Outreach Campaign Promotes Early Intervention, Prevention

Colorado’s community mental health system can keep thousands of people out of the criminal justice system. That is the conclusion of a groundbreaking study commissioned by the Metro Area County Commissioners (MACC).

Statewide, approximately 28 percent of all inmates have a diagnosable mental illness.  These individuals are consuming a significant share of the $599 million the State of Colorado spent on corrections in 2007. Additionally, our cities and counties are spending millions more on people with mental illness as they repeatedly cycle through local courts and jails.

MACC commissioned the study, Transforming Services for Persons With Mental Illness in Contact With the Criminal Justice System, in 2008. Initial findings released last spring show that mentally ill inmates in the seven-county, Denver-metro area have an average jail stay of 121 days while non-mentally ill inmates average 25 days in jail. Offenders with mental illness also have much higher rates of recidivism due to many factors, including substance abuse, lack of access to mental health treatment, homelessness, and unemployment.

According to the report, it’s more cost-effective for all stakeholders to intervene with many of these individuals in a community mental health setting before they encounter the law enforcement system. Secondly, people with mental illness who end up in jail or prison must be assisted with transition programs to maintain their health and independence. Several programs are in place across Colorado, but the report recommends expanding these services and others.

“Colorado is spending 8.8 percent of the state’s general fund on corrections,” said George DelGrosso, Executive Director of the Colorado Behavioral Healthcare Council. “Providing services and support to people with mental illness can save money, reduce recidivism, and improve overall outcomes. This report provides important information that can be used by the state and local communities to guide their use of limited public resources.”

Several metro area counties have already launched initiatives to address the high cost of incarcerating people with mental illness. For example, Community Reach Center recently became the designated mental health provider to Adams County Detention Center through a contract with Prison Health Services (PHS). PHS provides primary health services to jails, prisons, and juvenile facilities in 22 states nationwide.  A team of two therapists and two case managers from Community Reach Center are now on-site at the detention center to provide services 10 hours per day, seven days per week.  A psychiatrist is on-site 20 hours each week. The Center will continue to provide emergency mental health services after hours, as needed. Prior to their release from jail, discharge plans will be developed for each consumer, to help them find a place to live and ensure that they have a therapy appointment scheduled.

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“According to the MACC study, longer periods of incarceration for inmates with mental illness costs the metro counties almost $34 million each year,” said Rick Doucet, CEO of Community Reach Center.  “The goal of this new program is to get these individuals into treatment, in order to support their recovery, self-sufficiency, independence, and break the costly cycling through the courts and jails.”

Another metro initiative to reduce recidivism and avoid incarcerating mentally ill people is through Arapahoe/Douglas Mental Health Network (ADMHN). Its Criminal Justice Services Team has numerous strategies to divert mentally ill individuals from jail when appropriate and also assisting people with mental illness with reentry back into the community when they are scheduled for release from prison or jail.

In November 2004, ADMHN formed a first-of-its-kind case management team to support the efforts of officers who have completed Crisis Intervention Training (C.I.T.).  Through the  Colorado Division of Criminal Justice, local law enforcement officers learn to recognize, work with, and divert those they encounter with mental illness to appropriate interventions rather than to jail. Upon referral from a C.I.T. officer, the case management team either provides or finds needed services such as psychiatric care, mental health treatment and community resources for the referred individual. This intervention effectively prevents the revolving door of people who are not able to access treatment services and then rotate through emergency rooms, hospital beds and jails.

At the request of the Arapahoe County Sheriff’s Department, Arapahoe/Douglas Mental Health Network added a Jail Reentry case management team in 2006 to provide services to those with mental illness who are leaving jail so that they can successfully return to the community. The Jail Reentry team helps individuals access mental health and substance abuse treatment services, apply for benefits, and find housing, transportation,  medications, education, social and vocational rehabilitation program, and other necessary supports. This makes it more likely that the individual will recover from illness, and successfully reenter, the community. The Jail Reentry program also decreases the likelihood of recidivism.

ADMHN, along with more than one dozen agencies and approximately 60 individuals from the mental health and the criminal justice systems, is collaborating to develop a mental health court in the 18th Judicial District. The first district-wide effort of this kind in Colorado, this court will link individuals with mental illness to treatment when appropriate through intensive Court supervision of community-based treatment. This is a more appropriate alternative to incarceration, which has proven to be more expensive, and far less effective, than treatment for such individuals.  Benefits include improved psychiatric stability for the offender and increased public safety for the community. The court will start accepting clients by July 2009.  Also unique is the target population, which will for the first time include non-violent felons who have a major mental illness. This project will also address the need for affordable housing and transportation for these individuals.

Colorado has approximately 35,000 inmates in state prisons and county jails. According to Colorado Department of Corrections estimates:

  • 61.2 of all inmates have mild to severe mental health needs;
  • 28.7 percent of the current inmate population has moderate to severe mental health needs (up from 19.9% in FY ’04); and
  • 78% of all inmates need treatment for substance use.

Treating indigent individuals in the community when possible costs about $3,109 per year. Untreated mental health problems can escalate without early intervention and proper treatment. It can lead to incarceration, which costs up to $65,818 per year and offers minimal, if any, remedial benefit.

Additional Recommendations In The MACC Report

  • Improve coordination between local police and the Veterans Administration.
  • Develop behavioral management plans and coordinate agency strategy for persons who repeatedly utilize crisis services.
  • Open lines of communication to judges and the courts.
  • Develop affordable housing alternatives for persons with a criminal history.
  • Improve funding for community mental health services for the indigent population. “Decreasing criminal justice costs must go hand in hand with increasing treatment dollars.”
  • Improve resources for long-term care to provide increased levels of care.
  • Develop a good neighbor policy and cooperate across city and county lines to help individuals whether or not they are a resident of the city or county where an offense occurs.
  • Increase access to inpatient psychiatric beds.
  • Explore diverse funding options. “Many areas of Colorado’s mental health system are under-funded, leaving major gaps in servicing indigent persons.
  • Create more diversion opportunities and expand Re-Entry Service Initiatives.
  • Involve consumers in future task force activity.
  • Streamline the Medicaid eligibility process and include local social service departments.
  • Explore a medication assistance program
  • Develop crisis triage centers.
  • Help improve the efficiency of the Social Security application process.
  • Identify and employ a standardized screening instrument.
  • Organize data collection efforts.
  • Prioritize action steps and gain momentum with quick solutions where possible.

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