The Advocacy Handbook: A Guide for Implementing Recommendations of the Criminal Justice / Mental Health Consensus Project

Download Handbook pdf.

The Advocacy Handbook reflects a shared effort among NAMI (the National Alliance for the Mentally Ill), the National Mental Health Association (NMHA), the National Association of State Mental Health Program Directors (NASMHPD), the Bazelon Center for Mental Health Law, and the Criminal Justice / Mental Health Consensus Project.

COUNTY JAIL FAILS FEDS’ PROBE

From the Houston Chronicle:

Poor access to health care and life-threatening conditions at the Harris County Jail violate inmates’ constitutional rights, federal investigators said Friday in a report on their ongoing probe of the downtown lockup that houses more than 11,000 people.

The Department of Justice initiated its investigation last year after the jail, which has failed four of its last six state inspections, came under scrutiny for inmates’ deaths, overcrowding and inadequate access to medical treatment. Investigators last summer toured the facilities and this week notified County Judge Ed Emmett of its findings.

“The (DOJ) found that the jail fails to provide detainees with adequate: (1) medical care; (2) mental health care; (3) protection from serious physical harm and (4) protection from life safety hazards,” Justice Department spokesman Alejandro Miyar wrote in an e-mail to the Chronicle. Miyar would not detail the report’s recommendations and added that the investigation is open and ongoing. He said the Justice Department expects to work with Harris County to remedy any continuing problems.

If things are not corrected in a timely manner, the Justice Department could sue the county, but Miyar would not comment on that possibility, saying only that Harris County has been cooperative.

A spokesman for Sheriff Adrian Garcia, who oversees the jail, said many of the issues cited in the report already have been fixed.

“The guts of the report predate this administration,” sheriff’s spokesman Keir Murray said. “The language is troubling, but it is based on a review of conditions that happened almost a year ago. None of the policy changes that have happened since are reflected in the report.”

Both Justice and the Sheriff’s Office declined to release the report Friday, but Murray did elaborate on some of the findings. Investigators, he said, focused on problems with inmates’ inconsistent access to medical and mental health care, particularly for those with chronic problems. They also cited past incidents where jailers used force against inmates.

Last year, the sheriff’s office fired two detention officers for their actions after a confrontation with Clarence Freeman, an inmate who died several days after one of the officers forcibly restrained him.

Freeman told investigators the jailer had choked him until he nearly was unconscious. It was unclear Friday if Freeman’s death was one of the incidents federal investigators examined.

The report also focused on maintenance and sanitation issues, including problems with laundry facilities and grooming equipment. Grooming and shaving equipment were brought into compliance last year, Murray said.

Garcia has been attempting to take control of jail maintenance, which is handled by another county department, since the jail failed its annual state inspection in April.

Last month, Garcia traveled to Austin to negotiate with the state Commission on Jail Standards to keep the lockup operating despite its failed inspection. Commissioners revoked 230 so-called “variance beds” that allow the jail to increase its capacity, but let Garcia keep some 600 others.

The sheriff told the jail commission that broken intercoms, which contributed to the failure, should be replaced by this month, and that the jail’s 701 San Jacinto building should have a new security and communication system by next summer.

Garcia has said he will work with the Justice Department to fix the issues that have not yet been resolved.

“We are cooperating with DOJ,” Murray said. “Unfortunately, the DOJ report seems to be consistent with the overall management of the organization in the past. The sheriff is committed to changing that.”

More on jail diversion

Use of the Sequential Intercept Model as an Approach to Decriminalization of People With Serious Mental Illness

Abstract:
Mark R. Munetz, M.D. and Patricia A. Griffin, Ph.D.

The Sequential Intercept Model provides a conceptual framework for communities to use when considering the interface between the criminal justice and mental health systems as they address concerns about criminalization of people with mental illness. The model envisions a series of points of interception at which an intervention can be made to prevent individuals from entering or penetrating deeper into the criminal justice system. Ideally, most people will be intercepted at early points, with decreasing numbers at each subsequent point. The interception points are law enforcement and emergency services; initial detention and initial hearings; jail, courts, forensic evaluations, and forensic commitments; reentry from jails, state prisons, and forensic hospitalization; and community corrections and community support. The model provides an organizing tool for a discussion of diversion and linkage alternatives and for systematically addressing criminalization. Using the model, a community can develop targeted strategies that evolve over time to increase diversion of people with mental illness from the criminal justice system and to link them with community treatment.

