Julie has taken better physical care of herself and been clean for 14

Solutions
News & information about the AltaPointe Jail Diversion Program in Mobile County, Ala.
Volume 1 | Spring 2011
A personal story
INSIDE
‘My hope is to have a life’
I remember the first time I met Julie, one
of the first enrollees in the AltaPointe Jail
Diversion Program. We met at her friend’s
house where I introduced myself as her therapist. Nothing about her initial appearance
impressed me as unusual — a mother of two
in her mid 30s, dressed in jeans and a T-shirt.
She looked typical at first glance.
Then, I noticed her “I dare-you-to-cross
me” facial expression and street-wise attitude.
To a stranger, like me, she was intimidating.
Today, I have to laugh when I think about my
first reaction to Julie. After getting to know
her, I have learned
she is playful and likes
to joke; she is a very
kind, sensitive person.
Her hard appearance did not reflect
her as a person; it
reflected her experiences over many
years. With Julie’s
permission, I will tell you her story and the
way in which jail diversion has affected her life.
Julie was adopted at age six and regards
her adoptive parents as her real parents.
Before being adopted, she had been terribly
abused by her biological parents — an alcoholic and intellectually disabled father and
a drug-using mother. Her adoptive parents
were good to her, but she remembers having
lots of problems as a child and teen.
“I was locked up a lot [at the] youth
center… Bryce, state homes, mental hospitals;
a total of 12 altogether,” she said. “I had
problems that stemmed from the abuse.”
Julie ran away from home, had a temper
and felt unloved. She said she would fight
with the police. “Back then, I heard and saw
things; now I just hear things,” said Julie, who
experiences auditory hallucinations of people
talking to her. “I’ve always heard them.
Sometimes [I just] sit in a corner and cry.”
She began cutting herself as a child and
has scars on both arms. “I like the pain. I
start remembering stuff and the pain takes it
away.”
Julie said she began drinking alcohol and
smoking marijuana at age 18 and said she
“used every day all day.” She stopped smoking marijuana at age 24, and slowed down
on alcohol, but she began smoking crack
cocaine daily at age 27. The drugs eased the
emotional pain and made her not care about
the hallucinations.
In 2006, when
she was released
from jail after an
arrest, she had no
money or home,
felt suicidal and
had been victimized multiple times.
Police have arrested
and jailed her more than once for loitering for
the purpose of obtaining drugs, possession of
marijuana and violating her probation.
During 2008 and 2009, Julie was booked
into Mobile County Metro Jail four times
for various misdemeanors. She has not been
arrested since she entered AltaPointe Jail
Diversion in 2009.
A therapist and case manager began
meeting with Julie weekly when she began the
program, and a psychiatrist prescribed medications for her psychosis. Julie has stopped
using illegal drugs, has taken better physical
care of herself and been clean for 14 months.
Julie has reestablished her relationship
with her family. “As a mother and a daughter
my hope is to have a life, a life with my kids,
and to be happy.”
Julie has taken
better physical care
of herself and been
clean for 14 months.
