Mental Health & Substance Abuse Re-Entry Efforts Presented by Dean Aufderheide, PhD., Mental Health Service Director, on behalf of Daniel G. Ronay, Chief Deputy Secretary, Florida Dept. of Corrections

Just the Facts United States is about 5% of world population, but incarcerates 25% of world’s inmates 40% of individuals with serious mental illnesses have been in jail or prison at some time in their lives Americans with severe mental illnesses are 3 times more likely to be in jail or prison than in a psychiatric hospital In less than three decades, the percentage of seriously mentally ill prisoners has almost tripled from about 6% in 1983 to 15-20% today

Defining the Problem According to the NAMI report, Florida is 49th in the nation in per capita spending on mental health services In Florida, a person with serious mental illness is 5 times more likely to be in a jail or prison compared to in a hospital. There are more inpatient beds in the Florida prison system than the number of involuntary civil commitment beds in Florida’s state hospital system 18% of the inmates in the Florida DOC have a diagnosed mental disorder that requires mental health treatment 2010 Survey of states by the Treatment Advocacy Center and the National Sheriffs’ Association

Florida Mirrors the National Trend in Mentally Ill Population 59% Increase, but Has Stabilized Over Past 3 Years at About18%

Mental Illness in by Mental Health Grade Total Inmates 101,767 Florida Department of Corrections - Bureau of Research and Data Analysis - February 14, 2011

(Psychotic Disorders, Bipolar Disorders, Major Depression) Increase in the Percentage of Inmates with Severe and Persistent Mental Illness (SPMI) within the Mentally Ill Population (Psychotic Disorders, Bipolar Disorders, Major Depression) Florida Department of Corrections, Date Bureau of Research & Data Analysis

Mental Health ReEntry Program Meeting the Challenge in Florida Creating an Interagency Agreement between the Department of Corrections and the Department of Children and Families Coordinating with the Social Security Administration to complete SSDI/SSI applications Establishing Community Partnerships with Stakeholders Created a Central Office full-time staff position in mental health to provide oversight and coordinate aftercare services statewide and with stakeholders Created new institutional Mental Health ReEntry Specialist positions solely dedicated to coordinate aftercare services

Number of Offenders Eligible for Post-Release Aftercare Planning Annually Florida Department of Corrections; Bureau of Research and Data Analysis; November 30, 2010

DC/DCF Web-Based Electronic Referral System DCF Office of Disability Determination Agency for Persons with Disabilities Agency for Health Care Administration Potential Stakeholders Veteran’s Administration Agency Workforce Innovation County Sherriff’s Department Florida Institute Legal Services Parole and Probation Office of Homelessness DC Mainframe Encrypted file transfer DCF Mini-Mainframe Updated Weekly DCF Web Interface DCF staff receives email notice of referral and assigns community provider based on the county of destination DC staff enter referral information into DC Mainframe DC referral information de-encrypted DC, DCF, CMHC providers have access to aftercare database. DCF staff calls provider to establish appointment. DC staff obtains aftercare arrangements from aftercare database / communicates information to inmate.

“Seamless Delivery System” Residential Short-term (6 months) Outpatient UA Testing Residential Long-term Therapeutic Community Community Corrections Programs Assessment (if court ordered) Aftercare Upon Admission: CC Upon Admission: IP Post-Release Substance Abuse Transitional Housing In-Prison Programs The department strives to provide a seamless delivery of substance abuse programs between community corrections and in-prison services. An inmate who completes a substance abuse program and has supervision to follow can be successfully linked to a contracted aftercare provider in the community increasing their chances of maintaining sobriety and successfully completing their period of probation. If an individual on supervision fails their period of supervision as a result of drug usage or failure in a treatment program, this information is of importance in determining the needs and level of treatment they may need while incarcerated. Screening Upon Release: IP Prevention Support Groups Substance Abuse Transition Centers Motivational Groups Intensive Outpatient Residential Therapeutic Community

Type of In-Prison Inmate Treatment 2,533 Department Slots Intensive Outpatient: 1,168 14 – Correctional Institutions Residential Therapeutic Communities: 606 5 – Correctional Institutions 1 –Pre- Release Community-Based Substance Abuse Transition Centers: 759 Prevention/Outpatient/Aftercare 6 – Pre-Release Community-Based 1,048 - Male 120 - Female 561 - Male 45 - Female Of the 19 Institutions where we have substance abuse programming, 18 also have mental health services available. The needs of an offender with a co-occurring disorder in substance abuse treatment can be coordinated with the on-site mental health staff. Approximately 14% of the inmates currently enrolled in a substance abuse program are also receiving mental health services. Inmate substance abuse treatment programs in the community who house inmates with a co-occurring disorder either take them back to the institution for mental health services or if the inmate is employed, he/she is connected to the community based mental health provider and pays for services in accordance with the agencies sliding fee scale. 503 - Male 256 - Female

