State Population (millions)

3. Percentage of Population with Mental Illness, Incarcerated and VeteransStudy Summary – Heartland States & US (Part 1) • State Population (millions) Average 4.6; Colorado 5.3, Iowa 3.1, Kansas 2.9, Nebraska 1.9, Missouri 6.1, Oklahoma 3.9 • Number of Inmates Average 16,416; Colorado 17,699, Iowa 8,069, Kansas 9,580, Missouri 31,513, Nebraska 5,097, Oklahoma 26,539 • Average Daily Cost per Inmate Average $64.28; Colorado $95.77, Iowa $90.81, Kansas $67.14, Missouri $56.81, Nebraska $71.36 Oklahoma $41.68 • Percentage of the Population who are Mentally Ill Average 19; Colorado 18, Iowa 18, Kansas 18, Nebraska 18, Missouri 19, Oklahoma 22 • Percentage of Incarcerated Population who are Mentally Ill Average 33; Colorado 29, Iowa 47, Kansas 38, Missouri 16, Nebraska 37, Oklahoma 33

4. Percentage of Population with Mental Illness, Incarcerated and VeteransStudy Summary – Heartland States & US (Part 2) 6. Percentage of Population Incarcerated who are Veterans Average 7; Colorado 9, Iowa 6, Kansas 8, Missouri 7, Nebraska 3, Oklahoma 6 7. Percentage of Incarcerated Veterans who are Mentally Ill Average 44; Colorado 33, Iowa 50, Kansas 66, Missouri 18, Nebraska 60, Oklahoma 35 8. Percentage of Incarcerated Mentally Ill Veterans with Less than an Honorable Discharge (no data for Nebraska and Oklahoma) Average 21; Colorado 22, Iowa 4, Kansas 10, Missouri 46 9. Percentage of Incarcerated Mentally Ill Veterans convicted of Violent Crime Average 68; Colorado 66, Iowa 53, Kansas 84, Missouri 64, Nebraska 95, Oklahoma 45 10. Data for the United States as a whole 2013 Population 316.1M, Number of Inmates 731,208, Average Daily Cost per Inmate >$60, Percentage of Population Mentally Ill 18; No data on Percentage of Mentally Ill who are incarcerated; No Data on Mentally Ill or Incarcerated Veterans

5. Percentage of Population with Mental Illness, Incarcerated and VeteransStudy Summary – Kansas Counties

6. Percentage of Population with Mental Illness, Incarcerated and VeteransThe Cost of Mental Illness Treatment • Cost of Mental Health Treatment • On average, per day, it costs: • $428 at a State Psychiatric Hospital • $292 at a Psychiatric Residential Treatment Facility • $80 at Larned Correctional Mental Health Facility • $9 for Medicaid reimbursed community treatment • Incarceration: • Paying for the costs of treating mental illness is unavoidable! • Our only decision is how we as a State pay for it. Community Healthcare Cuts by KS FY07 – FY12 = 65% Cumulative Suicide rate climbs 30% as Kansas cuts budgets Sources: Association of Community Mental Health Centers of Kansas 2012 Testimony , 2013 KDOC Annual Report and KS County Sheriffs

7. Percentage of Population with Mental Illness, Incarcerated and VeteransThe Cost of Untreated Mental Illness • Health Care Foundation of Greater Kansas City 2012 Study “TheCosts of Untreated Mental Illness in Greater Kansas City” • Study quotes: • A high proportion, 87.5%, of these costs is in the form of indirect costs to employers and individuals. Indirect costs include unrealized earnings due to higher unemployment rates, the cost of lost productive time at work due to untreated SMI (presenteeism), time missed from work (absenteeism), and unrealized earnings due to permanent disability or premature death (suicides) • Those with severe mental illness are 10 times more likely to becomeincarcerated compared to the general population. • One barrier might be reluctance to consider mental illness on par with physical illnesses. However, in the Surgeon General’s report on mental health, major depression was the second-leading source of disease burden worldwide, behind only heart disease. • Some might argue that state and local governments cannot afford to improve the treatment rate of the seriously mentally ill. This economic model shows that improving the treatment rate for the mentally ill is something they cannot afford to ignore. Source: HCFGKC: http://hcfgkc.org/costs-untreated-mental-illness and US Census Bureau 2013 Estimates for KS