— Mary Lee Collins, AltaPointe Therapist
2 What is AltaPointe Jail Diversion?
Criminal Justice, Mental Health
Coordination
3 Community Spotlight: Mark Lasko
NAMI Mobile
Defining Serious Mental Illness
4 Crisis Intervention Training
Scope of the Problem
5 Sequential Intercept Model
6 Jail Diversion on a National Level
Co-occurring Disorders Among Detainees
AltaPointe Jail Diversion
Advisory Board
Warden Trey Oliver, Mobile Metro Jail, Chair
Tommie Anderson, Franklin Primary
Mary Lee Collins, AltaPointe
Michelle Dees, AltaPointe
Elaine Dorgan, NAMI
Steve Green, Ala. Dept. of Community Corrections
Megan Griggs, AltaPointe
William Harkins, City Smart
Rodney Hill, Salvation Army
Michelle Johnston, Dept. of Human Resources (DHR)
Florence Kessler, City Smart
Stephen Lane, Rehab Services
Janet Langley, AltaPointe
Mark Lasko, Metro Jail
David Little, South Ala. Cares
Zina May, NAMI/ Advocacy
Paul Mclendon, Volunteers of America
Jennifer McMillan, Community Corrections
Jane McLaughlin, Defense Attorney
Cynthia Nelms, Mobile Works
John Pafenbach, Mobile County Administrator
Nicki Patterson, Mobile County District Attorney Office
Tim Perrin, Mobile Police Dept. Special Ops
Ray Phillips, Karagan House
Nancy Thompson, Housing First
Sgt. Ernest Treubig, Mobile Police Dept.–Special Ops
Cella Walker, AltaPointe
Jail Diversion prevents needless incarceration of SMI offenders
The AltaPointe Jail Diversion program
averts needless incarceration of nonviolent,
misdemeanor adult offenders involved in the
Mobile County criminal justice system who
have mental health and substance abuse issues.
Jail diversion helps stabilize mentally
ill residents and assists law enforcement by
reducing court involvement, recidivism,
unnecessary incarcerations and mental
healthcare expenditures.
Jail Diversion Services
• Assessment
• Clinical Services
– Psychiatric Services
– Counseling
• Individual
• Group
• Substance Abuse Treatment
• Case Management
– Referrals
•Housing
• Social Security Benefits
• Medical Care
• Vocational Rehabilitation
• Transportation
Jail Diversion Goals
• Prevent initial court involvement of
persons with Serious Mental Illness
• Decrease incarcerations of persons with SMI
• Minimize jail time of persons with SMI
• Engage offenders with SMI at the earliest
opportunity
• Provide continuity of care and supportive
services as persons with SMI are released
from jail and returned to the community.
The Mobile County Sheriff’s Office is responsible for the Mobile County Metro Jail. The facility houses
an average of 1,500 inmates per day and is the detention facility for the county and the City of
Mobile. Approximately 16 percent of prisoners in the Mobile County Metro Jail require mental health
assistance.
Direct Benefits
Referral Sources
• Offers judges and prosecutors alternatives
for disposing cases involving offenders
with SMI
• Makes more jail and prison space available for violent offenders
• Reduces costs
• Redirects individuals to the mental health
service system
• Typically made by jail mental health staff
or probation officers
• Sometimes received from attorneys or other
treatment providers
• Individuals are screened either at Metro
Jail or at an AltaPointe Adult Outpatient
facility. Once it is determined an individual
meets criteria, his/her attorney will be
notified before court, if possible.
Eligibility Criteria
• Misdemeanor offense or non-violent
felony offense
• Identified as having an SMI
• Current incarceration in the Mobile
County Jail or facing incarceration as part
of sentence
• Mobile County resident
Jail Diversion is NOT
• Usual emergency mental health crisis
response
• An effort to prevent future offenses, only
• Discharge planning
• Placement for NGRI or competency
restoration
Criminal justice, mental health coordination essential
Over the past two decades, groups that have planned jail diversion programs develop
broad-based community consensus and collaboration. Without coordination between the
criminal justice and mental health systems, conflicts occurred such as:
People with mental illness were greatly overrepresented in the criminal justice system
compared to the general population.
These individuals cycled in and out of the mental health and criminal justice systems
often receiving little, if any, treatment.
People with mental illness were costly and time consuming for law enforcement officers
and local jails. Courts became backlogged trying to deal with the influx of these cases.
People whose mental illness was untreated often acted in ways that the public considered to be frightening or threatening. However, when effective treatment and support
services were available and used, people with mental illness presented no greater risk to the
community than other people.
Source: “Mental Health Issues in Jail and Prisons,”
Michael J. Perlin and Henry A. Dlugacz; Durham, Carolina Academic Press 2008
An officer fingerprints an offender at Metro Jail.
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NAMI Mobile helps families, consumers
The National Alliance for Mental Illness, NAMI, is the nation’s voice on mental illness. It is a
nationwide, self-help organization for relatives or friends of individuals with mental illnesses
and to people with mental illnesses. NAMI Mobile is an affiliate of the national organization
and is dedicated to improving the lives of people with mental illness through advocacy, support
and education.
