Investing in Rational System Change

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Investing in Rational System Change

• Henry J. Steadman, Ph.D.
• Orlando, FL
• October 3, 2007

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• In 2005, there were 14 million bookings into U.S.
  jails.

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• On June 30, 2005, approximately 7 million people
  were under correctional supervision in the U.S.
• Jail 747,529
• Prison 1,446,269
• Probation 4,162,536
• Parole 784,408

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Two-Week Prevalence of Severe Mental Disorder
Among the General Population and Jail Detainees
National GAINS Center. (2002). The Prevalence of
Mental Illness and Co-Occurring Substance Use
Disorder in Jails. Delmar, NY National GAINS
Center.
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Admission to U.S. Jails (2005)14 million
Proportion of Jail Inmates With Severe Mental
DisorderMen 6.4Women 12.2
Number of Annual Admissions to U.S. Jails with
Severe Mental Disorder1,112,000
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16 of State Prisoners Identified as Mentally Ill

• Inmates were identified as mentally ill if they
  met one of the two following criteria
• the inmate reported an overnight stay in a mental
  hospital or treatment program
• OR
• the inmate reported a current mental or emotional
  condition
• Ditton, P.M. (1999). Mental Health and Treatment
  in Inmates and Probationers. Washington, DC U.S.
  Department of Justice, Office of Justice
  Programs, Bureau of Justice Statistics.

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Bureau of Justice Statistics Special Report.
September 2006
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Bureau of Justice Statistics Special Report.
September 2006
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Prevalence of Current Substance Abuse Among Jail
Detainees with Severe Mental Disorders
Detainees with severe mental disorder plus either
alcohol or drug abuse/dependence
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Adapted from Abram, K.M. and Teplin, L.A.
Co-Occurring Disorders Among Mentally Ill Jail
Detainees Implications for Public Policy.
American Psychologist, 46(10)1036-1045, 1991 and
Teplin, L.A. Personal Communication. Policy
Research Associates, Inc. 6/17/98
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Treatment-Resistant Clients
OR
Client-Resistant Services
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Basic Goals

• Keep people out who do not need to be there
• Provide constitutionally adequate services
• Link people to services to keep them from coming
  back (because of mental illness)

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Sequential Intercept Model
Sequential - People move through the criminal
justice system in predictable ways

• Intercept - Examine this flow and look for ways
  to intercept persons with mental illness and
  often co-occurring disorders to ensure
• Prompt access to treatment
• Opportunities for diversion

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Sequential Intercept Model
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• Diversion avoiding or radically reducing jail
  time by using community-based treatment as an
  alternative.

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Diversion

• Specified target group

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Mentally Ill Jail Detainees


Eligible
?
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Diversion Basic Tasks

• Know who you Eligibility Criteria
• are looking for
• Find them Screen/Assess
• Engage them Services Plan
• Cut a deal Negotiate the terms and conditions
• Make it stick Linkage

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Publics Expectations
Reduce recidivism
Reduce violence
Diversion
Reduce jail days
Reduce costs
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Diversion Logic Model
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Mental Health Diversion Options

• Pre-Booking
• Police-Based
• Post-Booking
• Court-Based
• Jail-Based

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Some Common Pitfalls

• Missing key people in planning
• Vague criteria for target group
• Overestimating size of target group
• Overly ambitious goals
• From vs. To
• Overreliance on the ACT EBP