Presented by Dean Aufderheide, PhD., Mental Health Service Director, on behalf of Daniel G. Ronay, Chief Deputy Secretary, Florida Dept. of Corrections Just the Facts United States is about 5% of world population, but incarcerates 25% of world’s inmates 40% of individuals with serious mental illnesses have been in jail or prison at some time in their lives Americans with severe mental illnesses are 3 times more likely to be in jail or prison than in a psychiatric hospital In less than three decades, the percentage of seriously mentally ill prisoners has almost tripled from about 6% in 1983 to 15-20% today Defining the Problem According to the NAMI report, Florida is 49th in the nation in per capita spending on mental health services In Florida, a person with serious mental illness is 5 times more likely to be in a jail or prison compared to in a hospital. There are more inpatient beds in the Florida prison system than the number of involuntary civil commitment beds in Florida’s state hospital system 18% of the inmates in the Florida DOC have a diagnosed mental disorder that requires mental health treatment 2010 Survey of states by the Treatment Advocacy Center and the National Sheriffs’ Association Florida Mirrors the National Trend in Mentally Ill Population 59% Increase, but Has Stabilized Over Past 3 Years at About18% 20,000 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 2002 2003 2004 2005 2006 2007 2008 2009 2010 Mental Illness in by Mental Health Grade Total Inmates 101,767 1% 13% 4% S1 S2 S3 S4-S6 82% Florida Department of Corrections - Bureau of Research and Data Analysis - February 14, 2011 Increase in the Percentage of Inmates with Severe and Persistent Mental Illness (SPMI) within the Mentally Ill Population (Psychotic Disorders, Bipolar Disorders, Major Depression) 45% 40% 35% 30% 25% 20% 40.% 15% 10% 17% 5% 0% 1995 2010 Florida Department of Corrections, Date Bureau of Research & Data Analysis Mental Health ReEntry Program Meeting the Challenge in Florida Creating an Interagency Agreement between the Department of Corrections and the Department of Children and Families Coordinating with the Social Security Administration to complete SSDI/SSI applications Establishing Community Partnerships with Stakeholders Created a Central Office full-time staff position in mental health to provide oversight and coordinate aftercare services statewide and with stakeholders Created new institutional Mental Health ReEntry Specialist positions solely dedicated to coordinate aftercare services Number of Offenders Eligible for Post-Release Aftercare Planning Annually 5,000 4,500 4,000 3,500 3,000 2,500 2,000 4,481 4,287 2007 2008 2009 3,632 1,500 1,000 4,526 2,177 2,367 2,503 2000 2001 2002 2,891 2,740 2003 2004 3,141 500 - 2005 2006 Florida Department of Corrections; Bureau of Research and Data Analysis; November 30, 2010 8 DC/DCF Web-Based Electronic Referral System DCF Office of Disability Determination Potential Stakeholders Agency Workforce Innovation Florida Institute Legal Services DC Mainframe DC staff enter referral information into DC Mainframe Encrypted file transfer DCF MiniMainframe Updated Weekly Agency for Persons with Disabilities Veteran’s Administration Parole and Probation Agency for Health Care Administration County Sherriff’s Department Office of Homelessness DCF Web Interface DCF staff receives email notice of referral and assigns community provider based on the county of destination DC referral information de-encrypted DCF staff calls provider to establish appointment. DC staff obtains aftercare arrangements from aftercare database / communicates information to inmate. DC, DCF, CMHC providers have access to aftercare database. “Seamless Delivery System” Residential Short-term (6 months) Outpatient UA Testing Residential Long-term Therapeutic Community Community Corrections Programs Aftercare Upon Admission: IP Assessment (if court ordered) Upon Admission: CC Post-Release Substance Abuse Transitional Housing In-Prison Programs Screening Upon Release: IP Prevention Support Groups Motivational Groups Intensive Outpatient Substance Abuse Transition Centers Residential Therapeutic Community Intensive Outpatient: 1,168 • 14 – Correctional Institutions Residential Therapeutic Communities: 606 • 5 – Correctional Institutions • 1 –Pre- Release Community-Based Substance Abuse Transition Centers: 759 Prevention/Outpatient/Aftercare • 6 – Pre-Release Community-Based 1,048 - Male 120 - Female 561 - Male 45 - Female 503 - Male 256 - Female In-Prison Substance Abuse Gaps in Services vs. Need FY 2009-10 NEED 35,810 inmates were provided screening assessments at reception. ~65% of the total inmate population have consistently been screened to be in need of substance abuse treatment services. 65% Total = 102,232 As of June 30, 2010 2,533 available department substance abuse treatment slots. Approximately 19% of those have a co-occurring SA & MH disorder. 