What is criminalization of serious mental illness? The effect - PowerPoint PPT Presentation

D ecriminalization of serious mental illness in Oregon By: Lisa Dailey, Esq. Legislative and Policy Counsel Treatment Advocacy Center t rea eat m en ent advocacycen ent er er.org 703 703-294 294-6004 6004 (Direct ) dai aileyl yl@t reat at m ent ad advocac acyc ycent er.org

What is criminalization of serious mental illness? The effect created by public policies and practices that result in the transfer of individuals with mental illness from the mental health system to the criminal justice system, regardless of intent.

Factors in Criminalization:  Failure to create community treatment systems after deinstitutionalization  Civil commitment standards that require dangerousness prior to intervention  Lack of robust implementation of existing laws and policies by courts and mental health professionals

A Brief History of Deinstitutionalization 1945: Congressional hearings on the alarming number of  military recruits with mental illness 1945: Exposés of conditions in state mental hospitals begin  1946: Birth of the National Institute  of Mental Health (NIMH) 1953: First antipsychotic (Thorazine)  introduced in U.S. 1955-60: Joint Commission on  Mental Illnesses and Health convened 1960: John F. Kennedy elected president 

1963: Congress passes the Community Mental Health Act,  reversing 100 years of treatment policy for acute and chronic severe mental illness. No provision is made to link the new centers to public hospital patients. President Kennedy signs the bill into law. It is the last bill he signs before his assassination. 1965: Congress passes the Social Security Act of 1965  establishing Medicare and Medicaid – and excludes “institutes of mental disease” (IMD) from Medicaid coverage

The Ideal The idea behind deinstitutionalization was fundamentally sound. Most patients could live safely outside a hospital while being treated in community facilities, provided that such treatment facilities existed.

The Execution

Fifty Years Later

Lionel Penrose’s hypothesis of deinstitutionalization Based on a cross-sectional study in 18 countries, Dr. Penrose found that prison and mental hospital populations are inversely related. If one form of confinement is reduced, the other will increase. Where prison populations are extensive, psychiatric hospital populations will be small. And vice versa.

Re-institutionalization

Mental Illness Behind Bars An estimated 8.1 million adults in America have serious mental illness (SMI) That is a 3.3% prevalence rate of SZ and severe BP in the general population An estimated 50% receive no treatment in a given year Approximately 1.8 million of these individuals are booked into US jails every year Nearly 400,000 are incarcerated on any given day; 40% spend time behind bars during their lifetimes

Serious Mental Illness (SMI) in Oregon Jails and Prisons 2015 Adult prison population: 15,245 Prison inmates with SMI: 2,134 (14% ) Adult jail population: 5,755 Jail inmates with SMI: 1,496 (26% ) Incarcerated people with SMI in Oregon 3,631 adults SOURCE Bureau of Justice Statistics, National Prisoner Statistics Program, 2015

Civil Co mmitme nt Sta nda rds • Da ng e r to se lf/ Othe rs • Gra ve Disa b ility – I na b ility to immine ntly c a re fo r o ne ’ s o wn fo o d, c lo thing , she lte r, a nd me dic a l c a re due to a me nta l illne ss – Ma y b e a sub se c tio n o f the “da ng e r to se lf” pro visio n o f sta te sta tute • Sta te s a re mo ving in this dire c tio n: – Ne e d fo r T re a tme nt • I n o rde r to pre ve nt de c o mpe nsa tio n a nd physic a l/ psyc hia tric ha rm, pa tie nt sho uld re c e ive tre a tme nt, e ve n if invo lunta ry

Civil Co mmitme nt T ype s o f Co urt Orde re d T re a tme nt • E me rg e nc y e va lua tio n • I npa tie nt c o mmitme nt • Me dic a tio n o ve r o b je c tio n (inpa tie nt o nly) • Outpa tie nt c o mmitme nt • Co nditio na l re le a se

Ore g o n Civil Co mmitme nt sta nda rds a nd c rimina liza tio n • Ore g o n a llo ws invo lunta ry inte rve ntio n fo r da ng e ro usne ss a nd g ra ve disa b ility • Gra ve disa b ility ha s b e e n ve ry na rro wly c o nstrue d c o mpa re d with o the r sta te s • T he le g isla ture c a n a nd sho uld pro vide g uida nc e to the c o urts fo r ho w it inte nds the sta nda rds to b e inte rpre te d

A Criminal Justice Problem  If a system is set up to require dangerousness for involuntary treatment: 1. Individuals who become dangerous end up in jail or prison, and 2. Individuals who are very sick but don’t become dangerous to others get no treatment at all.

A Criminal Justice Problem  If a gravely disabled standard is construed to narrowly: 1. People die on the streets; 2. Neurological damage becomes so severe that recovery may not be possible; 3. People become invisible to the mental health treatment system.

