Joint Study Committee
on Treatment Options
for Offenders who have Mental Illness or
Substance Abuse Disorders (SJR 97/HJR 142, 2002)
June 28, 2002, Richmond
The 2002 Session of the General Assembly
(SJR 97/HJR 142) 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
(formerly SJR 440, 2001) 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 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 place. The SJR 97/HJR 142 committee
held it first meeting on June 28, 2002, in the General Assembly Building
in Richmond. Senator Stephen H. Martin was elected chairman and Delegate
Glenn M. Weatherholtz was elected vice-chairman.
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. The
Honorable Jane H. Woods, Secretary of Health and Human Resources, described
the services to offenders provided by state and local agencies associated
with the Health and Human Resources Secretariat. In addition, the Secretary
delineated changes in funding available for mental health and substance
abuse treatment for offenders as a result of the 2002-2004 biennium Appropriation
Act.
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 the Secretary.
Priorities and Goals. The Secretary
articulated a list of goals and priorities for her Secretariat in regard
to offenders with mental illness and substance abuse disorders.
- 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 on probation;
- 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. The
Honorable John W. Marshall, Secretary of Public Safety, 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 programs.
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 juvenile offenders;
- 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, Ph.D.
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 concerning diversion to
keep people out of jail who do not need to be there, provide adequate
services to incarcerated individuals who need them, and link 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
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, 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 does the empirical data say about
the effectiveness of these programs? Unfortunately, not much research
data is 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 radically reduced for pre-and post-booking programs
and they 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 is data to show the positive
impact of mandated treatment for substance abuse, there is 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 you
need someone to be looking for these opportunities.
Dr. Steadman said 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 shifts about community responsibility, it is a
hopeless battle. However, family members have historically been prime
movers in helping to change community thinking.
Member Discussion
Members raised several points in summary.
One member noted that the system is fractured with little discussion occurring
between criminal justice and treatment professionals. Moreover, there
is no evidence that the current system works, 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 individuals since offenders may be released into communities other
than their home communities. 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.
JOINT
COMMISSION ON BEHAVIORAL HEALTH CARE
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