Wayne State University Center for Behavioral Health and Justice Mental Health & Substance Misuse in Michigan’s Jail Population Presentation to the Michigan Joint Task Force on Jail and Pretrial Incarceration, September 20 th , 2019 Wayne State University Center for Behavioral Health and Justice Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 1
Wayne State University Center for Behavioral Health and Justice Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 2
Wayne State University Center for Behavioral Health and Justice Our Partners Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 3
Wayne State University Center for Behavioral Health and Justice Michigan Jail Data MI Mental Health Diversion Council Pilots in 10 Counties 2015 - 2019 Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 4
Wayne State University Center for Behavioral Health and Justice Data Collection • Prim imary Data • Standardized screen at booking on a sample, annually • Jail based identification, services, and diversion activities • Observation (jail processes) • Interviews / Monthly meetings since 2015 • Secondary ry Data (Linked to initial data) • SCAO/JDW – Court related sentencing/specialty court involvement • MDOC – prison post jail • CMH/Medicaid Data – treatment post jail incarceration • Law Enforcement/Dispatch call reports Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 5
Wayne State University Center for Behavioral Health and Justice Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 6
Wayne State University Center for Behavioral Health and Justice Intercept 2 Initial Detention/ Initial Court Hearings Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 7
Wayne State University Center for Behavioral Health and Justice What is the proportion of people entering jail with MH or SUD Disorders? • Who is determining? • Officer at arrest/booking • MH/Medical Professional • Current CMH involvement • Definitions: Serious and persistent; mild to moderate; suicidal? • When is the determination made? There is is no systematic approach or r standardized measure re required across ja jails in in th the state; so county estimates may not be accurate and are not comparable to each oth ther. Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 8
Wayne State University Center for Behavioral Health and Justice Systematic Screening for Serious Mental Illness (SMI) • Serio Ser ious Mental Il Illn lness ss: • Kessler 6 (K6) 1,2 : measures symptoms of psychological distress; SMI. • Score of 9 or higher in jail settings correlates with SMI 3,4 . • Substance Mis Su isuse se: • Alcohol and drug misuse • Opioid Preference • Withdrawal concern • Pas ast t treatment/medications, , ho housin ing instabil ility, rec ecidiv ivis ism 1 Kessler, R. C. , Andrews, G. , Colpe, L. J. , Hiripi, E. , Mroczek, D. K. , Normand, S. L. T., Walters, E. E. and Zaslavsky, A. M. (2002) Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine 32, pp. 959-976 2 Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., Howes, M. J., Normand, S-L. T., Manderscheid, R. W., Walters, E. E. and Zaslavsky, A. M. (2003) Screening for serious mental illness in the general population. Archives of General Psychiatry 60, pp. 184-189. 3 Kubiak, S.P., Beeble, M.L., & Bybee, D. (2009). Using the K6 to Assess the Mental Health of Jailed Women. Journal of Offender Rehabilitation, 48, 296-313. 4 Kubiak, S.P., Beeble, M.L., & Bybee, D. (2010). Testing the Validity of the K6 in Detecting Major Depression and PTSD Among Jailed Women. Criminal Justice and Behavior, 37 (1), 64-80. 5 Smith, P., Schmidt, S., Allensworth-Davies, D., & Saitz, R. (2009). Primary care validation of a single-question alcohol screening test. Journal of General Internal Medicine, 24 (7), 783-788. 6 Smith, P., Schmidt, S., Allensworth-Davies, D., & Saitz, R. (2010). A single-question screening test for drug use in primary care. Archives of Internal Medicine, 170 (13), 1155-1160. Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 9
Wayne State University Center for Behavioral Health and Justice Identifying SMI in Jail K6 Identifications Over Time SMI Identification by Type 35% 25% 30% 9% 9% 24% 24 23% 25% 20% 20% 20% 21% 11 11% 21% 21 15% 20% 20 19% 10% 13% 13 17% 5% 0% 15% 2017 2015 2017 2019 Jail K6 K6 + Jail Data Source: K6 Collection 2015, 2017, and 2019. Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 10
