Mental Health & Substance AbuseRe-Entry Efforts

Presented by Dean Aufderheide, PhD., Mental Health Service Director,

on behalf of Daniel G. Ronay, Chief Deputy Secretary,

Florida Dept. of Corrections

Just the Facts

United States is about 5% of world population, but incarcerates 25% of world’s inmates

40% of individuals with serious mental illnesses have been in jail or prison at some time in their lives

Americans with severe mental illnesses are 3 times more likely to be in jail or prison than in a psychiatric hospital

In less than three decades, the percentage of seriously mentally ill prisoners has almost tripled from about 6% in 1983 to 15-20% today

Defining the Problem

According to the NAMI report, Florida is 49th in the nation in per capita spending on mental health services

In Florida, a person with serious mental illness is 5 times more likely to be in a jail or prison compared to in a hospital.

There are more inpatient beds in the Florida prison system than the number of involuntary civil commitment beds in Florida’s state hospital system

18% of the inmates in the Florida DOC have a diagnosed mental disorder that requires mental health treatment

2010 Survey of states by the Treatment Advocacy Center and the National Sheriffs’ Association

Florida Mirrors the National Trend in Mentally Ill Population

59% Increase, but Has Stabilized Over Past 3 Years at About18%

2002 2003 2004 2005 2006 2007 2008 2009 2010 -

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

Mental Illness in by Mental Health Grade

Total Inmates 101,767

82%

4%

13%

1%

S1S2S3S4-S6

Florida Department of Corrections - Bureau of Research and Data Analysis - February 14, 2011

Increase in the Percentage of Inmates with Severe and Persistent

Mental Illness (SPMI) within the Mentally Ill Population

1995 20100%

5%

10%

15%

20%

25%

30%

35%

40%

45%

17%

40.%

(Psychotic Disorders, Bipolar Disorders, Major Depression)

Florida Department of Corrections, Date Bureau of Research & Data Analysis

Mental Health ReEntry ProgramMeeting the Challenge in Florida

Creating an Interagency Agreement between the Department of Corrections and the Department of Children and Families

Coordinating with the Social Security Administration to complete SSDI/SSI applications

Establishing Community Partnerships with Stakeholders

Created a Central Office full-time staff position in mental health to provide oversight and coordinate aftercare services statewide and with stakeholders

Created new institutional Mental Health ReEntry Specialist positions solely dedicated to coordinate aftercare services

Number of Offenders Eligible for Post-Release Aftercare Planning Annually

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 -

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

2,177 2,367 2,503 2,891 2,740

3,141 3,632

4,526 4,481 4,287

8Florida Department of Corrections; Bureau of Research and Data Analysis; November 30, 2010

DCF Mini-Mainframe

DC/DCF Web-Based Electronic Referral System

Veteran’s Administration

Agency for Health Care Administration

Parole and Probation

Agency for Persons with Disabilities

County Sherriff’s

Department

DC

Mainframe

DCF Web Interface

DC staff enter referral information into DC Mainframe

Encrypted file transfer

DCF staff receives email notice of referral and assigns community provider based on the county of destination

DC, DCF, CMHC providers have access to aftercare database.DC staff obtains aftercare

arrangements from aftercare database / communicates information to inmate.

Updated Weekly

DCF staff calls provider to establish appointment.

DC referral information de-encrypted

Office of Homelessnes

s

Agency WorkforceInnovation

Florida Institute Legal Services

DCF Office of DisabilityDetermination

Potential Stakeholders

“Seamless Delivery System”

CommunityCorrectionsPrograms

In-PrisonPrograms

Residential Short-term (6 months)

Residential Long-term Therapeutic

Community

Aftercare

Upon Admission:IP

Screening

Prevention

Motivational Groups

Intensive Outpatient

Substance Abuse Transition Centers

Residential Therapeutic Community

Support Groups

Upon Release: IP

Post-Release Substance Abuse Transitional Housing

Upon Admission: CC

Assessment (if court ordered)

UA Testing

Outpatient

Type of In-Prison Inmate Treatment2,533 Department Slots

Intensive Outpatient: 1,168 • 14 – Correctional Institutions

Residential Therapeutic Communities: 606 • 5 – Correctional Institutions• 1 –Pre- Release Community-Based

Substance Abuse Transition Centers: 759 Prevention/Outpatient/Aftercare

• 6 – Pre-Release Community-Based

1,048 - Male 120 - Female

561 - Male 45 - Female

503 - Male

256 - Female

In-Prison Substance Abuse Gaps in Services vs. Need FY 2009-10

NEED

65%

35,810 inmates were provided screening assessments at reception.

~65% of the total inmate population have consistently been screened to be in need of substance abuse treatment services.

Approximately 19% of those have a co-occurring SA & MH disorder.

84% of released inmates that needed treatment; did NOT receive it.

Total = 102,232 As of June 30, 2010 -

2,533 available department substance abuse treatment slots.

