Turning Point: Criminal Justice to Behavioral Health

07/18/2016

For individuals entering the criminal justice system, the experience of incarceration can lead to disconnection from supportive relationships, weakened self-esteem, and additional trauma and violence. Those with behavioral health conditions have a particularly difficult time in jail and prison – not only do these environments impede recovery, they can make life even more challenging after release. Many justice systems, including police, corrections, and courts work closely with behavioral health agencies to screen for mental or substance use disorders and refer individuals who need help to treatment and support.

SAMHSA has been supporting jail diversion programs – criminal justice system-based screening, assessment, referral to treatment, and diversion efforts – for individuals, including veterans, who enter the system, in part, because of mental or substance use conditions. Jail diversion programs are set up to be a “positive pipeline” to connect the person with behavioral health supports, while offering the chance to reduce or avoid jail time in exchange for a commitment to pursue wellness and recovery.

While some communities have a well-established court-to-provider diversion system, others are just starting to explore what might be established in their community. SAMHSA has two new resources that can help.

Screening and Assessment

Successful screening and assessment early in the criminal justice process are key to diverting people into treatment programs.

The GAINS Center, a SAMHSA-funded technical assistance center that specializes in criminal justice and diversion efforts, provides training on the Sequential Intercept Model, an approach to illustrate the linear and predictable stages of the criminal justice system. Each stage presents an opportunity for identification and intervention for behavioral health needs. The goal of diversion is to move the person out of the criminal justice system (i.e., divert or intercept) and into treatment, and to do that as early in the process as possible.

Graphic of the Sequential Intercept Model

To better screen for and identify individuals who could benefit from diversion, SAMHSA developed the Screening and Assessment of Co-Occurring Disorders in the Criminal Justice System toolkit. This publication is particularly useful for professionals along the spectrum of intercepts in the criminal justice system so they can effectively screen for a range of behavioral health disorders, including depression, co-occurring disorders, suicide, trauma, and PTSD. The toolkit also includes an assessment resource to screen for motivation and readiness for treatment.

“This [toolkit] outlines the importance of using screening and assessments to determine the appropriate level of care for program participants.” – Cindy A. Schwartz, Jail Diversion Program in the Eleventh Judicial Criminal Mental Health Project in Miami, FL

Many communities are already using this screening and assessment tool. Loel W. Meckel, LCSW, Assistant Director of the Division of Forensic Services at the Connecticut Department of Mental Health and Addiction Services, believes that smart criminal justice policy requires a multidisciplinary response that addresses the predictors of recidivism and other factors that affect a person’s ability to succeed in the community. “This resource blends research-based information from multiple systems [drug, mental health, veteran, and domestic violence courts] into a user-friendly guide to reducing recidivism for justice-involved adults with co-occurring mental illness and substance use disorders,” said Mr. Meckel. “The information is relevant at all points of involvement in the justice system and would be very useful to frontline staff in the justice and behavioral health systems, as well as policy makers, administrators, and judges.”

Cindy Schwartz, MS, MBA, a project director of the Jail Diversion Program of the Eleventh Judicial Criminal Mental Health Project in Miami, FL, echoed this opinion. “Our program has been using these evidence-based tools and it has helped to promote transition plans that are based on individualized risks and needs instead of what is available in the community. It is the next step toward system transformation.”

A Resource for Municipal Courts

SAMHSA also recently published a resource specifically to support municipal courts in the diversion process. Municipal Courts: An Effective Tool for Diverting People with Mental and Substance Use Disorders from the Criminal Justice System looks at the challenges when individuals are first arraigned in court following an arrest (Intercept 2 in the Sequential Intercept Model), where screening, assessment, and diversion opportunities are often missed. This publication discusses obstacles and offers strategies that will help identify individuals for diversion at this early stage.

The publication recognizes the role of poverty as a driver of entry into the criminal justice system with individuals who have a low risk of reoffending. By putting a clinical program into the municipal courtroom, people with mental illness can get referred to support, while justice officials are reassured that those who are being diverted are getting the help that they need.

The resource also highlights the benefit of having peers in the courtroom. Because of their own similar lived experience, it is often easier for those coming into the system to connect with a peer to talk about the opportunities of diversion and treatment.

“The Municipal Court tool is a comprehensive and very practical resource,” said David Morrissette, Ph.D., LCSW, lead for the criminal justice work in SAMHSA’s Center for Mental Health Services. “Communities will save time finding updated screening tools in the appendix – and these tools will improve their programs and clinical processes.”

“I highly recommend that Courts use this report to guide program development in creating effective diversion processes.” – Loel W. Meckel with the Connecticut Department of Mental Health and Addiction Services

Mr. Meckel is also using this tool in Connecticut where he has experienced low-level municipal courts provide both opportunities as well as present barriers to identifying and diverting persons with mental illness and substance use disorders. For example, large caseloads and lack of resources may create hesitation to invest in diversion efforts, whereas having the right resources can make a significant difference in making the effort. He spoke about some of the tool’s content being practical and useful. In particular, he noted, “Details of successful programs provide concrete examples of how such courts use diversion on a daily basis.”

SAMHSA encourages key partners to use both resources in the effort to divert individuals who could benefit from behavioral health services. These key partners include probation officers (who often contract with providers); professionals working in specialty courts; people working in shelters and with the homeless population; and providers of treatment for mental and substance use disorders, who are integral reporters of engagement and progress to the courts.

Challenges in Treatment and Recovery

While SAMHSA provides funding, technical assistance, and resources for diversion programs around the country, states and communities determine what will work best for their jurisdictions. Many services and programs are supported through SAMHSA block grants. Treatment can be funded a number of different ways, but is primarily supported by health insurance. But even with the Affordable Care Act and improved access and coverage for behavioral health supports, many who come into the justice system are uninsured.

Having insurance to cover treatment is not the only obstacle. According to a recent SAMHSA short report, clients often experience difficulty “overcoming their criminal histories as they seek employment, rebuilding relationships with loved ones, and ending old patterns of problematic behaviors, such as ingrained maladaptive behaviors that lead to drug use and crime.” The report also notes that the majority of people do not have health insurance when they complete treatment – so continued support may not be affordable.

“These products stem from SAMHSA’s deep commitment to enhancing and expanding diversion efforts in the criminal justice system,” said Mr. Morrissette. “With awareness, tools, and commitment to positive change, the criminal justice system can prove to be a meaningful pathway to better health and a brighter future for many.”