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St Steppin ping g Up: : Ke Key y Considerati siderations ons fo for Reduci ducing ng Ment ntal al Il Illness ess in Ja Jails ls The 6 th Amendment Right to Counsel: Representing the Mentally Ill Client Colette Tvedt NACDL

  1. St Steppin ping g Up: : Ke Key y Considerati siderations ons fo for Reduci ducing ng Ment ntal al Il Illness ess in Ja Jails ls

  2. The 6 th Amendment Right to Counsel: Representing the Mentally Ill Client Colette Tvedt NACDL ctvedt@nacdl.org

  5. Mental Illness in Jails Report

  6. 10X’s as many MI people in jail than hospital

  8. For Mentally Il Ill l In Inmates at t Rik ikers Is Isla land, a Cycle of f Jail il and Hospit itals • 40 % of the population at Rikers, a total of 4,000 men and women at any given time, more than all the adult patients in New York State psychiatric hospitals combined. • Studies show they are more likely than other inmates to be the victims as well as the perpetrators of violence.

  9. Justic ice Anth thony Kennedy: Soli litary Confinement 'L 'Lit iterally ly Driv ives Men Mad

  10. Kali lief Browder Took His is Own Lif ife, but t th the System Murdered Him im

  11. Counsel services in America are in a state of crisis ECONOMICALLY UNSUSTAINABLE UNWORTHY OF A LEGAL SYSTEM THAT STANDS AS AN EXAMPLE TO ALL THE WORLD

  12. Public Defense in America • Each state has a constitutional obligation to provide access to counsel under the 6 th Amendment • Between 60 and 90 percent of defendants charged with a crime cannot afford an attorney • Budget issues and competing criminal justice priorities have left many states with critically under-funded public defense systems

  13. Public Defense • An effective system of public defense can • Keep innocent citizens out of jail and prison • Keep mentally ill people out of jail and get them services • SAVE $$$$ • Some states and jurisdictions (UT, New Orleans, NY) are being or have been sued because of years of under-funding and shortcomings in their public defense systems • People languishing in jails for months- years without a lawyer

  14. Solutions • Increase services • Diversionary Programs • Mental Health Court • Crisis Intervention Training (CTI) for law enforcement • More training for prosecutors, judges, PTS, intake at jail and defenders • Avoid criminalizing people with mental illness • MORE FUNDING FOR PUBLIC DEFENSE

  15. Supportive Housing for The Source for Justice-Involved Individuals Housing Solutions Whitney Lawrence, CSH

  16. Why does housing matter? Supportive Housing will reduce the revolving door between incarceration, hospitalizations, and homelessness. Frequent User Case Study DHS DOC DHS DOC DHS DOC DHS DOC DHS DOC DOC DHS DOC DHS DOC DHS DOC DHS 1-Jan-01 15-Jan-01 26-Jan-01 3-Feb-01 21-Feb-01 9-Mar-01 22-Mar-01 14-Jun-01 18-Jun-01 17-Jul-01 23-Jul-01 4-Aug-01 7-Sep-01 16-Oct-01 12-Nov-01 21-Dec-01 8-Mar-02 9-Mar-02 5-Apr-02 8-Apr-02 2-Aug-02 31-Dec-02 DHS DOC Neither System

  17. Key Philosophies Housing First   Emphasizes rapid access to permanent housing  Support services focused on housing stability  N o “housing readiness” standards or other barriers to housing Right-sizing interventions  Immediate access to housing Housing is the platform for stabilization.

  18. What kind of Housing do people experiencing homelessness need? It varies! The needs of people who experience homelessness exist on a spectrum. An individual’s level of need determines what kind of housing is most appropriate. Section 8 Permanent Section 8 Rapid Re- Voucher with Supportive Voucher Housing Services Housing Lower Need Highest Need Individuals Individuals and Families and Families

  19. Understand the Components PSH • Very Vulnerable, chronically homeless • Non-disabled, high barrier TH • Requiring structured treatment • Most homeless families RRH • Newly homeless • Target those at-risk who actually Prevention enter system • Interim housing <30 days while ES waiting for Housing

  20. The Beginning: New York City FUSE Remember this graph? Frequent User Case Study DHS DOC DHS DOC DHS DOC DHS DOC DHS DOC DOC DHS DOC DHS DOC DHS DOC DHS 1-Jan-01 15-Jan-01 26-Jan-01 3-Feb-01 21-Feb-01 9-Mar-01 22-Mar-01 14-Jun-01 18-Jun-01 17-Jul-01 23-Jul-01 4-Aug-01 7-Sep-01 16-Oct-01 12-Nov-01 21-Dec-01 8-Mar-02 9-Mar-02 5-Apr-02 8-Apr-02 2-Aug-02 31-Dec-02 DHS DOC Neither System