In-Prison Substance Abuse Gaps in Services vs. Need FY 2009-10 35,810 inmates were provided screening assessments at reception. ~65% of the total inmate population have consistently been screened to be in need of substance abuse treatment services. Approximately 19% of those have a co-occurring SA & MH disorder. 84% of released inmates that needed treatment; did NOT receive it. 65% Total = 102,232 As of June 30, 2010 - 2,533 available department substance abuse treatment slots.

Community Corrections Substance Abuse and Mental Health Resources 775 Short – term – 73% 286 Long – term – 27% 1,061 – Contracted Residential Substance Abuse Treatment Beds 775 Short – term – 73% 286 Long – term – 27% 37 - Contracts for Outpatient Substance Abuse Programs and 22 Contracts for Outpatient Mental Health and Sex Offenders Treatment available throughout the 20 circuits. All of the residential and outpatient contracted substance abuse treatment programs are licensed by the Department of Children and Families (DCF) DCF requires providers to develop and implement operating procedures for serving or arranging services for persons who have co-occurring disorders (mental health and substance abuse disorders) Two of our contracted short-term residential programs have beds and specific services for offenders with co-occurring disorders. They are located in the following circuits: Circuit 13 (Hillsborough County) 10 dual diagnosis beds Circuit 17 (Broward County) 13 dual diagnosis beds These two programs provide psychiatric evaluations, medication and medication management, specialized mental health groups and case management services in addition to substance abuse treatment.

Community Corrections Substance Abuse: Gap vs Need FY2009-10 Total On 6/30/10, 152,928 offenders were on active supervision. Approximately 55.8% (85,341) offenders supervised are potentially in need of substance abuse treatment. Statistics compiled by the Bureau of Research & Data Analysis

Special Collaborative Re-Entry Project At Century Correctional Institution the Department of Children and Families is funding a Reentry Case Manager position that provides case management and follow up services to inmates with substance abuse problems released from Century CI to the Escambia County area. Services include: Family connectivity Housing Referrals Substance Abuse referrals/follow up Mental Health referrals/follow up Case management Century CI has a 68 bed therapeutic community that was implemented last fiscal year. This position also works closely with the contracted substance abuse treatment staff in assessing the inmate’s post-release needs. It is the intent of the Department of Children and Families to continue to fund this specialized position this fiscal year.

Seeking New Funding Opportunities and Partnerships Partnering with two community-based treatment providers the Department submitted a 2nd Chance Grant application for Adult Offenders with Co-occurring Disorders in June of 2011 . The program, if funded, would target inmates with co-occurring substance abuse and mental health disorders located in the Department’s Therapeutic Community Program at Jefferson Correctional Institution who are returning to the Circuit 2 vicinity. Post –release re-entry services include mental health and substance abuse aftercare and case management services, follow-up psychiatric care, and medication management. Based on individual needs, housing, transportation and employment skill training will be provided. . Circuit 2 includes: Leon, Gadsden, Jefferson, Liberty , Franklin, Wakulla

Circuit 17 Program Targets Severely and Persistent Mentally Ill In 2006, based on legislative appropriation, the Department partnered with Henderson Mental Health Center to develop a pilot program that provides intensive, specialized re-entry rehabilitation and support services to probationers and released inmates who have a severe and persistent mental illness. This program continues today. Program Goals include successful re-entry by preventing unnecessary psychiatric hospitalization(s), incarceration(s) or crises. Principle Services Provided: Intensive Case Management Psychiatric Evaluation Crisis Intervention Individual Therapy

Prison Diversion Currently, Circuit 13 has the only pilot prison diversion program (PDP) Offenders are sentenced to the program in lieu of prison. Program provides varying levels of care. Individuals in need of mental health services receive services through the provider’s psychiatrist or referred to an outside provider. Offenders in need of substance abuse treatment receive services through the program. This program was designed with input from the local judiciary to include the Chief Judge, the State Attorney and the Public Defender as well as the Florida Department of Corrections and the Program Provider. Appropriation language specifically designated funds for Judicial/DC pilot programs for offenders who would be sentenced to prison, but could be diverted to appropriate programs that allow the offender to retain community support, access drug treatment and/or employment opportunities while receiving life-skills assistance in a structured environment. The appropriation language also requires the programs to be in communities where the circuit court and Department of Corrections, in conjunction with community stake holders, agree to implement evidence-based practices and graduated incentives that are anticipated to result in a reduction in prison admissions for that community.

