1. DeCriminalizing Mental Illness in 2007 Is the Glass Half Full or Half Empty? Ron Honberg, Director of Policy and Legal Affairs, NAMI-National NAMI-NC Institute On Decriminalizing Mental Illness

2. The National Stats Approximately 2,300,000 people incarcerated in jails and prisons at year end 2005. 16% of all jail and prison inmates suffer from serious mental illness (conservative estimate). –368,000 people Approximately 550,000 people with serious mental illness on parole or probation. By contrast, approximately 70,000 people in hospitals at any given time –In many states, most of these are forensic patients.

3. ... jails and prisons have become the new psychiatric hospitals

4. High Costs of Incarceration Inmates with severe mental illnesses (SMI) 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. unpublished statistic provided to CJ/MH Consensus Project by John Shaffer, Pa. Department of Corrections.

5. Longer Incarceration Rikers Island (NYC) –Average length of incarceration: All inmates = 42 days Inmates with SMI = 215 days Pennsylvania Prisons –Inmates with SMI three times more likely to serve maximum sentences. www.consensusproject.org

6. Spending Money in All the Wrong Places! Florida spends roughly a quarter of a billion dollars annually to treat 1,700 individuals under forensic commitments. Purpose of this treatment is to restore competency to stand trial, not to help people recover. Federal Medicaid dollars cant be used for services provided in correctional settings or forensic hospitals. Denying services until people are in crisis is a penny wise, pound foolish strategy! Florida Supreme Court, Constructing a Comprehensive and Competent Criminal Justice/Mental Health/Substance Abuse Treatment System, November, 2007, http://www.floridasupremecourt.org/pub_info/documents/11-14- 2007_Mental_Health_Report.pdf

7. How Did We Get Here? Insurance disparities, managed care, and state cuts have made problems worse. Treatment is frequently unavailable until a crisis occurs. Care often is terminated after crisis, with no continuity or coordination between inpatient and outpatient. Police relied upon as front line crisis responders Inadequate hospital beds for people requiring inpatient treatment Treatment non-compliance Punitive society (retribution favored over rehabilitation)

8. Innovations from the Criminal Justice Field Collaborative efforts have led to progress on jail diversion and reentry. Hundreds of CIT programs throughout the country. At least 150 Mental Health Courts, plus other Court- based diversion models. Growing focus on reentry, e.g. Forensic-ACT, expedited restoration of benefits, etc. Initiatives to improve treatment of individuals with SMI who are incarcerated, including correctional training in Indiana and legislation to improve conditions of confinement in NY.

9. Does Jail Diversion Work? Does It Save Money? Does it Reduce Crime? Does it Help the People Intended to Benefit?

10. Cost Savings

11. Californias AB 2034 Program

12. Allegheny (Pa) Mental Health Court First independent cost-benefit analysis. Increase in mental health service costs (primarily Medicaid) virtually offset by decrease in jail costs. –State/local costs probably less since significant proportion of Medicaid funding is federal. Over two years, significant reductions in criminal recidivism and hospitalizations. No evidence of increased public safety risks. Rand Corporation, Justice, Treatment and Cost: An Evaluation of the Fiscal Impact of the Allegheny County Mental Health Court, 3/1/2007, http://www.rand.org/pubs/technical_reports/2007/RAND_TR439.pdf

13. The True Solution Lies In More And Better Mental Health Services Evidence based practices, including: –ACT –Integrated mental health/substance abuse treatment. –Supported Employment –Supportive Housing Peer services and supports Acute care beds and/or crisis stabilization services As last resort, court ordered inpatient or outpatient treatment

15. The National average is a D. Five states received Bs. Seventeen states received Cs Nineteen states received Ds (North Carolina got a D+) Eight states received Fs. Two states received Us. Grading the States

17. North Carolina - Positives CIT programs are being implemented throughout the state. Health insurance parity law passed! Growing interest in supportive housing (Housing 400 initiative). Strong mental health coalition. New MH leadership, dedicated oversight committee in legislature. Alternative to hospitalization programs being implemented in 4 sites.

18. North Carolina - Needs Although state has increased MH funding, overall spending is still inadequate. –State ranked 43 rd in per capita MH spending in 2006 Historically, state resources have been spent disproportionately on institutional care, not community services. Ongoing concerns about conditions in hospitals. State needs to invest more resources in evidence based practices, including ACT and Multi-Systemic Therapy (MST).

19. Financial Resources Criminal Justice/Mental Health Collaboration grants (U.S. Dept. of Justice – www.ojp.usdoj.gov/BJA) www.ojp.usdoj.gov/BJA –$5 million in FY 2007, $10 million in FY 2008 SAMHSA jail diversion grants (www.samhsa.gov).www.samhsa.gov Byrne Memorial State and Local Law Enforcement Assistance Grant Program (http://www.ojp.usdoj.gov/BJA/grant/byrne.html).http://www.ojp.usdoj.gov/BJA/grant/byrne.html More states (e.g. Georgia, Louisiana, Kentucky, Florida, Maine) providing grants for CIT and jail diversion. –Recognition that it is a cost-effective approach.

20. Websites and Resources Criminal Justice/Mental Health Consensus Project –www.consensusproject.orgwww.consensusproject.org National GAINS Center –http://www.gainscenter.samhsa.gov/html/http://www.gainscenter.samhsa.gov/html/ U.S. Department of Justice, Bureau of Justice Assistance (Mentally Ill Offender Treatment and Crime Reduction Act, etc.) –http://www.ojp.usdoj.gov/BJA/http://www.ojp.usdoj.gov/BJA/ NAMI website, www.nami.org, sections on:www.nami.org –Criminalization –CIT Action Center