Essential Elements of the Kalamazoo Community Mental Health Recovery

Court ProgramPresented By:

Aki Nearchou, LBSW&

Brian Fuller, PH.D.

KCMHSAS 418 W. Kalamazoo, MI 49007

269-373-6000

Overview

• The extent and nature of the concern• Ten Essential Elements of Mental Health

Courts (MHC)• Goals of Mental Health Courts• Kalamazoo Mental Health Recovery Court

(MHRC)• What are peer support specialists and why

they are an integral part of the MHRC team?

Extent and Nature of the Concern • 13 million adults booked into U.S. jails each year.• More than 1.3 million people are currently

incarcerated in the U.S.• 631,000 people in jail on any given day• 4.6 million under correctional supervision• Over 7% of those inmates suffer from a severe

mental illness (SMI).• About 75% of the incarcerated SMI population

has co-occurring addictive disorders.

Source: Steadman, Osher, Robbins, Case &Samuels, (2009)

World Incarceration Rate

Why are Persons with Mental Illness Over-Represented in the Criminal Justice System?

• Higher arrest rates• “War on Drugs”– 2/3 of inmates in local jails is due to drug law

violations– Increased drug related offenses results in

increased arrest for those that suffer from a SMI.

SMI Over-Representation Cont.

• housing of last resort

• Affordable housing crisis results in a very visible homeless population that leads to crimes of survival:– Urinating in public– Panhandling– Theft– Etc.

SMI Over-Representation Cont.

• Longer jail and prison terms• Higher recidivism rate on re-entry as a result

of the following:– Inadequate discharge planning– Inadequate resources– No connection to the community– Very little family and social supports– Etc.

Specialty Programs that Addresses Over-Representation of persons with SMI involved in the

Criminal Justice System

• Many communities have adapted the Crisis Intervention Team (CIT) model

• Growing number of Mental Health Courts – 10 Mental Health Courts in Michigan (as of 2009)

Ten Essential Elements of Mental Health Courts (MHC) • 1. Planning and Administration• 2. Co-Occurring Target Population• 3. Timely Participant Identification & Linkage to Integrated Services• 4.Terms of Participation• 5. Informed Choice• 6. Integrated Treatment Supports and Services• 7. Confidentiality• 8. Court Team• 9. Monitoring Adherence to Court Requirements•10. Sustainability Source: Council of State governments, Essential Elements of a MHC, (Third Edition.

MHC Planning & Administration

• A multidisciplinary planning committee should be charged with designing the MHC.

• The planning committee should identify agency leaders and policy makers to serve on an “advisory group”.

• Keep the committee informed

Co-occurring Target Population

• MI related to criminal offense• MHC’s offer options other than arrest and

detention• Well defined clinical and criminal eligibility

criteria• MHC screening tools

Candidate Identification and Linkage to Integrated services.

• Identified Participants• MHC Referral sources• Referral Source Training• Expedited referrals

Terms of Participation

• Minimize the impact of the charges• Individualized for each participant• Successful completion– Dismissal of charge– Reduced fines and cost– Well connected to community resources

• MHC is a voluntary program– Option to withdraw

Informed Choice

• Participants fully understand the requirements of the MHC

• Arising competency issue concerns are processed through well established and pre-determined procedures.

Integrated Treatment supports & Services.

• Mental health court participants require an array of services

• MHC participants typically have co-occurring substance abuse disorders

• Treatment providers, Mental Health Court Team and the Participants should communicate on a regular basis

Confidentiality

• Health and legal information is only shared in a way that protects the participants’ confidentiality rights as consumers and their constitutional rights as defendants.– Release forms that adhere to federal and state

laws– Participants review releases with their defense

counsel and treatment providers– Should not sign release of information forms until

competency issues have been resolved

The Court Team

• Mental health court team works collaboratively to help participants achieve treatment goals by bringing together many of the following staff:– Judicial officer– Integrated Recovery Specialist (case manager)– Prosecutor– Defense attorney– Court liaison– Peer Supports

Monitoring Adherence to Court Requirements

• stay up-to-date on their progress• The mental health team and case managers

regularly discuss the participants’ behavior rather positive or negative

• MHC team meets on a regular basis with the judicial team

• Regularly scheduled status hearings

Sustainability

• Performance measures and outcome data is essential.

• Data describing the court’s impact on individuals and systems should be collected and analyzed.

• MHC team should communicate with key county officers and state legislators.

• Attempt to cultivate long-term funding sources early on.

