The Justice Center is pleased to introduce a new regular feature to the Consensus Project Newsletter. Each month we will be spotlighting collaborative criminal justice/mental health initiatives that have received funding from the Bureau of Justice Assistance for the Justice and Mental Health Collaboration Program, asking the practitioners in these programs to discuss some successes and challenges they have encountered in the planning and implementation process. This month, Sheree Spear from the Cass County Justice and Mental Health Collaboration Project discusses activities under their 2007 grant.

Program summary

The Cass County (ND) Justice & Mental Health Collaboration Project is a jail-based postbooking program that identifies people in jail whose offense is likely a product of an untreated, or undertreated, serious mental illness and links them to treatment and services that improve mental health functioning and reduce or eliminate involvement with the criminal justice system. Potential participants are referred by jail staff to a full-time clinical mental health coordinator, a position funded by the grant, who completes a diagnostic assessment to screen individuals for program eligibility. Individuals selected voluntarily agree to adhere to prescribed medications and meet regularly with their case manager. They receive medication monitoring services, housing assistance, case management services and chemical dependency treatment as needed. Depending upon the charge, either the imposition of sentence is deferred or their sentence suspended. Until the participant graduates from the program, a nonjudicial Review Panel meets periodically with him to her to monitor progress and provide encouragement. Leadership and project management are provided by the Cass County Sheriff's Office. As of this writing, planning is complete, and full implementation will begin January 1, 2009.

How did your jurisdiction realize that there was a need to respond to the prevalence of individuals with mental illnesses in the criminal justice system?

Criminal justice personnel, including jail and court staff, have long recognized that some individuals would not be incarcerated if their mental illnesses were adequately treated. The Cass County Sheriff's Office formed a committee to determine how we might improve our response to individuals with mental illnesses booked into the jail and gathered data to better understand the issue. A manual search through records from 2005 showed that jail staff had referred 171 detainees for a psychiatric assessment, but only 90 actually received an assessment. Without a qualifying diagnosis, people cannot receive mental health services - so this necessary first step toward linking people to treatment was often missing due to inadequate resources. The committee recommended hiring a full-time clinical mental health coordinator at the jail to remove this barrier to treatment.

How did your initiative capitalize on preexisting relationships or partnerships in the jurisdiction, or build new ones?

The jail administrator, under the authority of the Sheriff's Office, brought community partners together to examine how our jurisdiction might implement the recommendations put forth in the Justice Center's Criminal Justice/Mental Health Consensus Project Report. The resultant committee - the Jail Intervention Coordinating Committee - built on the partnership already forged between the jail and Southeast Human Service Center (a community-based mental health service provider) and incorporated other agencies to share perspectives on the issue. Additional members included Fargo Police Department, Housing Authority, hospitals, ND Department of Corrections (DOC), family members, a state legislator, ND State University, National Alliance on Mental Illness, and Mental Health America. Input and support were also provided by the presiding district judge, state attorney, and defense attorneys.

Due to the degree of research by the group, a shared recognition of the need for a collaborative effort in addressing the issue, and the reputations of the individuals and agencies involved, the county gained support for the program from policymakers at the state level, including ND Supreme Court Chief Justice Gerald VandeWalle and ND Attorney General Wayne Stenehjem.

How did you identify your program's target population?

Our planning committee carefully examined the intent of the federal Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA), which generated the grant funding; spoke with and reviewed eligibility criteria from numerous jurisdictions across the country; and gathered data on those booked into and assessed at the jail.

Our Advisory Board included a respected psychiatrist who could lend insight regarding the types of diagnoses and their treatability. The DOC staff brought experience regarding the kinds of behaviors and offenses that typically bring individuals with these conditions to their attention.

Our programmatic strategy and target population needed to be consistent with one another. We carefully considered the types of services we planned to provide and our capacity to provide them. Knowing that case management services, for example, are an evidence-based practice and essential for our anticipated target population, we determined we would need to apply funding toward building capacity in that area, given the long wait list for these services in our region.

To estimate the number of potential candidates for mental health services, the committee compiled a list of how many detainees had each type of diagnosis from 2005 through 2007. While 36 different types of chemical dependency or mental health diagnoses were assessed in 2007, for example, the Advisory Board recommended that we focus on people with a primary diagnosis of schizophrenia, schizoaffective disorder, other psychotic disorders, bipolar disorder, and/or mood disorders. Eligible charges included Class C felonies and below.

Exclusionary factors include severe personality disorders, those required to register as a sex offender or child offender, and those whose current charge - if convicted - would require them to register as a sex or child offender.

What has been your biggest challenge and how are you addressing it?

Finding the right person to fill the new clinical mental health coordinator position at the jail. We needed someone with both the level of education and type of experience that would enable them to make accurate provisional diagnoses; to interactive effectively with detainees who may have a serious mental illness; and to communicate professionally with prosecutors, defense attorneys, and the court.

Because of the strong support from the sheriff and our County Commission, we were able to offer a salary that attracted an exceptional candidate, whom we recently hired. The rank of sergeant is attached to the clinical mental health coordinator position within our jail.

