Standard community criminal justice procedures are ineffective in reducing the high rates of recidivism by offenders diagnosed with severe mental illness (SMI). With limited access to community based mental health programs and the closure of institutional settings that serve people with mental health problems, jails and prisons have become the de facto institutions for people who suffer with severe mental illness across the United States. Adults diagnosed with SMI are overrepresented in our criminal justice system nationally (10-20%) and community-based interventions vary greatly in access and design. Beyond the human suffering, there are financial costs to this high incarceration rate. Housing an inmate with a severe mental health problem ranges between $31,000 to $168,000 (US)/inmate/year. Despite this high cost, the mental health needs of this population are not being adequately served. Recent national research in the United States indicates that many people with severe mental illness fail to receive minimally adequate mental health treatment in prisons (Wilper, et al. 2009).
The development of offender courts for persons with mental illness have changed this dynamic. The success of these programs is dependent upon the availability of appropriate community based services and treatment, therapeutic oversight from the courts and an interprofessional collaborative that is highly motivated to contribute to the success of the program. This presentation will focus on a model program, the California Support and Treatment After Release (STAR) program developed in Marin Co. in northern California, United States.
Methods: This comprehensive community intervention was designed using a public health evidence-based practice framework .
Results:
In 1998, California State Sheriffs worked with the legislature to create Senate Bill 1485 to fund pilot demonstration programs to reduce the recidivism rate of mentally ill offenders in local jails. A call was sent to local governments to submit applications for the 3-year grant funded Mentally Ill Offenders Crime Reduction Act (MIOCRA) program. SB 1485 required counties to form Strategy Committees comprised of the sheriff or department of corrections director; chief probation officer; county mental health director; a superior court judge; representatives of local law enforcement agencies and mental health provider organizations; and a client from a mental health treatment facility. The assumption was that local governments have a better understanding of the nuances of local criminal justice issues than a one size fits all statewide approach. Marin County, California was one of the recipients of the grant and developed the STAR program for severely mentally ill offenders.
Leaders in Marin Co. identified that a primary factor in the program would be an interprofessional collaborative form of leadership to advance the program. Too often, divergent interests between mental health professionals and the criminal justice system cause promising programs to fail. In Marin, important elements in the STAR program included implementation of an array of mental health services, pharmacologic management, safe housing, job training, oversight by the courts and the probation department for a one to two-year period and regular case management meetings with the interprofessional team. The program was implemented as volunteer entry by the offenders. Offenders regularly check in with the overseeing judge and the court team to monitor the progress with treatment. With completion of the program, offenders were able to petition for expunging their record of the offense, thus reducing the problem with stigma surrounding a mental health diagnosis.
Over a 10 year period, Marin demonstrated a reduction in recidivism by more than 80% and psychiatric emergency visits by more than half. Today the Marin County jail is one of the few jails in the State of California that can boast of empty jail beds. In summary, the positive outcomes of this program include reduction in recidivism, decreased use of psychiatric emergency visits, empty jail beds, employed and housed people, expansion of community-based services and a more humane way to treat people with mental illness who had become involved with the criminal justice system.
Conclusion:
The Marin Co. program is a model that has focused on interprofessional collaboration and can be replicated to develop programs that serve people with severe mental illness.