Draft Report from Forensic Issues Dialogue Session
Alternatives 2001
Philadelphia, PA
August 23-26, 2001

Facilitators: Mary Jadwisiak, Tom Lane
Reporter: Jeanette Cord (Session 1 only) Session 1, August 23, 2001

Goal: To develop an action plan, building on the work done at the National Summit of Mental Health Consumers and Survivors in Portland, Ore., and at Summit 2000, in Washington, D.C.

Issues:

  • Determining competency in a criminal proceeding can add a great deal of time to incarceration compared to the pre-trial incarceration, when competency is not an issue.
  • Other equality issues (when competency is an issue) include bail and visitation.
  • Education of magistrates, judges, law enforcement.
  • Forensic issues (beyond incarceration) include pre-sentencing and post-sentencing.
  • There is a need for research to evaluate programs. Jean Campbell, Ph.D., has offered to help with this.
  • There is no standard for assessing/screening for mental health status of persons arrested.
  • The criminal justice system is accessible 24/7; the mental health system is not.
  • Mental Health Courts (community-based, not statewide) exist in Washington, Alabama, Alaska, California, New York
  • [There is a need for] alternatives outside the mental health system.
  • What do the police need to know?
    - The distinction between a crime and a mental health crisis.
    - Alternative placements.
    - National certification curriculum.
    - Relief for their own mental health issues.
  • Correctional/hospital staff needs:
    - Understanding of medication and medication issues.
    - Sucide prevention (suicide is the number 1 cause of death in jail).
  • Incarceration settings: Formularies are different from those outside of jail.
  • When you are in jail, you lose all your benefits. When you get out of jail, your benefits resume after you re-apply.
  • How would you implement police training? Four time frames: Pre-incarceration, Arrest, Incarceration, Post-incarceration

    Other comments and concerns:

  • The need for public education.
  • Methods for eliminating the "revolving door."
    Foster inter-agency collaboration linkage.
  • We have a social responsibility to treat people well which goes beyond patients' rights.
  • The need for wellness projects.
  • Services/activity while in jail: Therapy, peer support, meaningful/challenging activity, socialization.
  • Modification of Department of Corrections regulations to allow accommodation of persons with mental health issues.
  • Citizens need to be informed so they can effectively make an impact on public policy.
  • Places/settings for diversion.

    An example of an alternative to jail and hospital:

  • Crisis intervention center
  • Rehab
  • Mental health court
  • Sub-acute facilities.

    Other points:

  • 80 Percent of people with mental illnesses have co-occurring substance abuse issues.
  • A clear definition of the term "forensic" is needed.
  • How will mental health and physical health parity be reconciled in licensing?
  • Private insurance does not cover anything in jail.
  • Federal guidelines for Medicaid, etc., are interpreted separately by each state based on the block-grant application.
  • Speedy resumption of benefits and resources after release is imperative to decrease recidivism.

    The suggestion was made to identify two to three key areas for focus.

  • Social responsibility
  • Linkages
  • Appropriate treatment while incarcerated
  • Changing culture in law enforcement.
    (List is incomplete.)

    One of the facilitators suggested these areas for priority consideration:

  • Pre-arrest diversion
  • Collaboration between mental health and law enforcement.
  • Release services: Case managers for those released.
  • In-jail services: Consumer review, consumer outreach teams, jail liaison
    Public Relations on Best Practices

    Other suggestions and questions:

  • Make a list of fundamental over-riding principles that will impact the entire process.
  • Accountability: What are the ethical/moral implications governing access to records and mental health information?
  • Involuntary Outpatient Commitment
  • The issue was raised concerning how one is treated when identified as mentally ill.
  • Stigma and Research (overlapping areas common to all planks)
  • Privacy
  • Training for parole officers assigned to persons with mental health issues.
  • Resources
  • Community Education

    Needs:

  • Information about what is actually being done at the local level
  • Pending and recently passed legislation.

    There is a great deal of work being done in addition to this conference:

  • Council of mental health professionals
  • Mental heath courts
  • Police training
  • National Association of State Mental Health Directors
  • Increasing cross-system collaboration.

    Addendum: Participants expressed a desire to find out what is being done currently in regard to model programs and strategies to address the needs of persons coming in contact with the criminal justice system in three areas: Pre-arrest diversion, services and supports while people are in correctional settings (primarily jails but also prisons), and post-release/transitional supports, including better education for probation and parole staff. The value and potential of peer-operated services and supports was also stressed.

    Information about model programs has been compiled and included in the Council of State Governments Mental Health/Criminal Justice Consensus Project.

    Session 2: August 24, 2001

    Facilitators: Mary Jadwisiak
    Reporter: Tom Lane(Session 2 only) Session 2, August 24, 2001

    Information Resources: National Forensic Resource and Information Center
    Consumer/survivor-run national technical assistance centers
    Best practices

    It is very difficult to formulate a plan because ordinances, laws, customs, resources and procedures vary widely from locality to locality across the country.

    Goals: Information and Referral Clearinghouse
    Allies: Medical Examiner, Criminal Justice staff, police, commissioners, non-mental health services

    Goal: Advocacy Training
    There was a vote to spend the remainder of the time focusing on these two goals: Information and Referral Clearinghouse and Advocacy Training.

    Objectives toward meeting identified goals:
    Goal 1: Information and Referral
    Local next steps: Invite police, commissioners, mental health agencies, judges, etc., to come together and talk.
    Allies: police, commissioners, non-mental health service systems, community leaders, trade associations, clergy, advocates, businesses.

    P&As (Protection and Advocacy agencies) are in every state and should be used as a resource. They are federally funded. They deal with all disabilities and do not necessarily prioritize mental health.

    Gather information in your community, and contact: Tom Lane mh4n6guy@aol.com
    Other information sources:

  • Department of Justice
  • States Justice Institute
  • Department of Corrections
  • Center for Disease Control
  • MacArthur Foundation
  • First Data Resources: This is a commercial data collection service.

    The group was charged with researching existing peer training programs and reporting back.

    Advocacy Objectives:

  • Research current programs.
  • Develop a curriculum.
  • Group to develop and/or review curriculum: former inmates (mental health consumers), peer advocates, corrections staff, counselors, institutional program directors, regular mental health consumers, educators, chaplains (faith-based professionals), technical assistance staff.

    Presented by:

    National Mental Health Consumers' Self-Help Clearinghouse

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