SD25 - Studying Treatment Options for Offenders Who Have Mental Illness or Substance Abuse Disorders
"The United States currently has more mentally ill men and women in jails and prisons than in all state hospitals combined," wrote Chris Sigurdson (2000) in an article published by the American Correctional Association. However, national research indicates that fewer than 50 percent of men and women with severe mental illnesses receive mental health treatment while they are incarcerated and fewer than 25 percent of inmates with more moderate forms of mental illness receive mental health services.
In its 2000 annual report to Congress, the Coalition for Juvenile Justice estimated that 50 percent to 75 percent of young people in the criminal justice system nationwide suffer from mental illness. Thirty-six percent of the parents surveyed by the Coalition said their children were in the criminal justice system because they could not get needed help outside the system.
The National GAINS Center (1997) estimates that sixty-three percent of jail detainees have a mental illness or a substance abuse disorder; five percent have both. Among state and federal prisoners, an estimated 57 percent have a mental or substance abuse disorder and approximately 13 percent of prisoners have both a serious mental illness and a co-occurring substance abuse disorder.
Offenders with mental illness are often jailed for relatively minor offenses, such as vagrancy, trespassing, disorderly conduct, alcohol-related charges, or failing to pay for a meal. The Center on Crime, Communities and Culture (1996) asserts that, "When it is mental illness and not criminal intent that underlies a petty criminal act, treatment in mental health programs is demonstrably more effective at reducing recidivism than a sentence to jail."
Against this background, the 2001 Session of the General Assembly directed the Joint Commission on Behavioral Health Care, the Virginia Commission on Youth and the Virginia State Crime Commission to examine treatment options for offenders who have mental illness or substance abuse disorders (SJR 440, Senator R. Edward Houck). As outlined in SJR 440, the study was to include mental health and substance abuse services delivered to and needed by adult and juvenile offenders at the state and local levels. Specifically, the Commissions were directed to review the:
• Incidence of mental illness and substance abuse among offenders;
• Current system for delivering mental health and substance abuse services, including assessment, treatment, post-release, and follow-up;
• Model treatment programs for offenders;
• Costs and benefits of private versus public delivery of treatment services;
• Need for specialized training of local law enforcement and court personnel; and
• Funding, sources of funding and legislation required to ensure adequate assessment and treatment services.
To address such a comprehensive mandate, each of the Commissions appointed members to serve on a special study committee. Senator Stephen H. Martin was elected Chairman and Delegate Glenn M. Weatherholtz was elected Vice-Chairman. Other members included Senator R. Edward Houck; Senator Janet D. Howell; Delegate David B. Albo; Delegate John H. Rust, Jr.; Delegate Robert Tata; Gary L. Close, Attorney for the Commonwealth, Culpeper County; and William G. Petty, Attorney for the Commonwealth, City of Lynchburg.
The Committee met six times, sent out questionnaires and held two public hearings to receive testimony and hear presentations from consumers, family members, advocates, criminal justice professionals, treatment providers, academic faculty and other experts. The Committee also maintained a website to facilitate the exchange of information, where interested persons were able to download agendas, presentations, meeting summaries, and a decision matrix that described the options being considered. The decision matrix was available for public comment from October 17 until November 9, 2001. A work group composed of consumer, family, advocacy, local government, defense attorney, mental health treatment, substance abuse treatment, and criminal justice representatives assisted with identifying issues, collecting data, and developing solutions.
The Committee wishes to express its gratitude to the numerous dedicated consumers, family members, advocates, criminal justice professionals, treatment providers, attorneys, academic faculty, local government officials and others who contributed to the Committee's deliberations and final work products. Their cooperation, candor, and innovative thinking were remarkable and greatly appreciated.
Recognizing the current budgetary situation, most of the Committee's recommendations were designed to lay the groundwork for future action: maintaining funds that are appropriated in the current biennium budget; gathering information about unmet needs; fostering interagency collaboration and planning; establishing minimum clinical guidelines; and providing a framework for information sharing and evaluating the effectiveness of existing programs. This Executive Summary highlights the Committee's key findings and recommendations.
Interagency Collaboration. Clearly defined responsibilities for serving adult and juvenile offenders with mental illness and interagency collaboration do not exist in many communities across the Commonwealth. Moreover, there does not appear to be a consensus as to whether the responsibility for providing treatment services should reside with the criminal justice system or the mental health treatment system. The Committee recommended that the General Assembly establish an interagency work group under the leadership of the Committee to develop a screening-assessment-treatment model for offender groups with mental health needs. The work group would be asked to make recommendations concerning the statutory assignment of responsibility for providing needed treatment services; a regional planning process to foster state and local interagency collaboration; model memoranda of agreement that detail responsibilities for services, information exchange, and cross training of staff; and a framework to pilot the memoranda and evaluate the results. In addition, the Committee recommended that the Office of the Secretary of the Supreme Court be requested to examine the feasibility of designing and implementing a model court order that addresses mental health needs of offenders.