Each fall and spring, NAMI Mobile offers
the “Family-to-Family” course that provides
insight into and resolution of the profound
concerns experienced by families, close relatives, and friends coping with relatives who
have mental illnesses. The most recent classes
began March 15.
NAMI Mobile meets on the third Monday of each month from 7 p.m. to 8 p.m. at the
Springhill Baptist Church Activity Center in the Second Floor Craft Room. It offers a support
group on the third Monday of each month at 6 p.m. also at Springhill Baptist Activity Center,
Room 220. The activity center is located near the intersection of McGregor Avenue and Old
Shell Road.
Volunteers staff the NAMI Mobile office Monday through Friday from 10 a.m. to 2 p.m.
For further information call (251) 461-3450 or send an email to [email protected].
This information was provided by Elaine Dorgan, the NAMI Mobile and family representative on
The Jail Diversion Advisory Board.
Defining ‘Serious Mental Illness’
A current diagnosis of serious mental illness
is a primary criterion for an individual’s
acceptance into the jail diversion program.
There is often confusion about what qualifies
as a serious mental illness, also referred to as SMI.
This article clarifies this criterion based
on psychiatric diagnoses as categorized in the
Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV).
The American Psychiatric Association
publishes the DSM-IV, which covers all mental health disorders. Mental health professionals use this manual to better understand
patients’ illnesses and potential treatment. It is
helpful to third parties who need to understand the needs of the patient.
“Serious mental illness” includes the Axis I diagnoses listed below:
Schizophrenia & Other Psychotic Disorders
295.xx Schizophrenia
.30 Paranoid Type
.10 Disorganized Type
.20 Catatonic Type
.90 Undifferentiated Type
.60 Residual Type
295.40 Schizophreniform Disorder
295.70 297.1 298.8 297.3 298.9 Schizoaffective Disorder
Delusional Disorder
Brief Psychotic Disorder
Shared Psychotic Disorder
Psychotic Disorder NOS
Mood Disorders (Major)
296.xx Major Depressive Disorder
.2x Single Episode
.3x Recurrent
296.xx Bipolar I
.0x Single Manic Episode
.40 Most Recent Episode Hypomanic
.4x Most Recent Episode Manic
.6x Most Recent Episode Mixed
.5x Most Recent Episode Depressed
.7 Most Recent Episode Unspecified
296.89 Bipolar II Disorder
296.80 Bipolar Disorder NOS
Anxiety Disorders (Severe)
300.01 Panic Disorder Without Agoraphobia
300.21 Panic Disorder With Agoraphobia
300.22 Agoraphobia Without History of Panic Disorder
300.3 Obsessive Compulsive Disorder
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COMMUNITY
SPOTLIGHT
Lasko focuses on
after-care planning
Mark Lasko, our
newest board
member, represents Correctional
Medical Services,
the contracted
provider for
inmate medical services at
Mobile County
Metro Jail. Lasko
became the direcMark Lasko
tor of Mental
Health at Metro Jail in July 2010. Lasko has spent his entire career in
the field of mental health. His work has
included working as the director of an
adult group home, a school counselor, a
research analyst for the state of Maryland,
a drug and alcohol counselor, a mental
health therapist and an assistant clinical
director of mental health. Immediately
prior to moving to Mobile, Lasko was the
administrator of a mental health program
in the Delaware prison system. Throughout all of these positions,
Lasko has always attempted to better
the lives of others. He brings this desire
to Mobile and currently serves on the
AltaPointe Jail Diversion Board aiming to
improve the after-care planning of inmates
who suffer from mental illness. Through
this team, Mark says he hopes to see
inmates receive care not only while incarcerated, but after they are released. Introducing ‘Spotlight’
Successful intervention for individuals with
mental illness is a team effort. Through
insightful ideas, hard work and a personal
drive to help those with special needs, the
AltaPointe Jail Diversion Advisory Board
has many members who give their time
to make this effort a success. Each issue
of “Solutions” newsletter will highlight a
board member.
