Enhancing Cross-Systems Coordination for Mental Health in Pennsylvania's Justice System

1. 11/26/12 Assessing the Need in Pennsylvania Kirk Heilbrun Ed Mulvey Carol Schubert Katy Winckworth-Prejsnar

2. Funded By: • Pennsylvania Commission on Crime and Delinquency (PCCD) • Department of Public Welfare Office of Mental Health and Substance Abuse Services (OMHSAS) • Oversight by the Mental Health and Justice Advisory Committee of PCCD Collaboration between Drexel University and Western Psychiatric Institute and Clinic University of Pittsburgh Medical School

3. Center of Excellence Staff • Edward P. Mulvey, Ph.D., Co-Director Professor of Psychiatry, University of Pittsburgh School of Medicine • Kirk Heilbrun, Ph.D., Co-Director • Professor and Head, Department of Psychology, Drexel University • Carol A. Shubert, M.P.H., Senior Consultant • Research Program Administrator, Law and Psychiatry Program, Western Psychiatric Institute and Clinic • David DeMatteo, J.D., Ph.D., Senior Consultant • Assistant Professor, Department of Psychology, Drexel University Co-Director, JD/PhD Program in Law and Psychology, Drexel University • Patricia A. Griffin, Ph.D., Senior Consultant • Consultant for a variety of agencies and organizations including the CMHS National GAINS Center & TAPA Center for Jail Diversion, the Philadelphia Dept. of Behavioral Health, and the Montgomery Dept. of Behavioral Health • Amanda Cross, Ph.D, Senior Research Associate • Katy Winckworth-Prejsnar, Project Coordinator • Sarah Filone, M.A., Project Coordinator

4. Many of the same people in multiple systems: Mental health Substance abuse Criminal justice Other social services Expensive - high service users, people who cycle and recycle through the system The Problem SOLUTION: Cross-Systems Coordination

5. Pennsylvania Center of ExcellenceGoals & Tools • Diversion • Technical Assistance • Sequential Intercept Model • Cross Systems Mapping and Action Planning Workshops • Education • Presentations • Consultation • Website

6. Web-based Resource Center www.pacenterofexcellence.pitt.edu

8. Sequential Intercept Model as our Organizing Tool

9. Sequential Intercepts The Ultimate Intercept I. Law Enforcement/Emergency Services II. Post-Arrest: Initial Detention/Initial Hearings III. Post-Initial Hearings: Jail/Prison, Courts, Forensic Evaluations and Commitments IV. Re-Entry From Jails, State Prisons, & Forensic Hospitalization V. Community Corrections & Community Support Munetz & Griffin Psychiatric Services 57: 544–549, 2006

10. Useful Organizing Tool • Identifies • Existing local services and systems • Issues considered important to local stakeholders • Data • Diagnosis • Strengths to be built upon • Helps everyone see “big picture” & how they fit • Helps diverse groups from various systems understand where/how everything fits • Intercepts provide “manageable” venues and opportunities for systems interventions

11. Five Key Points of Interception • Law enforcement / Emergency services • Booking / Initial court hearings • Jails / Courts • Re-entry • Community corrections / Community support

13. Cross-Systems Mapping Workshops

15. Workshop Tasks • Nurture cross-system collaboration • Map the local system • Inventory current resources, gaps, and opportunities • Agree on priorities • Build an Action Plan

17. Washington County Cross Systems Map

20. Final Report • Cross-systems picture • Available for wide distribution • Provided in PDF and Word formats • County-Specific Narrative for each intercept • Gaps and Opportunities • Action Plan • Support for future funding applications • Reference/resource materials included Drexel University & University of Pittsburgh BlairCounty Report of the Cross-Systems Mapping Workshop June 8th and9th , 2011 Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System

21. Cross Systems Mapping Workshops What We’ve Learned About Pennsylvania

22. Common Gaps in Service • Intercept 1 • Law enforcement agencies have limited time for training • Law enforcement officers spend hours waiting with individuals at local hospital • Lack of detoxification and sobering services • Intercept 2 • Lack of pretrial services • Problems with video arraignment equipment • Intercept 3 • Many jail admissions requiring detoxification • Lack of treatment staff • Medical Assistance benefits terminated after admission • Intercept 4 • Significant gaps in aftercare medication • Limited continuity of care • Limited re-entry efforts • Few systematic efforts to reinstate or start MA and/or SS benefits • Intercept 5 • Not enough housing

23. What We’ve Learned About PA • Many opportunities as well: • Support for Training at Intercept 1 • Collaborative efforts among systems (CJABs, Problem Solving Courts, Forensic Treatment Teams) • Growing interest in Peer Support Services for forensic settings • Individuals dedicated to change

24. What We’ve Learned About PA • Most Common County Priorities • Training at Intercept One • Formalized detoxification procedure • Reduce strain on hospitals, jails, and law enforcement • Continuity of care from local jails to community • Aftercare Meds • Re-activation of benefits • Psychiatric Appointments • Housing • Information sharing across systems

25. 23/27 identified SPR as a top priority 3 already has some type of SPR training in place

26. Specialized Police Response (SPR) Training : • Crisis Intervention Training (CIT) • Advanced CIT addressing veterans, military culture, and trauma topics • Mental Health First Aid (MHFA) -12 hour • MHFA – Public Safety 8 hour • Crisis Intervention Specialist (CIS) Police School • Family Training and Advocacy Center (FTAC) training

27. Specialized Police Response to People with Behavioral Health Problems in PA: A Survey of the Commonwealth A summary of results

28. Background • Survey developed by the COE regarding specialized police responses in PA Counties • Requested by Judge Zotolla and members of the Mental Health and Justice Advisory Committee (MHJAC) • Three groups targeted: • Law enforcement • County Office of Mental Health • Criminal Justice Advisory Board (CJAB) • Distributed with the assistance of PCCD and OMHSAS • Reflects views between December 2010-January 2011

29. What the survey covers • Respondent information • Activities taken to address responses to people with behavioral health challenges • Training provided in the area of behavioral health • Cross-system collaboration to address problems related to individuals with behavioral health challenges • Resources needed to better respond to people with behavioral health challenges • Opportunities for and barriers to change related to improving response to individuals with behavioral health challenges

30. Who Responded • Law Enforcement • 84 responses • 33 counties (1-9 responses per county) • Mental Health • 31 responses • 27 counties (1-3 responses per county) • CJAB • 21 responses • 16 counties (1-4 responses per county)

31. Responses: Training Percent of responses (received training on behavioral health issues) (provided training on behavioral health issues) (training provided to law enforcement on behavioral health issues)

32. Responses: Collaboration Percent reporting collaboration (Collaboration with non-law enforcement agencies) (Collaborate with law enforcement)

33. Responses: Needed Resources (to improve responses to people with behavioral health challenges) • In forced responses - over 80% in all 3 groups identified • Additional training on mental health issues • Crisis mental health services • In open-ended responses – all 3 groups identified • More training • Better access to crisis intervention services • Better system collaboration in the county

34. Responses: Barriers (to improving the response to people with behavioral health challenges)

35. For more information www.pacenterofexcellence.pitt.edu Contact: Katy Winckworth-Prejsnar Research Coordinator kw494@drexel.edu