Document

Report
Criminal Justice Behavioral
Health Initiative
Leah Kaiser
Human Service and Public Health Department
The Problem
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Disproportionate representation of persons with behavioral health needs in
jails and correctional facilities
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Emergency Hospital beds are at capacity serving people with behavioral health
needs
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Ineffective system response to behavioral health needs are driving public
safety and health care costs
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Poor client health outcomes, poor public safety outcomes
The Underlying Reason
Ineffective Access Process
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Gaps in access to medications, housing, treatment, jobs
Eligibility criteria promotes working the extremes and cycling, instead of promoting a range of
responses
System Fragmentation/Program Silos
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Separate funding streams
Addressing behavioral health needs in controlled, inappropriate settings
Misuse of public safety and health care resources
Community Supports Insufficient for Complex Populations
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State Operated Services- bottleneck (in and out)
Lack of discharge planning from Jail and Workhouse
Hospital discharges to shelters
Rule 20 - efficiencies and limited treatment options
The Partners
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Hennepin County Residents & Service Consumers,
Local Law Enforcement Agencies,
the Hennepin County Sheriff’s Office,
City and County Prosecutors,
the MN Fourth Judicial District,
the Hennepin County Public Defenders Office,
the Hennepin County Department of Community Corrections and
Rehabilitation,
the Human Services & Public Health Department,
the Hennepin County Medical Clinic,
National Council of Behavioral Health,
MN Department of Human Services & MN Department of Health,
Hennepin County Community providers.
The Response
• System Approach
– Shared goals across sectors: individual responsibility, collective
accountability
– Identify and activate partners
• Two Pronged Approach
– System Level Change
» Policy Change/Process Change
– Service Level Change
» Program and Service Development
• Use Best Practice Approaches
– Tailor criminal justice system with behavioral health needs in mind
– Tailor behavioral health services with criminal justice issues in mind
• Resources - ROI model
– Think big, start small, move fast
– Leverage system funds, grants, redeploy FTEs
The Response (continued)
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Dedicated Manager to Lead
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Stakeholder Priority Actions Taken
– Integrated Access Team and TJC
– Local restoration and services for incompetent clients
– Gap Case Pilot
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Governance Structure: aligning public safety, health and human service
partners
Integrated Access Team
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HSPHD, HCSO, and HCMC partnership
Multi-agency oversight
Imbedded social service team in jail
MOU with 2 navigator agencies
Functions:
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Assist inmates apply for medical care
Complete file clearances to determine case involvement and facilitate care coordination
Complete mental health assessments
Develop individual service plans/transition plans, same day service linkages
in the community and support for 90 days post release
Local Competency Restoration
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Stakeholder agreement of problem and expected end result
Data Review shows R20 trending upward
Best Practice Models Reviewed
Options to consider:
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Triage & range of options based on Tx needs & public safety risk
1. Hospital
2. Community
3. Jail
Gap Case Pilot
52 R20 clients since June
Initial Results:
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38 clients offered pre-trial services, 6 open to short term intensive case management.
• Housing is the most requested service.
• Mental Health services are warranted in most cases but few clients believe this is
necessary.
• Other services: coordination with probation, warrant coordination, AP referrals,
ES and SSI benefits, and service referrals.
• Insurance: 15 MA, 16 uninsured, 21 PMAP
Custody Status: 25 Clients were IN Custody, 27 Clients were NOT in custody
18 clients MI Committed
1 DD commit
18 clients Dismissed
12 with No Disposition (waiting)
2 MI Stays
1 found Competent
Desired Goals & Outcomes:
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Increase health care coverage for high need clients
Reduced use of emergency room
Increased use of community based services
Early identification of BH needs
Decrease recidivism
Increase coordination and communication across county
systems
The Challenges
• Community Resource Issues
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Housing, Forensic ACT, IRTS
Capacity
Appropriateness
Funding for in-custody services
• Data & Information sharing
– health, welfare, public safety data privacy issues
– Multiple source systems
Final Thoughts
• Success will not achieved independently, but will be achieved
through the engagement of others with a diversity of perspective,
knowledge and experience.
• The needs of our customers are complex and require innovative,
systemic and integrated approaches to solve.
• Persistence and a strategic focus will ultimately result in the
achievement of goals.
Input & Questions
Jennifer DeCubellis: 612-596-9416
[email protected]
Leah Kaiser:612-596-1779
[email protected]
Olmsted County Forensic Mental
Health Services
Timeline
• 1998
– Social Worker in ADC .2
• 2000
– Social Worker increased
to full time on site
• 2005
– Jail diversion begins
• 2006
– Second social worker
added on site
• 2007
– 1st CIT local training held
• 2009
– Re-Entry program begins
• 2010
– Rule 20 process defined
internally
• 2014
– WIT Grant
Sequential Intercept Model
• A conceptual framework
developed by Mark R. Munetz,
M.D. and Patricia A. Griffin,
Ph.D..
