Criminal Justice Behavioral Health Initiative Leah Kaiser Human Service and Public Health Department The Problem • Disproportionate representation of persons with behavioral health needs in jails and correctional facilities • Emergency Hospital beds are at capacity serving people with behavioral health needs • Ineffective system response to behavioral health needs are driving public safety and health care costs • Poor client health outcomes, poor public safety outcomes The Underlying Reason Ineffective Access Process – – 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 – – – 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 – – – – 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 • • • • • • • • • • • • 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) • Dedicated Manager to Lead • Stakeholder Priority Actions Taken – Integrated Access Team and TJC – Local restoration and services for incompetent clients – Gap Case Pilot • Governance Structure: aligning public safety, health and human service partners Integrated Access Team • • • • • HSPHD, HCSO, and HCMC partnership Multi-agency oversight Imbedded social service team in jail MOU with 2 navigator agencies Functions: 1. 2. 3. 4. 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 • • • • Stakeholder agreement of problem and expected end result Data Review shows R20 trending upward Best Practice Models Reviewed Options to consider: – 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: – – – – – – – – 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: • • • • • • 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 – – – – 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.. • Used for decisions around criminalization of people with mental illness and provides interception points for intervention. • 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….