Download Best Practices Model for Intervention with the Mentally Ill in the

Best Practices Model for Intervention with the
Mentally Ill in the
Broward County Criminal Justice System
Quality of Life Grant
2007 2008
2007-2008
James Pann,
Pann Ph
Ph.D.,
D Lenore Walker
Walker, Ed
Ed.D.
D (Co
(CoPrincipal Investigators), David Shapiro, Ph.D., &
Vincent Van Hasselt, Ph.D.
Introduction
y Rising trend for mentally ill to be in and out of jails nationally
y 20% diagnosable mental illness with over 50% history
y Broward jail no exception with 18% of 5,500 in 2005
y Special mental health unit with full range of services
y Evaluations 2001 – 464 p month to 2005 – 614 p month +32%
y MH Unit
2001 – 194 p month to 2005 - 375 p month +104%
y Speciall units in men’s
’ andd women’s
’ jails
l ffor ddomestic violence
l
&
substance abuse
y Design
g of a jjail not supportive
pp
of mental health treatment
y Revolving door with mentally ill having high recidivism rate
y No continuity of care and treatment with community agencies
O
Overview
i off P
Project
j t
y Grant was funded by the Broward Sheriff
Sheriff’ss Office (BSO)
and NSU
y NSU research group reviewed the literature and
consulted national eexperts
perts to determine the best
practices in the identification and intervention with the
mentally ill in the criminal justice system
y Researchers attempted to objectively examine the
relevant issues and related controversies while
conductingg this studyy
Overview of Project (cont.)
(cont )
y Conceptualized process a mentally ill person would go through once
y
y
y
y
y
y
y
y
y
y
encounteredd by
b police
l officer
ff
Reviewed the literature on best practices of each step
Interviewed consultants on best practices
p
Presentation at APA in August 2007 for feedback
Discussed available services at BSO
Attended Judge Speiser’s
Speiser s Task Force meeting
Telephone survey of community agencies
Attended misdemeanor and felony mental health courts
Hired lead interviewer, Julie Bruno, Psy.D. to assist with coordinating
and interviewing selected community agency personnel
Completed qualitative (interviews) and quantitative (surveys) data
analysis
l
Prepared report and submitted to BSO for feedback
Students & Residents Involved in Study
At all stages we worked together with graduate students at CPS
and Post Doctoral Residents at CJI.
y Ryan
R M
Montes, M
M.A.
A
y Justin Rigsbee, Ph.D.
y Amy Angleman, M.S.
y Alison Nemes, Psy.D.
y Lauren Katchen, Psy.D.
y Maria Karilshtadt,, Ph.D.
y Kelley Gill, M.S.
y Gretchen Lamendola,MS
y Gillespie Stedding,
Stedding M.S.
MS
y Markesha Bennett, M.S.
y Eduardo Vargas, M.S.
y Crystal
C
lC
Carrio,
i M
M.S.
S
WHAT IS THE
BEST PRACTICE MODEL?
KEEP MENTALLY ILL PEOPLE OUT OF JAIL
WHERE EVER POSSIBLE
BALANCE PUBLIC SAFETY
If need treatment, follow BPM
B
Best
P
Practice
i M
Model
d l
1.
2.
3.
4.
5.
6.
7.
Pre-arrest diversion by law enforcement into community
treatment facilities
Diversion out of the criminal justice system after arrest
into treatment or problem-solving
problem solving courts
Problem-solving court diversion with monitoring in the
communityy
Mental health treatment while in jail
Competency
p
y restoration simultaneous with treatment
programs in hospitals and in the community
Mental health probation if on community release
Long-term mental health treatment in the community
- Seamless continuity with treatment in jail
BPM for Treatment
y Good Case Management
y Housing Needs
y Job Training
y Crisis Services
y Coordinate with jail & probation
y Competent Medical Care
y Appropriate Medication Available
y Psychological & Neuropsychological Evals
y Psychotherapy
y Trauma Therapy
y Cognitive Rehabilitation
y Substance Abuse Treatment
y Competency Restoration Intervention
y Integration with families
y Continuity of Care & Integration with other community agencies and services
Crisis Intervention Team (CIT)
y Mission:
“CIT is a community partnership working with mental health consumers
and professionals, and family members. The goal is to set a standard of
excellence for officers with respect
p to the treatment of individuals with
mental illness. This is accomplished by establishing individual
responsibility for each event and overall accountability for the results.