  21. Supportive Housing is the Solution Supportive housing combines affordable housing with services that help people who face the most complex challenges to live with stability, autonomy and dignity. Employment Services Parenting/ Coaching Case Life Skills Management Housing: Support: Affordable Flexible Affordable Permanent Voluntary Housing Independent Tenant-centered Primary Substance Health Abuse Services Treatment Mental Health Coordinated Services Services

  22. Supportive Housing is for People Who:  Are chronically homeless.  Cycle through institutional and emergency systems and are at risk of long-term homelessness.  Are being discharged from institutions and systems of care.  Without housing, cannot access and make effective use of treatment and supportive services. 22

  23. Evaluation Results: FUSE Reduces Recidivism Results from Columbia University’s evaluation of the New York City FUSE program, released in November 2013 40% fewer jail days  91% fewer shelter days  50% fewer psychiatric  inpatient hospitalizations (not shown) Cost benefit analysis  showed $15,000 in savings per client

  24. Total Public Cost Avoidance for 10 th Decile $47,977 in estimated annual public costs avoided by housing 10th decile patients $70,000 $67,376 Probation Sheriff mental health jail $60,000 Estimated annual Sheriff medical jail public cost for 10th Sheriff general jail decile patients in $50,000 LAHSA homeless srv. Annual Cost in 2012 Dollars evaluation, using GR Housing Vouchers propensity scoring: General Relief n = 89 $40,000 Food Stamps $67,376 when homeless Paramedics $19,399 when in PSH $30,000 Substance abuse srv. Mental Health $19,399 Navigation and housing $20,000 costs not included County outpatient clinic Private hospitals-ER Health Srv - ER $10,000 Private hospital-inpatient County hospital-inpatient $0 When Homeless In Permanent Supportive Housing Getting Home: Outcomes from Housing High Cost Homeless Hospital Patients The Economic Roundtable, September, 2013 24

  25. What could this look like in your community?

  26. What could this look like in your community?  The Coordinated Entry System – a front door to services.  Reentry programs leverage the Coordinated Entry System (CES)- no dumping  Court System links to CES  Jail diversion & intercepts are part of CES design  Housing intercepts are part of CJ system design

  27. What can you do?  BE A CHAMPION – CULTIVATE CHAMPIONS  Data!  Connect to the housing world  Coordinated Entry System  Public Housing Authorities  Talk to CBOs, learn where the barriers are How can I create systems change?  Realign Resources  Do not trade the perfect for the very good – Systems change takes time!

  28. Where you can find me Whitney Lawrence whitney.lawrence@csh.org (213) 623-4342 ext. 16

  29. Housing Programs of the Office of Diversion and Reentry Corrin Buchanan Diversion and Reentry Housing Director cbuchanan@dhs.lacounty.gov

  30. OD&R HOUSING PROGRAMS 1. 1000 units of ODR Supportive Housing 2. 300 units funded through Pay for Success-Just In Reach (JIR)  Supportive services will be provided under DHS’ existing Intensive Case Management Services work orders and rental subsides will be provided through the FHSP.  The housing plan provides interim housing as a bridge to permanent housing with maximum flexibility in terms of housing type (Project-based, Scattered- site, Board and Care). 30

  31. INTENSIVE CASE MANAGEMENT SERVICES  Every client connected to services.  Individualized service planning and linkages to health, mental health, and substance use disorder treatment.  Help clients retain housing and reach health and wellbeing goals.  Services provided by on-site staff or mobile teams. 31

  32. INTERIM HOUSING Recuperative Care  Provides short-term care for homeless DHS patients who are recovering from an acute illness or injury or have a condition that would be exacerbated by living on the street or in shelter.  Program offers temporary housing, medical and mental health monitoring, meals, case management, and transportation Stabilization Housing  Provides short-term housing and support for homeless DHS patients who are moving into permanent housing soon.  Program offers temporary housing, meals, case management, and transportation. 32

  33. FL FLEXI EXIBL BLE E HOU OUSI SING NG SU SUBS BSID IDY PO Y POOL OL

  34. LOCAL RENTAL SUBSIDY PROGRAM  Launched: January 2014 by DHS Housing for Health  Mission: Quickly and effectively house homeless  Initial Funding: $18 million (w/ $4 million from Conrad N. Hilton Foundation)  Housing Types: Supportive, Affordable, Private market housing  Product Types: Single family home, single apartment unit, blocks of units, entire building 34

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