8. Percentage of Population with Mental Illness, Incarcerated and VeteransThe Cost of Untreated Mental Illness $1.7 Billion

9. Percentage of Population with Mental Illness, Incarcerated and VeteransThe Cost of Untreated Mental Illness $312 Million

10. Percentage of Population with Mental Illness, Incarcerated and VeteransThe Cost of Untreated Mental Illness $65 Million

11. Recommendations • Annual conference call among interested Heartland state agencies, federal agencies, state NAMI, and national NAMI • Review common areas of concern • Discuss potential solutions • Request that DOJ collect and report on this data beginning in FY 2016 • State of Kansas consider 2015 legislation to provide: • Diversion programs to keep people with Mental Illness out of the criminal justice system connecting them with mental health treatment; • Therapeutic care (prescribed mediations and counseling) for incarcerated offenders living with mental illness; • If incarcerated, benefits such as Medicaid (KH&E) and Food Stamps (DCF) will be suspended in lieu of cancelled; • Discharge planning linking people with mental illness to community based services upon their release from correctional facilities including reinstatement of any suspended services; • KDOC and KS Counties which operate Detention Facilities collect and report data annually; • KU and / or WSU annual and random, unannounced, KDOC and KS County Detention Facilities audits; and • Require Court Services to determine veteran status of anyone charged with a crime and if convicted their status must become part of their incarceration profile instead of relying on “self-identification”. Requires access to Veteran’s data similar to HB2655

12. Recommendations - KS County Sheriffs & Wyandot Inc. • Issue: Continuation of Therapeutic Mental Health Care when Discharged Statue requiring engagement of Community Mental Health Services prior to discharge and continuation of Therapeutic Mental Health Care • Issue: Larned Correctional Mental Health Facility is typically full, understaffed and a long distance for Eastern Counties Evaluate use of Johnson County Detention Center in lieu of Larned for Eastern Counties • Issue: Crisis Intervention Training needed for all KS jurisdictions • Recommend that CIT International evaluate CIT needs for counties that implement or have implemented CIT; should not be unfunded mandate • Recommend that KDADS establish a fund for “seed” money to assist a county or city to establish or improve CIT. Use a “grant” process to request and select • Enact Warrantless Apprehension for Law Enforcement Allow detention up to 3 days in a mental health facility deemed suitable by the local mental health authority. • Need for Regional Acute Care Centers similar to Rainbow KDADS is working on this capability using funds announced in the Governor’s May 27th initiative

13. Supporting Documentation Appendix

14. Percentage of Population with Mental Illness, Incarcerated and Veterans

15. Heartland Data 2013

16. Percentage of Population with Mental Illness, Incarcerated and Veterans

18. Mental Health and Criminal Justice System Source Synopsis

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36. Mental Health, Incarceration and VeteransStudies & News Studies • Orange County Ground Breaking Event • CIT Training Overview • Apprehension by a Police Officer without a Warrant • Help for Veterans Involved in the Justice System • Mercer Report-State of KS.pdf • West Virginia Survey of Veterans – Final Report 2012 • Validation of Self-reported Veteran Status Among Two Homeless Groups • The Costs of Untreated Mental Illness in Greater Kansas City News • Suicide Rates Climb by 30% as Kansas Cuts Budgets • Home From War, Our Soldiers Continue to Die • Brownback: Society Needs to Handle Mental Illness as Treatable Disease • Improve Mental Health Care for Our Veterans • Veteran’s Father Fights for More Treatment Less Jail Time for Mentally Ill • Brownback Outlines Plans to Improve Mental Health Services for Mentally Ill Kansans • Veteran Shot Dead by Police after he was Refused Psychiatric Care by Kansas City VA • Kansas City VA also had Secret List • Huge Backlog – VA Audit Show VA Uses Secret Lists • Kansas Citians Push to Remove Stigma of Mental Illness • State Funding for Mental Health Lagging