Decriminalizing Mental Illness: The Intersection Between Mental Illness and the Criminal Justice System Judge Roxanne Bailin Retired

Identifying Intersections Between Criminal Justice and Mental Health Law Enforcement Pre-Trial Services Jail Plea Negotiations Sentencing and Supervision

Law Enforcement Law enforcement interacts with people at their homes, on commercial streets, and in neighborhoods in a manner that often results in arrests for harassment, menacing, felony menacing, obstruction of justice, or resisting arrest.

Pre-Trial Services Pre-trial services personnel (if available) administer assessments and screens to make bond and supportive services recommendations. Pre-trial services personnel (if available) provide supervision and support to defendants released on bond.

Pre-Trial Services (Cont’d) Pre-trial services personnel often recommend more secured bonds and higher bond amounts. Pre-trial services often have no established mental health programming that allows early release.

Jail The jail provides pre-trial incarceration, sometimes in special management. People with mental illness remain in jail on a pre-trial basis for much longer than people without mental illness.

Plea Negotiations Prosecutors negotiate plea agreements that avoid trial in 97-98% of all criminal cases. Plea are often more protracted and often result in more severe plea bargains. Deferred prosecutions and deferred sentences may or may not be available for people with mental illness.

Sentencing and Supervision Judges sentence some people with mental illness to probation. Probation officers supervise defendants until the conclusion of the probationary period. Specialized programs and specialized caseloads may or may not be available for people with mental illness.

Mapping Programs and Processes That Reduce Incarceration and Convictions and Identifying Gaps Community Supports Law Enforcement Pre-Trial Services Jail Plea negotiations Supervision

Community Supports Do you have a food bank, a soup kitchen, a drop-in center that serves food, an agency that provides housing or shelter, and a resource center for homeless individuals? Do you have a drop-in or walk-in mental health clinic?

Law Enforcement Do you have a mobile law enforcement/mental health professional team that can be deployed to prevent arrest? Do you have a training program for law enforcement on mental illness such as CIT (Memphis Model Crisis Intervention Team)?

Law Enforcement (Cont’d) Do you have an outreach program to the homeless population that teams law enforcement with mental health professionals? Do you have a crisis drop-off/walk-in center for people experiencing psychotic symptoms that law enforcement can use?

Law Enforcement (Cont’d) Do you have a secure drop-off site at the local hospital? Do you have a hospital in your area that is certified by your state to hold people with mental illnesses on 72-hour holds pending evaluation for commitment or stabilization? What services do you have available for the police and sheriff to use to avoid taking people to jail?

Pre-Trial Services Do you have bail procedures that use validated assessments to release all but dangerous people who are likely to commit crimes while on bond or people who are likely to abscond? Do you have bail procedures that largely eliminate money bonds?

Pre-Trial Services (Cont’d) Do you have a validated mental health screen administered to all arrestees? Do you have an alliance with your local community mental health center that will allow for pre-trial release engagement, medication, and therapeutic support?

Pre-Trial Services (Cont’d) Do you have a pre-trial supervision program? Do you have the ability to bring people back for bond reconsideration if they become stabilized in jail?

Jail Do you have jail-based therapeutic programming? Do you have jail-based medication evaluations and administration? Do you have community mental health center application procedures?

Jail (Cont’d) Do you have Medicaid enrollment procedures? Do you have a process for obtaining identification cards for inmates?

Plea Negotiations Does your prosecutor offer deferred prosecutions so that defendants can be placed on supervision without a guilty plea with charges dismissed upon completion of conditions? Does your prosecutor offer deferred sentences so that defendants plead guilty to negotiated charges but the guilty plea is withdrawn and charges dismissed if conditions are completed? Does your prosecutor support recommendations to specialized court dockets?

Supervision Does your probation department have specialists in mental illness? Does your jurisdiction have a treatment (mental health/drug) court? Does your probation department have an alliance with the community mental health center and other supportive services, such as housing and financial support through work or benefits?

Forming Collaborative Infrastructures The Philosophy of Judicial Leadership Presiding Judge Leadership Enthusiastic Motivated Organized Inclusive and Open Trusted Who is at the Table?

Forming Collaborative Infrastructure (Cont’d) Working together: The Individual and Mutual Benefit What’s in it for you? Why will working together be better than working separately? What worries you?

