RD470 - Forensic Discharge Planning for Persons with Serious Mental Illness in Virginia Jails (HB1784 & SB941) – November 1, 2017

Executive Summary:
The Forensic Discharge Planning for Persons with Serious Mental Illness in Virginia’s Jails report was undertaken to provide a potential solution to the challenges faced by jails, local communities, and the Commonwealth in their attempts to manage the growing problem of persons with serious mental illness (SMI) in Virginia’s local correctional institutions. As directed in HB 1784 and SB 941, which passed in the 2017 session of the Virginia General Assembly, DBHDS convened a workgroup to develop a comprehensive plan to address the needs of this population as they are released from jail.(*1) Virginia faces growing pressures to address the problem of persons with SMI in jails and the impact of unaddressed mental health needs upon release on criminal justice and behavioral health systems, and the community at large.

Summary of the Problem(*2)

• 3,556 individuals in Virginia jails have been reported to have a SMI such as schizophrenia, schizoaffective disorder, bipolar disorder, or post-traumatic stress disorder (PTSD) on any given day.

• Virginia jails report spending $14 million per year in medication and treatment costs alone, but expenses are likely much higher due to uncalculated costs for staffing, injuries, emergency hospitalizations, and other indirect costs.

• Individuals with SMI who are released from jails have higher rates of re-arrests when they are not linked to mental health care in the community than those who are provided this type of discharge planning services.

Proposed Forensic Discharge Planning Structure

Forensic discharge planning should be provided by community services board (CSB) staff and should begin as soon as possible upon entry into the jail and prior to jail release. It should continue no less than 30 days post-release to ensure a smooth transition.

• Caseload size for a full-time forensic discharge planner should be approximately 20 clients, as these individuals will likely be high need and high intensity.

• Forensic discharge planning should be made available in every jail in Virginia, for every inmate with an SMI.

• DBHDS supports use of the “APIC Model” – Assess, Plan, Identify, and Coordinate – of discharge planning and principles of the Risk Needs Responsivity (RNR) model in identifying levels of risk and needs.3

Proposed Implementation Plan

The total cost to fund a robust forensic discharge planning system from all local and regional jails is $12,367,400 annually. DBHDS proposes a tiered approach to implementation based upon the percentage of SMI inmates in each jail.

• Phase 1: Funding should be allocated to the five (5) jails with the highest percentage of SMI inmates, which house one-third of the inmates with SMI in Virginia’s local and regional jails. Funding this Phase would total $4,109,900.

• Phase 2: Funding should be allocated to the ten (10) jails representing the next one-third of inmates with Serious Mental Illness in Virginia jails. Funding this Phase would total $4,099,200.

• Phase 3: Finally, the remaining 45 jails that represent the remaining third of the inmates with SMI should be funded, totaling $4,158,400

Even if funding is unavailable to fully implement each phase of this plan, should additional resources be made available, priority should be based upon the percentage of SMI in each jail, which will enable most individuals to access to this service as soon as possible.

In conclusion, funding for the implementation of comprehensive forensic discharge planning services throughout Virginia will enable better use of state and local resources (by allowing for better coordination of care and by more consistently referring individuals to non-crisis care), enhance public safety (by linking individuals to the care they need thus potentially mitigating future involvement in the criminal justice system), and enhance the quality of life for those who are struggling to extricate themselves from criminal justice involvement.
(*1) Virginia Acts of Assembly - 2017 Session, Chapter 192 (HB1784). Available at: http://lis.virginia.gov/cgi-bin/legp604.exe?ses=171&typ=bil&val=HB1784 and http://lis.virginia.gov/cgi-bin/legp604.exe?ses=171&typ=bil&val=SB941.
(*2) Virginia Compensation Board. (2016). Mental Illness in Jails Report: November, 2016. Available at: http://www.scb.virginia.gov/docs/2015mentalhealthreport.pdf.

O'Keefe, M.L. and Schnell, M.J. (2007). Offenders with Mental Illness in the Correctional System. Journal of Offender Rehabilitation, 45(1), pp. 81-104.

Lovell D, Gagliardi G.J., Peterson PD. (2002). Recidivism and Use of Services among Persons with Mental Illness after Release from Prison. Psychiatric Services, 53, pp. 1290-1296.