SJR 97/HJR 142: Committee to Study Treatment Options for Offenders with Mental Illness and Substance Abuse Disorders

October 18, 2002

Senator Stephen H. Martin, chair of the committee, convened the second of three meetings for 2002 to hear presentations on the status of drug courts, the U.S. Department of Health and Human Services' perspective on diversion strategies, and reports requested by SJR 97/HJR 142.

Drug Courts

Presenters informed the committee that a substantial portion of offenders who entered the criminal justice system in fiscal year 2001 had substance abuse problems; at least half of adults arrested for major crimes tested positive for drugs at the time of their arrest, and untreated addicts committed an average of 63 predatory crimes during the year before sentencing. Various studies of drug offenders in Virginia have confirmed the "revolving door" experienced by the criminal justice system. The Virginia Criminal Sentencing Commission found that 50 percent of offenders released from Virginia prisons in 1993 who had been incarcerated for a drug offense had a new arrest within three years.

In response to the "revolving door," the committee heard that some Virginia localities have established special court dockets (drug courts) as an alternative to traditional adjudication and/or sentencing options. These drug courts combine strict and frequent supervision by probation staff with intensive drug treatment by clinicians and close judicial monitoring by the court. Drug courts are developed through multidisciplinary and interagency efforts among judges, Commonwealth's attorneys, defense attorneys, treatment professionals, local law enforcement and jail staff, Department of Corrections personnel, and private agency staff. In Virginia, 18 drug courts are operational and 17 are in the planning stages. The following are frequently asked questions concerning drug courts.

1. What is the cost of drug courts?

  • $3,000 to $5,000 per participant per year.

2. How is the money spent?

  • Over half of the funds are spent for treatment.
  • A small portion goes to probation services and the reminder goes to the administration of the program.

3. How many defendants are served by drug courts in Virginia?

  • 1,621 adults and 182 juveniles have participated in a drug court.
  • More than 500 individuals are currently participating in a drug court.

4. What is known about the effectiveness of drug courts?

  • During fiscal year 2001, 10 percent of voluntary clients completed treatment in community services boards, but 62 percent of drug court clients and 53 percent of juvenile drug court clients completed or are enrolled in treatment.
  • In contrast to the 50 percent re-arrest rate for Virginia drug offenders who are sentenced to jail, prison, or probation, 9 percent of drug court graduates had a new arrest for a misdemeanor and 14 percent were arrested for a felony during the 1 to 18 months following program completion.
  • Substance abuse treatment saves approximately $9,177 per client from reduction in crime-related costs, post-treatment increase in earnings, and reduced health care costs. In addition, savings accrue from fewer drug-exposed babies and reduced costs for foster care placement.
  • Virginia has recently received federal awards totaling $586,770 to develop a statewide management information system and conduct comprehensive evaluations of drug court effectiveness.

5. Why are drug courts effective?

  • Retention in treatment is the greatest factor in predicting long-term sobriety; and individuals who are coerced into treatment by the courts perform better than "voluntary" clients because drug courts keep clients in treatment longer.
  • Drug courts incorporate the principles of effective treatment outlined by the National Institute of Drug Abuse.
  • Drug courts offer the only example of full-integration of the judicial, treatment and probation systems within the criminal justice field, including interdisciplinary training, memorandum of agreement among all systems that outlines roles and responsibilities, shared funding and blending of expertise among the disciplines.

Recommendations to the committee for addressing long-term drug court funding included directed use of federal Byrne funds, restoring the use of funds collected as a percentage of court costs in drug cases, and using the offender assessment fees for treatment instead of using the funds to assess all felons and misdemeanant drug offenders for substance abuse.


The director of the Division of Service and Systems Improvement in the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services, U.S. Department of Health and Human Services, presented the SAMHSA perspective on diversion strategies. He indicated that the appropriate approach to diversion is to achieve public safety objectives by providing treatment and avoiding unnecessary incarceration. Preliminary results from a SAMHSA diversion study indicate that individuals who are diverted from jail spend significantly fewer days in jail and are arrested less often. In addition, diversion costs slightly less than incarceration. Chesterfield County was awarded a grant (one of nine nationally) on September 30, 2002, to form a partnership among community corrections services, the day reporting center, the community services board, and social services agencies to create a program of diversion at arraignment for persons with co-occurring disorders, including a comprehensive service package and continuing reports to the Court.

SJR 97/HJR 142 Reports

SJR 97/HJR 142 (2002) requested certain information from cabinet secretaries and state agencies related to treatment options for offenders with mental illness or substance abuse disorders.

Evaluation Plan. The Secretary of Public Safety, in conjunction with the Secretary of Health and Human Resources and the Secretary of Administration, was requested to develop a plan, including the estimated cost, for collecting data on treatment services provided to and needed by state-responsible offenders and a process for evaluating the effectiveness of treatment services. The secretaries have created a preliminary evaluation plan that will update the inventory of current and needed treatment services; inventory previous and current evaluation findings; define potential program outcome measures; identify the limits of past studies; form strategies to improve future program evaluations; identify costs associated with data collection and conducting outcome evaluations; and determine potential federal and other sources of funding for outcome evaluation studies.

The secretary identified several evaluation projects already underway. The Department of Corrections is conducting an outcome evaluation of a transitional therapeutic community; the Department of Juvenile Justice is conducting an outcome evaluation for juvenile sex offenders treated in juvenile correctional centers; and the Department of Juvenile Justice also recently completed an evaluation of outcomes for juveniles from the substance abuse treatment program at the Barrett Juvenile Correctional Center.

