Ohio Justice Alliance for Community Corrections October 13, 2011

MHAC’s Mission Foster education and awareness of mental health issues while advocating for public policies and strategies that provide an effective, well-funded mental health system that serves those in need, resulting in a stronger community.

What the MHAC Does The MHAC provides a unique forum for interested organizations to share experiences, needs and expectations of the mental health system; to set priorities and an agenda for change; and to speak with one voice on the public policies and funding issues that impact mental health. Work to create change leading to an effective, efficient, and integrated mental health system Promote diversifying resources to support maintenance and improvements to the current system of mental health service delivery Increase awareness, knowledge, and understanding of mental health and the impact of untreated mental illness on the community

By The Numbers: Developing a Common Understanding for the Future of Behavioral Health Care Completed in partnership with The Center for Community Solutions Purpose was to:  Consolidate and highlight existing statewide data on behavioral health to better inform policy decisions

Content Introduction Community Behavioral Health System Medicaid Spending for Individuals Previously Treated in the Community System Hospitals and Emergency Departments Long-term Care Adult and Juvenile Justice Primary and Secondary Education Premature Death Recommendations

Landscape Over 2.8 million Ohioans have a diagnosable mental illness Over 550,000 adult Ohioans have a severe mental illness Over 851,000 Ohioans have a substance dependence or abuse disorder Roughly 50% of individuals with a severe mental illness are also affected by substance abuse

Landscape Many individuals who need behavioral health treatment receive it; too many others do not Treatment and supportive services ideally should be available early enough to prevent the need for more costly interventions

Adult Criminal Justice ODRC provided the data for this section of the report ODRC provides outpatient care, prescription drugs, residential care and acute care psychiatric treatment Every new inmate receives a mental health evaluation at reception and further evaluations if necessary

Mental Health Caseload Inmates are assigned to the “mental health caseload” if:  They are on psychotropic medications prior to entry into the prison system and their evaluation indicates the need to continue medication and/or other treatments  They are referred based on the initial and detailed screenings at reception  Referrals from self or staff Inmates not on the “mental health caseload” can receive crisis services and/or up to 3 clinical contacts.

Mental Health Caseload Numbers 20.4% of the inmate population is on the mental health caseload 44.3% of the mental health caseload (9% of the entire inmate population) has a severe mental illness  This is higher than in the general population The number of inmates on the mental health caseload grows proportionately to the growth of the total inmate population

Recovery Services for Substance Disorders 35% of inmates receive recovery services Less than 1% of inmates utilize both substance abuse treatments and mental health services Unlike mental health services, substance abuse treatments are voluntary

Intake Study – Mental Health 67% of inmates did not have a history of a mental illness 29% received treatment for a mental illness prior to incarceration 4% either self-disclosed a mental illness or showed evidence of a mental illness Less than 1% had a diagnosis of a mental illness but had not received treatment prior to incarceration

Intake Study – Substance Disorders Over 78% of inmates showed evidence of recent drug abuse  Including 1.7% who reported receiving treatment in the last 6 months About 90% of inmates had a history of drug abuse  Including 33% that had received treatment more than 6 months prior to their arrest 49% of inmates have recent alcohol abuse 70% of inmates have a history of alcohol abuse

Average Length of Stay Less than 12% of inmates on the mental health caseload are serving sentences less than 1 year The average length of stay is 3 times as long for individuals on the mental health caseload  6 years and 2.5 months vs. 2 years

Recidivism 36% of individuals admitted to prison because of a probation violation have mental health needs Recidivism rates for individuals with and without severe mental illnesses are similar

Forensic Hospital Population Forensic patients use half of the state psychiatric bed days during the year Forensic hospital bed days are used for:  Restoring competency to stand trail  Individuals deemed Not Guilty by Reason of Insanity  Individuals deemed Incompetent to Stand Trail - Unrestorable

Juvenile Justice DYS provided the data for this section of the report DYS is responsible to confine and provide services to youth that have been adjudicated for a felony and committed to a facility. Not all youth adjudicated for a felony are committed to DYS Rate of commitment is 17%

Mental Health Caseload Growth From 2006 to 2010, the percent of youth on the mental health caseload grew by 14.5% 49.5% of youth in DYS facilities are on the mental health caseload 6% were on a mental health unit

Average Length of Stay Youth on the mental health caseload stay twice as long as the total DYS population  22 months for youth on the mental health caseload  11.9 months for the total DYS population

Juvenile Diversion Behavioral Health/Juvenile Justice Initiative diverts youth to community treatment Youth display improved functioning levels, decreased drug utilization and less risk for out of home placement after the program Youth also have decreased juvenile court involvement after the program

Recommendations - Funding If state policies change to require treatment instead of incarceration, then appropriate and adequate funding for behavioral health services must be allocated to build capacity to ensure services are available to all those in need.

Recommendations - Policy Federal and State rules and regulations around “aging out of foster care” need to be examined to allow for youth who turn 18 in the ODYS system to utilize the expansion of Medicaid for foster children.

Recommendations - Policy Improve connections and access to services for individuals leaving the custody of the adult and juvenile criminal justice system. Individuals with behavioral health disorders leaving state institutions must be connected with and have access to a continuum of adequate and appropriate community based services, including behavioral health services.

Recommendations - Policy ODRC should revisit policies around recovery services to refocus on appropriate and adequate treatment and education for alcohol and other drug abuse.

Recommendations – Additional Data Centralized data on the mental health caseload and spending for individuals incarcerated in jails. Further research on why prisoners on the ODRC mental health caseload are incarcerated 3 times longer than those not on the caseload and juveniles on the ODYS mental health caseload are incarcerated 2 times longer than those who are not.

Elizabeth Cornachione Program and Policy Director Mental Health Advocacy Coalition (MHAC) mentalhealthadvocacy.org facebook.com/MHAC.Ohio Questions & Answers