Wayne State University Center for Behavioral Health and Justice SMI by County Size 35% 30% • Rural jails have a higher 25% proportion of individuals with SMI in their jails 20% (34%), compared to 34% 34% metropolitan (21%) or 15% urban jails (19%)*. 21% 21% 23% 23% 10% 19% 19% 5% 0% SMI Overall Metropolitan Urban Rural *Difference statistically significant Data Source: K6 Collection 2019; N=3,802 Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 11
Wayne State University Center for Behavioral Health and Justice Substance Misuse by SMI and Demographics 17 17-24 24 25 25-30 30 31+ 31+ Females Individuals with SMI were more likely to report White individuals opi pioid pr preference & Older individuals were more likely to report were more likely to report drug drug misu suse opio pioid pr preference, were more likely to report opi pioid pr preference, than males* . opi pioid pr preference & al alcohol l misuse & alcohol al l misuse & al alcohol l misuse drug rug misu suse Males drug rug mis isuse than younger individuals*. than individuals were more likely to report than People of Color* . alc lcohol l misuse without SMI*. than females*. Data Source: K6 Collection 2019, N=3,802 *Difference statistically significant Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 12
Wayne State University Center for Behavioral Health and Justice Risks, Substance Misuse & SMI Alc AND Drug Alc AND Drug 14% 14% 26% 26% 51% 51% Alc OR Drug 66% 66% 37% 37% Alc OR Drug • Individuals with SMI had higher 40% 40% incidence of substance misuse, than individuals without SMI*. No Sub Use No Sub Use 49% 49% 34% 34% SMI Non-SMI • Individuals with SMI were much 0-1 risks 2 risks 3-4 risks more likely to experience more risk SMI 10% 10% 36% 36% 54% 54% for recidivism, such as: mental health issues, substance abuse Non- issues, housing insecurity, and 51% 51% 33% 33% 16% 16% SMI recent incarceration than those without SMI. *Difference statistically significant Data Source: K6 Collections across jails 2017, N=2,913 Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 13
Wayne State University Center for Behavioral Health and Justice Withdrawal Concern & SMI 20% 18% 16% 14% • Individuals with SMI are more 20% 20% 12% likely to report withdrawal concern (20%) than individuals 10% who do not have SMI (6%)*. 8% 6% 9% 9% 4% 6% 6% 2% 0% Withdrawal Concern SMI+ SMI- Data Source: K6 Collection 2019, N=3,802 *Difference statistically significant Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 14
Wayne State University Center for Behavioral Health and Justice Intercept 3 Jails/Courts Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 15
Wayne State University Center for Behavioral Health and Justice Jail-Based Mental Health Processes 100% 93% Failure to identify serious mental health 90% concerns at booking can result in reduced 80% access to services; increased risk to the individual, jail staff, and other inmates; 70% 64% and increased length of stay. 60% 50% 40% 30% 20% 10% 10% 0% Jail SMI Referral Assessment/Services Diversion Data Source: Jail-Based Services 2017; N=1,160 Kubiak, S.P., Comartin, E., Hanna, J. & Swanson, L. (2020). Identification, referral, and services for individuals with serious mental illness across multiple jails. The Journal of Correctional Health Care. All differences statistically significant Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 16
Wayne State University Center for Behavioral Health and Justice Days in Jail Non-SMI, 17 17 SMI, 34 34 0 10 20 30 40 After controlling for offense type, individuals with SMI spent 14 more days in jail than Non-SMI*. Data Source: County Jails 2017; Sample Size 1,160 *Difference statistically significant Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 17
Wayne State University Center for Behavioral Health and Justice Release Time 43% of individuals were Overnig ight Hou ours Busi siness Hours released during non-business (5 pm – 8 am) (8 am - 5 pm) hours (5 pm – 8 am). There 43% 43% 57% 57% was no significant difference between SMI and Non-SMI. Data Source: County Jails 2017; Sample Size 1,160 *Difference statistically significant Michigan Joint Task Force on Jail and Pretrial Incarceration – September 20, 2019 18
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