Illnesses in County Jail Marilyn Brown Commission President Paula - - PowerPoint PPT Presentation

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Reducing the Numbers of People with Mental Illnesses in County Jail

Presentation to Board of Commissioners May 13, 2015

Marilyn Brown

Commission President

Paula Brooks

Commissioner

John O’Grady

Commissioner

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Project History / Approach Findings Recommendations Next Steps

Overview

Council of State Governments Justice Center

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December 9, 2014 federal, state and local leaders, such as Commissioner Brown, discussed their support for reducing the number of people with mental illnesses in jails.

Franklin County is part of a large national movement to reduce mental illnesses in jails

Council of State Governments Justice Center

Federal speakers discussed legislation that supports counties’ efforts to reduce the number of people with mental illnesses in jails

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U.S. Sen. Al Franken (left, D-MN) and U.S. Rep. Richard Nugent (above, R-FL)

The Stepping Up Initiative officially launched with a series of events in May 2015

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• May 5, Washington DC
• May 5, Johnson County, KS
• May 6, Miami-Dade County, FL
• May 7, Sacramento, CA

National Initiative

6 Johnson County KANSAS Bexar County TEXAS Franklin County OHIO Hillsborough County NEW HAMPSHIRE

Council of State Governments Justice Center

New York City NEW YORK

(5 Counties)

Salt Lake County UTAH

Much innovation already underway in Franklin County

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Council of State Governments Justice Center

But Franklin County leaders agree more needs to be done…

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Council of State Governments Justice Center

Jail Population Declining Nationally

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Council of State Governments Justice Center

• 3.0
• 2.0
• 1.0

0.0 1.0 2.0 3.0 4.0 5.0 6.0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000 900,000 00 01 02 03 04 05 06 07 08 09 10 11 12 13

YEAR ANNUAL PERCENT CHANGE NUMBER OF INMATES AT MIDYEAR

Source: Bureau of Justice Statistics, “Jail Inmates at Midyear 2013—Statistical Tables,” 2014.

Inmates confined in local jails at midyear and percent change in the jail population, 2000-2013

What About Persons with Mental Illnesses ?

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Council of State Governments Justice Center

Source: The City of New York Department of Correction

3,319 4,391 10,257 7,557

2005 2012 M Group Non-M Group 76% 63% 37% 24%

AVERAGE DAILY JAIL POPULATION (ADP) AND ADP WITH MENTAL HEALTH DIAGNOSIS

13,576 Total 11,948 Total

NEW YORK CITY

5% 95%

The Problem: Overrepresentation of Persons with Serious Mental Illnesses

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Council of State Governments Justice Center

Arrested at disproportionately higher rates

• Co-occurrence of SUD
• Homelessness

Stay longer in jail and prison Limited access to health care Low utilization of EBPs High recidivism rates More criminogenic risk factors

– ≠ Crime type – ≠ Dangerousness – ≠ Failure to appear – ≠ Sentence or disposition – ≠ Custody or security classification level

Recidivism Is Not Simply a Product of Mental Illness: Criminogenic Risk

Risk = How likely is a person to commit a crime

• r violate the conditions of supervision?

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RISK

How do we measure criminogenic risk ?

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Dynamic factors Static Factors Criminal history

• number of arrests
• number of convictions
• type of offenses

Current charges Age at first arrest Current age Gender History of antisocial behavior Antisocial personality pattern Antisocial cognition Antisocial associates Family and/or marital factors Poor school and/or work performance Few leisure or recreational activities Substance abuse

Risk-Need-Responsivity Model as a Guide to Best Practices

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• Focus resources on high RISK cases
• Target criminogenic NEEDS, such as antisocial behavior,

substance abuse, antisocial attitudes, and criminogenic peers

• RESPONSIVITY – Tailor the intervention to the learning

style, motivation, culture, demographics, and abilities of the offender. Address the issues that affect responsivity (e.g., mental illnesses)

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Project History / Approach Findings Recommendations Next Steps

Overview

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*Included only first bookings and removed cases missing DOB and SSN

Sources of Data

SHERIFF’S OFFICE ADAMH Board Community Shelter Board

Matched to SMI Services Flags

1,554

Accessed the Shelter System One Year Prior to Booking

1,168

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2010 Jail Bookings 32,638

Unique Individuals Booked* 21,966

2011 Jail Bookings 2012 Jail Bookings 2013 Jail Bookings

Study Cohort

Used for re-booking recidivism analysis 2009 Jail Bookings 2008 Jail Bookings Used to develop risk proxy

56% 49%

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More than half of all adults re-enter jail within 3 years of release

