Joint Committee Studying Treatment Options for Offenders with Mental Illness or Substance Abuse Disorders
May 31, 2001, Richmond
The second meeting of the SJR 440 Joint Committee focused on the delivery of services to adult offenders in facilities and communities.
Department of Corrections
Mental Health. The mental health program director for the Department of Corrections (DOC) reported that mental health professionals, including psychologists, psychiatrists, clinical social workers, and mental health nurses, provide three levels (acute, residential, and outpatient) of mental health treatment, according to the inmate's needs, in 29 major DOC facilities. The "typical" mental health staffing, excluding acute care units at Marion and Fluvanna, is one psychologist for every 250 general population inmates and eight hours of contract psychiatric services per week. In contrast, the acute care staffing (120 beds) at Marion Correctional Treatment Center is four full-time psychiatrists, four full-time psychologists, four full-time clinical social workers, and 24-hour nursing. The average cost per inmate receiving mental health services at the Marion Correctional Treatment Center (acute care) is $56,979 per year, compared to the average cost per inmate in general population of $19,428 per year. Mental health classification codes ("severe impairment" to "no mental health services needs") are assigned by clinical staff at initial intake, reviewed a least annually, and reviewed again when the inmate is ready for release. Evaluations are based on interviews, record review and psychological testing.
Treatment. DOC focuses its treatment services on Axis I disorders, which include diagnoses of major depression, schizophrenia, and substance abuse. Aggregated data are not available but a spot sample showed that out of a population of 923 inmates at Red Onion maximum security facility, 629 (68 percent) had an Axis I diagnosis. Of the 629, 431 had a substance abuse diagnosis and 217 were dually diagnosed with Axis I mental illness and substance abuse. "Novel" or atypical antipsychotic medications (Clozaril, Risperdal, Seroquel, and Zyprexa) are available to inmates.
Discharge Planning. Offenders receiving mental health services are evaluated by a qualified mental health professional prior to release. A discharge summary is forwarded to the offender's Probation and Parole (P&P) District and the DOC mental health clinical supervisor. The DOC relies exclusively on community services boards (CSB) for post-release services. The first appointment with the CSB typically occurs six weeks after release.
Staff Training. In 2000, 3,025 DOC staff were trained in mental health services through the training academy. Classes vary in length from one to three days.
Critical Needs. Mental health specialist in each P&P District; regional mental health professionals for P&P districts; day treatment services; housing; services in the community for offenders with a history of violence; services in the community for dual or multiple diagnosed individuals; matching services to facilities based on mission of each and needs of offender population; evaluation of programs and services; identifying and developing transition services and resources; and information management for tracking and monitoring diagnostic information, medication use, etc.
Substance Abuse. The substance abuse program manager for DOC noted that the statutory requirement for screening and assessment is contained in §§ 18.2-251.01 and 2.1-51.18:3 of the Code of Virginia. Virginia's system for identifying, sanctioning and treating drug-involved offenders consists of screening and assessment, community-based services for probationers, institutional-based services for inmates, transitional services for inmates being released to the community, and community-based services for newly released offenders. DOC, through Probation and Parole districts, has responsibility for screening and assessment of adult felons; adult misdemeanants are screened and assessed by local Alcohol and Safety Action Programs and Local Community Corrections Programs; all juveniles are screened and assessed by the Department of Juvenile Justice through Court Service Units. The Simple Screening Instrument (SSI), a 16-item, self-administered questionnaire, is used to screen adult offenders. If indicated by the screening, assessment is completed by means of a 130-question Standard Addiction Severity Index (ASI). Based on the assessment, the court requires education or treatment, as appropriate, as part of probation or as part of post-release supervision following incarceration. Treatment is provided by the DOC, community services boards or private providers if the community services board does not offer the required treatment. Contracts or memoranda of agreement between DOC and the CSBs define the services and access to those services. The Substance Abuse Reduction Effort (SABRE) provides additional positions and funds to purchase treatment services, residential transitional release, peer support programs, substance abuse treatment program management and training. Model court orders have been developed to assist the court with integrating treatment options with criminal justice sanctions, and model memoranda of agreement govern the relationship between the criminal justice agency and CSBs. Oversight of the system and the continuum of services is provided by an interagency committee, consisting of representatives of criminal justice and treatment agencies.
Prison Facilities. Substance abuse education programs are available in prison security levels 1 through 5; treatment programs are available in prison security levels 1 through 3. The therapeutic community is available in eight of the lowest security level facilities. Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are available in most institutions.