Probation Officers work with Mental Health Courts Circuit 15- Mental Health Court Circuit 17-Mental Health Court Circuit 12-Sarasota County Mental Health Court was established in the 1990’s.  Circuit 13-Pre Trial Intervention Mental Health Court Circuit 20-Lee and Collier counties have Mental Health Courts Circuit 8 –Alachua County Mental Health Court Circuit 2 – Mental Health Court Many judiciaries have established specialized mental health courts. The department has dedicated probation officers to work in these courts. These court officers serve as a liaison between the Department and the Court.

Veterans Dorm Program Over 6,700 self-reported Military Service personnel Identified Dorms 6 dorms sites Inmate relocation in process Curriculum development in process Identify programming Thinking for a Change, staff trained Establishment of community partners and stakeholders The Florida Department of Corrections is committed to helping inmate’s successful transition back into their communities, as part of an effort to build a life in the community for everyone.  The Department agrees that veteran specific services are greatly needed.  To address these needs the Department has several initiatives in place and future projects that we feel you may be interested.       Currently, the Department identifies veterans through a self-report questionnaire during the intake process.  A recent count of this designation identified approximately 6,700 individuals reporting military service duty.   A handful of these veterans are already participating in our Veteran Dorm project at Martin Correctional Institution and South Florida Reception Center.  These dorms have been specifically designed to address the transition needs of veterans.  We recognize the importance of addressing the cognitive-behavioral issues, housing, employment and vocational skills in an effort to reduce recidivism.  Additionally, each institution hosts Re-Entry Seminars. During these seminars staff coordinate with various service providers and local agencies to provide useful resource information that will aid the inmate in their transition back into the community. We strive to include Veteran’s Healthcare Administration in each seminar to provide valuable healthcare information to our veterans. Our Office of Health Services has assigned Aftercare Specialists at all institutions with inmates in need of psychiatric assistance (grade 3 through 6). When the inmate’s end of sentence date is within 180-days, the Department initiates their Mental Health Re-Entry Planning.  Eligible inmates that consent to aftercare planning receive a 30-day supply of their prescribed medication on the day of their release and an appointment with a community mental health provider. This initial intake appointment is always scheduled within the first 30-days of their release to provide continuity of care for their mental health treatment and continued medication treatment. The Mental Health Re-Entry Program also initiates Social Security SSI/SSDI applications on all inmates that have been diagnosed with a Severe and Persistent Mental Illness 45-days prior to their release. There is also a designated individual from the Office of Health Services that works with the Bureau of Admission and Release to assist in reentry planning for inmates with physical health conditions that require post-release follow-up. Of interest for future endeavors related to serving veterans is the Department’s Veteran Dorm expansion. The Department will be increasing the number of Veteran Dorms throughout the state and will include a female site.  The selected locations are Gulf CI - Annex, Santa Rosa CI - Annex, Sumter CI, Martin CI, Marion CI and Lowell CI (female).  These dorms will offer participants the Thinking for a Change curriculum, outreach and assessment services, case management assistance, referrals and linkages to medical, psychiatric, and social services upon release.  The Department is seeking to establish an American Legion Post at our Veteran Dorm sites.  We feel the commitment of the American Legion matches our intent to provide Veterans with the core values held by the Posts in advocating patriotism and honor. The institution Post activities will focus on strengthening its commitment to communities and providing mentoring relationships to our veterans. Finally, our Office of Community Corrections has a few initiatives that attempts to solve some of the veterans’ underlying health and psychosocial problems that bring them into contact with the criminal justice system.  Circuit 12 (i.e., Desoto, Manatee and Sarasota Counties) offers the “Courts Assisting Veterans Program” (CAV).  The goal of this program is the identification of veterans and to intervene post-arrest and refer the veterans to mental health, drug treatment, housing, medical and employment services.  Additionally, identified veterans are matched with mentors to assist them in meeting their release conditions.  The CAV program provides these services as part of enhancing the veterans’ successful readjustment back into civilian life.  Circuit 15 (i.e., Palm Beach County) operates the “Veterans Treatment Docket.”  This initiative focuses on the supervision of felony or misdemeanor combat and non-combat Veteran defendants who have been referred for treatment and rehabilitation services.  The goals of the Veterans Treatment Docket are to “reduce veterans contact with the criminal justice system; reduce costs associated with criminal case processing and re-arrest; and introduce participants to an ongoing process of recovery. Veteran participants are matched with a mentor who offers them assistance, assesses their needs, and helps them solve their problems. In addition to assisting the veteran with readjustment to civilian life, the mentor aids with navigating the Court, treatment, and the Department Veteran’s Affairs system, while acting as a mentor, advocate, ally and role model.

