadows, 1997
. . . jails and prisons have become the new “psychiatric hospitals”
0
50,000
100,000
150,000
200,000
250,000
300,000
Nu
mb
er
of
Pe
op
le
Hospitals Jails & Prisons Homeless
Non-Traditional Allies
Police, judges, correctional officials have become strong allies of NAMI advocates in many states and communities.
Significant growth of pre and post-booking jail diversion programs, e.g. CIT programs MH Courts.
Enactment of federal legislation (P.L. 108-414).
Mental Health Courts
Treatment is better than jail. For many of these offenders, mental illness
is their primary issue, not criminality – not addressing the primary issue destines the offender to a revolving door at the jail.
Important differences from drug courts. Psychiatric relapse is not a crime.
Drug Courts vs. Mental Health Courts
Similarities Ongoing judicial interaction Use of sanctions/incentives Integration of services with
judicial case processing Non-adversarial approach
of prosecution and defense Use of drug testing Coordinated strategy of
court team Necessary coordination
with community resources
Differences Level and type of sanctions Court atmosphere Intensity of case
management Lack of emphasis on
payment of fees Judicial demeanor Inclusion of mental health
system, consumer and advocacy partners
Focus on medication compliance
Need for treatment specific to co-occurring disorders
Mental Health Program Principles
Divert persons with mental illness from unnecessary and inappropriate incarceration
Improve treatment access and recovery options
Reduce cost and risk for jail and law enforcement
Reduce recidivism and problem behaviors
Benefits of MH Courts
Help people with mental illness who are in the criminal justice system BECAUSE of their illness, out of jails and into treatment and more stable lives in the community.
Better treatment outcomes, reduced recidivism, enhanced public safety.
Provides options for other specialty courts (e.g. drug courts, domestic violence courts).
H.E.L.P Program
A pilot program of the Georgia Department of Corrections in partnership with the Hall County Superior Court
Services provided by MHM Correctional Services, Inc., a national vendor of mental health services to correctional systems and the current vendor to the Georgia Department of Corrections
Background
High recidivism rates for offenders with mental illness (16-18% in HCDC diagnosed MI)
GDOC desired pilot program to prevent the return to prison of offenders with mental illness
GDOC received grant from the Governor’s Criminal Justice Coordinating Council
Hall County selected as pilot site
Coordination
18 months planning and coordination prior to start
Stakeholders attend training conference
Retention of vendor (MHM) Development of service provider team
and program procedures
Mission Statement
It is the mission of the HELP Program to provide alternatives to incarceration for
defendants who are involved in the criminal justice system as a result of their
mental health or mental retardation issues. We accomplish this by linking those individuals to local, community
based treatment resources with the goals of reducing recidivism and helping the participants become stable, productive
members of the community.
Program Objectives
1. Provide offenders with community-based case management and treatment services as an alternative to incarceration
2. Stop the cycle of imprisonment of individuals with serious mental illness
Initial Program Staffing
Project Coordinator (licensed masters level)
Two full-time case managers (licensed masters level)
Half-time clinical psychologist (doctoral level)
Current Program Staffing
Project Clinical Coordinator (licensed masters level)
Clinical Case Manager Community Support Person
Additional Support: Working with Georgia Mountains Community
Service Board – GMCSB Team is similar in make-up Psychiatric Social Worker Community Support Individual Access to psychiatric support and other therapeutic
support
Eligibility Requirements
1. Incarcerated, charged, or on probation/parole in Hall County (Misdemeanor or Felony)
2. Not charged with one of seven serious or violent crimes (prosecutor consent required for enrollment)
3. Hall County residency
4. Voluntary participation
5. Criminal Adult Population
Eligibility Requirements
Mental Health Criteria:a. Severe and Persistent Mental Illness
(psychotic disorders and major mood disorders)
