November 27, 2007 NAMI North Carolina, Raleigh 2007 NAMI North Carolina Decriminalizing Mental Illness Institute The Jericho Project: Overcoming jail diversion barriers for persons with serious mental illness & serious criminal justice involvement Stephen C. Bush Supervising Attorney/Special Litigation Shelby County Public Defender System 201 Poplar, Suite 2-01 Memphis, TN Fax Fax

November 27, 2007NAMI North Carolina, Raleigh

November 27, 2007NAMI North Carolina, Raleigh “The Jericho experiment sought to create a consumer driven public health jail diversion model based on principles of recovery and resilience, relying on best practice transition planning to access integrated treatment and services, understanding that relationships, peers and community are paramount on the journey to recovery.” SAMHSA Grants 5 H79 SM & 1 H79 TI A C Wharton, Jr Mayor, Shelby County, Tennessee

November 27, 2007NAMI North Carolina, Raleigh High end target population Serious Mental Illness – Axis I Serious Mental Illness – Axis I –Bipolar Disorder –Schizophrenia spectrum –Major Depression … Co-occurring substance use – 74% Co-occurring substance use – 74% Felonies, misdemeanors, kitchen sink Felonies, misdemeanors, kitchen sink Taps free leverage Taps free leverage With dignity and minimal stigma With dignity and minimal stigma

November 27, 2007NAMI North Carolina, Raleigh Eligibility Serious mental illness Serious mental illness Stable on medication Stable on medication Willing to embrace treatment Willing to embrace treatment Seeking to serve persons whose contact with the justice system is related to untreated mental illness Seeking to serve persons whose contact with the justice system is related to untreated mental illness

November 27, 2007NAMI North Carolina, Raleigh Jail Diversion Quick Reference Guide Reference: Sequential Intercept Model Pre-booking jail diversion Pre-booking jail diversion –Crisis Intervention Teams – law enforcement –Mobile Crisis Models – mental health –Blended models Post-booking jail diversion Post-booking jail diversion –Fast track supervised release –Mental Health specialty courts –Non-specialty courts - Jericho Re-entry – from Jails & Corrections Re-entry – from Jails & Corrections

November 27, 2007NAMI North Carolina, Raleigh The Sequential Intercept Model Munetz & Griffin, 2006 Conceptual framework Conceptual framework Series of points of interception Series of points of interception Prevent deeper penetration of CJS Prevent deeper penetration of CJS Organizing tool for systematically addressing decriminalization Organizing tool for systematically addressing decriminalization Develop targeted strategies to increase diversion & linkage Develop targeted strategies to increase diversion & linkage

November 27, 2007NAMI North Carolina, Raleigh Systems Barriers Inadequate community services Inadequate community services Waiting lists for treatment & services Waiting lists for treatment & services Lack of adequate housing Lack of adequate housing Fragmentation among MH, SA, housing, social services & health care Fragmentation among MH, SA, housing, social services & health care Stigma, discrimination, NIMBY Stigma, discrimination, NIMBY

November 27, 2007NAMI North Carolina, Raleigh Jericho in a Box 1. Best Practice Transition Planning 2. Community Linkage Plans 3. Conditional Release Strategies 4. Independent, Layered Supervision 5. Integrated Treatment 6. Bridge Case Management 7. Mainstream Services

November 27, 2007NAMI North Carolina, Raleigh Jericho in a Box 1. Best Practice Transition Planning 2. Community Linkage Plans 3. Conditional Release Strategies Free 4. Independent, Layered Supervision Free 5. Integrated Treatment 6. Bridge Case Management 7. Mainstream Services Free

November 27, 2007NAMI North Carolina, Raleigh APIC for Transition Planning Osher, Steadman & Barr, 2002 APIC-model best practice transition planning APIC-model best practice transition planning –Assess clinical and social needs –Plan for treatment and services –Identify community programs –Coordinate transition plan to avoid gaps in care Key Domains of Services Key Domains of Services Developed by Recovery Support Specialists Developed by Recovery Support Specialists –“Boundary Spanners” per Steadman Result is the Community Linkage Plan Result is the Community Linkage Plan \\Scfntdata1\vol1\PBDF\MyDocuments\stephen.bush\Art & Templates\Jericho sample CLP.doc \\Scfntdata1\vol1\PBDF\MyDocuments\stephen.bush\Art & Templates\Jericho sample CLP.doc

November 27, 2007NAMI North Carolina, Raleigh Insert pdf of checklist

November 27, 2007NAMI North Carolina, Raleigh Recovery Toolkit Case management resources Case management resources Treatment options Treatment options Rental assistance Rental assistance Transportation resources Transportation resources Bridge medication resources Bridge medication resources Temporary identification Temporary identification Housing – transitional to permanent Housing – transitional to permanent

