1. Mentally Ill Offender Crime Reduction Grant Programs in Riverside and San Mateo Counties Michael Oprendek, LCSW State DMH Mental Health Services Act Team

2. Riverside County Program Type of Program Type of Program –In and out of custody – Specialized jail housing and post custody diversion –Key Strategies: Dedicated 80-bed housing unit in jail, mental health training for jail staff, after custody day treatment as condition of probation for dually diagnosed offenders, community based housing assistance, strong probation involvement

3. Riverside County Program Target Population: Target Population: –In-custody: Mentally ill offenders booked into and housed at the Robert Presley Detention Center (RPDC) or transferred to RPDC within 24 hours of booking; post-custody: dually diagnosed offenders booked into and housed at RPDC or transferred there for housing within 24 hours of initial booking

4. Riverside County Program Target Population: Target Population: –Study population: Enhanced Treatment in- custody: 304; Enhanced Treatment post- custody: 83*; Treatment as Usual: 289

5. Riverside County Program Summary Description Summary Description –The in-custody component of Riverside County’s project was a specialized inmate housing unit with pre-release discharge planning. The Sheriff’s Department dedicated an 80-bed housing unit at the Robert Presley Detention Center (RPDC) to mentally ill offenders.

6. Riverside County Program Summary Description Summary Description –The in custody unit was staffed around the clock by correctional deputies who had been trained for this assignment in a specially developed, 24- hour training course in the supervision and handling of mentally ill offenders

7. Riverside County Program Summary Description Summary Description –The non-custody component, the Alternative Sentencing Program, provided comprehensive day treatment to dually diagnosed mentally ill offenders in lieu of state prison or county jail sentences. The Alternative Sentencing Program was a collaboration among the County’s mental health, probation and sheriff’s departments, detention health services and the courts, to provide comprehensive mental health treatment and support, coupled with strict terms of probation and intensified probation officer supervision.

8. Riverside County Program Goals and Approach Goals and Approach –Riverside County’s goals were multiple. Through the specialized housing unit, the County sought to increase and streamline services, provide 24- hour coverage, and provide better access to mentally ill inmates by jail medical and mental health staff. The housing unit supported those goals and further helped to decrease the use of safety cells, both in frequency of use and in average duration of stay, for mentally ill inmates.

9. Riverside County Program Goals and Approach Goals and Approach –Because it provided better access to mental health and medical staff and closer supervision by trained custody staff, the unit facilitated interventions before a mentally ill offender decompensated to the point of needing placement in a safety cell

10. Riverside County Program Goals and Approach Goals and Approach –The in-custody component of Riverside County’s project was also focused on reducing recidivism, and thereby jail crowding and costs, by providing discharge plans for the aftercare of mentally ill offenders. Mental health workers identified the specific needs of randomly selected inmates housed in the specialized unit and began working on individualized discharge plans prior to selected inmates’ release from custody.

11. Riverside County Program Goals and Approach Goals and Approach –An inmate’s discharge or aftercare plan might included referrals to specific community based programs, follow-up treatment, initial prescription medication, assistance with filling out applications and paperwork for benefits, and sheltered living vouchers if necessary. To ensure compliance with discharge plans, inmates released from jail on formal probation were closely monitored by one of the program’s two dedicated deputy probation officers.

12. Riverside County Program Goals and Approach Goals and Approach –The primary goal of the post-custody part of Riverside County’s project was to divert mentally ill offenders from the criminal justice system, and thereby reduce jail crowding, by giving the courts an alternative to incarceration. To accomplish this goal, Riverside used a part of its MIOCR grant to double the capacity of a pre- existing Alternative Sentencing Program using a day treatment format.

13. Riverside County Program Goals and Approach Goals and Approach –This expansion of the Alternative Sentencing Program added the staff and resources to not only administer comprehensive therapy and counseling, but also provide linkage to community based support and services, and help obtaining public assistance and housing assistance as necessary. Two probation officers were dedicated to the program. Offenders’ terms of probation required that they report and take part in day treatment activities every day. Failure to comply with the rules and regulations or failure to complete any portion of the program could result in revocation of the participant’s probation and a return to custody. This gave the program the “teeth” it needed to be successful.

14. Riverside County Program Local Perspective of What Worked: Local Perspective of What Worked: –The specialized housing unit increased the number of dedicated jail beds for mentally ill offenders from 8 to 80, and helped ensure timely service delivery and helped expedite correctional staff’s rapid referrals to mental health and/or medical personnel.

15. Riverside County Program Local Perspective of What Worked: Local Perspective of What Worked: –The unit also provided safer, sheltered housing where mentally ill offenders were less likely to be victimized by other inmates and it allowed for 24-hour coverage by the specially trained deputies who recognized and were able to deal with issues unique to mentally ill offenders. Further, the specialized housing unit helped reduce the use of safety cells and the costs associated with psychiatrists’ services for inmates housed in safety cells.