b. Co-occurring Disordersc. Mental Retardationd. Other Axis I disorders that are primary
to their involvement in the criminal justice system
Services
Linkage and close supervision of: Treatment – Inpatient/Outpatient Counseling Medication management Vocational placement assistance Housing placement assistance Transportation linking Length of program: 9 – 18 months or longer
Process
Referral: by police, attorney, DA, courts, probation, self-referral
Screening conducted by licensed staff
Assessment conducted for placement
Determination of suitability for program
Referral to HELP case management or declined services
Initiation of case management services
Court involvement
If not appropriate for Program – will be linked to services in community when possible to do so
Referral Sources
Hall County Public Defender Office 24% Hall County Detention Center 23% Private Attorneys 14% Probation/Pretrial 13% District Attorney/Solicitor 12% Family/Self Referred 3% Judicial 3% Other 8%
(Defense Attorneys account for 37% of referrals)
Hall County, GeorgiaHELP Program Participants
Active 24 Graduated 30 Terminated 35 Opted Out 8 Enrolled (since inception) 97
Hall County, GeorgiaHELP Program - Jail Days
97 Participants: Jail Days in 18 months prior to entry
7183 AVG 74
Jail Days while in Program 1333 AVG 14
Jail Days for 30 Graduates (in 18 months) 9 Jail Days for 30 Grads (prior 18 months) 1759
AVG 59
Hall County, GeorgiaHELP Program – Cost Benefit
These 92 persons spent 7183 days incarcerated in the 18 months prior to program entry, costing $359,150 in jail costs alone (does not include costs associated with officers dealing with issues these offenders caused while incarcerated, medical staff costs, transportation costs, or other jail related costs other than standard cost for an offender per day of $50)
Hall County, GeorgiaHELP Program – Cost Benefit
Jail Costs for participants in 18 months
immediately prior to entry $ 359,150 Active participants have spent 1333
days in jail while active in program $ 66,650 30 Graduates have spent 9 days in jail $ 450
Program has been operational for 30 months and first graduation was 12/2005
Participants
65% of women have been victims of trauma Childhood physical/sexual abuse and/or
adult abuse Co-occurring
Nearly 60% have co-occurring substance abuse issues in conjunction with their mental illness diagnosis
50% Female – Male
William M.
Hall County Arrest Record: Drunk in Public - 1996 Convicted – Armed Robbery in 1998 - GDC from 6/11/98
until 3/23/05 Committed Simple Assault 6/13/05 (1 day in jail);
Probation Warrant 7/8/05 (7 days in jail) Entered HELP 7/15/05 1 day in jail during program Graduated 6/29/06 – 0 days incarcerated since graduation Jail Days in 18 months prior to entry 447 Jail Days in Program 1 Jail Days since Graduation (9+ months) 0
Keys toSuccessful Diversion Programs
Fixed Point of Accountability Sufficient Case Management
Resources 24/7 Staffing, On Call and On Site Low Patient-to-Staff Ratios Access to Full Range of MH/SA
Services
Keys toSuccessful Diversion Programs
Safe, transitional housing Job placement opportunities Supportive law enforcement
community Focus on recovery Certain discretionary resources
Governor’s Mental Health Diversion ProgramConceptual Model for Comprehensive Hall County
Program
Hall CountyJail – Mental Health Care
Local Hospitalsand Health
Sector,Housing and Job
Resources,Community Agencies
Law EnforcementProbation
Parole
Corrections,Transition and Aftercare for
Probationers and Parolees(TAPP)
Community Service Board,
MHSA Forensic Services,
State Hospitals
CIT Program
Diversion Intensive Case Management
(Currently HELP)
Hall County Courts and Treatment Services
Funded through and managedby Hall County Superior Court
Key Program Supports
Mental Health Court IssuesThe Great Unknowns
The issue of perception The effect of medications Learned helplessness Identifying target behaviors “½ the sanctions and twice the
patience”
It Just Makes Sense97 Participants: Jail Days in 18 months prior to entry
7183(AVG. 74)
Jail Days while in Program 1333(AVG.
14) Jail Days for 30 Graduates (in 18 months) 9 Jail Days for 30 Grads (prior 18 months) 1759
(AVG. 59)
Jail Costs for participants in 18 months immediately prior to entry $ 359,150
Active participants have spent 1333 days in jail while active in program $ 66,650
30 Graduates have spent 9 days in jail $ 450