Treatment as an Alternative to Jail for People with Mental Illness

By Rebecca A. Clay


Imagine you’re a police officer who spots a man trespassing, urinating in an alley, or engaging in some other illegal behavior. When you confront him, he mutters, won’t look you in the eye, and just seems a little strange. Not knowing what else to do, you put him in jail.

And there he sits, not getting treatment for what turns out to be a serious mental illness. The trauma of incarceration actually makes the man’s psychiatric problems worse. Soon after his release, he gets arrested again.
Related Stories

That’s just the kind of scenario that the Targeted Capacity Expansion Grants for Jail Diversion Programs is designed to prevent. Launched by SAMHSA’s Center for Mental Health Services (CMHS) in 2002, the program targets the unnecessary incarceration of nonviolent adult offenders with mental illnesses.

Read the rest here.

Click here for some links for jail diversion.

New Study Documents High Prevalence of Serious Mental Illnesses among Nation’s Jail Populations

WASHINGTON (June 1, 2009) – A new study released today of more than 20,000 men and women entering jail offers the most accurate accounting in more than two decades of the number of adults with serious mental illnesses in these facilities.
Using screening instruments to identify individuals entering jails with the most serious mental illnesses and the greatest need for comprehensive and continuous treatment, a team of researchers from the nonpartisan Council of State Governments Justice Center and Policy Research Associates found that 14.5 percent of males and 31 percent of females—or 16.9 percent overall—met that criteria. The percentage of women with serious mental illnesses in jail is double that of men—a particularly troubling finding given the overall growth in the female jail population and the lack of research on the reasons for this overrepresentation.

Here we go again - another jail plan for Smith County

From the Tyler Paper:

2 New Plans To Add Beds To Smith Jail On Agenda
By ADAM RUSSELL

Staff Writer

Ending jail overcrowding in Smith County by renovating and constructing jail space will be discussed by architects and members of the Commissioners Court during a meeting tentatively scheduled for this month, County Judge Joel Baker said.

Baker discussed options and an expected meeting with commissioners Jeff Warr and Terry Phillips during Monday's Commissioners Court meeting. Commissioners Bill McGinnis and JoAnn Hampton were not present because of scheduled leave. Baker said the group will discuss two possibilities for adding between 147 and 294 additional beds to the existing central jail facility for $15 million to $22 million. Building up and adding one or two floors are viable options, Baker explained to the court.
He said adding one floor would allow for 147 extra beds at a cost of around $15 million while adding two new levels would cost around $22 million for 294 additional beds.

Architect Curt Parde, of HDR Inc., said he and his staff have evaluated the drawings for the central jail facility and that "the structure as it was designed is more than adequate" for two additional floors. County officials toured the site with Parde in December to discuss possible additions and changes to maximize the number of beds and usable space.

Parde said the scope of the preliminary project includes applying the jail's current design elements to any additions to maximize prison beds in a "confined space." The project would also call for building a new kitchen/laundry space on the Low/Medium Risk site, freeing up the lower level for renovation. The lower level would be used as clinic and infirmary space and a new exterior sally-port and use the existing sally-port area to expand the inmate booking area.

"Those are the major components," he said.

The central jail can house up to 276 prisoners on the second and third levels in a combination of single cells, multi-occupancy cells and dormitories. The ground level of the jail serves as its primary support space.

Warr said "all options," even privatization, are "on the table."

"We are looking for every option available," Warr said. "Building costs are down and it could be a good time for us to take care of this problem that has been within the county for going on a decade."

He said he was pleased the initial idea would add needed beds and facilities and utilize the existing structure and tunnel at lower cost than proposed in prison bond packages previously rejected by voters.

Phillips said the plan sounded like a positive step toward addressing the county's needs and reducing the financial burden on taxpayers. But, he said, he couldn't give a definitive statement on the possibility of adding floors because Monday's meeting was the first he had heard about the plan and more details are needed.

He said the proposal would bring shipped prisoners back to the county, along with the money it costs to ship, house and care for out-of-county inmates. Phillips suggested after the previous defeats of jail bonds this would probably be an acceptable alternative for voters, but that if the numbers showed there would be no increase to the tax rate, he would be willing to consider certificates of obligation to fund the project.

