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People with Mental Illness and Cognitive Disabilities in the Criminal Justice System

People with Mental Illness and Cognitive Disabilities in the Criminal Justice System

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People with Mental Illness and Cognitive Disabilities in the Criminal Justice System

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  1. People with Mental Illness and Cognitive Disabilities in the Criminal Justice System Bob Fleischner Center for Public Representation

  2. The Problem • At least 16% of the US prison/jail population has a serious mental illness. • Of the 10 million people booked in into US jails in 1997, at least 700,000 had a serious MI • Men involved in the MH system are 5 times more likely to be incarcerated than men in the general population; women 6 times more likely. • Same sorts of statistics for people with MR

  3. More problems • On any given day, L.A. County Jail holds as many as 3,300 individuals with MI • Recidivism rates for inmates with MI are over 70% in some jurisdictions • Once incarcerated, inmates with MI often decompensate • They are especially vulnerable to assault or intimidation

  4. Contact with Law Enforcement • Requests for police services • On-scene assessment • On-scene response • Specialized police units • Cooperation with MI/DD providers • Training for law enforcement personnel

  5. Pre-trial, Adjudication & Sentencing • Diversion efforts and programs • Effective assistance of counsel • Prosecutorial review and decisions • Evaluation and assessment • Adjudication and sentencing • Probation conditions • Incarceration

  6. Legal right to mental health services • Estelle v. Gamble, 429 U.S. 97 (1996) • 8th Amendment requires that prison officials • Not be “deliberately indifferent” (subjective component) to • The “serious medical” needs of inmates (objective component).

  7. Objective component – Serious medical need • Generally, prisoner have a right to treatment if health care provider concludes with reasonable degree of medical certainty: • Prisoner’s symptoms evidence serious disease or injury • Disease or injury is curable or may be substantially alleviated • Potential for harm to inmate by delay or denial would be substantial. • Bowring v. Godwin, 551 F. 2d 44 (4th Cir. 1977)

  8. Basic components of prison MH system • Screening and evaluation • Treatment modalities • Qualified mental health staff in sufficient numbers • Special needs units & inpatient hospitalization • Accurate MH records • Discharge planning • QA program

  9. Screening & assessment • Everyone at least upon admission • To identify MI or DD • By specially trained staff • Confidential • Prompt referral for comprehensive assessment by MH professional if necessary

  10. Qualified mental health staff • Sufficient numbers of qualified and trained staff • Physicians (psychiatrists), psychologists, social workers • Reasonable case loads

  11. Treatment modalities • Medication • Prescribed by psychiatrist • Monitored • Formulary should contain a range of psychiatric medications • Overall therapy program • Emergency services

  12. Special units & inpatient • Special housing for more intense treatment • Transfer to psychiatric hospital or facility

  13. Accurate mental health records • Accurate • Complete • Up to date • Well organized • Confidential

  14. Discharge planning • Benefits • Housing • Medications • Treatment follow up services

  15. Quality assurance • Studies of utilization patterns • Studies of clinical outcomes • Policies

  16. Special issues • MH treatment in isolation • Use of physical restraint • Suicide prevention • Discipline • Access to programs and credits