Misdemeanor N=14,198 PERCENT REBOOKED IN 3 YEARS Felony N=5,643

* Analysis of first Franklin County jail bookings in 2010

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People with serious mental illnesses return more frequently

* Analysis of first Franklin County jail bookings in 2010 ** SMI identified using match to behavioral health service utilization data

51% 60%

Non-SMI Flag SMI

PERCENT RE-INCARCERATED IN THREE YEARS

N = 20,412 N = 1,554

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People with serious mental illnesses stay longer in jail

* Analysis of first Franklin County jail bookings in 2010 ** SMI identified using match to behavioral health service utilization data

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SMI Non-SMI

AVERAGE LENGTH OF STAY IN JAIL (DAYS)

N = 20,412 N = 1,554

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People with serious mental illnesses are slightly higher risk

* Analysis of first Franklin County jail bookings in 2010 ** SMI identified using match to behavioral health service utilization data

46% 30% 24% 41% 29% 30%

Low Risk Med Risk High Risk

RISK DISTRIBUTION

Non-SMI SMI

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How Does the Population Identified with SMI Differ from Those Not Identified as Having SMI?

* Analysis of first Franklin County jail bookings in 2010 ** SMI identified using match to behavioral health service utilization data

No significant differences in charge level Similar proportion booked pretrial vs. sentenced Different ALOS regardless of risk level*

Risk factors include prior jail bookings, age, charge level, and offense type Council of State Governments Justice Center

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Individuals with serious mental illnesses who experienced homelessness prior to jail booking have higher recidivism rates

*Analysis of first Franklin County jail bookings in 2010; SMI identified using match to behavioral health service utilization data; ** Shelter flag defined as accessing shelter one year prior to jail booking

N = 20,412 N = 1,554 Council of State Governments Justice Center

45% 56% 63% 76%

Non-SMI flag SMI flag

PERCENT RE-BOOKED IN THREE YEARS

No shelter contact Shelter contact 1 yr prior to booking

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Information on risk is not systematically collected to inform decision-making

Pretrial Risk

• Risk of failure to appear in

court

• Risk of re-arrest during

pretrial period

Decisions Regarding Community Supervision

• Municipal Probation
• Class 1 Misdemeanants only
• Common Pleas Adult Probation

(felony probationers)

?

(ORAS)

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Information on needs is not systematically collected to inform decision-making

People Booked into Franklin County Jail*

21,966

Bookings with ALOS > 3 Days

10,523

Actual Number of People with SMI Entering Jails is

UKNOWN

Matched to ADAMH Data and Identified as SMI Prior to Booking National Estimates**

• f SMI Population in

Jail After 3 Days

9% 22%

**Extrapolated from national data on jail populations. * Analysis of first Franklin County jail bookings in 2010

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Many people with serious mental illnesses released from jail are not receiving the treatment and supports they need in the community

Bookings with ALOS > 3 Days

10,523

Actual Number of People with SMI Entering Jails is

UKNOWN

Matched to ADAMH Data and Identified as SMI Prior to Booking* National Estimates of SMI Population in Jail After 3 Days**

969

People with SMI

2,315

People with SMI

**Extrapolated from national data on jail populations * Analysis of first Franklin County jail bookings in 2010 Council of State Governments Justice Center

609

Received treatment from ADAMH funded provider within a year of release

360

Did NOT receive treatment from ADAMH funded providers within a year of release KNOWN GAP

Treatment following release 609

Received treatment from ADAMH funded provider within a year of release

1,706

As many as 1,706 did NOT receive treatment from ADAMH funded providers within a year of release

POTENTIAL GAP

LOW RISK 40%

HIGH/ MOD RISK 60%

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Project History / Approach Findings Recommendations Next Steps

Overview

Council of State Governments Justice Center

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Objective 1: Increase access to crisis services and alternatives to incarceration for law enforcement

Recommendation A: Charge ADAMH with providing a resource guide for people with mental illnesses and family members who don’t know what services are available 24/7. Recommendation B: Expand the capacity of NETCARE and

• ther crisis service options to allow for diversion of individuals

with mental illnesses that are not a risk to public safety.

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Objective 2: Improve response by local law enforcement to people with mental illness

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15% 85%

Crisis Intervention Training in 2015

CIT Trained Officers Non-CIT Trained Officers

25% 75%

Potential goal for % of CIT Trained Officers

CIT Trained Officers Non-CIT Trained Officers Council of State Governments Justice Center

Objective 3: Use the results of a validated pretrial risk assessment to inform decisions about pretrial release and detention

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Recommendation A: Charge the judges of the Municipal and Common Pleas Courts, with the support of the Probation Department directors, to design of a process that ensures timely and effective pretrial decision-making.