Post-Release. The continuum of services available to post-release offenders includes NA/SA support groups, residential treatment, therapeutic communities, outpatient treatment, peer support, relapse prevention, and drug testing. Transitional release is available to drug offenders participating in DOC's in-prison therapeutic community treatment programs that include employment, community service, and treatment in a highly structured residential environment for at least six months. Approximately 100 beds will be opened in FY 2001, increasing to 200 in FY 2002 at multiple sites.
Funding Sources. Screening and assessment are funded through offender fees, and treatment funding sources vary according to the treatment setting. In-prison treatment is supported by state general funds; community treatment is supported by a combination of offender pay, federal funds and state general funds.
Staff Training. DOC is developing a training plan to ensure that training is provided to all field staff delivering services and/or screening and assessment.
Evaluation. An evaluation plan to measure outcomes is scheduled for completion by January 1.
Gaps in Services. Gaps include lack of family programs; limited availability of day treatment programs; bed shortage for detox, residential/in-patient services, halfway houses, and recovery houses; limited availability of aftercare/relapse prevention, post-residential, intensive outpatient, outpatient or prison programs; lack of residential programs for violent offenders; no system for matching offenders to programs; lack of uniformity of services statewide; no integrated communication system across programs/agencies; need to link drug treatment with vocational training and job placement; and lack of programs for the dually diagnosed.
Community Corrections. The chief of operations, Community Corrections, for the DOC reported that Probation and Parole has supervision for almost 40,000 offenders. At least 70 percent of those offenders who are screened for substance abuse require substance abuse education and treatment and at least 18 percent have co-occurring psychological disorders. Community Corrections maintains memoranda of agreement with 36 local CSBs and 36 contracts for inpatient and outpatient services. Forty-two staff are designated to provide clinical services and oversight. Plans are underway to expand substance abuse clinical staff. On the other hand, Community Corrections relies on CSBs for mental health services, but lacks the clinical capacity to oversee the services.
Gaps in Services. The gaps are similar to those reported for substance abuse treatment: no uniformity in service availability; lack of medical and social detoxification in some areas; few family programs; shortage of residential substance abuse treatment programs; insufficient programs for the dually diagnosed offender; lack of specialized housing, particularly for violent offenders, sex offenders, and chronically mentally ill offenders; need for more specialized training for officers and specialized caseloads for mentally ill offenders; need for a system to match services to offenders; need for more formal working arrangements with CSBs for dually-diagnosed offenders; lack of sufficient clinical oversight and technical assistance; need for improved management information and communication across programs and services; need for joint training and collaborative planning at the local and state levels; and need for smaller workloads to allow more individual attention to offenders.
Local and Regional Jails
The executive director of the Virginia Sheriffs' Association reported that 52 local jails are operated by sheriffs and 21 regional jails are operated by sheriffs or regional superintendents. The total jail population is 21,443, while operating capacity is 16,398. According to the executive director, cuts in allocations to local sheriffs and staffing pressures created by new responsibilities mean fewer resources for services other than those needed to maintain public safety. Preliminary results from a survey of local sheriffs indicated that the need for substance abuse treatment for inmates is an important concern. The Virginia Sheriffs' Association recently entered into an agreement with a medical insurance provider that has resulted in significant cost savings to jails that participate in the program. Whether and to what degree the insurance provides coverage for mental health services was unknown. Representatives of the Henrico and Virginia Beach Sheriffs' Offices reiterated the problems that stem from lack of treatment options for offenders. Henrico has a well-developed system for screening and assessment, and the staff is trained in both mental illness and substance abuse so that offenders with co-occurring disorders get appropriate treatment. Virginia Beach indicated problems with (i) lack of appropriate facilities for housing inmates with mental illness and (ii) securing appropriate training in mental health issues for correctional officers.
Community Services Boards
A representative of the Virginia Association of Community Services Boards (VACSB) indicated that coordinated programs at the local level have emerged as local agencies have engaged in identifying needs and priorities, identifying funds, and planning, implementing, and coordinating services. As a result, services vary among localities. There is no state mandate or state funding for comprehensive mental health and substance abuse services to inmates in local jails. The availability of services often depends on local priorities, relationships, and resources.
Of the 29 CSBs that responded to a questionnaire, 26 provide some mental health services to jail inmates. The other three cited local jail contracts with private entities. Twenty-nine provide some substance abuse services to jail inmates and all 29 provide services to released offenders if the offenders present for services. All 29 CSBs also expressed the desire to provide more extensive services for jails if CSB and jail resources, including space, were available.
According to the VACSB representative, there are no statewide protocols for localities or funding streams to coordinate services. State agencies are often unable to go beyond their own systems. Communication, coordination, and linkage with case management among the CSBs, probation officers, or community corrections case managers are often lacking. Planning for services must begin while the offender is incarcerated to create a smooth transition to the community.