A year ago, the President signed a new law to improve treatment and reduce recidivism for mentally ill prisoners, and while the size of the population hasn't changed much since then, some improvements are underway to address the situation.

Last week an appropriations bill was sent to the President's desk that would provide $5 million in funding for last year's Mentally Ill Offender and Crime Reduction Act. This sum is small in relation to the challenges faced by corrections and mental health agencies, but it shows that there is support for new collaborations to work with this population.

“It really has become a big deal. I've heard corrections administrators comment that they have become the default state hospitals,” said Margie Phelps, Director of Release Planning for the Kansas Department of Corrections.

Phelps said her department estimates that 20 percent of the inmate population has significant mental health needs and at least half of those inmates are severely or persistently mentally ill.

In Kansas, officials have supported alliances between the corrections department and mental health agencies to share information about the mentally ill population once they are incarcerated and prepare them for a smooth transition to the community and community-based treatment after release.

“We've always dealt with the quality of mental health care in the system, but this is an issue of when they leave the system and connecting them to services in the community,” said Phelps. “One of the most significant issues is how they look on paper in the structured setting of a prison is very different than how they look in the unstructured setting in the community. You realize you have a breakdown right out of the chute.”

Kansas and other jurisdictions are strengthening collaborations between mental health services and criminal justice agencies to better serve and prepare this group for release into the community.

Over the last year and a half the Council of State Governments and the National Institute of Corrections have joined to provide technical assistance around this issue to four jurisdictions, Kansas, Rhode Island, Orange County, Fla. and Philadelphia, Pa. Each have similar problems, but each is approaching those problems a little differently.

In Kansas, for example, officials have improved data sharing and communication between agencies, while in Philadelphia; officials are testing different re-entry models for the mentally ill offender population.

The project, which has one more year of funding left, hopes to create learning centers that can provide information to other agencies across the country about how to manage this population.

Building Relationships

According to Fran Zandi, Corrections Program Specialist for the National Institute of Corrections, the project intends to look at the differences between jails and prisons in managing the mentally ill population.

The jails are considering diversion and reentry services, while the prisons look deeper at managing these offenders on the inside, she said. But both types of agencies would like to see these offenders cared for on the outside.

“The repeat mentally ill offender – and every jail can tell you they have one of them --they get arrested 30 – 40 times a year. That is a disruption for their treatment, so keeping them out a little longer is to their benefit,” said Zandi.

Zandi said the President's New Freedom Commission on Mental Health report of 2003 set out three issues that need to be handled in relation to prisoners with mental illness – that they should be diverted from incarceration when possible, services should be provided for those whose crimes are serious enough to warrant incarceration and discharge planning needs to be done for those who are sentenced.

Those are all important principles, she said, but in addition, corrections and mental health agencies should try to avoid replicating services for those who pass between the two systems.

That is part of what the CSG/NIC project is all about.

“We can't just concentrate on diversion without realizing there are some constitutional levels of care that need to happen in the facility,” Zandi said. “[And] what good does it do us if we are replicating services.”

Zandi said the four learning sites receiving technical assistance from the CSG/NIC project will not only serve as resources for other agencies, but will also test out assessment tools so that other jurisdictions don't have to reinvent the wheel as they create collaborations to handle the mentally ill offender population.

“We prefer to call them learning sites. You are always learning and something might benefit you, where for others it might not. [But] you can tweak it to your agency and deal with it in the context of your jurisdiction,” she said.

One of the lessons that the sites have learned is the importance of communication and information sharing between corrections and mental health agencies.

Communication is Key

Kansas officials knew that in order to improve collaboration between mental health and corrections it had to improve its process of information sharing.

“If you think in broad strokes, you've got to address information and data sharing and that has both components of confidentiality and system interface,” said Phelps.

The DOC/mental health collaboration received a boost of support for their efforts when legislation was passed to allow the two agencies to share information for purposes of discharge planning, she added.

With the barriers removed, the DOC set out to create a way to query the mental health system databases that hold information from all mental health centers with the idea that the information would tell offenders' treatment histories and interactions with the mental health system on the outside. With that information, corrections personnel could better serve these offenders on the inside and better prepare them for release.

“We're looking at data systems around substance abuse [and], state hospital stays we are going to tackle next. It's a comprehensive approach to recognizing that case management in all these arenas continues when they are in prison,” said Phelps.

With the information piece taken care of, corrections officials also focused on transitional planning for offenders. Through the DOC's collaboration with the Department of Social and Rehabilitation Services, it has positioned a transitional or discharge planner in each of the facilities.

Through the Community Offender Reentry Pathways program, the DOC and the SRS combined resources to identify offenders early on and involve them in multi-disciplinary team transition planning. The team involves mental health providers, release planners and parole representatives who work together to connect the mentally ill offender to services in the community and – hopefully – result in fewer returns to the criminal justice system.

“Some early returns have shown that we have brought the return rates down,” said Phelps.

The program has also recently reached out in a pilot project to a county community mental health center in Wyandotte County, where mental health officials have joined the multi-disciplinary team to assist with transition planning for offenders returning to that area of the state.

As part of the project, a case manager comes into the facilities to help the offenders prepare for release by discussing housing opportunities, employment and family issues.

“We really want to look at how we hope to improve the service delivery system – be it less emergency care, less response from the police officer or the mental health provider feeling like they could deliver the resources better – we are going to try to capture all of that,” she said.

Next on tap for the project, Phelps said, is to create an interface specifically between parole officers and mental health providers in the community so they are able to share information about the work that has begun and the work that should be continued in the community. Currently some specialized parole caseloads have been created with the intention of creating more as the benefits become evident.