"If we can cover it and build it without changing the tax rate, I don't mind not going to voters. But if it does, I think we should," Phillips said.

Baker said when Parde confirmed the structure could support additional floors and saw the preliminary price tag, he believed it to be the best option for the county. He said, even after the previous failed bonds, he believes the decision should go before voters.

"I want voter approval, especially based on the history of this project," he said.

Probationers and Parolees with Mental Illness: What Works

Attached is a powerpoint on the above

Copies of presentation overheads regarding the community supervision of mentally ill offenders are provided. Topics covered by this session include: the problem of supervising mentally ill parolees and probationers; improving supervision success; evidence-based practice; specialty caseloads; and implications for practice.

Congressional Briefing on the Prevalence of Adults with Serious Mental Illnesses in Jails

From the Consensus Project:
On Monday, June 1, the Council of State Governments Justice Center will host a Congressional staff briefing on a new study on the prevalence of adults with serious mental illnesses in jails. The study, highlighted in the June issue of Psychiatric Services, was conducted by the Council of State Governments Justice Center, in partnership with Policy Research Associates.

The briefing will focus the study findings, implications for jail systems, the courts, communities, and persons with serious mental illnesses. The role of the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA) grant program in stimulating comprehensive evidence-based services and supports will be discussed.

Presenters will include, Fred Osher, Director, Health Systems and Services Policy, Council of State Governments Justice Center and Study Co-Author; Judge Steven Leifman, Special Advisor on Criminal Justice and Mental Health, Supreme Court of Florida; Art Wallenstein, Director, Montgomery County Department of Correction and Rehabilitation, MD; and Fred Frese, Ph.D., Psychologist who is a leading expert and spokesperson on serious mental illnesses, diagnosed with schizophrenia at the age of 25.

Waco crisis center can help small town police departments handle individuals with psychological issues

Waco crisis center can help small town police departments handle individuals with psychological issues

Riesel Police Chief Danny Krumnow started off his workweek with a frustrating experience that kept his town without a local police presence for most of a day.

On Monday and early Tuesday, Krumnow and his officers spent 17 hours trying to get medical help for a local man who was suicidal. Most of that time was spent waiting in a local emergency room for the man to be assessed and then admitted to a psychiatric hospital.

Because Riesel has a small police department — Krumnow and three other officers — the city had to rely on the McLennan County Sheriff’s Office to handle calls for help during that time. Luckily, it was an uneventful day, Krumnow said, but he was irked that the department’s time was monopolized by a non-law enforcement matter.
Riesel Police Chief Danny Krumnow stands in front of his patrol car. On Monday, Krumnow spent hours waiting in a local emergency room to try to get help for a man who was suicidal. A new center in Waco should help law enforcement officials avoid most such waits. (Duane A. Laverty photo)

Similar scenarios play out about once a month, Krumnow said, leaving the city without the protection of its police department. The waits usually aren’t as long, he said, but officers generally have to be out of the city for at least four hours on each mental health call.

* A 5 percent decrease in the number of mentally ill people booked into local jails.

* An 18 percent decrease in the number of people admitted to Waco’s psychiatric hospital, the DePaul Center.

* A decrease of nearly 6 percent in the number of days local residents are in state mental hospitals.

The Law Enforcement Response to People with Mental Illnesses: A Guide to Research-Informed Policy and Practice

The Council of State Governments Justice Center announced today the release of The Law Enforcement Response to People with Mental Illnesses: A Guide to Research-Informed Policy and Practice. The guide examines studies on law enforcement interactions with people with mental illnesses and translates the findings to help policymakers and practitioners develop safe and effective interventions. Supported by the John D. and Catherine T. MacArthur Foundation, it reviews research on the scope and nature of the problem and on a range of law enforcement responses.

Understanding how law enforcement officers engage people with mental illnesses is an issue of national importance. "These interactions are often time-consuming, difficult to resolve, and, can result in tragic outcomes," said Justice Center Board Member and Mesa, Arizona, Police Chief George Gascn. "This guide will help law enforcement and policymakers better understand these encounters and the specialized responses, which research suggests may lead to more positive results for all involved."