775 Short – term – 73% 286 Long – term – 27%

Community Corrections Substance Abuse and Mental Health Resources

1,061 – Contracted Residential Substance Abuse Treatment Beds 775 Short – term – 73% 286 Long – term – 27%

37 - Contracts for Outpatient Substance Abuse Programs and 22 Contracts for Outpatient Mental Health and Sex Offenders Treatment available throughout the 20 circuits.

Community Corrections Substance Abuse: Gap vs Need FY2009-10

•On 6/30/10, 152,928 offenders were on active supervision.•Approximately 55.8% (85,341) offenders supervised are potentially in need of

substance abuse treatment.

Statistics compiled by the Bureau of Research & Data Analysis

Need

Total

Special Collaborative Re-Entry Project

• At Century Correctional Institution the Department of Children and Families is funding a Reentry Case Manager position that provides case management and follow up services to inmates with substance abuse problems released from Century CI to the Escambia County area. Services include: – Family connectivity– Housing Referrals– Substance Abuse referrals/follow up– Mental Health referrals/follow up– Case management

Seeking New Funding Opportunities and Partnerships

• Partnering with two community-based treatment providers the Department submitted a 2nd Chance Grant application for Adult Offenders with Co-occurring Disorders in June of 2011 .

• The program, if funded, would target inmates with co-occurring substance abuse and mental health disorders located in the Department’s Therapeutic Community Program at Jefferson Correctional Institution who are returning to the Circuit 2 vicinity.

• Post –release re-entry services include mental health and substance abuse aftercare and case management services, follow-up psychiatric care, and medication management. Based on individual needs, housing, transportation and employment skill training will be provided.

.

Circuit 17 Program Targets Severely and Persistent Mentally Ill

• In 2006, based on legislative appropriation, the Department partnered with Henderson Mental Health Center to develop a pilot program that provides intensive, specialized re-entry rehabilitation and support services to probationers and released inmates who have a severe and persistent mental illness. This program continues today.

• Program Goals include successful re-entry by preventing unnecessary psychiatric hospitalization(s), incarceration(s) or crises.

Prison Diversion

• Currently, Circuit 13 has the only pilot prison diversion program (PDP)

• Offenders are sentenced to the program in lieu of prison. Program provides varying levels of care.

• Individuals in need of mental health services receive services through the provider’s psychiatrist or referred to an outside provider.

• Offenders in need of substance abuse treatment receive services through the program.

Probation Officers work with Mental Health Courts

• Circuit 15- Mental Health Court• Circuit 17-Mental Health Court• Circuit 12-Sarasota County Mental Health Court

was established in the 1990’s. • Circuit 13-Pre Trial Intervention Mental Health

Court• Circuit 20-Lee and Collier counties have Mental

Health Courts• Circuit 8 –Alachua County Mental Health Court• Circuit 2 – Mental Health Court

Veterans Dorm Program

• Over 6,700 self-reported Military Service personnel

• Identified Dorms– 6 dorms sites

Inmate relocation in process Curriculum development in process

• Identify programming– Thinking for a Change, staff trained– Establishment of community partners

and stakeholders

Veteran Inmates Requiring Post-Release Mental Health/Substance Abuse Treatment

4%

96%

Veterans(115)

Non-Veterans(3200)

828

25 114

6

Routine Care

Outpatient w/o Medications

Outpatient with Medications

Inpatient

Level of Service Required for VeteransInmates referred to DCF/VA for Post-ReleaseMental Health/Substance Abuse Treatment in 2007

The Florida Department of Corrections, Bureau of Research and Data Analysis, Inmate Data Section, January 29, 2008; (1) National Survey on Drug Use and Health, “Male Users with Co-Occurring Serious Mental Illness and a Substance Use Disorder,"  Nov.11, 2004,  http://www.oas.samhsa.gov/2k4/vetsDualDX/vetsDualDX.htm ;

In 2002/2003, an estimated 1.2 million male veterans were identified as suffering from serious mental illnesses.

Approximately 340,000 of these individuals had co-occurring substance abuse disorders (1). 

Recidivism Reduction Initiatives and Priorities

Increase the number of Pre-Release Substance Abuse Treatment slots.

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Recidivism Reduction Initiatives and Priorities

Increase mental health training opportunities for Probation and Correctional Officers

Increase communication between Institutional Substance Abuse Treatment Staff and Mental Health Treatment Staff

Enhance continuum of care by increasing communication between Institutions and Community Corrections staff

Recidivism Reduction Initiatives and Priorities

Develop one (1) additional Pilot Prison Diversion Program in a rural circuit.

Partner with Florida Certification Board, Florida Alcohol Drug Abuse Association, and Substance Abuse providers to replicate a certification process for a Recovery Specialist Credential.

Recovery Health Network Discount Prescription Drug Cards

The Importance of Collaborative Leadership to the Right Thing, the Right Way for the Right Reasonsin Our Mental Health and Substance Abuse Programs

When They Succeed, We Succeed!