Capacity. Virginia communities lack sufficient capacity, including the availability of acute psychiatric care, to treat offenders with mental illness and substance abuse disorders while they are incarcerated and when they are released from state correctional facilities, jails or detention homes. Moreover, lack of a comprehensive and systemic approach to funding these services has resulted in inequitable access to care across Virginia. The Committee recommended that the General Assembly (i) direct the Department of Criminal Justice Services (DCJS), in collaboration with other stakeholder agencies and groups, to identify the unmet need for mental health and substance abuse treatment services for adult offenders and to develop a comprehensive plan, including the necessary resources and funding sources for covering the increasing costs of providing existing services and to fill service gaps; (ii) direct the Commissioner of Mental Health, Mental Retardation and Substance Abuse Services to make recommendations to the Committee concerning access to psychiatric care for jail inmates and to ensure an adequate supply of acute psychiatric beds for children and adolescents; (iii) direct the Department of Medical Assistance Services to examine ways to provide immediate access to Medicaid to eligible offenders when they are released from prisons or jails; (iv) direct the Department of Corrections to recommend ways to ensure the appropriate management of medications for offenders when they are released from state correctional facilities; (v) direct the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) and the Department of Juvenile Justice (DJJ) to identify and create opportunities for public-private partnerships and the necessary incentives to establish and maintain an adequate number of residential and acute psychiatric beds for the treatment of juvenile offenders; (vi) continue the funding for the "Keep Our Kids At Home" (KOKAH) project, which has demonstrated success at reducing inpatient hospitalization; (vii) include juvenile offenders in the plan being developed as a result of Item 323K in the current biennium budget to provide and improve access by children to mental health, substance abuse and mental retardation services; (viii) continue the funding for recruitment and retention of psychiatrists in medically underserved areas, which is currently $500,000 each year; (ix) appropriate $50,000 to expand the National Health Service Corp-Virginia Loan Repayment Program to include mental health professionals; and (x) explore ways to expand the use of telepsychiatry in underserved areas.
Clinical Guidelines. The Commonwealth has not developed clinical guidelines for jails or detention homes to ensure an adequate level of mental health services for people who are incarcerated. The Committee recommended that the General Assembly direct the State Board of Corrections, the State Mental Health, Mental Retardation and Substance Abuse Services Board and the Board of Juvenile Justice as appropriate to develop minimum guidelines for the provision of mental health and substance abuse treatment services in jails and detention homes and a plan, including the necessary fiscal and staff resources, for meeting the guidelines.
Training. Cross training for balancing therapeutic goals with security needs and public safety is needed for law enforcement, judges, jail and detention staff, and community treatment staff. The Committee recommended that DMHMRSAS be requested to develop and make recommendations for implementing a curriculum for cross training law-enforcement officers, judges, jail and detention staff, and community treatment staff in security and treatment.
Data Collection, Evaluation and Information Sharing. No comprehensive mechanism exists to systematically collect complete and accurate data on treatment services provided to and needed by adult and juvenile offenders or to evaluate the effectiveness of the services. The Committee recommended that the General Assembly (i) request the Secretary of Public Safety, in conjunction with other Cabinet Secretaries, to develop a plan, including the estimated cost, for the collection of data on treatment services provided to and needed by state-responsible adult and juvenile offenders and for the evaluation of the effectiveness of treatment services; (ii) continue the funding for intensive substance abuse treatment services in jails for the next biennium and direct DMHMRSAS to conduct comprehensive process and outcome evaluation of therapeutic communities in local jails; and (iii) direct the Virginia Commission on Youth to coordinate the collection and dissemination of information on effective treatment modalities and practices.
Continuation of the Study. The Committee brought together members of the Joint Commission on Behavioral Health Care, the Virginia State Crime Commission and the Virginia Commission on Youth to apply their individual expertise to the study of issues related to adult and juvenile offenders with mental illness and substance abuse disorders. During their deliberations, the members collected a great deal of information and acquired additional expertise, both individually and collectively, on issues that cross the boundaries between the criminal justice system and mental health and substance abuse treatment systems. The members of the Committee would like to use the expertise that they have acquired to track the activities that they set in motion, provide legislative oversight to the interagency group that will develop a screening-assessment-treatment model for offender groups with mental health needs and continue their research into programs that will prevent persons with mental illness and substance abuse disorders from entering the criminal justice system in the first place. The Committee's final recommendation is to continue the study of treatment options for offenders with mental illness or substance abuse disorders and to include the Secretaries of Public Safety and Health and Human Resources in their deliberations.