Officers will be pprovided with the best qqualityy trainingg available,, theyy
will be part of a specialized team which can respond to a crisis at any
time, and they will work with the community to resolve each situation
in a manner that shows concern for the citizen’s well being.”
g
Major Sam Cochran
Memphis Police Department
Historical Overview
y Initiated in 1988 b
by Memphis PP.D.
D in partnership with
ith NAMI
NAMI,
mental health providers, and two Universities (Memphis and
Tennessee)
y Developed to provide a more intelligent and safe approach to
crisis events
y Composed of volunteer officers
y Training by mental health providers, family advocates, and mental
health consumer groups
CIT Training Topics
y Suicide Awareness and Intervention
y Alcohol and Drug Assessment
y Co-Occurring Disorders
y Homeless Mentally Ill
y Psychotropic Medications & Side Effects
y Personality Disorders
y Developmental Disorders
y Posttraumatic
P
SStress D
Disorder
d
y Crisis Intervention
CIT Training Topics (cont.)
(cont )
y Clinical Issues - Children’s Mental Health
y Baker Act/Marchman Act
y Special Needs of Older Adults
y Family & Consumer Perspective
y Role Plays
y Legal Aspects
y Community Resources
y CIT Policy
P l & Philosophy
Ph l
h
y Mental Illness from the Inside
CIT Program Benefits
y Immediate Crisis Response
y Decrease in Arrests and Use of Force
y Decrease in Patient Violence and Use of Restraints
y Decline in Officer and Consumer Injuries
y Consumers are Identified by Officers and Provided with Care
CIT in Broward County
y Initiated in 2002, with Fort Lauderdale Police Department as
First Participating Agency
y CIT C
Coordinated
d
d andd FFacilitated
l
d bby N
Norma W
Wagner off the
h
Broward Regional Health Planning Council
y Program Has Expanded to Six Additional Law Enforcement
Agencies
g
y From 2002-2008, 12 CIT Trainingg Events With 286
Participating Officers
Participating Agencies
y National Alliance on Mental Illness (NAMI) of Broward
y Henderson Mental Health Center
y Broward Regional Health Planning Council
y North Broward Hospital District
y Department of Children and Families
y Broward Coalition for the Homeless
y Nova Southeastern University
Future Plans
y Encourage a Greater Number of Police Agencies to
Participate
y Implement
I l
t a Research
R
h Program
P
tto D
Determine
t i th
the Impact
I
t off
CIT in Broward County
Problem Solving Courts
y
y
y
y
Deferral at earliest point in system
Vl
Voluntary
consent
Cooperation between prosecution and defense
Community agency collaboration and funding
y Adequate Programs
y Out Patient
y Residential
y Adequate Space
y Adequate case management
y Frequent status conferences
y Adequate housing
Misdemeanor Mental Health
y
y
y
y
y
y
y
y
Broward is the model and leader in US
Early identification
Non-punitive
Voluntary
Mental health staff in courtroom
Frequent status conferences (monthly)
Strong case management
P supportt group
Peer
y Collaboration with NAMI
y Will be staffing Freedom House
y N
Needd more community
it agencies
i andd services
i
y Goal is to take responsibility for maintaining own mental health
Felony Mental Health
y Person may be deferred into felony MHC if history of or current
y
y
y
y
y
y
serious mental illness and arrested for non-violent felonyy
Referral after arrest or while in jail by attorney, judge or jail staff
Not voluntary
Mental health staff in courtroom
Court Projects refers for competency or psychological evaluation
Referrals to MH agencies after reports to judge
C management andd speciall probation
Case
b
y Follow up with VOPs to avoid revocation & jail
y Psychological evaluation is done prior to being deferred into
y
y
y
y
MHC by court-appointed psychologist
MHC judge keeps case and continues to follow up legally
Some ggo to MH pprobation and communityy treatment pprogram
g
Judge holds monthly meeting for all stakeholders
Over 1400 cases in first three years
Drug Court
y Early identification of addiction
y Immediate
I
di t deferral
d f l upon arrestt
y Voluntary and must meet state criteria
y Users not drug pushers or sellers
y 12 to 18 months treatment for addiction
y Residential or out-patient treatment
y Develop substance abuse therapeutic community
y BPM includes SA +2 co-occurring
co occurring disorders – M.I.
