Stepping Up: Addressing a National

Crisis
Too Many People with Mental Illnesses in our
Jails

Fred C. Osher, M.D., CSG Justice Center |September 19, 2016 | Washington, DC

The Council of State Governments Justice

Center
Corrections

Courts

Justice Reinvestment

Law Enforcement

Mental Health

Reentry

Substance Abuse

Youth

National nonprofit,
nonpartisan membership
association of state
government officials

Represents all
three branches of
state government

Provides practical
advice informed by the
best available evidence

A crisis thats hard to miss

County is ready,
but is it able to deal
with mentally ill?

Mentally ill Mainers

are still
warehoused, but
now its in jail

Mentally ill inmates

at Franklin County
Jail stay longer

Johnson County
Sheriff: Mental
health is number
one problem

Inmates with
mental health
issues inundate
Pima County Jail

Mental health crisis

at Travis County
jails

Nearly a third of
county inmates
require drugs for
mental illness

Jail violence
increasing due to
mental illnesses

Overview

Scope of the issue: How did we get here?

Key challenges counties face: Why is it so
hard?
Effective Strategic Plans: How do we move
forward?

01. Mental Illnesses in the Criminal Justice

System:
How did we get here?

Millions of Adults Now Under Correctional

Supervision
Bureau of Justice Statistics 1980 - 2014

Total
Probatio
n
Prison
Parole

Jails are Where the Volume is

Number of Admissions to Jail and Prison Weekly and
Annually, 2012

Annual
ly

11,605,175

222,565

553,843

10,621

Jails Report Increases in the Numbers of

People Mental with Illnesses
NYC Jail Population (2005-2012)
Average Daily Jail Population (ADP) and ADP with Mental
Health Diagnoses

13,576
Total

11,948
Total

10,257
76
%

63
7,557
%

37
4,391
%

24
3,319
%
M Group

Non-M Group

Mental Illnesses: Overrepresented in Our Jails

General Population

5%

Serious
Mental Illness

Jail Population

17%

Serious
Mental Illness

72%

Co-Occurring
Substance Use
Disorder

Factors Driving the Crisis

Disproportionat
ely higher rates
of arrest

Longer stays in
jail and prison

Limited access
to health care

Higher recidivism
rates

Low utilization
of EBPs

More
criminogenic risk
factors
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02. Counties Step Up but Face Key

Challenges:
Why is it so hard to fix?

11

Key Challenges Counties Face: Observations

from the Field

1.

2.

3.

4.

Being
data
driven

Using
best
practice
s

Continui
ty of
care

Measurin
g results

12

Challenge 1 - Being Data Driven:

Policymakers Face Complex Systems with Limited Information

13

Challenge 1 - Being Data Driven:

Not Knowing the Target Population

County A
Mental
Health
Assessment

Substance
Abuse
Assessment
Risk
Assessment

County B

County C

County D

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Challenge 2 Using Best Practices:

The Science to Service Gaps

Past Year Mental Health Care and Treatment for Adults 18 or Older
with Both SMI and Substance Use Disorder

NSDUH (2008)
15

Challenge 3 Continuity of Care

Existing Services Only Reach a Small Fraction of Those in Need

10,523
Individuals

969

People with
serious mental
illness

609

Received
treatment in the
community

Example from Franklin

2,315

People with
serious mental
illness based on
national
estimates

1,70
6

Did NOT
receive
treatment

926
LOW
RISK

1,389
HIGH/
MOD RISK

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Challenge 4 Tracking Progress:

Focusing County Leaders on Key Outcomes
Measures

Outcome measures needed to evaluate impact and prioritize

scare resources

1.
Reduce

2.
Shorten

thenumber of
people with
mental illness
booked into jail

the length of stay

for people with
mental illnesses in
jails

3.
Increase

4.
Lower

the percentage of
people with
mental illnesses in
jail connected to
the right services
and supports

rates of
recidivism

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03.Effective Strategic Plans:

How do we more forward?

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A national initiative to reduce the number of people with mental

illnesses in jails

Council of State Governments Justice Center |

Counties and Individuals Join Call to Action

Pennsylvania Counties with a Resolution

Allegheny

Berks

Carbon

Chester

Dauphin

Eerie

Franklin

Fulton

Mckean

Pike

Westmoreland

How do We Know if a County is Positioned to Reduce Number of People with

Mental Illness in Jail?

Six Key
Question
s

1. Is your leadership
committed?
2. Do you have timely
screening and assessment?
3. Do you have baseline data?
4. Have you conducted a
comprehensive process
analysis and service
inventory?
5. Have you prioritized policy,
practice, and funding?

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Components of Stepping Up
Offsite broad-based
county technical
assistance

National
Summits

State level
initiatives

On-site
intensive
technical
assistance

Federal
policy
agenda
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Key Takeaways for Journalists

Be aware not only of this omnipresent crisis, but also of
the growing national movement to address it

Pilot programs are good initial steps, but true solutions

will come from cross-system collaboration and
comprehensive plans for change

Stay up to date with Stepping Up status and other

informational materials at www.stepuptogether.org

Learn, share and promote promising approaches around

the country
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Overarching Goal

There will be fewer

people with mental
illnesses in our
jails tomorrow
than there are
today.

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THANK YOU
For more information, contact: Fred Osher (fosher@csg.org)

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