38
Reducing the Involvement of Persons with Behavioral Health Disorders in the Criminal Justice System Through Jail Diversion Programs Henry J. Steadman, Ph.D. Vancouver, WA June 15, 2017
Reducing the Involvement of Persons
with Behavioral Health Disorders in
the Criminal Justice System Through
Jail Diversion Programs
Henry J. Steadman, Ph.D.
Vancouver, WA
June 15, 2017
2
Main Points
• Who are we talking about?
• A Framework for jail diversion in your community
• Relevance of criminogenic risk factors
3
In 2015, approximately 7 million people under correctional supervision in the U.S.
• Jail: 721,300
• Prison: 1,526,800
• Probation: 3,789,800
• Parole: 870,500
4
PRA/CSG Jail Prevalence Study Sites:
Time:
Serious Mental Illness:
Prevalence:
Prevalence Rates:
5 jails (2 – MD; 3 – NY)
2002 and 2006
Depression/Bi-Polar/Schizophrenia/Schizo-Affective/Schizophreniform/Brief Psychosis/ Delusional/Psychosis NOS
Last Month
Men – 14.5%
Women – 31%
Steadman, H.J., Osher, F., Robbins, P., Case, B., Samuels, S. (2009). Prevalence of serious mental illness among jail inmates,
Psychiatric Services 60, 761-765.
5
Prevalence of Current Substance Abuse Among Jail Detainees with Severe Mental Disorders
Males Females
Disorder Alcohol Abuse/
Dependence
Drug Abuse/
Dependence
Alcohol Abuse/
Dependence
Drug Abuse/
Dependence
Schizophrenia 59% 42% 56% 60%
Major Depression 56% 26% 37% 57%
Mania 33% 24% 39% 64%
Any Severe Disorder 58% 33% 40% 60%
Detainees with severe
mental disorder plus either
alcohol or drug
abuse/dependence
= 72% = 72%
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, LA. “Personalized Communication.”
6
Any Physical or Sexual Abuse (N=2, 122)
Lifetime Current
Female 95.5% 73.9%
Male 88.6% 86.1%
Total 92.2% 79.0%
7
Experience of Trauma
Witness Violence Sexual Abuse Physical Abuse
Lifetime Current Lifetime Current Lifetime Current
Female 69.7% 35.0% 76.0% 33.1% 91.4% 65.8%
Male 65.1% 30.2% 34.1% 21.9% 87.1% 61.7%
Total 67.4% 32.9% 55.9% 29.9% 89.4% 63.8%
8
“Treatment-Resistant” Clients
OR
“Client-Resistant” Services
9
“Mentally ill people often end up in jail because there is no other place for them in our communities”
National Coalition for Jail Reform
10
“Mentally ill people often end up in jail because there is no other place for them in our communities”
National Coalition for Jail Reform
1985
11 Griffin and Munetz, 2006
12
13
Core Principle
Minimize inappropriate penetration into the
criminal justice system.
14
Core Principle II
The basic unit of analysis is the
community
15
Core Principle III
Bringing any one program to scale will not get you
where you need to be.
16
Goals
• Keep people out of jail who don’t need to be there and get them into treatment
• Provide constitutionally adequate treatment in jail
• Link to comprehensive and appropriate integrated community-based services
17
Diversion = avoiding or radically reducing
jail time by using community-
based treatment as an
alternative.
18
Criminal Justice → Not filing or dropping charges (ATI)
Mental Health → Not filing
Condition of bail
Deferred prosecution (stipulate to police report)
Deferred sentencing
Condition of probation
“Diversion”
19
Diversion Logic Model
Identify and
Enroll People
in Target
Group
Linkage Comprehensive/
Appropriate Community-
Based Services
Improved
Mental Health
/Individual
Outcomes
Improved
Public Safety
Outcomes
Stage 1 Stage 2
Diversion
Stage 3
20
Essential System of Care
21
Essential System of Care*
Phase I
• Forensic Intensive Case Management
• Supported Housing
• Accessible and appropriate medication
• Peer Support
*National Leadership Forum on Behavioral Health/Criminal Justice System
22
Essential System of Care*
Phase II
• Integrated Dual Disorder Treatment
• Supported Employment
• FACT
• Cognitive Behavioral Interventions
*National Leadership Forum on Behavioral Health/Criminal Justice Services
23
Diversion FROM
Diversion TO What?
