SJR 97/HJR 142: Committee to Study
Treatment Options for Offenders with Mental Illness and Substance Abuse
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.
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
- $3,000 to $5,000 per participant
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
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
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
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
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
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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