Mental Health Treatment Systems Jolene Rebertus, MA, LPCC, NCC Corrections Program Director Behavioral Health Release Planning Jolene Rebertus, MA, LPCC, NCC Corrections Program Director – Behavioral Health Release Planning Kathryn Lockie, MA, LPCC Corrections Program Director – MCF-Oak Park Heights

Treatment Systems Overview 1. Review DOC treatment systems 2. Discuss offered release planning services

DOC Treatment Systems Behavioral Health Mission "To provide effective, evidence-based behavioral health services that enhance facility and public safety, reduce criminal recidivism, and foster healthier offender functioning." DOC Background: MH Services

DOC Treatment Systems Behavioral health includes Mental health Chemical dependency Sex offender Release planning 200+ staff All State employees DOC Background: MH Services

DOC Treatment Systems Mental Health Services by the numbers Approx 25% adult males utilize ongoing mental health services Approx 22% adult males on psychotropic medications Approx 65% adult females utilize ongoing mental health services Approx 68% adult females receiving psychotropic medication DOC Background: MH Services

DOC Treatment Systems Continuum of Services Available through self, professional, or institutional referral ANY DEPARTMENT STAFF MAY REQUEST A MENTAL HEALTH ASSESSMENT OF AN OFFENDER Evaluations are provided at various levels of referral and need DOC Background: MH Services & DOC Division Directive 500.303

DOC Treatment Systems Offender Intake Screening and Processing New admit - mental health screen completed within 14 calendar days of admission Release violator – mental health screen completed within 14 calendar days of admission Transfer – behavioral health staff sending facility prepares summary and need for follow up to receiving facility MN DOC Division Directive: 202.040

DOC Treatment Systems Mental Health Assessment Suicidal ideation History of suicidal behavior Prescribed psychiatric medication Current mental health complaint Out/inpatient history Substance use Observation of appearance Evidence of abuse or trauma Current symptoms Disposition MN DOC Division Directive: 500.303

DOC Treatment Systems Those with a history, suicidal ideation, and/or display symptoms participate in further evaluation File review Additional clinical interviews Obtaining collateral material from outside resources Psychological testing DOC Background: MH Services

DOC Treatment Systems Mental Health Continuity of Care Ensure offenders receiving mental health care in the community are provided appropriate care during admission, incarceration, transfer, and release MN Department of Corrections Policy: 500.302

INTERVENTION SERVICES DOC Treatment Systems INTERVENTION SERVICES Level 1 Volunteer assistance Referral to self-help groups AA NA Anger management Parenting Level 2 Provided by DOC professional staff Outpatient intervention Psychoeducational groups Psychotherapy groups Individual psychotherapy DOC Background: MH Services

DOC Treatment Systems Level 3 DOC professional staff INTERVENTION SERVICES Level 3 DOC professional staff Heightened level of supportive services Chronically mentally ill Socially low functioning Supportive Living Services (SLS) Residential level services Daily support Designated area Level 4 Acute level of mental illness Requires residential care Specialty assessment Chronic mental health care within a secure environment NOTE: programs are available at each custody level, but not at each facility -LL, RC, SHK, OPH, RW (SLS) -SHK, OPH, RW – Level 4 DOC Background: MH Services

DOC Treatment Systems Additional Services Psychiatric Services All psychiatric providers are contract providers Psychiatric medication management Medical practitioners must provide non-neuroleptic, psychotropic medications only when medically indicated for treatment of mental illness MN Department of Corrections Policy: 500.301 & 500.321

DOC Treatment Systems Additional Services Mental Health Services On-Call 1 or more licensed mental health providers are continuously on-call to provide urgent mental health services Handle situations by telephone Schedule distributed Watch commander Master control Associate warden of operations Health services administrator All mental health providers MN Department of Corrections Policy: 500.305

DOC Treatment Systems Additional Services Mental Health Observation - COS Comprehensive mental health and suicide prevention program Offender placed on restrictive conditions Physical and electronic observation Logging behavior Directly observed medication administration Behavioral health staff must meet with offender daily Termination determined by behavioral health staff MN Department of Corrections Policy: 500.300

DOC Treatment Systems Psychiatry and outpatient services provided at each DOC facility What is unique to each facility?

DOC Treatment Systems MCF- Oak Park Heights Mental Health Unit Process-type groups Time to talk about person issues/struggles, thoughts, feelings Psychoeducation-type groups Educational components Symptom management Adjustment to prison MH cycle & interventions

DOC Treatment Systems MCF- OPH Mental Health Unit CD Pre-treatment groups Does not fulfill mandatory CD requirements Help prepare for future treatment Resource for seeking CD information Pre-release groups For offenders within 1 year of release Housing, employment, supervision, medical/mental health aftercare

DOC Treatment Systems MCF-OPH Outpatient services Offered groups “Doing Time” Poetry Outpatient MHU group Anger management

DOC Treatment Systems MCF- Stillwater Transitions Services Program (TSP) Serious and persistent mental illness Roughly 10 inmates 2 inmate mentors Attend group counseling sessions 2x week General mental health education, symptom management, process group Expectation of actively working towards general population, seeking employment, working knowledge of dealing with mental illness