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Used for decisions around
criminalization of people with
mental illness and provides
interception points for
intervention.
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Ideally people will be
intercepted at earlier points
with decreasing numbers at
each subsequent point,
preventing deeper penetration
into the criminal justice system.
Olmsted County Adult Detention and Forensic
Behavioral Health Programs
Crisis
Intervention
Team (CIT)
Post-Booking
Jail Diversion
Forensic
Commitments
WIT Grant
Re-Entry Services
Community
Supports
Pre- Booking Diversion/ CIT
• Crisis intervention training provides police and probation
officers, social workers, detention deputies and other
professionals who recognize and respond appropriately
to people in psychiatric crisis.
• Local program is a self-sustaining collaboration between
Olmsted Count Social Services, Sheriff’s Office, Rochester
Police Department, and community providers.
• CIT training for police officers began locally in 2007, as of
2014 over 120 local officers and 24 dispatchers are now
trained. A 2015 training is currently being planned.
Post Booking Jail Diversion & Forensic
Commitments
• Rule 20
– Collaboration with County Attorney, court services, and Competency
Restoration to streamline Rule 20 commitments and timelines.
• Forensic Commitments
– Case management for SDP and MI&D commitments and competency cases
from admission to discharge.
• “Whatever It Takes” (WIT Grant)
– The WIT grant was provided by DHS in June of 2014 to provide an array of
wrap around services including flexible funds, necessary to obtain and retain
community tenure and stability for individuals discharged from Anoka Metro
Regional Treatment Center (AMRTC) or Minnesota Security Hospital (MSH) St.
Peter.
– Modeled after AMRTC liaison which reduced hospital days beyond medically
necessary by 30%.
– Liaison case management for CREST region (Dodge, Fillmore, Goodhue,
Houston, Mower, Olmsted, Rice, Steele, Wabasha, and Winona counties).
Jail Diversion
• Decrease in jail diversions
• Reduction in time spent
in jail prior to diversion
• Possible causes:
– Beginning of CIT training in
2007 increasing CIT
officers each year
– Increased collaboration
with mental health, court
services, and law
enforcement
Mental Health Services in ADC
• Services
– Full time mental health
professional
– Psychiatry (4 hours per
week)
– Full time forensic social
worker
– Full time behavioral health
social worker
– Part time discharge
planner
– ADC program Sgt/deputies
• Population
– May 2013 and July 2014
• 412 detainees assessed
half met the criteria for
Serious Mental Illness
(SMI) or Serious/Persistent
Mental Illness (SPMI)
– January through July 2014
• 237 offenders with an
assessment, 47% met
SMI/SPMI criteria.
• 63% of females met
SMI/SPMI criteria
compared to 42% of males
Re-Entry (ROC)
• Sentenced adults in Olmsted
• 2012-2014
County Detention Center with at
– 14 people participated in ADC ROC
least 30 days before release
– 8 people are still in community ROC
– 1 has not yet been released
• Adults diagnosed with severe
– 5 people have been discharged
mental illness (SMI) or severe
• 3 to prison
persistent mental illness (SPMI)
• 1 moved with probation transferred out
• Areas ROC can provide help with:
of county
– Case Management
– Short and long term goal planning
– Referrals to community
providers/services/ supports
• 1 now in Assertive Community Treatment
• 2009-2012
– Two years after release:
• Re-Entry clients (14)
– average of 1.6 visits to jail
– averaging only 22.9 days (321 total
days)
• Non-re-entry clients (10)
– average of 2.1 visits to jail
– averaged 99.6 days in jail (996 total
days)
Goals
• Expand CIT into more community agencies
• Increase Re-entry services
• Improve Rule 20 tracking and commitment
process in CREST region
• Reduce hospital days at St. Peter due to lack of
placements, resources, and system gaps
Ramsey County
Mental Health Court:
Working with the Mentally Ill
Defendant
Judge John H. Guthmann
Judge William H. Leary
Judge Theresa Warner
Brandi Stavlo, MSW, Program Coordinator
RCMHC Background
Goals
Important Considerations for Eligibility
Collaboration
RCMHC works closely with:
• Ramsey County Mental Health Center
• Ramsey
County
Pretrial
Conditional
(Project Remand)
• Ramsey County Adult Probation
• Ramsey County Correctional Facility
• Second Judicial District Research Department
Release
Agency
How it Works
How it Works continued…
Mental Health Supports
Recent Program Statistics [through December 2013]
RCMHC
COMPARISON GROUP
Recidivism and Jail Impact
In both a one year and three year follow-up, RCMHC graduates
have been less likely to be charged with a new offense and spend
time in jail than those in a comparison group.
Comparison Group
Graduates of RCMHC
New Charges
60%
17%
New Convictions
45%
9%
Jail Time
65%
9%
New Charges
71%
30%
New Convictions
60%
26%
Jail Time
68%
25%
One Year After RCMHC
Three Years After RCMHC
Awards and Recognition
Invest in Better Mental Health Services
Final Thoughts….

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