1. Illinois Department of Human Services Division of Mental Health Services and Forensic Initiatives April 23, 2009

2. 2 Presenters  Anderson Freeman, PhD., Director, Forensic Services  Jordan Litvak, Executive Director, Region 3&4  Gustavo Espinosa, Executive Director, Region 1 Central  James Novelli, Executive Director, Region 5  Robert Granger, Acting Executive Director, Region 1 South  Dan Wasmer, Acting Director of Region Services

3. Hospital-Based Care There are 9 State Operated Hospitals h mental illness. There are 23 private hospitals providing care funded by DMH under the Community Hospital Inpatient Psychiatric Services (CHIPS) contracts.

4. Illinois Department of Human Services Division of Mental Health State Operated Facilities Catchment Area Map by Hospital

6. DMH Community Providers Regions manage contracts with 149 private provider organizations. Each provider operates a different array of program and residential sites. Some providers operate 1 site, others operate multiple sites. DHS/DMH sets standards the providers must conform to maintain certification. Individual services must comply with Rules and Regulations set by DHS/DMH.

8. DMH Vision It is the vision of the DMH that all persons with mental illness recover, and are able to participate fully in life in the community. “The Expectation is Recovery!”

9. Three Ways to Access DMH Service System 1.Consumer request for services at local Community MH Center. 2.Consumer in crisis presents at a local community hospital emergency room. 3.Family and/or friends can go to the Cook County States Attorney’s Office to get a Writ of Detention.

10. Local Emergency Room  A common entry point for the public MH system.  Result in the patient receiving: Medical Clearance Psychiatric Evaluation Benefits Clearance Pre-screening by community MH provider  )Relationship building  )Offer less restrictive, community based alternative  )Begin discharge planning

11. Emergency Room [Continued]  If hospitalization needed -- three choices: 1. Private community hospital admission using insurance/other coverage; 2. Private community hospital admission using CHIPS funding from DMH; or 3. Transfer to State Operated Hospital.

12. Emergency Room [Continued] Sometimes hospital crisis workers, or community agency crisis workers co-located at the emergency room, will help construct a plan by which the individual can leave the ER without hospitalization. When this happens, the individual may be immediately linked or rapidly linked to community- based services.

13. Principals of Recovery  Hope  Self-Direction  Individual and Person- Centered  Empowerment  Holistic  Non-Linear  Strength – based  Peer support  Respect  Responsibility Excerpts from the Goal of Services in a Transformed Mental Health System Prepared by: Nanette Larson, Director of Consumer Recovery Support Services

14. DMH Community-Based Services: Designed for People who have a Serious Mental Illness (SMI) or a Serious Emotional Disorder  Schizophrenia  Schizophreniform Disorder  Schizo-affective disorder  Brief Psychotic Disorder  Psychotic Disorder NOS  Bipolar Disorders  Major Depression  Obsessive-Compulsive Disorders  Anorexia Nervosa  Bulimia Nervosa

15. DMH Funded Services  Assertive Community Treatment (ACT)  Case Management  Community Support (Team, Group, Individual)  Crisis Intervention  Psychosocial Rehabilitation  Counseling/Therapy  Psychiatric evaluation, medication administration & monitoring  Supported Residential  Supervised Residential  Permanent Supportive Housing (New)

16. Valued Approaches to People Recovering from a Serious Mental Illness  Wellness Recovery Action Planning (WRAP)  Peer Support Services  Mental Health and Justice Initiatives  Diversion activities  Individual Placement and Support  Rapid engagement in job search, job development and retention,  Ongoing supports

17. How to locate a mental health center? By computer: www.illinois.gov/government/agency.cfm Scroll to: Department of Human Services, then down to Office Locator Type in: Mental Health; Look up by County. For Cook County type in Zip Code. The nearest MH Center will be listed.  Via phone call:  1 (800) 853-6154 (voice)  1 (800) 447-6404 (TTY)

18. DMH Regional Offices  Regional Directors represent the Division of Mental Health  Monitor state contracts with community mental health agencies  Help Coordinate Services with other Divisions.  Work towards integrating services.  Region 1 North – (773) 794-4139  Region 1 Central – (708) 338-7200  Region 1 South – (708) 614-4002  Region 2 (collar counties) – (847) 742-1040 #2002  Region 2 (northwest)- (815) 987-7910  Regions 3 and 4 (central) – (217) 786-6866  Region 5 (metro east southern) – (618) 474-3348  Region 5 (southern) – (618) 833-8266

19. An FYI -- Illinois Mental Health Collaborative for Access and Choice (The Collaborative)  Serves as a third party administrator for the Division of Mental Health  Processes claims and maintains the DMH data base  Supports DMH monitoring of services  Supports DMH Recovery Services, including “Warm Line”  Provides centralized clearing house for complaints: (866) 359-7953 (voice) (866) 880-4459 (TTY)

20. Questions

21. BREAK

22. Mental Health and Justice System Transformation: Special Projects Anderson Freeman, Ph.D., Deputy Director for Forensic Services

23. Three Cs of Transformation  Capacity Building  Continuum of Care  Collaboration …….For the Justice Involved Individual with SMI and Co-Occurring Disorders

24. DMH Community Treatment Data (2006)  2,244 consumers of 129,564 consumers were UST or NGRI  2,872 consumers of 129,564 were referred by corrections or under court supervision (parole or probation) IDOC & Jail Data Based on IDOC data approximately 3000 or 10% of all inmates paroled in a given year have serious mental health issues that necessitate care in the community. Cook County Jail which has a daily census ranging from 9,000 to 11,000 treats 10% of the jail population for serious mental illness. There 22,000+ jail beds in Illinois. Researchers estimate that 10% -16% of detainees have serious mental illness.

