Bridging the Great Divide: Exploration of Self- Determination and Mandated Treatment MADCP Mental Health Training March 12, 2014 Angie Reid, MA AJ Kitchen,

Bridging the Great Divide: Exploration of Self-Determination and Mandated Treatment

MADCP Mental Health Training March 12, 2014

Angie Reid, MAAngie Reid, MA

AJ Kitchen, LMSWAJ Kitchen, LMSW

The System

9 to 19% of jail inmates are mentally ill.

One fourth of all jail inmates state that they have been treated for mental or emotional problems.

About twice as many incarcerated females have diagnosable serious mental illness.

It costs 30% more to house the mentally ill in jail due to the security and service needs of this special population.

There are more mentally ill people in our jails and prisons in this country than there are in psychiatric institutions.

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V. Morgan Moss, Jr., Ed. S., L. P. C.Penny Patton, Ed. S., L. P. C.

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The average length of stay in jail for a mentally ill person is about five times as long as for a normal inmate.

Rates of schizophrenia in jails and prisons are four or five times higher than in comparable groups in society.

Public mental hospitals are under mandates to serve fewer and fewer of the mentally ill making it more difficult to use this resource.

As many as 85% of inmates have substance abuse problems that further mask mental illness.

What Can Be Done…………..What Can Be Done…………..

Stages of Collaboration

11stst: Sharing information: Sharing information

22ndnd: Cooperation: Cooperation

33rdrd: Coordination: Coordination

44thth: Collaboration: Collaboration

55thth: Seamless Delivery: Seamless Delivery

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Collaboration: It’s an unnatural act between…

…two or more unconsenting adults.

DEFINITIONSMandated Treatment Mandated Treatment

CoercedCoerced

Compulsory Compulsory

Mandated Mandated

InvoluntaryInvoluntary

Legal pressureLegal pressure

Criminal justice referralCriminal justice referral

IT CAN WORK!!!IT CAN WORK!!!

Self-DeterminationSelf-Determination

Enhances AutonomyEnhances Autonomy

Promotes informed decision Promotes informed decision makingmaking

Identifies specific Stage of Identifies specific Stage of Change Change

Allows for non-judgmental Allows for non-judgmental planningplanning

Shared decision making can Shared decision making can lead to individual being lead to individual being INVESTED in their recovery INVESTED in their recovery

List benefit & risks to List benefit & risks to behaviors behaviors

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Court Liaison and It’s Many RolesCourt Liaison and It’s Many Roles

Assist with jail overcrowding by screening and providing alternative solutions

Being the “connector” between client and justice system

Assist with safety of individual & the community

Jail is not the source of treatment for Mental Health or Addictions unless the person is a harm to society. ***100% of the people are getting out of jail.

Bringing awareness to the systems

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Known Barriers of Collaboration Known Barriers of Collaboration Between the SystemsBetween the Systems

HIPPA/ EthicsHIPPA/ Ethics

Medical Model that shapes the “Medically Necessary” Medical Model that shapes the “Medically Necessary” criteria to treat within Community Mental Healthcriteria to treat within Community Mental Health

Denial/being labeled “mentally ill” - Stigma runs deep: In Denial/being labeled “mentally ill” - Stigma runs deep: In Oakland County Drug Court ¾ Women participants are in Oakland County Drug Court ¾ Women participants are in the Mental Health Court, while only ¼ of Men in MHC the Mental Health Court, while only ¼ of Men in MHC

Court systems “knee jerk” reaction to high profile cases; Court systems “knee jerk” reaction to high profile cases; changing of the guards with Probation and Judgeschanging of the guards with Probation and Judges

Identifying the driving force of changes & how Identifying the driving force of changes & how communication can give perspective communication can give perspective

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Fear of the therapeutic rapport being damaged if Fear of the therapeutic rapport being damaged if disclosure occursdisclosure occurs

Therapist fear of consumer “getting into more Therapist fear of consumer “getting into more trouble” if I disclosetrouble” if I disclose

Access to the most appropriate means of Access to the most appropriate means of treatment; which system is responsible for the treatment; which system is responsible for the consumers? MDOC, DHS, CMH, Substance Abuse consumers? MDOC, DHS, CMH, Substance Abuse etc…. etc….

The Access and Eligibility Determination Process

• To support the process the OCCMHA network uses the LOCUS (Level of Care Utilization System)

• The LOCUS is an empirical instrument which assists in determining eligibility and subsequent level of care decisions.

• The LOCUS assesses these dimensions:1. Risk of harm2. Functional status3. Medical, addictive and psychiatric co-morbidity4. Recovery environment

A. Level of stressB. Level of support

5. Treatment and recovery history6. Engagement and recovery status

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Gap Clients - Who are they and why do they matter?

Part of our system

Self medicate

Have a diagnosis but not SMI…. YET!