CIT offers law enforcement basic understanding of SMI
Crisis Intervention Training (CIT) provides
law enforcement officers with a basic understanding of mental illness and enhances
traditional law enforcement roles by offering
tactics and techniques proven to de-escalate
situations involving individuals in a serous
mental health crisis. When appropriate, law
enforcement can establish a link for these
individuals to services in the community.
This type of specialized training effort
throughout the country has resulted in
decreasing officer injuries, reducing SWAT
call-outs, reducing arrest rates and increasing
access to mental health services.
For example, in Memphis, Tenn., CITtrained officers have decreased officer injury
rates from one in every 28,571 events in the
three-year period prior to implementing CIT,
to one in every 142,857 events in the years following implementation. The San Jose, Calif.,
Police Department’s CIT program reported a
32 percent decrease in officer injuries over a
one-year period following program implementation (Reuland, 2004).
The rate of TACT (similar to SWAT)
calls in Memphis has decreased by nearly
50 percent since the implementation of
CIT (Dupont & Cochran, 2000); and in
Albuquerque, N.M., the use of SWAT teams
involving a mental health crisis intervention
has decreased 58 percent since implementation of CIT training objectives (Bower &
Pettit, 2001).
arrested (Reuland, 2004).
AltaPointe coordinated with Frank Webb,
M.Ed., a 30-year veteran officer with the
Houston Police Department, to provide two
trainings in 2007 and 2008, for frontline law
enforcement personnel in Mobile County.
Webb, a senior police officer, will return
to Mobile in the summer of 2011 to lead
another two-day presentation.
If you are interested in attending this
training, please contact Mary Lee Collins
at [email protected] or call (251)
450-5971.
Resources for this article:
Bower, D.L, and G. Petit. The Albuquerque police
department’s crisis intervention team: A report
card, FBI Law Enforcement Bulletin 70: 1–6, 2001.
Frank Webb, 30-year Houston Police Department
veteran, leads a Crisis Intervention Training.
When appropriate, individuals with serious
mental illnesses can be diverted into treatment
instead of facing criminal charges. CIT training reviews symptoms experienced by those
with mental illnesses and ways to effectively
respond to crises that involve those who
are mentally ill. The program in Houston,
Texas, is a model CIT program. An analysis
of Houston’s 1,439 CIT calls revealed that
only 17 people with mental illnesses had been
Adult Correctional Populations, 1980–2006
Probation
4,000,000
Dupont, R., and S. Cochran. Police response to
mental health emergencies—barriers to change.
Journal of the American Academy of Psychiatry and
Law 28(3): 228–244, 2000.
Reuland, Melissa. A Guide to Implementing PoliceBased Diversion Programs for People with Mental
Illness. Delmar, NY: Technical Assistance and Policy
Analysis Center for Jail Diversion, 2004.
Reuland M., Schwarzfeld M., Draper, L. (2009). Law
Enforcement Responses to People with Mental
Illnesses: A Guide to research-informed policy and
practice. Council of State Governments Justice
Center, New York, NY, 2009.
Scope of the Problem
• More then 14 million arrests
occur each year, involving
more than 9 million adults.
3,000,000
• More than 1 million arrestees
have serious mental illnesses.
2,000,000
• 75 percent of those with
serious mental illnesses have
co-occurring substance use
disorders.
Prison
1,000,000
Parole
Jail
0
1980
1985
1990
1995
2000
2005
4
• The vast majority will be
released to the community.
Room for growth
Sequential Intercept Model for Developing CJ–MH Partnerships
Probation
Prison
Jail
Sentenced
Jail
Pretrial
Intercept 5
Community Corrections /
Community Support
Probate
Intercept 4
Reentry
Dispositional Court
Intercept 3
Jails / Courts
Specialty
Court
First Appearance Court
Initial Detention
Arrest
Local Law Enforcement
Intercept 2
Initial Detention /
Initial Court Hearings
COMMUNITY
COMMUNITY
Intercept 1
Law Enforcement /
Emergency Services
A jail diversion program focused on helping those with mental illness has possibilities for growth in many areas. Based upon the
sequential intercept model, the current diversion program is focused primarily on Intercept Stage 1 and Intercept Stage 2.