M I & Trauma
y Need psychotherapy, DV & trauma tx with S.A. treatment as part of
probation
y Treatment may be in jail or in community settings
settings, or in other locked
y
y
y
y
residential facility
Treatment for abuse issues is also major importance.
Frequent follow-up by court
Need more mental health and trauma treatment
Need more programs for ‘co-occurring’ disorders or ‘dual diagnosis’
Domestic Violence Court
y Early identification
y Well trained BSO DV Officers
y Not voluntary
y Misdemeanor and felony criminal
y Restraining
R
i i orders
d ffor protection
i off victims
i i
y Need better understanding of protective mothers re: child access
y More coordination with familyy court re: p
protect children
y More coordination with DCF & dependency court re: children
y Referral to approved treatment providers
y Offender Specific
p
Treatment + MH therapy
py is BPM
y BPM for Treatment includes MHP contact with victims & DV probation
y Need special treatment for women DV perpetrators
y Need better follow up
p and timelyy contempt
p hearings
g
y Need better collaboration with BSO DV officers and units
Mental Health Programs in Jails
y
y
y
y
Jail vs. Prison
Sh t t
Short-term
Focused on acclimating to jail
Psychiatric
y
unit
y Individual therapy
y Psychotropic medication
y Domestic violence units
y Women
y Men
y Substance
S b
abuse
b units
i
y AA, NA, ALANON groups
y Educational programs
p g
Important Issues for Treatment in Jail
y Groups in jails different from prisons or other agencies
y Open groups rather than closed groups
y Best if on special contained unit
y Can not control numbers attending so need more therapists
y Less like therapy if new members in & out but still therapeutic
y Time commitment is great for outside therapists
Helpful to have manualized treatment but may not cover same issues in one
session in jail as in community due to factors beyond control
y Each session must stand on its own as cannot count on women
returning to group next week.
week Each unit requires own materials &
evaluation measures.
y Expect group members to be on different levels
y Staff
S ff ffollow-up
ll
iff emotionall issues occur& coordinate
d
MH tream
y Continuation in community when discharged
STEP in Detention Center Setting
C bi d BAI M
Combined
Means ffor S
Sessions
i
1
1-10
10
Literature Review on Tx in Jails
y Need to train correctional officers in M.I.
y Need
N d trained
i d MH caseworkers
k as part off staff
ff
y Need to do Admission Screening
y Mental
M
l ill
illness
y Suicide risk
y Need special mental health housing
y Types of tx available
y CBT,
CBT DBT,
DBT therapeutic communities
communities, behavioral techniques
(token economies, skills training), medication, groups
y Not useful
y Regressive interventions, interpersonal trust, development of
insight
Competency Restoration
y Problem area
y What constitutes competency? What does it mean to be restored?
y Adjudicated
Adj di t d ITP
y the person must be mentally ill
y unable to understand the charges or court proceedings or assist counsel in his or her
own defense
y Treatment of mental illness should occur simultaneously in BPM
y When should competency restoration begin?
y Cannot force medication in jail unless dangerous
y Need more collaboration with defense attorneys
y Frequent
q
movement in and out for hearings
g
y Where should treatment occur?
y Out-patient
y In-patient
y How longg should it last?
y What to do about those deemed non-restorable?