The secretary recommended a planning approach: to focus on improving future program evaluations by making outcome measures an integral part of the program design; current evaluations may yield useful outcome measures but a more systematic approach to evaluating program effectiveness is needed. Moreover, retroactive evaluation is difficult because base data and outcome measures are typically not defined or collected for these programs. During this period of limited funding, emphasis should be placed on creating improved evaluation blueprints to use when funding for new treatment initiatives is more stable. Language that authorizes and funds treatment programs should require evaluation planning as part of initial program design, including setting aside program funds for evaluation.

Cross Training and Innovative Practices. The Department of Mental Health, Mental Retardation and Substance Abuse Services was requested to (i) develop a curriculum for cross-training among the various agencies and staff involved with offenders with mental illness or substance abuse disorders and to (ii) recommend ways to disseminate information about innovative practices among treatment providers working with these offenders. The department convened a work group to begin developing a core curriculum for training and designing a web-based approach for dissemination of information about innovative practices. The work group developed a philosophy of training and five related core curricula that articulate the basic knowledge, skills and abilities needed by key persons involved in or providing services to offenders with mental illness or substance abuse disorders. The work group will continue to meet during the year to complete development of the cross-training curriculum. Plans for dissemination of innovative practice information include development of a dedicated web site managed by a single agency or a network of linked web pages that would be managed by the various agencies working in collaboration with other organizations. The work group will continue to identify information-sharing capabilities of the various agencies and finish development of a web-based approach for dissemination of information.

Access to Medication. The Department of Corrections (DOC) and the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) were asked to examine ways to ensure that offenders being released from state correctional facilities have access to appropriate medications and that these medications are managed while the offender is in the community. Psychotropic medications and follow-up prescriptions are provided by the DOC to offenders with mental illnesses who are being released to the community. Persons with mental illness who are scheduled for release but need acute care mental health services are civilly committed to the Forensic Unit at Central State Hospital. The DOC does release planning for aftercare and other services for offenders who do not meet civil commitment criteria. To expand and enhance services related to discharge planning and aftercare, DOC and DMHMRSAS recommended the following:

1. Fill the only existing Community Corrections mental health services position;

2. Establish a senior psychologist position for each region in community corrections to supplement and expand upon the services provided by the one existing mental health position;

3. Designate at least one Probation and Parole District in each region to pilot specialized mental health caseloads and identify at least one probation officer as a mental health services specialist;

4. Distribute basic information on Medicaid and disability programs to all mental health services professionals to aid in the discharge planning process; and

5. Develop a means for all case management counselors to be provided information and application forms for offenders for all relevant federal and state benefit programs.

In addition, the memorandum of understanding would include the following information. DOC would: begin discharge planning for an offender with mental illness upon his/her intake into DOC; notify the designated Probation and Parole District at least 90 days prior to the offender's expected release date; notify the community services board or other local mental health services provider at least 60 days prior to release; initiate planning with the Forensic Unit at Central State for civil commitment to be effective on the day the acutely ill offender is to be released from DOC; ensure that an adequate supply of medication and a back-up prescription are provided to the offender being released; and forward a copy of the aftercare discharge plan to the Probation and Parole District and to the community services board or other community mental health services provider.

Model Court Order. The Office of the Executive Secretary of the Supreme Court was asked to examine the feasibility of designing and implementing a model court order that addresses mental health services for offenders. Model court orders can take two forms: preprinted with text set forth and check boxes or a more open text document in a word-processing format. A process for developing orders already exists, so it is feasible to develop a model court order when decisions have been made about the subject population, when the orders will be used in the judicial process, and what services will be covered.

Medicaid Access. The Department of Medical Assistance Services (DMAS) was asked to examine ways to provide immediate access to Medicaid benefits for eligible offenders when they are released from prisons, jails, juvenile correctional centers or detention homes. Federal money is not available for services provided in correctional institutions, but benefits can be suspended rather than terminated during the period of incarceration to allow smoother transition to the community. According to DMAS, benefits are terminated rather than suspended because the individual's situation could change and because the Medicaid information system does not accommodate suspension of benefits. Under current procedures, the individual may apply during pre-release. DMAS made the following recommendations: (i) DMAS and the Department of Social Services (DSS) should furnish information and training to Medicaid eligibility workers in local Departments of Social Services to ensure awareness of these procedures, and (ii) DMAS and DSS should develop a fact sheet for correctional facilities concerning Medicaid eligibility of inmates and those pending release.

Uniform Mental Health Screening for Juveniles. The Department of Juvenile Justice (DJJ) was requested to design and implement a uniform mental health screening instrument and interview process for juvenile offenders admitted to secure detention and to make recommendations concerning the feasibility of implementing a similar system for pre-dispositional investigations. DJJ identified the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) as the most appropriate screening tool. A focused interview protocol was developed for use at admission for the purpose of determining suicide risk and other acute mental health problems. The cost of implementing uniform screening in the detention centers will be minimal. However, to implement uniform screening at the pre-dispositional stage in court service units would cost approximately $1 million. More than 50 percent of the cost is the psychologist evaluation. DJJ recommended that implementation of uniform screening at the pre-disposition investigation process be deferred until the results of uniform screening in juvenile detention homes is known and adequate resources are identified and secured. In addition, DJJ recommended that enhanced resources be developed to provide treatment for juveniles identified as in need of services as a result of uniform mental health screening and interview process.


The Hon. Stephen H. Martin

For information, contact:

Nancy L. Roberts
Division of Legislative Services



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