Is there an example of a particular success your program has had to date that you can share?

A success in the planning phase was getting people at the right level engaged in designing the program: a District Court judge; the state attorney; a defense attorney; a psychiatrist and medical director of our state hospital; and representatives from the Sheriff's Office, DOC, and a transitional housing facility. This resulted in creation of a detailed manual and program description, which clearly outlines roles and responsibilities.

What steps have you taken or are planning to take to sustain your initiative?

We presented the program plan to our State Commission on Alternatives to Incarceration. In October, they formally recommended that the governor include funding for our program in his Executive Budget, although the governor elected not to implement that recommendation. We also presented to our State Mental Health Planning Council, who cited their support for our program in their annual report to the governor. As we move forward in implementation, we hope our data collection efforts will further substantiate the necessity of closing gaps.

Contacts:
Sheree Spear, grant manager
Cass County Justice & Mental Health Collaboration Project
Cass County Sheriff's Office
Fargo, ND 58103
Phone: (701) 371-9892
Email: SpearS@casscountynd.gov

Lt. Col. Glenn Ellingsberg; Technology, Finance, Strategic Planning
Cass County Sheriff's Office
Fargo, ND 58103
Phone: (701) 241-5802
Email: EllingsbergG@casscountynd.gov

A pair of recently released studies found that two mental health courts in Alaska may lead to the better use of public funds, reduced crime, and improved outcomes for people with mental illnesses involved in the criminal justice system. Researchers examined mental health courts in both Anchorage and Palmer and reported that they effectively fulfilled their shared mission to connect individuals with mental illnesses with treatment services while under court supervision.

These specialty courts were developed through the cooperative efforts of the Alaska Court System and many state and local agencies and with funding from the Alaska Mental Health Trust Authority and the Alaska Legislature. The two studies, which were funded by the Trust Authority and conducted by Hornby Zeller Associates of Portland (Maine), ME, include the following highlights:

• The average daily cost to operate the Anchorage program is estimated at $19.82 per person, which is substantially less than the average daily cost of incarceration ($121.60).
  
• Palmer Mental Health Court participants were less likely to engage in new criminal conduct after exiting the program (17%) than an equivalent group of people with mental illnesses involved in the criminal justice system (40%). Program graduates were the least likely overall to re-offend (5%).
  
• Reductions in both the number of incarcerations and psychiatric hospital visits and the length of stay in either institutional setting generated a net savings for the Anchorage Mental Health Court over time as well as compared to a control group ($97,685).
  

The authors suggested several further improvements to the mental health court process. Their recommendations included changes to target populations, how individuals enter the program, and the monitoring of participant progress. The Alaska Court System will work with other criminal justice and behavioral health entities involved with the Anchorage and Palmer mental health courts to implement these findings.

The Anchorage study is available online here and the Palmer study can be found here.

PressConnects.com (NY) - Follow-up care hard to find: More mental health patients ending up in prison
12/15/08 - "Mentally ill patients with little or no support network are taking up more time and attention of correctional staff, police and courts as they run afoul of the law. Peg that trend to deinstitutionalization, patients refusing treatment and cuts in mental health programs, according to a report by the Broome County Mental Health Department."

The Times-Herald (MI) - Grant lets judge choose treatment
12/8/08 - "People with mental illnesses who are charged with crimes may have a better chance of getting treatment rather than jail time, thanks to a St. Clair County District Court program slated to start next year."

Foster's Daily Democrat (NH) - Rochester police create Crisis Intervention Team to help handle issues of mental illness
12/6/08 - "New Hampshire's status as one of six states without a single police unit to handle issues involving mental illness is set to end in the next few weeks when the Lilac City's Crisis Intervention Team begins operating."

The Crescent News (OH) - Judges dealing with more mentally ill defendants
12/3/08 - "While some large cities have established specialized courts and dockets for people who suffer from mental illnesses, such is not the case in rural northwest Ohio."

NJ.com (NJ) - Gloucester County mental illness/intervention committee is five years old
11/26/08 - "Completing its fifth year, the Gloucester County Mental Illness and Intervention Committee has been a leader in training law enforcement officers and others in recognizing and responding to persons with mental illness on the streets, and in providing help to discharged jail inmates with psychiatric problems."

The Daily Progress (VA) - Mental health systems troubles targeted
11/21/08 - "Statewide law enforcement authorities who came to Albemarle on Thursday to learn about the Thomas Jefferson Area Crisis Intervention Team heard an impassioned speech from a man who has seen a flawed mental health system at work."

KCUR (MO) - Reducing recidivism: New program aims to help mentally ill inmates
11/19/08 - "Over half of the inmates at the city jail have been imprisoned there at least three times before. Local corrections and community leaders say that's in large part due to untreated mental illness and substance abuse. But a new program at the Municipal Correctional Institution, or MCI, aims to break that cycle."

KOAT (NM) - Officer transforms tragedy into action for mentally ill
11/19/08 - "Sgt. Carol Oleksak almost died when she was shot in the head by a mentally ill man. But instead of getting angry, she's trying to get help for others with mental illness."