How can you help? Building a strong rapport cansecure a successful assessment

When the individual stops “self medicating” and can thenrecognize their need or ability to seek treatment within the mental health system

This can take several months to uncover and engage…

PATIENCE!!11

What we are seeing-Are more likely to be homeless, unemployed, sustained trauma and have a criminal history

-Those who fail community supervision are no more likely to be rearrested but 1.38 times more likely to be revoked.

-If they adhere to treatment: fewer arrests/revocations; decrease jail/prison days; fewer emergency visits and less hospital stays.

-Arrest rarely is a direct product of mental illness; even for mentally ill

-Leading risk factors (e.g., criminal history, young age, substance abuse, personality traits) for violence and other crime are shared by those with and without mental illness 12

Junginger, Claypoole, Laygo, & Cristina (2006)Bonta, Law, & Hanson (1998)

Risk and Criminogenic Needs The three core principles can be stated as follows:

Risk principle: How likely a person is to engage in criminal behaviors

Need principle: What areas in a person’s life should be targeted for intervention / supervision in order to decrease their likelihood of future criminal behavior

Responsivity principle: What personal strengths and/or specific individual factors might influence the effectiveness of treatment services

Andrews, 2001; Andrews & Bonta, 2006

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Risk Principle

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Target those offenders with higher probability of recidivism

Provide more intense services to higher-risk offenders

Targeting lower risk offenders can lead to increases in recidivism rates

Use an assessment tool that has been validated to determine risk level and criminogenic needs

Risk and Criminogenic Needs Predicting Risk of

Re-offending

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Work together and list your top 4 predictors of re-offending

Criminogenic NEEDS - Top Four

•Anti-social Attitudes: values, beliefs, rationalizations, and cognitive emotional states of anger, resentment, defiance

Anti-social Peers: Anti-social friends / acquaintances and relative isolation from pro-social others; it increases an offender’s risk if they have few or no pro-social supports in their life.

Anti-social Personality Pattern: restlessly aggressive, weak self control, adventurous pleasure seeking, egocentrism, weak socialization and problem solving skills

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History of Anti-Social Behavior: A history of anti-social behavior evident from a young age, involving a number and variety of anti-social acts; criminal record

These are knows as the “Big Four” Risk Factors

Most highly correlated with criminal behavior among all other factors

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The Remaining 4 Risk Factors

Family / Marital Factors: low levels of affection, care, cohesiveness; poor parental supervision and inconsistent discipline; neglect and abuse

Lack of Achievement in Education/ Employment: Low levels of achievement and satisfaction in school and at work; it is noted that IQ testing has no significance in this need area

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Lack of Pro-social Leisure Activities: Little involvement in pro-social leisure and recreational pursuits

Substance Abuse: Abuse of alcohol and/or drugs

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Andrews & Bonta, 2006 20

Non-Criminogenic, Minor NeedsNon-Criminogenic, Minor Needs

Self-esteemSelf-esteem

Vague feelings of personal distressVague feelings of personal distress

Anxious, feeling blueAnxious, feeling blue

Major mental disorderMajor mental disorder

Physical healthPhysical health

Learning disabilityLearning disability

Victimization IssuesVictimization Issues

There is no significant correlation between these NEEDS and criminal behavior but still need to be addressed

AGAIN…. THE C WORD

Collaborative partnerships between treatment and probation officers/court is key for offenders with high criminogenic risk factors and high clinical need These newer arrangements integrate roles, rules, and relationships between the two systems in ways that appear to allow the needs of mentally ill persons to be addressed without undermining public safety goals. Joseph P. Morrissey; Jeffrey A. Fagan; Joseph J. Cocozza

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A closer look at dual role relationship quality

• Relationship quality in mandated treatment – Therapeutic role– Surveillance role

Skeem, Eno Louden, Polaschek, & Camp (2007); Skeem & Manchak (2008); Kennealy, Skeem, et al. (2009)

How Can I Help?How Can I Help?Communicate, Communicate, Communicate

Having a valid ROI between consumers and legal system.

Asking questions: Have you ever received or are you currently participating in mental health treatment? Did you find it helpful?

If not currently engaged, make appropriate referrals/connections for assessment

Opening the lines of communication is specifically meant to be in the best interest of assisting the individual to “Successfully Complete” the court process.

Engaging in long term treatment to address Risk and Need factors.

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Tips for Continuum of Care

Remember… Crisis is an opportunity for changeRemember… Crisis is an opportunity for change

This is a community effort: Share the creditThis is a community effort: Share the credit

Acknowledgement and utilization of each agencies strengthsAcknowledgement and utilization of each agencies strengths

Be solution focusedBe solution focused

Remaining in treatment = Safety of the individual, safety of Remaining in treatment = Safety of the individual, safety of the community, saving tax dollars, reduction of jail/prison the community, saving tax dollars, reduction of jail/prison daysdays

Collaboration: “When spider webs unite they can tie up the Collaboration: “When spider webs unite they can tie up the lion”lion”

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QUESTIONS??QUESTIONS??????

THANK YOUFOR

ATTENDING!!!

Angie Reid: [email protected] 248-618-7621AJ Kitchen: [email protected] 248-417-0378