y Up to 3 years misdemeanor & 5 years felony and then discharged or civilly
committed
y Need more communityy based services integrated
g
with BMP
y Address psychological issues and not only competency in competency restoration
programs
Community Based Programs
Community-Based
y Forensic clients be seamlessly integrated into community programs
y Similar treatment programs in the community
communit as when
hen the
they lea
leavee a
facility, ensuring continuity of care
y It is the availability of intervention programs with intensive case
management access to psychotropic medication when needed
management,
needed,
psychotherapy, competency restoration, drug treatment, domestic
violence trauma therapy, and residential services for short periods (or
longer
g pperiods for severelyy and ppersistentlyy mentallyy ill)) that is needed
in the community
y Appropriate housing including Assisted Living Facilities (ALF) with
transportation
p
to treatment facilities are needed
y Family members need support services to assist them in their care of
the mentally ill.
Needs Assessment in Community
y Needs of mentally ill
y Needs of community agencies
y Program practices
y Community service listing
y Staff challenges
y Pre-arrest
Pre arrest diversion
y Competency restoration
y Special mental health jail
Stakeholder Interviews
y The research group conducted semi-structured
interviews with 24 key community stakeholders
representing the criminal justice and mental health
systems in Broward County
Department of Children & Families (DCF)
Nova Southeastern University
Broward Sheriff's Office (BSO)
Judges and public defenders office
DCF have privatized some of its services in Broward County, so
agencies within the community that have been awarded such
contracts
t t are also
l included.
i l d d
y Independent mental health agencies and independent mental
health providers who also are available to deliver services to the
mentally ill
y
y
y
y
y
Data Analysis
y Notes from the interviews were compiled and analyzed by the
y
y
y
y
researchh team
Conventional content analytic approach was utilized
Two members from the research team independently read and
attempted to obtain an understanding of the interview notes
The researchers coded the notes and identified response patterns
Codes were sorted into categories and then themes were
identified
Data Analysis (cont.)
(cont )
y Patterns were identified as relevant themes if they occurred with
sufficient
ffi i frequency
f
y Research group members conducted a review of the themes with
the interviewers in order to ensure the reliabilityy and validityy of
the findings
y Descriptions for each theme were developed and the themes were
organizedd bbasedd on respondent
d type (e.g., community provider,
d
court, etc.) to facilitate the reporting of the results
y For example
y For pre-arrest diversion most respondents indicated that it was
effective but that it should be more widely used.
y Need
N d more iincentives/encouragement
i /
ffor officers
ffi
to participate.
ii
y Need more efficient system for Baker acting indiv.; Freedom house
Survey
y Developed instrument to administer along with interviews
y Assessed 14 priority areas
y Specialized treatment
y Dual
D l di
diagnosis
i
y Women- trauma and DV
y Structured approach
pp
to complement
p
interviews
y Descriptive analysis by item
y Findings were consistent with the interviews
Findings
y Increase available services
y Case management
y Co-occurring
Co occurring disorders
y Residential treatment facilities
y Better integration between mental health programs in jail and in community
y Medication issue
y Treatment planning
y Dynamic referral system using current IT
y Training for staff
y Need
d better
b
forensic
f
related
l d training for
f sociall service staff
ff
y Partner with NSU for training future staff needs
y CE & certificate programs for current staff needs
y Mental health p
probation officer program
p g
y Special needs jail
y Therapeutic design
y Not to become a “dumping ground”
NSU Recommendations
y
y
y
y
y
y
y
y
y
y
Community Agencies & BSO adopt BPM
BSO continue training in CIT model
Increase residential beds in community for M.I.
Develop coordination for forensic & non-forensic
C
Community
it llearn about
b t jjailil treatment
t t
t & BSO llearn about
b t community
it
treatment
Integrate continuity of care whether in jail or community
All attend monthly
monthl MHTF meetings coordinated by
b Judge Speiser
Increase budget and MH staff for problem solving courts & integrate
with community & jail
Special programs for women in community including trauma treatment
Develop problem solving courts for mentally ill, domestic violence, and
substance abusing juveniles and integrate especially for those who are
about to “age-out”
g
of the DCF system
y