Veteran Inmates Requiring Post-Release Mental Health/Substance Abuse Treatment In 2002/2003, an estimated 1.2 million male veterans were identified as suffering from serious mental illnesses. Approximately 340,000 of these individuals had co-occurring substance abuse disorders (1).  Inmates referred to DCF/VA for Post-Release Mental Health/Substance Abuse Treatment in 2007 The Florida Department of Corrections, Bureau of Research and Data Analysis, Inmate Data Section, January 29, 2008; (1) National Survey on Drug Use and Health, “Male Users with Co-Occurring Serious Mental Illness and a Substance Use Disorder,"  Nov.11, 2004,  http://www.oas.samhsa.gov/2k4/vetsDualDX/vetsDualDX.htm ;

Recidivism Reduction Initiatives and Priorities Increase the number of Pre-Release Substance Abuse Treatment slots. Decrease the number of inmates who are released from prison without receiving needed treatment. Target level and length of treatment based on inmate needs. Goal: Increasing public safety by decreasing recidivism- less crime / fewer victims and stronger communities. The department is exploring ways to increase the number of in-prison treatment slots, looking at the type of slots we need, and how we can best meet our needs within available resources. By increasing slots, we will decrease the number of inmates who need treatment and are released without it. Increase evidenced-based practices through standardization will allow inmates to enter a program and if transferred continue the program at the new facility. All TC’s function in the same way. For example T4C being offered in programs. Goal: is to get the inmate in the appropriate level of treatment, for the appropriate time frame to meet his/her individual needs. Match inmate need to appropriate dosage of treatment.

Recidivism Reduction Initiatives and Priorities Increase mental health training opportunities for Probation and Correctional Officers Increase communication between Institutional Substance Abuse Treatment Staff and Mental Health Treatment Staff Enhance continuum of care by increasing communication between Institutions and Community Corrections staff Additional Mental Health training for probation officers will increase their skill sets and knowledge base for dealing with mentally ill probationers who wish to successfully complete their period of supervision. Realistic expectations can be established from additional training and the probation officer will be equipped to respond to the offender in an appropriate manner. This will assist in decreasing violations and increasing the number of offenders who successfully terminate from their period of probation. Some probation officers received this type of training last fiscal year and found it to be beneficial to them in performing their supervision job functions. Increase communication between the substance abuse treatment team and the mental health treatment team increases the continuity of care for the individual being treated. This will also decrease manipulation. Two treatment teams will jointly be working to provide the inmate with tools for a successful re-entry and appropriate aftercare. Goal of enhancing the continuum of care between community corrections and institutions includes not duplicating services and ensuring treatment previously provided is included in any new assessment.

Recidivism Reduction Initiatives and Priorities Develop one (1) additional Pilot Prison Diversion Program in a rural circuit. Partner with Florida Certification Board, Florida Alcohol Drug Abuse Association, and Substance Abuse providers to replicate a certification process for a Recovery Specialist Credential. The additional pilot program will be developed in accordance with the appropriation language previously discussed. Recovery Specialist Certification – increase skills opportunity for employment upon release from prison. Can work in an addictions setting as a Recovery Specialist. These are individuals that assist clients to navigate the substance abuse treatment and related service systems to achieve and maintain Sobriety. Recovery Specialist: Advocate for needs of consumer Teach consumer how to develop skills necessary to advocate for self Serve as a mentor, instilling a sense of hope that recovery is an achievable goal.

Recovery Health Network Discount Prescription Drug Cards A supply of cards was sent to each institutions and probation office for distribution to newly release inmates and supervised offenders. This card is absolutely FREE with no expiration. Discounts up to 87% Use at more than 54,000 national and regional pharmacies No Medical Coverage needed to use our discount Rx card. No Application, Enrollment, or Eligibility Requirements or Fees Lower Price Guaranteed! Can be used immediately! All cards are active Unlimited uses Everyone qualified Never expires Works for all FDA approved prescription medications The partnership between the Florida Department of Corrections and Recovery Health Network has allowed our agency to provide a critical reentry resource to our inmates and offenders at no cost to the Department. 

The Importance of Collaborative Leadership to the Right Thing, the Right Way for the Right Reasons in Our Mental Health and Substance Abuse Programs

When They Succeed, We Succeed!