• Staffing
• Timing
• Risk assessment tools
• Information sharing
• Training

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Objective 4: Use results of behavioral health risk screening and assessment to inform treatment and supervision plans

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The Franklin County Sheriff’s Office will implement universal screening for mental illnesses and substance use disorders Assessment results inform jail interventions and connections to community-based treatment and supervision. This effort should address the following:

• Staffing
• Timing
• Behavioral health screening tools
• Information sharing
• Training

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Objective 5: Use risk and behavioral health information to develop comprehensive community-based supervision plans

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Low Criminogenic Risk (low) Medium to High Criminogenic Risk (med/high)

Low Severity of Substance Abuse (low) Substance Dependence (med/high) Low Severity of Substance Abuse (low) Substance Dependence (med/high) Low Severity of Mental Illness (low) Serious Mental Illness (med/high) Low Severity of Mental Illness (low) Serious Mental Illness (med/high) Low Severity of Mental Illness (low) Serious Mental Illness (med/high) Low Severity of Mental Illness (low) Serious Mental Illness (med/high)

Group 1 I – L

CR: low SA: low MH: low

Group 2 II – L

CR: low SA: low MH: med/high

Group 3 III – L

CR: low SA: med/high MH: low

Group 4 IV – L

CR: low SA: med/high MH: med/high

Group 5 V – H

CR: med/high SA: low MH: low

Group 6 VI – H

CR: med/high SA: low MH: med/high

Group 7 VII – H

CR: med/high SA: med/high MH: low

Group 8 VIII – H

CR: med/high SA: med/high MH: med/high

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Objective 6: Ensure people are connected to community- based behavioral health care services prior to release

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Recommendation A: Charge the Franklin County Sherriff’s Office and ADAMH with developing a plan that connects people who qualify for the following services:

• ADAMH agencies
• Veteran’s services
• Ohio Benefits Bank for connections to healthcare

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Objective 7: Ensure availability of community based behavioral health services

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Recommendation A: Increase availability of case management: ACT Teams with forensic expertise; additional peer support positions Recommendation B: Train and incentivize providers to deliver services that address the behaviors associated with recidivism Recommendation C: Improve access to housing and support services to reduce rates of homelessness

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Objective 8: Track progress

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Recommendation A: Generate bi-annual reports that provide the County Commissioners the following measures:

• Prevalence of mental illness of those booked into the jail
• Prevalence of substance use disorders of those booked into

the jail

• Profile of risk of those booked into the jail
• Of those released how many are connected to services
• Of those released with high risk and high need how many

connected to services

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Project History / Approach Findings Recommendations

Overview

Council of State Governments Justice Center

Next Steps

Opportunities

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• 1. Increase Public Safety

There are likely 1000+ people with SMI released from jail in need of treatment who are at moderate/high risk of re-

• ffense
• 2. Maximize impact of resources

People with SMI stay almost twice as long in jail as the non- SMI population and cost significantly more to detain

• 3. Improve health outcomes

There are significant gaps in the continuum of care that could be improved with increased treatment capacity and better cross-systems coordination

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Goal 1: Divert additional people from arrest

Increase alternatives to incarceration

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Increase crisis services

Goal 2: Increase the number of individuals connected to services

39 *Numbers extrapolated from national estimates

2,300 SMI individuals released from jail* Target group who should receive community mental health services 600 received treatment from ADAMH funded provider*

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Goal 3: Lower recidivism rates

* Analysis of first Franklin County jail bookings in 2010 ** SMI identified using match to behavioral health service utilization data

51% 60%

Non-SMI Flag SMI

PERCENT RE-BOOKED IN THREE YEARS

N = 20,412 N = 1,554 Council of State Governments Justice Center

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Goal 4: Reduce length of stay

* Analysis of first Franklin County jail bookings in 2010 ** SMI and AOD identified using match to behavioral health service utilization data

Council of State Governments Justice Center

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SMI Non-SMI

AVERAGE LENGTH OF STAY IN JAIL (DAYS)

N = 20,412 N = 1,554

Next Steps

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CHARGE a single entity with responsibility for achieving these goals

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COMMISSION periodic reports highlighting progress toward goals REQUIRE regular written updates reviewing status of implementation of recommendations

Thank you!

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Michael Thompson Director, CSG Justice Center Fred Osher, M.D. Director of Health Systems and Services Policy, CSG Justice Center www.csgjusticecenter.org

The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect the views of the authors, and should not be considered the official position of the Justice Center, the members of the Council of State Governments, or the funding agency supporting the work.

Council of State Governments Justice Center

Please contact Kati Habert at khabert@csg.org with any questions.