“Creating Opportunities for Safer Communities” Recidivism and mental health: what is the connection and what are we doing about it in Iowa? MARCH 29, 2017 “Creating Opportunities for Safer Communities” Iowa Department of Corrections

Scope of Reentry Challenge Over 98% of individuals in jail/ prison return to the community, and: 68% of state prisoners are rearrested in 3 years 50% of state prisoners are reincarcerated in 3 years So, to set the stage for our discussion this morning, what does reentry look like? The bad news… High numbers of people are released from jails and prisons Approximately 650,000 individuals are released from prisons each year. Over 7 million different individuals are released from jails. Most people released from jail and prison recidivate Thirty-percent of individuals released from state prisons will be rearrested in the first six months following their release. Within three years the percentage increases to two-thirds rearrested. Within the same time frame, half (52%) will return to prison for either new crime or parole revocation. Need to understand what your recidivism is—to be able to develop comprehensive approaches to transition, to determine what kinds of interventions/approaches will have the greatest impact on recidivism, and demonstrate effectiveness of these interventions Source: Pew Center on the States (2012); Bureau of Justice Statistics (2014) Iowa Department of Corrections

Reducing recidivism has emerged as a national priority 8/2/2013 Reducing recidivism has emerged as a national priority 1 in 33 adults is under correctional control. Spending increased from $12 billion in 1988 to $53 billion in 2013. While many states are seeing cuts to criminal justice components serving recidivism reduction functions. Despite dropping crime rates across the country, recidivism rates remain stubbornly high. 1 in 33 adults is under some form of correctional control – probation, in prison, on parole… Over the past 23 years, state spending across the country on corrections has skyrocketed—from $12 billion in 1988 to more than $53 billion in 2013. As corrections spending has increased, many states are seeing cuts to law enforcement, community-based supervision, treatment, and other criminal justice components providing recidivism reduction functions. Despite dropping crime rates across the country, recidivism rates remain stubbornly high. Source: National Association of State Budget Officers, State Expenditure Report (1988 and 2014) Iowa Department of Corrections

National statistics Nearly 25% of both State prisoners and jail inmates who had a mental health problem, compared to a fifth of those without, had served 3 or more prior incarcerations. About 74% of State prisoners who had a mental health problem met criteria for substance dependence or abuse. Nearly 63% of State prisoners who had mental health problems had used drugs in the month before their arrest. State prisoners who had mental health problem were twice as likely as those without to have been homeless in the year prior to their arrest. Over 1 in 3 State prisoners who had a mental health problem had received treatment since admission to prison. BJS Special Report, 2006 Iowa Department of Corrections

Iowa Department of Corrections

IOWA Prison Population Iowa Department of Corrections

RETURN RATES TO PRISON WITHIN 3 YEARS Iowa Department of Corrections

Statement of the problem Persons with mental illness are grossly overrepresented in the criminal justice system Criminal justice systems has become the de facto mental health system Persons with mental illness are at double risk for failing supervision …and more likely than their counterparts to fail because of technical violations Jennifer Skeem, 2016 Iowa Department of Corrections

Additional Challenges Due to Stigma 5/2/2018 Additional Challenges Due to Stigma Reduced Access: Housing Employment Treatment Other services Bias Distrust Prejudice Fear Avoidance Distress Anger Stereotyping Perception of violence In addition to the actual mental illnesses and CODs, these individuals face the challenge of how people perceive mental illness In fact, these individuals are facing three layers of stereotypes: for mental illness, criminal justice involvement, and COD Real effects on their abilities to interact in society and build the stability that will keep them safe Derives in part from poor understanding of causes and treatment of mental health and substance use disorders Many believe that mental illnesses and substance use disorders are signs of individual weakness and not health conditions Can occur at all levels of society (affects attitudes of individuals with mental illnesses themselves, family members, court personnel, health providers, mental health providers, etc.) Manifestations of stigma Impact on access to community supports (e.g., housing, employment) and treatment Reluctance to seek access to services and treatment Reluctance to provide access to services and treatment (providers who are reluctant to serve “criminals”) Inaccurate perception that individuals with mental illnesses are more violent than individuals without mental illnesses Most people with mental illnesses are not violent, and most people who are violent do not have a mental illness More likely to be victims than perpetrators Two significant exceptions – substance abuse and medication adherence Discrimination Iowa Department of Corrections Source: Surgeon General’s Report on Mental Health (1999)

The Behavioral Health – Criminal Justice Problem in Summary 5/2/2018 The Behavioral Health – Criminal Justice Problem in Summary Arrested more often . . . Incarceration exacerbates symptoms of mental illness. . Incarcerated longer . . . Difficulty accessing treatment in the community.. . More likely to “fail” community supervision . . What can you do to help support criminal justice and behavioral health staff, providers, and administrators address this problem? Iowa Department of Corrections 10

What is the relationship between crime and mental illness? Arrest rarely is a direct product of mental illness. Mental illness is a modest risk for recidivism. Leading risk factors ( e.g., criminal history, substance abuse, antisocial values & beliefs, antisocial peers, antisocial personality) are shared by those with and without mental illness. Individuals with mental illness have various pathways into the criminal justice system. Individuals with mental illness are at increased risk of developing substance abuse disorders and arrests have skyrocketed since 1980s. Once involved, individuals tend to get caught up in a whirlpool fueled with managing illness and supervision conditions. Iowa Department of Corrections Jennifer Skeem, 2016

Improving outcomes Quality mental health treatment Supervision- Quality Access/Dosage of correctional interventions Improved Outcomes—Symptoms & functioning + Reduced risk Iowa Department of Corrections

IDOC’s approach to improving Mental Health outcomes Mental health training for staff Core Correctional Practices Recruiting and retaining mental health staff Tele-psychiatry Mental health information sharing program NAMI P2P Continuity of treatment Community Connections Supporting Reentry (CCSR) Iowa Department of Corrections

Criminal Justice Professionals Must Be Able to Rely on Their Partners in the Behavioral Health System Conduct comprehensive assessments Develop treatment plans Provide necessary services Continuous quality improvement Improve Public Safety Improve Public Health Iowa Department of Corrections

Moving forward Balanced approach—supervision and treatment Opportunities for diversion Training Collaboration Information sharing Reentry Bipartisan support National resources Iowa Department of Corrections

Smarter use of taxpayer dollars: Reentry Matters 8/2/2013 Public safety: Helps reduce recidivism, resulting in fewer victims of crime and stops the revolving door of the criminal justice system Stronger families: Promotes family reunification and pro-social relationships Improved community well-being: Improves economic outcomes and yields healthier communities. Smarter use of taxpayer dollars: Reduces costly reincarceration, which diverts public resources away from other public priorities, such as education and social services Can we tie recidivism reduction to fewer crimes? Put a face – something for liberals. Families is an example. Reentry matters. What’s next – how do we take all three categories to the next level – reentry matters, sca, and nrrc – looking ahead – more does the next 5 years hold. We don’t really lay out an agenda for what we’re doing in the future. Slide 3 – parallel that can bring us back to where we’re going.