Essential Elements of the Kalamazoo
Community Mental Health Recovery
Court Program
Presented By:
Aki Nearchou, LBSW
&
Brian Fuller, PH.D.
KCMHSAS
418 W. Kalamazoo, MI 49007
269-373-6000
Overview
• The extent and nature of the concern
• Ten Essential Elements of Mental Health
Courts (MHC)
• Goals of Mental Health Courts
• Kalamazoo Mental Health Recovery Court
(MHRC)
• What are peer support specialists and why
they are an integral part of the MHRC team?
Extent and Nature of the Concern
• 13 million adults booked into U.S. jails each year.
• More than 1.3 million people are currently
incarcerated in the U.S.
• 631,000 people in jail on any given day
• 4.6 million under correctional supervision
• Over 7% of those inmates suffer from a severe
mental illness (SMI).
• About 75% of the incarcerated SMI population
has co-occurring addictive disorders.
Source: Steadman, Osher, Robbins, Case &Samuels, (2009)
World Incarceration Rate
Why are Persons with Mental Illness OverRepresented in the Criminal Justice System?
• Higher arrest rates
• “War on Drugs”
– 2/3 of inmates in local jails is due to drug law
violations
– Increased drug related offenses results in
increased arrest for those that suffer from a SMI.
SMI Over-Representation Cont.
• housing of last resort
• Affordable housing crisis results in a very
visible homeless population that leads to
crimes of survival:
– Urinating in public
– Panhandling
– Theft
– Etc.
SMI Over-Representation Cont.
• Longer jail and prison terms
• Higher recidivism rate on re-entry as a result
of the following:
– Inadequate discharge planning
– Inadequate resources
– No connection to the community
– Very little family and social supports
– Etc.
Specialty Programs that Addresses OverRepresentation of persons with SMI involved in the
Criminal Justice System
• Many communities have adapted the Crisis
Intervention Team (CIT) model
• Growing number of Mental Health Courts
– 10 Mental Health Courts in Michigan (as of 2009)
Ten Essential Elements of Mental
Health Courts (MHC)
• 1. Planning and Administration
• 2. Co-Occurring Target Population
• 3. Timely Participant Identification &
Linkage to Integrated Services
• 4.Terms of Participation
• 5. Informed Choice
• 6. Integrated Treatment Supports and
Services
• 7. Confidentiality
• 8. Court Team
• 9. Monitoring Adherence to Court
Requirements
•10. Sustainability
Source: Council of State governments, Essential Elements of a MHC, (Third Edition.
MHC Planning &
Administration
• A multidisciplinary planning committee should
be charged with designing the MHC.
• The planning committee should identify
agency leaders and policy makers to serve on
an “advisory group”.
• Keep the committee informed
Co-occurring Target Population
• MI related to criminal offense
• MHC’s offer options other than arrest and
detention
• Well defined clinical and criminal eligibility
criteria
• MHC screening tools
Candidate Identification and Linkage to
Integrated services.
•
•
•
•
Identified Participants
MHC Referral sources
Referral Source Training
Expedited referrals
Terms of Participation
• Minimize the impact of the charges
• Individualized for each participant
• Successful completion
– Dismissal of charge
– Reduced fines and cost
– Well connected to community resources
• MHC is a voluntary program
– Option to withdraw
Informed Choice
• Participants fully understand the requirements
of the MHC
• Arising competency issue concerns are
processed through well established and predetermined procedures.
Integrated Treatment supports &
Services.
• Mental health court participants require an
array of services
• MHC participants typically have co-occurring
substance abuse disorders
• Treatment providers, Mental Health Court
Team and the Participants should
communicate on a regular basis
Confidentiality
• Health and legal information is only shared in
a way that protects the participants’
confidentiality rights as consumers and their
constitutional rights as defendants.
– Release forms that adhere to federal and state
laws
– Participants review releases with their defense
counsel and treatment providers
– Should not sign release of information forms until
competency issues have been resolved
The Court Team
• Mental health court team works collaboratively
to help participants achieve treatment goals by
bringing together many of the following staff:
–
–
–
–
–
–
Judicial officer
Integrated Recovery Specialist (case manager)
Prosecutor
Defense attorney
Court liaison
Peer Supports
Monitoring Adherence to Court
Requirements
• stay up-to-date on their progress
• The mental health team and case managers
regularly discuss the participants’ behavior
rather positive or negative
• MHC team meets on a regular basis with the
judicial team
• Regularly scheduled status hearings
Sustainability
• Performance measures and outcome data is
essential.
• Data describing the court’s impact on
individuals and systems should be collected
and analyzed.
• MHC team should communicate with key
county officers and state legislators.
• Attempt to cultivate long-term funding
sources early on.
The Goals of MHC are:
The primary goal of MHC courts is to
reduce recidivism and enhance access to &
engagement in community treatment
1.
2.
3.
4.
5.