Establishing a Vision for Closing the Gaps Obtain Best Practices information to develop ideas for programs and procedures. Obtain data that demonstrates problems, such as the substantially greater length of stay in jail for persons with mental illness. Envision programs and procedures that fill the gaps and improve success of current programming.

Evaluating Current Resources Within the collaborative, each organization already provides services that can be reorganized around a project or procedure; for example, the services could be performed in a different place or the organization could increase speed of access to services. Within the collaborative, each organization has financial resources that are already being used to serve people with mental illness.

Evaluating Current Resources (Cont’d) Combine or redirect funds within the collaborative. Eliminate “stove-piping” funds. Redirect funds currently used for programs that are not evidence-based or have poor outcomes. Achieve cost savings through integration of services. Achieve cost savings through improved outcomes, e.g. fewer jail bed days.

Possible Resources Local, state, and federal funding and grants Private grants Philanthropic donations to non-profit organizations that can support your work In-kind contributions from faith communities and non-profit organizations. Establishment of non-profits to provide services

Establishing Priorities for Decriminalization Ask the Question: What can we do to prevent people with mental illness from entering the criminal justice system in the first place or get them out of the system with services but no conviction? This is your lodestar.

Priorities (Cont’d) What shall we do first? Chose a change that is achievable to accomplish a first “win” for the collaboration. Identify a project that can be done simultaneously such as training law enforcement regarding mental illness and substance abuse and providing continuing training in the CIT model.

Priorities (Cont’d) What can be done using existing resources? Choose a project that involves everyone in the collaboration, that is nationally recognized as evidence-based, that can be achieved with relatively little outside financial support, and that will demonstrate a substantial positive change in decriminalizing mental illness.

Priorities (Cont’d) What will make the most difference? Avoid “low-hanging fruit” unless the change will be substantially beneficial. Take risks—address the needs of high risk/high needs people within the criminal justice system. Help develop appropriate supports in the community for people with low risk/low needs or low risk/high needs that eliminate the connection with the criminal justice system. This is where decriminalization happens.

Priorities (Cont’d) What will best drive further changes? Consider whether there are one or two entry points into the interface between criminal justice and mental illness that will drive other changes within agencies to increase effectiveness and quality, i.e. a high tide raises all boats.

Examples of Evidence-Based Programs and Community Supports Social Supports Independent of the Criminal Justice System Collaborations between Law Enforcement and Mental Health Professionals Homeless Outreach Programs Crisis Intervention Teams (CIT Training) Drop-off Centers Crisis Intervention and Stabilization Centers Hospital Collaborations Family Education Programs Regarding Resources Deferred Prosecution and Deferred Sentence Opportunities Treatment Courts  

Decriminalizing Mental Illness: The Intersection Between Mental Illness and the Criminal Justice System Judge Kyle Bryson Arizona Superior Court in Pima County

Chief Justice Scott Bales Strategic Agenda: “Advancing Justice Together” Advocates the use of evidence based practices Five goals of strategic plan Protecting Children, Families and Communities Supervision of the seriously mentally ill Problem solving courts

Fair Justice For All Task Force Reccomendations: “Coordinate where possible with the local regional behavioral health authority to assist the court or pretrial services in identifying defendants who have previously been diagnosed as mentally ill” “Revise mental health competency status for expediting mental competency proceedings for misdemeanor cases” “Bring together criminal justice and mental health stakeholder in larger jurisdictions to adopt protocols for addressing people with mental health issue who have been brought to court” “Consider the use of specialty courts and other available resources to address the defendant’s treatment needs, as well ask risk to the community, when processing cases involving persons with mental health needs or other specialized groups”

Pima County Services Mental Health Courts Pretrial Services Superior Court City Court Pretrial Services Programs and Collaboratives Behavioral Health Treatment Court Collaboratives (BHTCC) Criminal Justice Summit Justice Coordinating Council

Tucson Police Department Mental Health Support Team Represents a shift in law enforcement response to behavioral health incidents After several high profile incidents, law enforcement recognized a need for a specialized approach Launched in January 2014 Clearing house for mental health court orders

Pima County Sheriff’s Department Mental Health Investigative Support Team Allows for a parallel criminal justice and behavioral health approach Incidents are prevented through early intervention Includes speedy and thorough case follow-up Launched in late May 2013 Allows for behavioral health interventions where traditional criminal justice approaches may be inappropriate Also serve Mental Health Orders from Superior Court Partners with: Crisis Response Network, Pasadera, Cenpatico, Crisis Response Center and other Law Enforcement