Intercept Stage One — Law enforcement
Intercept Stage Two — Initial detention /
Initial court hearings
• 911: Train dispatchers to identify calls involving persons with
mental illness and refer to designated, trained respondents
• Police: Train officers to respond to calls where mental illness
may be a factor
• Documentation: Document police contacts with persons with
mental illness
• Emergency/Crisis Response: Provide police-friendly drop off at local hospital, crisis unit, or triage center
• Follow Up: Provide service linkages and follow-up services to individuals who are not hospitalized and those leaving the hospital
• Evaluation: Monitor and evaluate services through regular
stakeholder meetings for continuous quality improvement
• Screening: Screen for mental illness at earliest opportunity;
initiate process that identifies those eligible for diversion or
needing treatment in jail; use validated, simple instrument or matching management information systems; screen at jail or at court by prosecution, defense, judge/court staff or
service providers
• Pre-trial Diversion: Maximize opportunities for pretrial release
and assist defendants with mental illness in complying with
conditions of pretrial diversion
• Service Linkage: Link to comprehensive services, including care
coordination, access to medication, integrated dual disorder
treatment (IDDT) as appropriate, prompt access to benefits,
health care, and housing; IDDT is an essential evidence-based
practice (EBP)
Intercept Model defines intercept points within criminal justice system
Developed by Mark R. Munetz, MD, and
Patricia A. Griffin, PhD, the Sequential
Intercept Model provides a conceptual
framework for communities to organize
targeted strategies for justice-involved
individuals with serious mental illness.
Within the criminal justice system there
are numerous intercept points — opportunities for linkage to services and for prevention of further penetration into the criminal
justice system.
In 2006, Munetz and Griffin said that
“the Sequential Intercept Model … can
help communities understand the big
picture of interactions between the criminal
justice and mental health systems, identify
where to intercept individuals with mental
illness as they move through the criminal
justice system, suggest which populations
might be targeted at each point of interception, highlight the likely decision makers
who can authorize movement from the
criminal justice system, and identify who
needs to be at the table to develop interventions at each point of interception.”
By addressing the problem at the level
of each sequential intercept, a community
can develop targeted strategies to enhance
effectiveness that can evolve over time.
The Sequential Intercept Model has
been used as a focal point for states and
communities to assess available resources,
5
determine gaps in services and plan for
community change. These activities are best
accomplished by a team of stakeholders
that cross over multiple systems, including mental health, substance abuse, law
enforcement, pre-trial services, courts, jails,
community corrections, housing, health,
social services and many others.
Source: The Center for Mental Health Services’
National GAINS Center (2004). “Developing a
Comprehensive Plan for Mental Health & Criminal
Justice Collaboration.” Available at http://
gainscenter.samhsa.gov/pdfs/integrating/GAINS_
Sequential_Intercept.pdf.
Understanding How Jail Diversion Works on a National Level
Excerpts taken from full article, “Getting Inside
the Black Box: Understanding How Jail Diversion
Works,” August 2010, CMHS National GAINS
Center, Delmar, NY, www.gaincenter.samhs.gov
Co-occurring Substance Use Disorders
among Jail Detainees with SMI
Percentage WITH Co-occurring
Substance Use Disorders
Over the past 20 years, jail diversion for
persons with mental illness and co-occurring
substance use disorders has become a widely
accepted part of the criminal justice system.
The frequent contact with police by people
with unmet mental health needs and the high
rates of mental and substance abuse disorders
among correctional populations have created
broad support for diversion across criminal
justice, health and advocacy lines. Jail diversion programs provide a way to redirect
high-risk individuals from justice settings into
community-based services and supports, often
with judicial supervision.