DOC Treatment Systems MCF-Rush City Supportive Living Services (SLS) 32 beds 2-3 groups a week Anger management Community/Social skills Depression management Grief process Special topics STEPPS Personal goals

DOC Treatment Systems MCF- Lino Lakes Supportive Living Services (SLS) Serious mental illness and/or significant cognitive impairment Groups offered Adaptive living skills group Psychological education Daily living skills Mental health movie activity Art and gardening Recovery group

DOC Treatment Systems MCF-LL Outpatient services Coping Skills group Offered 1x week Relaxation skills Problem solving Goal planning Sleep hygiene Work readiness Provide variety of tasks while under staff supervision Allow to practice skills, working with others and self discipline

DOC Treatment Systems MCF- Shakopee Women of Wellness (WOW) Supportive living unit Provides psycho-education, skills and therapy to offenders in order to better manage mental health symptoms Goal to return to general population 21 days

DOC Treatment Systems MCF-SHK Women of Wellness – Pain Management (WOW-PM) Women of Wellness – Transition (WOW-T) 21 days Begin working Women of Wellness – Extended (WOW-E) Women of Wellness – General Population Aftercare (WOW-GPAC)

Release Planning in Behavioral Health http://www.youtube.com/watch?v=AcBg1qfNoeM&feature=related Approach Prevention through planning and action MN DOC Release Planners SPMI SO CD Medical TBI

Community “Philosophy” Wisconsin Minnesota State population 5.6M 5.0M Probation population 53K 130K Prison population 23-24K 9.5K % incarcerated 43% 7% www.nicic.org/Features/StateStats

Mental Health Release Planning Function as a mental health practitioner Assess and review client management needs Create individualized discharge plan aimed at successful integration into the community

Mental Health Release Planning Introduction Significant increase in awareness of number of mentally ill offenders in prison population Results in homelessness, unemployment, hospitalizations, subjection to abuse and exploitation, alcohol and drug dependence

Mental Health Release Planning Introduction 2002, MN State Legislature passed law requiring mental health release planning for all SPMI offenders Community mental health services preplanned prior to release

Mental Health Release Planning Importance Enhance community safety Reduce recidivism Meet state legislatively mandated laws Provide advanced notification to community social service agencies

Mental Health Release Planning Importance To ensure offender access to state, county, and federal health care Transition mental health services from prison to community Medically based treatment that supports court’s objectives and conditions for release Best possible aftercare for SPMI offenders

Mental Health Release Planning Definition of Serious and Persistent Mental Illness (SPMI) A person has diagnosis of: Schizophrenia Bipolar Disorder Major Depressive Disorder Borderline Personality Disorder Schizoaffective Disorder

Mental Health Release Planning How to identify? Past records Pre-sentence investigations Clinical records Case notes Police reports Offender interview Have you ever been hospitalized? Have you seen a counselor or therapist? Do you have a mental health diagnosis? Medications?

Mental Health Release Planning Begin working with offender 120 days prior to release Voluntary Service Limits of Confidentiality Assessment of need completed Obtain emergency contact, recreational activities, etc.

Mental Health Release Planning County Mental Health Case Management Rule 79 Assessment Each county has their own rule 79 assessment Certifies a person with a serious and persistent mental illness County involvement important in order to assist with connecting offender to community mental health resources Day tx. MI/CD groups Vocational programming Housing Funds

Mental Health Release Planning ARMHS-Adult Rehabilitative Mental Health Services Medical Assistance required Intensive Community services that focus on offender’s mental health stability in community

Mental Health Release Planning MN Department of Economic Assistance GAMC (expired 02/28/11) MN Care MA Expansion (March 2011) MNSure SMRT Food Stamps Personal Needs Money

Mental Health Release Planning Financial Benefits-Social Security Multi-stage process Referral phone call to SSA representative at 120 days SSI phone interview with offender in prison Completion of important paperwork Possible psychiatric evaluation SSI provide a means of support to pay for housing, food, and increase the offender’s health insurance coverage

Mental Health Release Planning Housing Placement SPMI release planner involved in order to find appropriate housing Rule 25 assessment for MI/CD programming Collaboration with various providers Community agencies Case manager Housing manager Economic Assistance DOC case manager Field agent

Mental Health Release Planning Community appointments Outpatient Psychiatry-medication monitoring Release medication 30 day supply Written script #30 Outpatient Psychology-primary therapist Community Treatment Program Sex offender MI/CD DBT Day treatment

Mental Health Release Planning Employment Resources Vocational Rehabilitation Services – MN Field Offices AMICUS TASKS Unlimited Goodwill – Easter Seals New Leaf Workshop

Mental Health Release Planning Community Support Crisis phone numbers and outreach Local hospitals AA/NA meeting directories Transit information The essentials Clothing, food shelves, shelters

Mental Health Release Planning Prevention Plan Reviewed and processed with the offender To improve his/her cognitive thinking skills Build self-confidence in managing their mental health in the community

Mental Health Release Planning Summary and Key Points Frequent communication with various parties Within Department of Corrections Community mental health agencies Field agents Always aware of security of facility Limits of confidentiality

Mental Health Treatment Systems Look back DOC Treatment Systems Mental Health Release Planning

Mental Health Treatment Systems QUESTIONS