The Goals of MHC are:

The primary goal of MHC courts is toreduce recidivism and enhance access to &

engagement in community treatment

1. To preserve public safety2. To divert offenders with mental illness & co-occurring disorders3. To maintain treatment, housing, insurance benefits and community

support services for participants with mental illness4. To reduce repeated criminal activity5. To decrease the utilization of high cost system services

Inside a Mental Health Court

Video is Courtesy of PBS and Frontline

Kalamazoo Mental Health Recovery Court (MHRC)

• Founded in fall of 2008• State and Federal Grants• MHRC Team:– 8th District Court Judge– Kalamazoo Community Mental Health &Substance

Abuse Services staff.– Defense Counsel– Prosecuting Attorney

Nature and Scope of Concern in Kalamazoo County

• Undersized jail • Large number of bookings and jail housing

cost• High utilization of services for SMI population• Strain on budgets

Program Description

• Misdemeanors • Recovery focused• Participants must have staff who will come to court• 2 clinical staff and 2 Forensic Peer Support Specialists• Year long program• Two phases• Will take persons who have MI/DD, co-occurring and

Personality Disorders• Provide Crisis Intervention Team Training (CIT) for Law

Enforcement

Who is eligible to Participate in the Kalamazoo Mental Health Recovery Court?1. Must be charged with a misdemeanor2. At least 17-years-old3. Has a diagnosis of mental illness or is dually diagnosed

with a developmental illness and substance abuse disorder and is in need of or assigned to case management services.

4. Is a Kalamazoo County Resident5. No pattern of violent behavior6. No more than one prior assault/battery7. No more than two prior felony conviction of any kind8. No violence at the time of arrest

The Referral Process

MHRC accepts referrals from: Police Officers, District Judges, Defense

Attorneys, Prosecuting Attorneys, Probation Officers, Kalamazoo County Jail staff, Family Members, KCMHSAS staff, Provider Agencies and Members of the public.

What Happens to an Accepted Case?

• Agree to comply• Determine and assign team• Attend scheduled court hearings• Graduated incentives and sanctions

Incentives and Sanctions

Incentives

• Praise from the Judge• Positive report by case mgr/PO• Clapping• See judge less often• Less judicial supervision

requirements• Reduced or waived court cost

/fees

Sanctions

• Lecture from Judge • Report to MD, PhD, PO more

often• Jail • Move back to phase I• Daily report to CMH• community service• Increase AA/NA, etc.

Performance Measure Criteria

• Decrease in jail admissions, jail days, and psychiatric admissions among successful participants

• Number served in MHRC• Outside researcher evaluation results• CIT training

Outcomes for MHRC Participants* (N=37)

8.8

0.51.1 1.5

3.4

16.7

0

10

20

30

Before MHRC During MHRC After MHRC*

Hospital Days

Jail Days

*Only those completing MHRC(N=37) (N=37) (N=20)

*Those completing MHRC or still participating in MHRC

72.6%

BOTH new offense & jail

11.3%

Jail only

12.9%

New offense

only

3.2%

Nei

ther

Before MHRC*% with Criminal Justice Involvement (N=62)

*In 12 months prior to enrollment

96.8%

Criminal Justice-Involved

35.5%

BOTH crisis contact & hospitalization

6.5%

Hosp only

46.8%

Crisis contact

only

11.3%

Neither

Before MHRC*% with Mental Health Crisis (N=62)

*In 12 months prior to enrollment

88.7%

Mental Health Crisis

Felony-level Offenses (N=62)

28.0%21.7%

0.0%

20.0%13.5%

21.6%

BeforeMHRC

DuringMHRC

After MHRC

TerminatedCompleted/Still

*statistically significant difference

*

Limitations of the MHRC

• The impact of the program is limited to those charged with misdemeanors.

• Integrated recovery specialist (case managers) are required to attend court with individuals they serve, but have no specific criminal justice training.

• Number of participants and length of the program.

Role of Forensic Peer Specialist within Criminal Justice System

What is a Peer Support Specialist?• Individuals willing to provide history of disability and recovery with people

in earlier stages of recovery

The stages of change are:1.Precontemplation

2.Contemplation 3.Preparation/Determination 4.Action/Willpower 5.Maintenance 6.Relapse

• Forensic peer support involves trained peer specialist with histories of mental illness and criminal justice involvement helping those with similar histories

Role of Peer Support Specialists within the MHRC Program

• Participate in all status meetings, court sessions, etc.

• Meet one on one with potential participates to determine recovery eligibility

• Facilitate a 16 hour Wellness Recovery Action Plan (WRAP) training.

• Meet with participants prior, during and after court sessions as needed.

MHRC Participant Outcomes

• MHRC successful and unsuccessful participant outcomes

Questions?

Thank You

Kalamazoo Community Mental Health & Substance Abuse Services

Brian Fuller&

Aki Nearchou