Joint Study Committee
on Treatment Options
for Offenders who have Mental Illness or
Substance Abuse Disorders (SJR 97/HJR 142, 2002)
Meeting Summary
October 18, 2002, Richmond
Senator Stephen H. Martin, Chair of the
Committee Studying Treatment Options for Offenders with Mental Illness
or Substance Abuse Disorders (SJR 97/HJR 142, 2002) 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 3 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.
- What is the cost of drug courts?
- $3,000 to $5,000 per participant
per year.
- 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.
- 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.
- 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.
- 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; and
- 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.
Diversion
Michael J. English, 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. Mr. English also reported
that 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 (1) develop a curriculum for cross-training
among the various agencies and staff involved with offenders with mental
illness or substance abuse disorders and to (2) 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:
(1) 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 (2) 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 predispositional 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 predisposition investigation process be deferred
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.
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