“We've put our heads together trying to interface two burdened systems. My hope is we will be able to do things more effectively,' said Phelps. “A lot of mental health centers are concerned about the safety of their consumers and whether they can be effective with this population. I know for a fact they are already serving these folks. They may not know it, but I think they will be better off having this information [about them].”

Similar lessons have been learned in Philadelphia, where collaborations between corrections and mental health agencies in the city have also taken place as part of the CSG/NIC technical assistance project.

Philadelphia Looks for Reentry Solutions

For Philadelphia corrections and mental health providers, their alliance over the years has helped the two systems establish a baseline for communicating about offenders on the system's mental health caseload. But what they two agencies have not been able to accomplish, until now, is determining which of those offenders have major mental illness.

According to Patty Griffin, Co-Chair of the Philadelphia Forensics Task Force, the work of the two agencies has provided the baseline for a more focused effort on transitioning these offenders back into the community.

“What we are trying to do as a part of this initiative is get a much better understanding of the proportion of people who have major mental illness, how they get referred and how we can help them when they go back into the community,” said Griffin.

With information gathered from a previous reentry pilot project and the technical assistance from the CSG/NIC project, the two city agencies have been able to create new data sharing opportunities and test out three different reentry approaches to determine which one works best to transition offender successfully into the community.

“There was a long standing collaboration and there was good flow of information between agencies, but we needed to do better with the providers. My philosophy has been to err on the side of sharing information rather than hoarding the information,” said Leon King, Commissioner of the Philadelphia Prison System.

At the heart of the project is a datamap that has helped the two agencies identify those who come into the criminal justice system with a history of mental illness or receiving mental health services. The offenders undergo a screening by a corrections officer who in turn makes a referral to a mental health program, where they are screened again. The offenders with their accompanying information are identified in a flow chart.

The datamap not only maps who comes in the door, Griffin said, but the referrals they received, the procedures that are done and  the links they obtain.

“The project [goal] is to understand the volume and find more efficient ways to identify these folks, then link them to the mental health program and the community,” Griffin said.

Simultaneously, three different reentry programs work with offenders from different geographical locations and different mental health groups to provide positive outcomes after release.

One program works with offenders in a wellness group and includes peer counseling to make a smooth transition into the community, another looks at transition from the probation side of the equation and a third has specialized a case management unit within the mental health services system that is specialized to the criminal justice population.

On a day to day level, the collaboration has worked to educate both the corrections and mental health sides about the functions of each.

“A lot of this has to do with understanding the systems. The case managers don't understand the release procedures, with the jail, so we work with them so they can pick up their clients and be able to transport them to a safe place [after release],” said Griffin.

On the criminal justice side, Griffin said, mental health providers have worked with the sheriff's department – which transports offenders to the courthouse – to make sure that their medications go with them in case they are released directly from the court.

“We've been looking at it from any number of angles to make the process more visible to everyone involved,” she said.

As part of that goal, King said, his department has tried to educate the public and legislators about the mentally ill incarcerated population as well.

“Not only are they here [in jail] but there's a good chance they are known by people servicing them in the community,” he said.

Officials in Rhode Island have also made a special effort to raise awareness about the population when they hit the street after their sentences are over.

Rhode Island Takes Collaboration to the Community

Rhode Island has also had a history of collaboration between corrections and mental health, but the missing piece for both was taking that collaboration to the street after offenders are released into the community.

According to A.T. Wall, Director of the Rhode Island Department of Corrections, offenders who come into the system – which manages both the jails and the prisons  in the state – are screened for a history of mental illness and cross-checked against the Department of Mental Health's information database to pinpoint the types of services they might need while in custody.

“We matched our databases, did some research on incarcerations and hospitalizations and discovered there is, indeed, a pool of people who shuttle back and forth between the two systems frequently. They cost a lot of money and present a risk to public safety. In addition, the continual disruptions in their lives aren't supporting their treatment of their mental illness,” said Wall.

Once identified, the mental health department's mobile treatment teams are set into action to provide the services the offenders need. The joint collaboration, which is supported by CSG/NIC technical assistance, seeks to communicate this information to probation and parole so that treatment and specialized services can continue.

Wall said this is especially important since about 90 percent of sentenced offenders receive split sentences, which includes time inside a facility and time on probation or parole.

 “Traditionally when someone is on probation or parole, our staff at corrections don't know if they are under the care of a mobile treatment team and don't have communication. Similarly, the mobile treatment team has not worked with corrections to address the criminogenic issues that the client presents,” Wall said.

He added that the project involves cross training between the mobile treatment teams and corrections fields services staff, consultation with our clinicians who have treated the person behind the walls, and joint meetings before the individual is released and while he or she is under mobile treatment team care.

“The mobile treatment team can provide supports and stabilization that will help us supervise someone on probation or parole. In turn the conditions of supervision provide leverage for the mobile treatment team to provide services for difficult clients,” Wall said.  “This project takes it out to the street where, after all, the rubber meets the road when it comes to public safety.”

Wall and other corrections and mental health officials believe these types of programs are only the start of what will likely become a long-standing relationship between corrections and mental health in communities across the country.

“At the end of the day, both industries have a common piece of their mission which is healthy, safe communities. And recognizing that their populations are overlapping is critical to working together and learning what each other has done,” said Griffin. “At the end of the day, we should try to avoid people going to or going back to prison because they are mentally ill, and we won't get there until we work together and recognize there is a direct correlation between public safety and delivery of services to this population.”

Resources:

Criminal Justice/Mental Health Consensus Project – www.consensusproject.org