Research findings show that law enforcement encounters with people with mental illnesses are often more time-consuming than other calls for service,
require officers to have special training and skills,
may be shaped by available community mental health resources,
typically involve repeat contact with the same people who have unmet mental health needs, often are in response to a complaint of "nuisance" behavior,
occasionally involve volatile situations that risk the safety of all involved.
The guide asserts that specialized responses such as crisis intervention teams, co-response teams, and other police-based efforts show great promise for increasing public safety, reducing repeat calls for service, and better serving people with mental illnesses. Yet policymakers and planners generally implement these initiatives without the benefit of research and data to guide program development for their community. This guide is meant to provide that foundation.

The Justice Center report, as well as related materials from a Bureau of Justice Assistance-supported series including The Essential Elements of a Specialized Law Enforcement-Based Program and Strategies for Effective Law Enforcement Training, can be downloaded for free at http://www.consensusproject.org/issue-areas/law-enforcement. A similar report on what the research says about community corrections responses to people with mental illnesses can be downloaded at http://www.consensusproject.org/downloads/community.corrections.research.guide.pdf.

The Guide was produced under Grant No. 05-82376-000-HCD for the John D. and Catherine T. MacArthur Foundation. A limited number of hard copies (NCJ 226965) can be ordered through the National Criminal Justice Reference Service at www.ncjrs.gov or by calling 800-851-3420 (international: 301-519-5500;TTY: 301-947-8374).

Impact of Mental Health on Business Activity in Texas

Costs, Consequences, and Cures!!!
An Assessment of the Impact of
Severe Mental Health and Substance Abuse Disorders on
Business Activity in Texas and the
Anticipated Economic and Fiscal Return on
Investment in Expanded Mental Health Services

The benefits from implementing a $20 million hypothetical
jail diversion program would include a positive net annual
impact of $1.074 billion in total expenditures and 6,420
permanent jobs. The yearly increment to State tax receipts
that could be expected was calculated to be $53.964 million,
or a return of $2.70 per dollar of investment and $53.71 in
overall benefit.

TDCJ pay raise is upsetting

by the Back Gate:

In a move by Texas legislators that has already had resounding effects just hours after it's announcement, TDCJ employees will only see 7% in pay raises over the next two years. That's a mere 3.5% this year and next. With the current state of the economy, the failure of the pay raise proposition has some seeking higher ground already. The Backgate Website's general manager Duane Stuart stated, " This is sure to create an unimaginable ripple effect all over the state with TDCJ employees." " Terrible morale is sure to get even worse, and i see the ones that can get out to choose now to do it." The 2,500 empty correctional officer positions TDCJ has held for nearly 5 years will surely grow as well many have said.

The AFSCME correctional officer's union has released a list of Texas Legislators that failed to push the originally proposed raises through. The union also blames employees themselves for their lack of attention and commitment to calling legislators and getting out to vote in the last election. Below is a list of legislators that held the key to a TDCJ employee payraise. Call them, write them, and get out to vote next time to get rid of them. What will you do?

Peavy Switch May Reopen

HUDSON, TX (KTRE) - Peavy Switch used to be a place adults could get help for drug abuse, but it closed down due to a lack of funding. Now, the Burke Center may re-open their old facility to help younger people with a different set of problems … The plan is to help 11 to 14-year-olds struggling with mental health issues.

Protect Public While Limiting costs

From the Texas Public Policy Foundation:
There are common sense initiatives that states can take to protect public safety while limiting costs to taxpayers. These include drug courts, graduated sanctions for probationers and parolees, and electronic monitoring.

Dallas Morning News puts Homelessness in the Headlines Again

From the Dallas Morning News:

… The center, which now has a $7 million annual budget, was built to help the chronically homeless and quickly move them into longer-term housing. The costs rose during the first year, from $6.4 million annually, after twice as many people as expected came for help. In addition to sheltering 300 a night, The Bridge provides a place for hundreds more to go during the day for mental health care, substance abuse treatment, meals and laundry.

Telepsychiatry

John Gramlich of the state policy-focused nonprofit news organization Stateline.org reports that more states are using videoconferencing for inmate health consultations to avoid the cost and danger involved in transporting a prisoner outside prison grounds. Texas is a national leader in the practice; Georgia primarily uses video conferences for psychiatric evaluations.