24
Baseline Characteristics Within Criminal Justice Outcomes
Recidivism
No Post-Enrollment
Arrest
(n=286)
One Post-Enrollment
Arrest
(n=148)
Two or More
Post Enrollment
Arrests
(n=145)
Sex 54% Female 48% Female 47% Female
Age 36 36 35
Race 55% White 53% White 55% White
Charge Level 70% Misdemeanor 69% Misdemeanors 72% Misdemeanors
Illegal Drug Use (Last 30 Days) 50% 63% 55%
CSI 31.5 32.2 32.2
Lifetime Sexual Abuse 56% 54% 60%
Lifetime Physical Abuse 89% 92% 91%
Prior Arrests 1.75 2.36 3.17
Prior Jail Days 40 56 59
25
TAPA TCE: Arrest and Service Use
Number of
Cases*
Mean Number
of Service
Contracts^
Mean Number
of Days to First Visit^
No Subsequent Arrest 260 70.1 7.1
One Subsequent Arrest 159
68.4 9.0
Two or More Subsequent
Arrests
173 77.1 3.2
Total 592 71.9 6.4
*Includes all cases.
^Includes cross-site eligible cases.
26
“The Risk-Need-Responsivity (RNR) Model of
Correctional Assessment & Treatment”
D.A. (Don) Andrews pp. 127-156 in Using Social
Sciences to Reduce Violence Offending. Ed. JA
Dvoskin, JL Skeem, RW Novaco & KS Douglas.
Oxford University Press, 2012.
27
DEFINITIONS
• Risk – Chance of future criminal activity
• Need – Target changeable risk factors for crime
• Responsivity –
• General – Learning style of offenders generally
• Specific – Specific characteristics of individual
28
• Risk - WHO
• Need - WHAT
• Responsivity - HOW
29
PRINCIPLES
• RISK – Focus on high risk individuals
• Need – Criminogenic needs
• Responsivity –
• General – Cognitive-Behavioral
• Specific – Gender, age, cognitive-skill level, motivation
30
Major Risk Factors for Recidivism: Central Eight
• Big Four
• History of antisocial behavior
• Antisocial personality pattern
• Antisocial cognition • Antisocial associates
• Moderate Four
• Family circumstances
• School/Work • Leisure/Recreation • Substance Abuse
31
CAUTION ABOUT RNR
• Risk likelihood of violence
• Limited data on applicability of person with
mental illness & co-occurring disorders
32
Relevant Research for Persons with Mental Illness/Co-occurring
• Risk – Solid on same risk factors & assessment tools
• Need – Solid on criminogenic needs
• Responsivity –
• General – Solid on behavioral/cognitive strategies
• Specific – No evidence
33
Take Homes
• Trifecta
• Community = core planning unit
• Need options at every intercept
• Be clear what we don’t know about R-N-R
34
• We know how to do this stuff – Let’s Do It!
35
“Sometimes…..specific responsivity concerns are misused as a way to keep doing what has always been done”.
(Andrews, 2012: 139)
36
“Non-criminogenic needs that clinicians enjoy addressing may be declared mistakenly to be specific responsivity factors that demand special attention”
(Andrews, 2012: 139)
*
37
The Three E’s
• Eligibility
• Enrollment
• Essential Health Benefits
38
Policy Research Associates, Inc.
345 Delaware Avenue
Delmar, NY 12054
Creating positive social change for people who are disadvantaged through
technical assistance, research and training.