To preserve public safety
To divert offenders with mental illness & co-occurring disorders
To maintain treatment, housing, insurance benefits and
community support services for participants with mental illness
To reduce repeated criminal activity
To decrease the utilization of high cost system services
Inside a Mental Health Court
Video is Courtesy of PBS and Frontline
Kalamazoo Mental Health Recovery
Court (MHRC)
• Founded in fall of 2008
• State and Federal Grants
• MHRC Team:
– 8th District Court Judge
– Kalamazoo Community Mental Health &Substance
Abuse Services staff.
– Defense Counsel
– Prosecuting Attorney
Nature and Scope of Concern in
Kalamazoo County
• Undersized jail
• Large number of bookings and jail housing
cost
• High utilization of services for SMI population
• Strain on budgets
Program Description
•
•
•
•
•
•
•
Misdemeanors
Recovery focused
Participants must have staff who will come to court
2 clinical staff and 2 Forensic Peer Support Specialists
Year long program
Two phases
Will take persons who have MI/DD, co-occurring and
Personality Disorders
• Provide Crisis Intervention Team Training (CIT) for Law
Enforcement
Who is eligible to Participate in the
Kalamazoo Mental Health Recovery Court?
1. Must be charged with a misdemeanor
2. At least 17-years-old
3. Has a diagnosis of mental illness or is dually
diagnosed with a developmental illness and substance
abuse disorder and is in need of or assigned to case
management services.
4. Is a Kalamazoo County Resident
5. No pattern of violent behavior
6. No more than one prior assault/battery
7. No more than two prior felony conviction of any kind
8. No violence at the time of arrest
The Referral Process
MHRC accepts referrals from:
Police Officers, District Judges, Defense
Attorneys, Prosecuting Attorneys, Probation
Officers, Kalamazoo County Jail staff, Family
Members, KCMHSAS staff, Provider Agencies
and Members of the public.
What Happens to an Accepted
Case?
•
•
•
•
Agree to comply
Determine and assign team
Attend scheduled court hearings
Graduated incentives and sanctions
Incentives and Sanctions
Incentives
•
•
•
•
•
Praise from the Judge
Positive report by case mgr/PO
Clapping
See judge less often
Less judicial supervision
requirements
• Reduced or waived court cost
/fees
Sanctions
•
•
•
•
•
•
•
Lecture from Judge
Report to MD, PhD, PO more
often
Jail
Move back to phase I
Daily report to CMH
community service
Increase AA/NA, etc.
Performance Measure Criteria
• Decrease in jail admissions, jail days, and
psychiatric admissions among successful
participants
• Number served in MHRC
• Outside researcher evaluation results
• CIT training
Outcomes for MHRC Participants*
(N=37)
30
20
Jail Days
10
16.7
Hospital 8.8
Days
3.4
1.1
1.5
0.5
0
Before MHRC
(N=37)
During MHRC
(N=37)
After MHRC*
(N=20)
*Only those completing MHRC
*Those completing MHRC or still participating in MHRC
Before MHRC*
3.2% Neither
% with Criminal Justice Involvement (N=62)
11.3%
12.9%
72.6%
Jail only
New
offense
only
BOTH new
offense & jail
96.8%
Criminal Justice-Involved
*In 12 months prior to enrollment
Before MHRC*
% with Mental Health Crisis (N=62)
11.3%
46.8%
6.5%
35.5%
Neither
Crisis
contact
only
Hosp
only
BOTH crisis contact
& hospitalization
88.7%
Mental Health Crisis
*In 12 months prior to enrollment
Felony-level Offenses
(N=62)
Terminated
Completed/Still
20.0% 21.6%
28.0%
*
21.7%
13.5%
0.0%
Before
MHRC
*statistically significant difference
During
MHRC
After MHRC
Limitations of the MHRC
• The impact of the program is limited to those
charged with misdemeanors.
• Integrated recovery specialist (case managers)
are required to attend court with individuals
they serve, but have no specific criminal
justice training.
• Number of participants and length of the
program.
Role of Forensic Peer Specialist
within Criminal Justice System
What is a Peer Support Specialist?
• Individuals willing to provide history of disability and recovery with people
in earlier stages of recovery
The stages of change are:
1.Precontemplation
2.Contemplation
3.Preparation/Determination
4.Action/Willpower
5.Maintenance
6.Relapse
• Forensic peer support involves trained peer specialist with histories of
mental illness and criminal justice involvement helping those with similar
histories
Role of Peer Support Specialists within
the MHRC Program
• Participate in all status meetings, court
sessions, etc.
• Meet one on one with potential participates
to determine recovery eligibility
• Facilitate a 16 hour Wellness Recovery Action
Plan (WRAP) training.
• Meet with participants prior, during and after
court sessions as needed.
MHRC Participant Outcomes
• MHRC successful and unsuccessful participant
outcomes
Questions?
Thank You
Kalamazoo Community Mental Health &
Substance Abuse Services
Brian Fuller
&
Aki Nearchou