16. Riverside County Program Local Perspective of What Worked: Local Perspective of What Worked: –Providing day treatment services was considered successful. A particularly effective element of the Alternative Sentencing (day treatment) Program was the use of probation orders and the supervision and support of the program’s probation officers.

17. Riverside County Program Local Perspective of What Worked: Local Perspective of What Worked: –While there were cases of participants who failed to complete the program, staff felt the authority that came from the conditions of probation and the presence of the probation officers had a positive impact on many participants and were contributing factors to their successful graduation from the program.

18. Riverside County Program Future of the Program Future of the Program –The jail housing unit and the training and use of specialized correctional deputies are continuing. Unfortunately, fiscal limitations have forced the mental health department to significantly reduce the level of discharge planning it can provide and rendered the probation department unable to provide intensive supervision of small caseloads of mentally ill offenders. The Alternative Sentencing Program cannot operate even at the level it did prior to the MIOCR Grant.

19. SAN MATEO COUNTY THE OPTIONS PROJECT Type of Program Type of Program –Primarily after custody -- Community based –Key Strategies: Intensive case management with a focus on co- occurring disorders; ACT model; multi- disciplinary team; supportive housing; court involvement; strong probation involvement

20. THE OPTIONS PROJECT Target Population Target Population –Jail inmates with serious and chronic mental illness; residents of San Mateo County; not charged with a heinous crime –Study population: Enhanced Treatment 37; Treatment as Usual 36

21. THE OPTIONS PROJECT Summary Description Summary Description –The Options Project provided intensive case management in the Assertive Community Treatment (ACT) model, using a multi- disciplinary team and creative strategies for engagement. Partners in the Options Project – Mental Health, Probation, Correctional Mental Health and the Sheriff's Department – jointly provided close monitoring and collaborative interaction with clients. The case managers, probation officers and staff psychiatrist held weekly meetings for treatment planning and to coordinate client care, and case managers were issued County cars and cell phones to facilitate transportation and communication.

22. THE OPTIONS PROJECT Summary Description Summary Description –Program oversight and ongoing coordination were provided by monthly MIOCRG Steering Committee meetings that yielded management- level support and guidance for programmatic policy and process and served to quickly solve problems as they arose.

23. THE OPTIONS PROJECT Goals and Approach Goals and Approach –The primary goal of the Options Project was to reduce recidivism among mentally ill offenders by engaging them in intensive community case management combined with intensive probation supervision. Additional goals included reducing overcrowding in San Mateo County's jails and reducing criminal justice costs. To address these goals, Options provided a range of services including but not limited to help with benefit acquisition and money management and placement in community housing or residential treatment for dual diagnosis/substance abusing clients.

24. THE OPTIONS PROJECT Goals and Approach Goals and Approach –The Project contracted for 10 shelter beds to provide transitional housing for clients returning to the community from jail and also used beds in existing mental health and substance abuse treatment programs as needed. Additionally, the project offered consumer-run monthly support groups, which included guest speakers on educational topics chosen by clients/consumers, as well as additional social activities designed to inspire peer bonding and mutual support.

25. THE OPTIONS PROJECT Goals and Approach Goals and Approach –Innovative bi-monthly case review meetings were implemented in which clients presented progress reports to a formal panel comprised of the case management supervisor, case managers, the probation supervisor, probation officers and forensic mental health staff. This self-review process was designed to replace courtroom appearances in front of a judge and to build in accountability and support for clients.

26. THE OPTIONS PROJECT Local Perspective of What Worked Local Perspective of What Worked –The Options Project reported that its "intensive case management in collaboration with intensive probation/court supervision" clearly demonstrated its efficacy by producing a "reduction in incarceration days, reduction in court costs as well as improved quality of life for Options clients."[1] [1] – [1] San Mateo County Mental Health Service, A Summary of the Options Project, page 2 [1]

27. THE OPTIONS PROJECT Local Perspective of What Worked Local Perspective of What Worked –Additionally, the project's interagency cooperation and collaboration was noted as particularly effective in accomplishing the intended outcomes and helping to build credibility for Options' services with the judiciary. One of the County's judges was reported to have been not only "effusive in his praise of the program," but also convinced to introduce the idea of a mental health court for San Mateo County as a result of his experience with Options.[1] [1] – [1] ibid. [1]

28. THE OPTIONS PROJECT Future of the Program Future of the Program –The Options Project was discontinued at the end of the grant period due to fiscal constraints facing the County. However, San Mateo County continues to research potential resources that would support the future continuation of the most successful aspects of the project.

29. Questions?