Transcript Jail Care Matches (September – May 2008)

Bridging the Great Divide:
Exploration of SelfDetermination and
Mandated Treatment
MADCP Mental Health Training
March 12, 2014
Angie Reid, MA
AJ Kitchen, LMSW
The System
9 to 19% of jail inmates are mentally ill.
One fourth of all jail inmates state that they have been
treated for mental or emotional problems.
About twice as many incarcerated females have
diagnosable serious mental illness.
It costs 30% more to house the mentally ill in jail due to
the security and service needs of this special
population.
There are more mentally ill people in our jails and
prisons in this country than there are in psychiatric
institutions.
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The average length of stay in jail for a mentally ill person is
about five times as long as for a normal inmate.
Rates of schizophrenia in jails and prisons are four or five
times higher than in comparable groups in society.
Public mental hospitals are under mandates to serve fewer
and fewer of the mentally ill making it more difficult to use
this resource.
As many as 85% of inmates have substance abuse problems
that further mask mental illness.
What Can Be Done…………..
V. Morgan Moss, Jr., Ed. S., L. P. C.
Penny Patton, Ed. S., L. P. C.
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Stages of Collaboration
1st: Sharing information
2nd: Cooperation
3rd: Coordination
4th: Collaboration
5th: Seamless Delivery
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Collaboration: It’s an unnatural act between…
…two or more unconsenting adults.
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DEFINITIONS
Mandated Treatment
Self-Determination
Coerced
Enhances Autonomy
Compulsory
Promotes informed
decision making
Mandated
Identifies specific Stage
of Change
Involuntary
Allows for non-judgmental
planning
Legal pressure
Criminal justice referral
IT CAN WORK!!!
Shared decision making
can lead to individual
being INVESTED in their
recovery
List benefit & risks to
behaviors
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Court Liaison and It’s Many Roles
Assist with jail overcrowding by screening and
providing alternative solutions
Being the “connector” between client and justice
system
Assist with safety of individual & the community
Jail is not the source of treatment for Mental Health
or Addictions unless the person is a harm to
society. ***100% of the people are getting out of
jail.
Bringing awareness to the systems
Known Barriers of Collaboration
Between the Systems
HIPPA/ Ethics
Medical Model that shapes the “Medically Necessary”
criteria to treat within Community Mental Health
Denial/being labeled “mentally ill” - Stigma runs deep: In
Oakland County Drug Court ¾ Women participants are in
the Mental Health Court, while only ¼ of Men in MHC
Court systems “knee jerk” reaction to high profile cases;
changing of the guards with Probation and Judges
Identifying the driving force of changes & how
communication can give perspective
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Fear of the therapeutic rapport being damaged if
disclosure occurs
Therapist fear of consumer “getting into more
trouble” if I disclose
Access to the most appropriate means of treatment;
which system is responsible for the consumers?
MDOC, DHS, CMH, Substance Abuse etc….
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The Access and Eligibility
Determination Process
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To support the process the OCCMHA network uses the
LOCUS (Level of Care Utilization System)
The LOCUS is an empirical instrument which assists in
determining eligibility and subsequent level of care
decisions.
The LOCUS assesses these dimensions:
1. Risk of harm
2. Functional status
3. Medical, addictive and psychiatric co-morbidity
4. Recovery environment
A. Level of stress
B. Level of support
5. Treatment and recovery history
6. Engagement and recovery status
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Gap Clients - Who are they and why do
they matter?
Part of our system
Self medicate
Have a diagnosis but not SMI…. YET!
How can you help? Building a strong rapport can
secure a successful assessment
When the individual stops “self medicating” and can then
recognize their need or ability to seek treatment within the
mental health system
This can take several months to uncover and engage…
PATIENCE!!
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What we are seeing
-Are more likely to be homeless,
unemployed, sustained trauma and have
a criminal history
-Those who fail community supervision
are no more likely to be rearrested but
1.38 times more likely to be revoked.
-If they adhere to treatment: fewer
arrests/revocations; decrease jail/prison
days; fewer emergency visits and less
hospital stays.
