SJR 97/HJR 142: Committee to Study
Treatment Options for Offenders with Mental Illness and Substance Abuse
June 28, 2002
The 2002 Session of the General Assembly
directed the Joint Commission on Behavioral Health Care and the Virginia
Commission on Youth to continue the study of treatment options for offenders
with mental illness and substance abuse disorders for two more years.
SJR 97/HJR 142 authorized three meetings per year with a final report
to the 2004 Session of the General Assembly. The resolutions also authorized
the commissions to establish a committee to provide leadership and direction
for an interagency work group, oversee implementation of the SJR 440 (2001)
recommendations, and conduct further research concerning diversion programs
that would prevent some individuals with mental illness and substance
abuse disorders from entering the criminal justice system in the first
Staff described the actions taken by the
2002 General Assembly on the committee’s SJR 440 recommendations and outlined
a proposed work plan, which was approved by the committee with the addition
of opportunities for public comment. A copy of the work plan is available
on the committee’s website.
Secretary of Health and Human Resources
Status of Current Funding
Secretary of Health and Human Resources
Jane H. Woods described the services to offenders provided by state and
local agencies associated with the Health and Human Resources Secretariat
and delineated changes in funding available for mental health and substance
abuse treatment for offenders as a result of the 2002-2004 biennium Appropriation
Funding appropriated to the Department of
Mental Health, Mental Retardation and Substance Abuse Services for existing
mental health services in community services boards and state facilities
was maintained. However, no new funds were provided to address unmet needs
or to develop an adequate state and community-based system of mental health
services. In addition, funding for substance abuse assessment and treatment
services for offenders was reduced by 70 percent, creating a loss of essential
substance abuse treatment capacity across the Commonwealth. Ten adult
and two juvenile drug court treatment programs provided through community
services boards were continued for one year at 80 percent of their previous
funding levels. Full funding of drug courts is a high priority for Secretary
Priorities and Goals
The Secretary articulated a list of goals
and priorities in regard to offenders with mental illness and substance
- Define statutory responsibilities for
treatment services to adult and juvenile offenders;
- Develop standards for mental health
and substance abuse services that should be available to adult and juvenile
offenders, including diversion, assessment and diagnostic services,
expansion of drug courts, involvement of case managers in pre-release
planning, and assertive case management and treatment for offenders
- Develop model agreements for coordination
and cross-training among jails, detention centers, court services, probation
and parole and community services boards;
- Increase the availability of psychiatrists;
- Evaluate the effectiveness of community-based
programs for offenders;
- Develop the capacity to collect and
analyze data on the availability and costs of treatment services; and
- Develop a comprehensive and systematic
approach to set priorities and fund service gaps.
Secretary of Public Safety
Status of Current Funding
Secretary of Public Safety John W. Marshall
affirmed that multiple needs compete for resources in institutions and
communities. While public safety is the first priority, other needs include
mental health and substance abuse treatment, education, job skills and
transitional services. However, lower than expected general fund revenues
have forced reductions in current programs. Exacerbating the problem is
the potential expiration within one to four years of a number of federal
grants that funded mental health, substance abuse and sex offender treatment
For the 2002-2004 biennium, Substance Abuse
Reduction Effort (SABRE) funding totaling $9.2 million, which provided
substance abuse treatment services in the community, was eliminated. Additional
reductions that will impact community-based substance abuse and mental
health treatment include:
- Reduction of $15 million per year for
the Virginia Juvenile Community Crime Control Act (VJCCCA), which removes
much of the capacity for localities to provide treatment services to
- Reductions in funding for Drug Courts,
jail treatment grants, and SABRE program evaluations; and
- Closing of Department of Corrections
day reporting centers and reductions in juvenile programs, including
Richmond Continuum ($780,000) and the Norfolk and Portsmouth Marine
Institutes ($1 million).
The Secretary indicated that reductions
in VJCCCA could result in increased costs for the Comprehensive Services
Act or increased commitments to juvenile detention or to the state, when
judges believe that required treatment is not otherwise available.
Priorities and Goals
The Secretary emphasized the need "to improve
our abilities to assess, prioritize and evaluate so that we can do the
most good with what we have available to us." He also indicated that the
Governor has said that developing new initiatives should not cease because
of the downturn in funding; rather a "laundry list" of initiatives should
be ready when revenues improve.
Secretary Marshall further elaborated that
some individuals may be placed in the criminal justice system at considerable
cost when treatment, not sanctions, is the primary need. The focus has
tended to be on those individuals who are already incarcerated, but the
Commonwealth needs to do a better job of identifying and addressing the
needs of those for whom intervention and early treatment might prevent
entry into the criminal justice system. Moreover, a balance needs to be
achieved between those individuals with acute treatment needs, who absorb
a disproportionate share of resources, and the escalation of illness in
individuals with lower level treatment needs. Screening and assessment
of offenders with substance abuse is required by the Code of Virginia,
but the resources for providing treatment have been reduced considerably.
Finally, program evaluation, while important for defining appropriate
treatment methods, is difficult to accomplish when the scope of programs
is reduced or eliminated.