State Schools to get 1100 new employees

From Statesman's Jason Embry

Texas institutions for people with mental disabilities will get more than 1,100 new employees under an agreement reached between the state and the U.S. Department of Justice, The Statesman’s Corrie MacLaggan reported: “The bulk of those would be direct-care workers, said Cecilia Fedorov, a spokeswoman for the Department of Family and Protective Services. The workers would also include 27 psychiatrists, 11 clinical pharmacists and eight dentists, according to the department Web site. There are now between 12,000 and 13,000 employees at the 13 institutions known as state schools, Fedorov said. State Sen. Jane Nelson, R-Flower Mound, has said the plan — which has been approved by the Department of Justice but still needs an OK from the Texas Legislature — will cost $112 million over five years. Nelson and Rose today filed a resolution approving the agreement.”

The state schools were among three areas of the newly agreed-upon budget that Sen. Steve Ogden singled out for praise, saying budget-writers’ work will allow the schools to be better run and will allow Texans who do not want to be in the schools to receive services in their communities.

Any Word on Diversion Initiatives and the Budget?

I have been looking for any activity on the Budget, specifically on diversion programs, but it appears stifled since conferees appointed 4/28/09.

Fight Club Revisited

After the world watched the Fight Club scenarios played out at the Corpus Christi state school, I found this article on the Statesman:

Texas, feds reach tentative agreement on state schools

By Corrie MacLaggan | Wednesday, May 13, 2009, 06:15 PM

Texas and the U.S. Department of Justice have reached a tentative agreement on the state’s troubled institutions for people with mental disabilities, according to a state representative.

The agreement requires legislative approval, said the representative, Abel Herrero, D-Robstown.

“It’s a proposal that the state feels addresses the issues raised in the DOJ report,” Herrero said, referring to a December report by the federal agency that said the institutions fail to protect residents from harm.

It did not state what the agreement is, however.

Update:
State school settlement approved
By Mike Ward | Wednesday, May 27, 2009, 09:21 PM

The Texas Senate just a few minutes ago approved a resolution ratifying a settlement with the U.S. Department of Justice over abuse allegations at state schools.

The vote on Senate Concurrent Resolution was 31-0.

Calling the confirmed cases of past abuse “unexcusable,” state Sen. Jane Nelson, R-Flower Mound, said the settlement and accompanying reforms will ensure that conditions at state schools for the developmentally disabled will never revert.

The Senate earlier in the day approved $48.1 million for reforms to curb any future abuses of state school residents.

A Guide for Probation and Parole: Motivating Offenders to Change

From the National Institute of Corrections:

Motivating Offenders To Change
The corrections field, and community corrections in particular, has long experienced tensions between its two main missions, protecting public safety and rehabilitating offenders. Treatment-oriented strategies that had as their goal the reintegration of offenders into society have contended with deterrence-oriented strategies based on apparent findings that “nothing works” in treating offenders. In recent years, the development and application of evidence-based practices (EBP)—practices informed by the results of scientific research and shown to increase public safety and reduce recidivism—have had a profound and positive impact on the corrections field. More thorough scientific analysis of both treatment- and deterrence-oriented programs has shown that many programs that emphasized motivation and behavior change over punishment have been successful in reducing crime rates among offenders. The National Institute of Corrections (NIC), through its sponsorship of studies and its training programs, has been a leader in the movement toward EBP in the corrections field and an advocate of more rigorous scientific analysis of programs for offenders.
One promising evidence-based practice for motivating offenders and fostering positive behavioral changes is motivational interviewing (MI). MI, which was first developed in the addiction treatment field, is now being applied widely and with positive results in corrections, particularly in probation and parole. The principle behind MI is that by listening to offenders and following up on the positive aspects of their speech and thinking, corrections professionals can help increase offenders’ motivation to make positive changes in their lives that will reduce their likelihood of reoffending.
This publication, Motivating Offenders To Change: A Guide for Probation and Parole, provides probation and parole officers and other correctional professionals with both a solid grounding in the principles behind MI and a practical guide for applying these principles in their everyday dealings with offenders. Through numerous examples of questions, sample dialogues, and exercises, it presents techniques for interacting with offenders at all stages of supervision and at varying levels of commitment to positive change. In addition, it recognizes that deception, resistance to change, and relapse into criminal behaviors are realities for many offenders, and sets forth strategies for dealing with those issues that avoid unproductive confrontation with the offender.