November 27, 2007NAMI North Carolina, Raleigh PD Special Litigation Section Pretrial Services Jail Medical Community Providers Multiple Referral Streams Confirm Diagnosis & Meds Jericho Roundtable Housing Medications Benefits Case Mgt Transportation Treatment Consumer Input

November 27, 2007NAMI North Carolina, Raleigh Conditional Release Strategies Many forms of conditional release Many forms of conditional release –Supervised pretrial release –Probation: county, state, private –Avoiding revocation on probation Supervision is layered over CLP Supervision is layered over CLP Independent eyes and ears Independent eyes and ears Material noncompliance reported Material noncompliance reported

November 27, 2007NAMI North Carolina, Raleigh Relationships RelationshipsRelationshipsRelationships

November 27, 2007NAMI North Carolina, Raleigh Successes Improved quality of life Improved quality of life Reduced severity of symptoms Reduced severity of symptoms Reduced jail days Reduced jail days Reduced arrests Reduced arrests Judges approve over 95% of CLPs Judges approve over 95% of CLPs

November 27, 2007NAMI North Carolina, Raleigh Successes Referrals from prosecutors Referrals from prosecutors Referrals from judges Referrals from judges High tolerance of relapse High tolerance of relapse Better, faster dispositions Better, faster dispositions The branding of Jericho The branding of Jericho

November 27, 2007NAMI North Carolina, Raleigh Outcomes At 6 months 76% no adverse CJ contact At 6 months 76% no adverse CJ contact 25% bump up against the system 25% bump up against the system 25%, usually new offenses, result in reincarceration 25%, usually new offenses, result in reincarceration Overall more than half no further arrests Overall more than half no further arrests Overall 99 fewer jail days per divertee/year Overall 99 fewer jail days per divertee/year

November 27, 2007NAMI North Carolina, Raleigh Systems Impact, n=55 Jail days dropped from 13,946 in the year preceding linkage to 6,159 in the year following Jail days dropped from 13,946 in the year preceding linkage to 6,159 in the year following 7,787 fewer $708,617 7,787 fewer $708,617 $708,617 / 55 = $12,884 per detainee $708,617 / 55 = $12,884 per detainee Overall divertees averaged 99 fewer days per year in jail after linkage Overall divertees averaged 99 fewer days per year in jail after linkage

November 27, 2007NAMI North Carolina, Raleigh Comparision Conditional Release Conditional Release –All courts –No preset limitations –Driven by dynamics of adversarial system –Bottom up Mental Health Courts Mental Health Courts –One division –Usually nonviolent, low grade offenders –Driven by judge –Top down

November 27, 2007NAMI North Carolina, Raleigh Looking Forward Gender-specific, trauma-centered Gender-specific, trauma-centered Targeted resources for homelessness Targeted resources for homelessness Consumer Peer Specialists & WRAP Consumer Peer Specialists & WRAP Supportive Employment Supportive Employment Transitional Housing Transitional Housing Gideon – IMS and early intervention Gideon – IMS and early intervention

November 27, 2007NAMI North Carolina, Raleigh Factors for Success Interagency collaboration Interagency collaboration Active stakeholder involvement Active stakeholder involvement Effective boundary spanner(s) Effective boundary spanner(s) Strong leader or change agent Strong leader or change agent Quality transition planning Quality transition planning –Incorporate evidence-based practices Specialized case management services Specialized case management services

November 27, 2007NAMI North Carolina, Raleigh Values Statement Recovery is real and possible. Recovery is real and possible. Relationships are important. Relationships are important. Listen to persons with mental illness. They know what what works for them. Listen to persons with mental illness. They know what what works for them. Services should be comprehensive, integrated & evidence-based. Services should be comprehensive, integrated & evidence-based. Overcome stigma through education and example. Overcome stigma through education and example. Access to treatment should not compromise due process. Access to treatment should not compromise due process. Avoid artificial limits on eligibility. Avoid artificial limits on eligibility.

November 27, 2007NAMI North Carolina, Raleigh

November 27, 2007NAMI North Carolina, Raleigh Why Jericho? For 3000 years a place of safety For 3000 years a place of safety Food, water, and protection Food, water, and protection A safe place in the desert A safe place in the desert Metaphor of bringing down walls Metaphor of bringing down walls Bringing down barriers to recovery Bringing down barriers to recovery

November 27, 2007NAMI North Carolina, Raleigh Resources The National GAINS Center The National GAINS Center – Council of State Govts Mental Health Consensus Project Report Council of State Govts Mental Health Consensus Project Report – – SAMHSA SAMHSA – –National Registry of Evidence-based Px & Prgms