25. Data-Link July 1, 2007 - May 20, 2008 WillPeoriaJefferson MarionProvisoCook* JailAdm.7620134092518218875140 JailAdmU6450 90161913 1684 62398 Positve X 1010 1528 292 368 514 4476 PositiveUX 786 934 202 251 387 3546 #exclus. 663 730 83 172 353 1292 #elig. Link 123 204 119 79 34 2254 Actual Link 118 184 119 79 31 168 30 Day 47 77 26 43 15 25

26. Top Ten High Impact IDOC Re-Entry Regions in Illinois (2004 data) County/Community Ranked / Parole Rate % of Parole Population Parole Population Rate #Parolees per 100,000 Recidivism Rate (%) Macon (Decatur) 1.9114,7066896.050.1 Cook59.75,376,74119,5613.657.4 Winnebago (Rockford) 2.8284,3139303.151.6 Peoria1.8183,4335713.160.7 Champaign/ Vermillion 2.3262,9697642.954.4 Jefferson0.340,0451052.654.4 Sangamon (Springfield) 1.5114,7064602.454.6 Rock Island0.8147,9122731.945.4 St. Clair /Madison (East St. Louis) 3.1258,606 261,689 416 534 1.854.2 Collar Counties (esp. Aurora) 9.82,954,5773,2231.1n/a

27. DMH Justice & Mental Health Transformation Goals  A Recovery Oriented System for Individuals with mental illness who are involved in the criminal justice system.  Improved continuum of mental health care for individuals involved with the criminal justice system.

29. Transformative Activities  Cook County Jail Diversion Community Re-integration Collaborative (SMHSA Grant 2006-2008)  Jail Data Link Expansion 2 (ICJIA)  Transformation Transfer Initiative/MHJ Regional and Statewide System Mapping (NASMHPD)  Veterans Re-integration Initiative (SAMHSA Grant 2009)  Mental Health Court Association Development  Integrated Mental Health Court Database (Partnership with Justice Kathryn Zenoff and Council of State Governments)  Mental Health and Justice Center of Excellence (BJA Grant Application 3/12)  Mental Health Juvenile Justice Program Expansions

30. Examples of Impact of Transformation Activities  Jail Data Link Program County Expansions  Additional CIT officers trained (over 800 trained in Cook County)  Expanded Cook County Mental Health Court  Statewide Mental Health Court Expansions (over 300 participants)  Veterans Re-integration Initiative projects in Cook County and Rock Island  Regional Mental Health and Justice stakeholder groups  Judiciary Involvement  Development of an Integrated MHC Database  Development of a Center of Excellence for Mental Health and Justice (BJA grant application)

31. Description of Jail Data Link The Jail Data Link program provides a web based computer cross match between the census in county jails and open DHS cases. The program identifies individuals in our targeted mental health population that should have been involved in services with community mental health providers, but have been detained in jail. The program also provides case managers located with community providers that provide linkage to community services from county jails.

32. Contact Information Anderson Freeman, Ph.D. Anderson.Freeman@Illinois.gov (312) 814-1646

33. DMH Justice & Mental Health Transformation Goals (continued)  Increased collaboration between system partners and stakeholders to facilitate federal funds to the state, advocacy for helpful legislation, and expansion of existing initiatives and practices.  Improved integration with Illinois county court systems in responding to Forensic and MH/Criminal Justice issues.

35. Sample Case #1 -- Region 3 & 4 Steven -- Illustrates how people released from DOC informally make their way into DMH funded programs. At the same time, it underscores the risk factors that could be avoided if a coordinated referral and linkage effort was in place between these service sectors.

36. Sample Case #2 -- Region 5 Alex – Illustrates how collaboration between the Probation Office and the local Community MHC can help to titrate services from each partner to match need of the individual over time.

37. Sample Case #3 – Region 1 John -- A case that illustrates how some cases take continued hard work by all partners over time. Partners do much to keep each other going under circumstances that would overwhelm a single provider.

38. Sample Case #4 -- Region 3 & 4 Sally -- A case that illustrates how existing relationships between Probation Office and Community Provider can pave the way for quick response to emergent needs that might otherwise cause a person to loose ground or return to an institution (prison/hospital/or both).

39. Sample Case #5 -- Region 5 Jeremy -- A case that illustrates how the addition of a court order to existing ACT services helped a homeless person with a history of violence find stable housing, stay off drugs, make friends, and begin to re-connect with family.

40. Sample Case #6 – Region 3&4 Bobby -- A case that illustrates how “disconnects” from DOC to community public mental health services could create high risk situations for the individual, the community MHC, and the Department of Correction.

41. Sample Case #7 -- Region 5 John II -- A case that illustrates how the addition of mental health court oversight helped to bring very troublesome symptoms, which were not previously controlled by mental health care alone, under control and lead to positive steps to recovery.

42. Questions