84% of released inmates that needed treatment; did NOT receive it. 1,061– –73% Contracted Residential 775 Short – term Substance Abuse Treatment Beds 286 Long – term – 27% 775 Short – term – 73% 286 Long – term – 27% 37 - Contracts for Outpatient Substance Abuse Programs and 22 Contracts for Outpatient Mental Health and Sex Offenders Treatment available throughout the 20 circuits. Community Corrections Substance Abuse: Gap vs Need FY2009-10 Need Total •On 6/30/10, 152,928 offenders were on active supervision. •Approximately 55.8% (85,341) offenders supervised are potentially in need of substance abuse treatment. Statistics compiled by the Bureau of Research & Data Analysis Special Collaborative Re-Entry Project • At Century Correctional Institution the Department of Children and Families is funding a Reentry Case Manager position that provides case management and follow up services to inmates with substance abuse problems released from Century CI to the Escambia County area. Services include: – – – – – Family connectivity Housing Referrals Substance Abuse referrals/follow up Mental Health referrals/follow up Case management Seeking New Funding Opportunities and Partnerships • Partnering with two community-based treatment providers the Department submitted a 2nd Chance Grant application for Adult Offenders with Co-occurring Disorders in June of 2011 . • The program, if funded, would target inmates with co-occurring substance abuse and mental health disorders located in the Department’s Therapeutic Community Program at Jefferson Correctional Institution who are returning to the Circuit 2 vicinity. • Post –release re-entry services include mental health and substance abuse aftercare and case management services, follow-up psychiatric care, and medication management. Based on individual needs, housing, transportation and employment skill training will be provided. . Circuit 17 Program Targets Severely and Persistent Mentally Ill • In 2006, based on legislative appropriation, the Department partnered with Henderson Mental Health Center to develop a pilot program that provides intensive, specialized re-entry rehabilitation and support services to probationers and released inmates who have a severe and persistent mental illness. This program continues today. • Program Goals include successful re-entry by preventing unnecessary psychiatric hospitalization(s), incarceration(s) or crises. Prison Diversion • Currently, Circuit 13 has the only pilot prison diversion program (PDP) • Offenders are sentenced to the program in lieu of prison. Program provides varying levels of care. • Individuals in need of mental health services receive services through the provider’s psychiatrist or referred to an outside provider. • Offenders in need of substance abuse treatment receive services through the program. Probation Officers work with Mental Health Courts • Circuit 15- Mental Health Court • Circuit 17-Mental Health Court • Circuit 12-Sarasota County Mental Health Court was established in the 1990’s. • Circuit 13-Pre Trial Intervention Mental Health Court • Circuit 20-Lee and Collier counties have Mental Health Courts • Circuit 8 –Alachua County Mental Health Court • Circuit 2 – Mental Health Court Veterans Dorm Program • Over 6,700 self-reported Military Service personnel • Identified Dorms – 6 dorms sites Inmate relocation in process Curriculum development in process • Identify programming – Thinking for a Change, staff trained – Establishment of community partners and stakeholders Veteran Inmates Requiring Post-Release Mental Health/Substance Abuse Treatment In 2002/2003, an estimated 1.2 million male veterans were identified as suffering from serious mental illnesses. Approximately 340,000 of these individuals had co-occurring substance abuse disorders Inmates referred to DCF/VA for Post-Release Mental Health/Substance Abuse Treatment in 2007 Level of Service Required for Veterans 6 4% 25 Routine Care 114 Veterans (115) 96% (1). NonVeterans (3200) Outpatient w/o Medications Outpatient with Medications 828 Inpatient The Florida Department of Corrections, Bureau of Research and Data Analysis, Inmate Data Section, January 29, 2008; (1) National Survey on Drug Use and Health, “Male Users with Co-Occurring Serious Mental Illness and a Substance Use Disorder," Nov.11, 2004, http://www.oas.samhsa.gov/2k4/vetsDualDX/vetsDualDX.htm ; Recidivism Reduction Initiatives and Priorities Increase the number of Pre-Release Substance Abuse Treatment slots. Decrease the number of inmates who are released from prison without receiving needed treatment. Target level and length of treatment based on inmate needs. Recidivism Reduction Initiatives and Priorities Increase mental health training opportunities for Probation and Correctional Officers Increase communication between Institutional Substance Abuse Treatment Staff and Mental Health Treatment Staff Enhance continuum of care by increasing communication between Institutions and Community Corrections staff Recidivism Reduction Initiatives and Priorities Develop one (1) additional Pilot Prison Diversion Program in a rural circuit. Partner with Florida Certification Board, Florida Alcohol Drug Abuse Association, and Substance Abuse providers to replicate a certification process for a Recovery Specialist Credential. Recovery Health Network Discount Prescription Drug Cards The Importance of Collaborative Leadership to the Right Thing, the Right Way for the Right Reasons in Our Mental Health and Substance Abuse Programs When They Succeed, We Succeed!