1 Diversion and Jail Discharge Strategies Presentation by Ron Honberg, NAMI National Alliance to End Homelessness Conference Washington, DC July 18, 2006

2... jails and prisons are de-facto “psychiatric hospitals”

3 Statistics  About 16% (in excess of 300,000) jail and prison inmates suffer from severe mental illnesses. (U.S. DOJ, 1999)  Prevalence rates even higher in juvenile justice facilities  Approximately 550,000 people on probation suffer from severe mental illnesses. (15% of total).  African-Americans and other minority populations disproportionately represented.  Nearly 3/4 of inmates with a mental illness have a co- occurring substance abuse problem.  20% of inmates with SMI were homeless during the year before incarceration.  Very high rates of recidivism, particularly among prison inmates with SMI (75%).

4 Types of Crimes  Jails - most individuals with SMI charged with non-violent misdemeanors or felonies.  Trespassing, disorderly conduct, public nuisance, loitering, etc.  Prisons - 53% of inmates with SMI convicted of violent crimes, versus 46% for all other inmates.

5 High Costs Inmates with severe mental illnesses cost more per day to incarcerate. E.g. Pa. Dept. of Corrections: –Average per diem cost of incarceration, inmates with SMI - $140 per day. –Average per diem cost of incarceration, all inmates - $80 per day.

6 Jail Diversion Pre-booking –Police-based (e.g. Crisis Intervention Team (CIT) Model. –Provider-based (e.g. Montgomery County, Pa.). Post-booking –E.g. Mental Health Courts Regardless of model, linkages with appropriate services are critical.

7 Essential Services Intensive case management/assertive community treatment (ACT), including mobile crisis management Supportive housing (preferably, permanent housing) Integrated mental health/substance abuse treatment Access to medications/medication management Acute care services Supported employment Peer education and peer supports

8 California’s AB 2034 Program

9 Cost Savings

10 Reentry Challenges and Opportunities How to initiate reentry planning prior to discharge? Timely restoration of benefits (SSI/SSDI – Medicaid/Medicare) Intensive mental health treatment and supports –E.g. Forensic Assertive Community Treatment (F- ACT) programs Housing and employment. Specialized parole and probation Information sharing Treatment engagement strategies.

11 Federal Funding for Diversion and Community Reentry Mentally Ill Offender Treatment and Crime Reduction Act (P.L ) –Currently a $5 million program. SAMHSA jail diversion grants. Federal Mental Health Courts program. Byrne grants (administered by DOJ, awarded to states).