Henry J. Steadman, president of Policy Research
Associates, Inc. and a leading authority on mental illness, co-occurring
substance abuse disorders and the criminal justice system, addressed the
committee on diversion: What types of diversion work? Under what circumstances?
And for whom?
Priority issues surrounding diversion are
keeping people out of jail who do not need to be there, providing adequate
services to incarcerated individuals who need them, and linking people
to services when they are released from jail so they do not keep recycling
back. A study of Cook County Jail in Chicago revealed that of people with
a serious mental illness, 72 percent of men and 75 percent of women have
a co-occurring substance abuse disorder. The fundamental question is who
are the people that we should try to keep out of jail and for whom there
should be some alternative. Dr. Steadman stated that the first priority
should be on those who (i) have a clinical diagnosis of serious mental
illness and a co-occurring substance abuse disorder, (ii) depend on the
public sector for income and insurance support, and (iii) cycle in and
out of jail repeatedly.
What needs to be understood about diversion?
First is the target population. Most communities usually start with a
category of charges (i.e., misdemeanors or felonies). Further, some communities
have established additional criteria; for example, meeting the definition
of priority population for mental health services. Second, diversion is
a specific program with dedicated staff whose job is to find the target
group when they come in contact with the criminal justice system. The
third characteristic of diversion is that it is community-based mental
health and substance abuse services in lieu of jail or reducing jail time;
it is not competency evaluation that results in placing the individual
in the forensic inpatient system.
Diversion can take on a variety of forms,
including charges not being filed, conditions of bail or probation, or
deferred prosecution. The diversion program, whether it is police-, court-,
or jail-based, is the identification of the target group and "cutting
a deal" between the public defender and the prosecutor. But there have
to be adequate community-based services, including mental health and substance
abuse treatment, housing, health, entitlements and employment.
What are the options? Pre-booking is a police-based
program where persons are diverted before the charge is filed. Post-booking
programs can be court-based or jail-based. There are three basic models
for police-based programs: police team, social workers working for police
or mobile crisis team. The Memphis Crisis Intervention Team (CIT) is a
group of specially trained officers who are called to the scene and then
become responsible for the resolution of the occurrence; currently about
one-sixth of the Memphis police force, distributed in precincts all over
the city, receive the special training. Birmingham has five social workers
who work with the police department and are called upon to deal with situations.
Los Angeles has four or five mobile Systemwide Mental Assessment Response
Teams (SMART), consisting of a police officer and a mental health professional
who can respond to the scene.
Post-booking programs can be court-based
or jail-based. Court-based programs can occur at first appearance in a
regular court or in a specialty court, such as a mental health court.
Disposition can include dropping charges and relying on voluntary compliance,
continuing the charges and deferring prosecution, or pleading the case
resulting in either probation with terms and conditions or deferred sentence
with terms and conditions.
In jail-based programs (usually pre-trial
services), staff, who can identify those persons who need to be moved
through the system more quickly, are located in the jails. The staff meets
with the prosecutor and the public defender to get agreement on disposition.
Usually, this process takes approximately one week, and, typically, the
person is diverted from the jail, the charges are continued, and the person
is given a court date. The court’s discretion over punishment is retained
since the court still retains jurisdiction. Part of the responsibility
of the staff is to make sure that the individual actually appears on the
court date, since failure to appear is often a problem.
What do the empirical data say about the
effectiveness of these programs? Unfortunately, not much research data
are available. On pre-booking programs, a much smaller percentage (approximately
two percent versus 16 percent) of persons actually get arrested where
the programs are in effect. The second finding is that the time in jail
is reduced for pre-and post-booking programs, and offenders pose no greater
risk to the community for re-arrest or violent re-arrest than anyone else.
Not much can be said about treatment outcomes because the persons who
are diverted may still not get services in most communities. Diversion
only helps identify persons who need services.
While there are data to show the positive
impact of mandated treatment for substance abuse, there are no data to
show the impact of mandated treatment for persons with mental illness.
How can evaluation be accomplished? Usually
when programs are established, basic data collection is not included.
Dr. Steadman suggested looking to universities for graduate students who
need research projects. Also federal grants are sometimes available to
fund evaluations of mental health and substance abuse programs, but someone
needs to be looking for these opportunities.
Dr. Steadman says significant results have
occurred, often with very little additional money, when the right people
get to the table and form partnerships. The basic philosophical point
is that "people. . . with serious mental illness who continually come
in contact with the criminal justice system is not a criminal justice
problem; it is a community responsibility." Dr. Steadman went on to say
that until the thinking is shifted about community responsibility, it
is a hopeless battle; however, family members have historically been prime
movers in helping to change community thinking.
Members raised several points in summary.
One noted that the system is fractured, with little discussion between
criminal justice and treatment professionals. Moreover, there is no evidence
that the current system is working, so the status quo should not be viewed
as preferable to new initiatives. A discussion also occurred concerning
the potential for required treatment following incarceration. There was
concern expressed that the responsibility would need to follow the individual,
since offenders may be released into communities other than their own.
Moreover, a requirement for treatment for those involved in the criminal
justice system would push others further down on the waiting list for
services in the communities.
The next meeting of the committee will be
on October 18.
The Hon. Stephen H. Martin
For information, contact:
Nancy L. Roberts
Division of Legislative Services
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