T AC Re po rts 4 Millio n Adults with untre a te d se ve re me nta l illne ss • 1 in 4 o f a ll fa ta l po lic e e nc o unte rs • 1 in 5 o f a ll ja il a nd priso n inma te s • 1 in 10 o f a ll la w e nfo rc e me nt re spo nse s

T AC Re po rts Pe o ple with untre a te d SMI a re 16 time s mo re like ly to b e kille d tha n o the r c itize ns a t the first ste p o f the c rimina l justic e pro c e ss, while b e ing a ppro a c he d o r sto ppe d b y la w e nfo rc e me nt.

T AC Re po rts I nc ide nt Ca ll • Whe n a pe rso n with SMI b e c o me s a n inc ide nt c a ll, the y a re no w a t risk o f b e ing invo lve d in the c rimina l justic e syste m, inc luding a rre sts, inc a rc e ra tio ns, o r po lic e sho o ting s. • Ho w do we g e t so me o ne he lp b e fo re the po lic e a re invo lve d?

AOT is a (one of many) decriminalization tool.

Anosognosia – impaired awareness of illness  Anosognosia is b e lie ve d to re sult fro m a na to mic a l da ma g e to the b ra in tha t impa irs the a b ility to pe rc e ive o ne ’ s o wn illne ss  Diffe r e nt fr om de nial Conside r e d the most c ommon r e ason individua ls with psyc ho tic diso rde rs do no t ta ke the ir me dic a tio ns If I’m no t sic k, why take me dic ine ? Ve r y c ommon with SMI:  Pr e vale nc e in sc hizophr e nia is ro ug hly 50%  Pr e vale nc e in bipolar disor de r is ro ug hly 40%  Impr ove s in some pe ople whe n the y ta ke the ir me dic a tio ns

Wha t is AOT ? • SAMHSA, the fe de ra l a g e nc y a dministe ring the ne w a ssiste d o utpa tie nt tre a tme nt fe de ra l g ra nts, de fine s AOT a s: • “Assiste d o utpa tie nt tre a tme nt (AOT ) is the pra c tic e o f de live ring o utpa tie nt tre a tme nt unde r c o urt o rde r to a dults with se ve re me nta l illne ss who me e t spe c ific c rite ria , suc h a s a prio r histo ry o f re pe a te d ho spita liza tio ns o r a rre st. AOT invo lve s pe titio ning lo c a l c o urts to o rde r individua ls to re ma in in tre a tme nt within the c o mmunity o f a spe c ifie d pe rio d o f time . AOT pa rtic ipa nts a re g ive n due pro c e ss pro te c tio n, tre a tme nt a nd suppo rtive se rvic e s… • T he g o a l o f AOT is to impro ve he a lth a nd so c ia l o utc o me s fo r the individua ls se rve d in the pro g ra m, suc h a s inc re a se d he a lthc a re utiliza tio n, impro ving b e ha vio ra l he a lth a nd o the r he a lth o utc o me s, a nd re duc ing ra te s o f ho me le ssne ss a nd inc a rc e ra tio n.” • I t is no n-punitive – pa rtic ipa nts c a nno t b e he ld in c o nte mpt, fine d, o r ja ile d.

Suppo rt fo r AOT • F o rms o f AOT in a ll sta te s b ut Co nne c tic ut • Na tio na l Allia nc e o n Me nta l I llne ss • SAMHSA- impro ve s o utc o me s, re duc e s ho spita liza tio ns • DOJ- re duc e s c rime a nd vio le nc e • I nte ra g e nc y Bo a rd • Ame ric a n Psyc hia tric Asso c ia tio n • I nte rna tio na l Asso c ia tio n o f Chie fs o f Po lic e • Na tio na l She riffs Asso c ia tio n • I t is inc lude d in a ll ma jo r fe de ra l me nta l he a lth re fo rm a nd c rimina l justic e dive rsio n b ills, inc luding HR246

Sta te o f Ore g o n: Assiste d Outpa tie nt T re a tme nt • Sta tuto ry la ng ua g e is unc le a r (two type s) • Spo tty imple me nta tio n • I nste a d o f re c e iving inte rve ntio ns in the c o mmunity, pe o ple a re de c o mpe nsa ting to the po int whe re the y ne e d e me rg e nc y c risis c a re a nd inpa tie nt ho spita liza tio n • Co urt inte rpre ta tio ns o f c ivil c o mmitme nt sta nda rds a re pre ve nting use o f AOT

Early I ntervention is Key • AOT is specifically designed to keep mental health professionals dynamically engaged with consumers so they and the Court can intervene right away if needed. • Treatment plans and medications can be re-evaluated before an individual decompensates to the point of becoming a danger to self or others. • Each psychotic episode causes neurological damage. AOT allows the system to catch people in trouble in a timely way, before they slip fully into a psychosis.

F o r Mo re I nfo rma tio n: www.T re a tme ntAdvo c a c yCe nte r.o rg L isa Da ile y da ile yl@ tre a tme nta dvo c a c yc e nte r.o rg Offic e :703-294-6004; Mo b ile : 703-300-2276