The CMHS TCE Jail Diversion
Program
The Center for Mental Health Services
(CMHS) of the US Department of Health
and Human Services, Substance Abuse and
Mental Health Services Administration
(SAMHSA) has supported the development
and expansion of jail diversion programming
nationwide since 1992. After the initial 1997
Jail Diversion Knowledge Development
Application (KDA) demonstration project,
expansion efforts included authorizations
for the 2001 Targeted Capacity Expansion
(TCE) initiative and 2002-2007 TCE for Jail
Diversion Programs, followed by the 2008
13-state Jail Diversion and Trauma-Recovery:
Priority to Veterans initiative.
The New Freedom Commission on
Mental Health (2004) recommended jail
diversion as a public health and public safety
strategy. By connecting justice-involved people
with a serious mental illness to comprehensive
and effective mental health treatment in the
community, individuals would be stabilized
and communities could expect a reduction in
arrests, fewer jail days and lower charge levels
for subsequent arrests.
Over 18 years, there has been dramatic
program growth from 52 programs identified
in the initial 1992 national survey (Steadman,
Barbera & Dennis, 1994) to now some 560
programs operating across 47 states based on
current GAINS Center estimates.
Percentage WITHOUT Co-occurring
Substance Use Disorders
Source: The Center for Mental Health Services’
National GAINS Center (2004).
Convening the Experts
In January 2010, a small, diverse group of
researchers, policymakers and jail diversion practitioners convened in Bethesda,
Maryland, to assess what conclusions could be
derived from the TCE Jail Diversion cross-site
evaluation project data. Present were representatives from Policy Research Associates,
Inc., the Council of State Governments
(CSG), and Westat; federal representatives
from CMHS; program evaluators; psychiatrists; peer specialists; and criminal justice
professionals from the bench, prosecution and
defense. The group was charged with critiquing findings, using data from 14 post-booking
TCE I programs.
Major Findings
The TCE data showed the clearest impact of
jail diversion in the areas of drug and alcohol
use, functionality in daily living, re-arrest history and jail days, and timely service linkage.
Across each of these categories, data showed
improved outcomes for clients involved in a
diversion program.
Drug and alcohol use dropped dramatically during the first six months. Self-report
of any alcohol use dropped by more than 50
percent, while use of alcohol to intoxication
and illegal drug use both decreased 70 percent
from baseline with the decrease mostly
sustained at 12 months.
Assessment of individual improvement
and capacity for independent living showed
equal improvement: the daily living/role
functioning scale demonstrated improvements
in functioning with baseline reductions of -0.7
and -0.78 at six and 12 months from a mean 2.02 baseline (scale of 1-4). The Colorado
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28%
72%
Symptom Index (CSI) demonstrated an
average 30 percent improvement in symptom
reduction and well-being ratings.
Public safety improvements were observed
in 12-month data, with a 53 percent decrease
in arrests post-enrollment and a corresponding reduction in jail days from 52 days
pre-enrollment to 35 days at one-year postenrollment. Across charge history, 46 percent
of clients diverted on misdemeanor charges
and 49 percent of those diverted on felony
charges experienced no further arrests during
the following year, so that charge severity itself
made no difference to the likelihood of future
arrest or charge severity. Overall, diverted
clients had 44 percent fewer arrests and 33
percent fewer jail days (Case et al., 2009).
Data analysis identified three outcome predictors for future criminal activity: lengthier
prior arrest history, gender (with women less
likely to reoffend) and more illegal drug use.
Overall, the data demonstrated improvement in mental health outcomes with reduced
symptoms and improved well being, and
improvement in public safety outcomes, with
reduced re-arrest rates, lower charges, and
fewer jail days. These data also suggest the
predominant factor related to public safety
outcomes is past criminal behavior. However,
prior arrest history is, by itself, an insufficient
determinant of future risk. Other compounding risk factors must be considered and the
treatment and supports occurring within the
black box of the jail diversion process must be examined.
For the complete article and references, visit:
http://www.gainscenter.samhsa.gov/pdfs/jail_
diversion/Getting_inside_the_black_box.pdf