-Arrest rarely is a direct product of
mental illness; even for mentally ill
-Leading risk factors (e.g., criminal
history, young age, substance abuse,
personality traits) for violence and other
Junginger, Claypoole, Laygo, & Cristina (2006)
crime are shared by those with and
Bonta, Law, & Hanson (1998)
without mental illness
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Risk and Criminogenic Needs
The three core principles can be stated as follows:
Risk principle: How likely a person is to engage in
criminal behaviors
Need principle: What areas in a person’s life should
be targeted for intervention / supervision in order to
decrease their likelihood of future criminal behavior
Responsivity principle: What personal strengths
and/or specific individual factors might influence the
effectiveness of treatment services
Andrews, 2001; Andrews & Bonta, 2006
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Risk Principle
Target those offenders with higher probability of
recidivism
Provide more intense services to higher-risk offenders
Targeting lower risk offenders can lead to increases in
recidivism rates
Use an assessment tool that has been validated to
determine risk level and criminogenic needs
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Risk and Criminogenic Needs
Predicting Risk of
Re-offending
Work together and list your top 4 predictors of re-offending
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Criminogenic NEEDS - Top Four
•Anti-social Attitudes:
values, beliefs,
rationalizations, and cognitive emotional states of
anger, resentment, defiance
Anti-social Peers:
Anti-social friends /
acquaintances and relative isolation from pro-social
others; it increases an offender’s risk if they have few or
no pro-social supports in their life.
Anti-social Personality Pattern:
restlessly aggressive, weak self control, adventurous
pleasure seeking, egocentrism, weak socialization and
problem solving skills
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History of Anti-Social Behavior:
A
history of anti-social behavior evident from a young age,
involving a number and variety of anti-social acts;
criminal record
These are knows as the “Big Four” Risk
Factors
Most highly correlated with criminal
behavior among all other factors
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The Remaining 4 Risk Factors
Family / Marital Factors:
low levels of
affection, care, cohesiveness; poor parental supervision
and inconsistent discipline; neglect and abuse
Lack of Achievement in Education/
Employment: Low levels of achievement and
satisfaction in school and at work; it is noted that IQ
testing has no significance in this need area
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Lack of Pro-social Leisure
Activities: Little involvement in pro-social leisure
and recreational pursuits
Substance Abuse:
Abuse of alcohol and/or
drugs
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Non-Criminogenic, Minor Needs
Self-esteem
Vague feelings of personal distress
Anxious, feeling blue
Major mental disorder
Physical health
Learning disability
Victimization Issues
There is no significant correlation between these NEEDS and
criminal behavior but still need to be addressed
Andrews & Bonta, 2006
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AGAIN…. THE C WORD
Collaborative partnerships
between treatment and
probation officers/court is key
for offenders with high
criminogenic risk factors and
high clinical need
These newer arrangements integrate roles, rules, and
relationships between the two systems in ways that appear to
allow the needs of mentally ill persons to be addressed
without undermining public safety goals.

Joseph P. Morrissey; Jeffrey A. Fagan; Joseph J. Cocozza
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A closer look at dual role
relationship quality
• Relationship quality in mandated
treatment
– Therapeutic role
– Surveillance role
Controlling
Caring
Skeem, Eno Louden, Polaschek, & Camp (2007); Skeem & Manchak (2008); Kennealy, Skeem, et al. (2009)
How Can I Help?
Communicate, Communicate, Communicate
Having a valid ROI between consumers and legal system.
Asking questions: Have you ever received or are you
currently participating in mental health treatment? Did
you find it helpful?
If not currently engaged, make appropriate
referrals/connections for assessment
Opening the lines of communication is specifically meant
to be in the best interest of assisting the individual to
“Successfully Complete” the court process.
Engaging in long term treatment to address Risk and Need
factors.
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Tips for Continuum of Care
Remember… Crisis is an opportunity for change
This is a community effort: Share the credit
Acknowledgement and utilization of each agencies
strengths
Be solution focused
Remaining in treatment = Safety of the individual, safety
of the community, saving tax dollars, reduction of
jail/prison days
Collaboration: “When spider webs unite they can tie up
the lion”
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QUESTIONS????
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THANK YOU
FOR
ATTENDING!!!