CHAPTER 6

Breaking the Cycles of Mental Health, Substance Abuse, and Crime

BJA oversees initiatives to assist communities in planning, implementing, and enhancing criminal justice system diversion and intervention for offenders with substance abuse, mental health, and co-occurring disorders. BJA supports cross-system collaboration and partnerships among the criminal justice system and substance abuse and mental health agencies through grants, TTA, and policy development to help them address situations where substance abuse and mental illness are the root or a contributing cause of criminal behavior. BJA provides this support in contexts such as first encounters with law enforcement, adjudication, incarceration, and reentry. BJA also helps communities track prescriptions for controlled substances to prevent fraud and abuse, and assist children who are endangered by drug manufacturing, sales, and abuse.

Justice and Mental Health Partnerships

The purpose of the Justice and Mental Health Collaboration Program (JMHCP) is to increase public safety and public health by supporting innovative cross-system collaborations between criminal justice and mental health professionals to improve access to effective treatment for justice-involved individuals with mental illnesses or co-occurring mental health and substance abuse disorders. The JMHCP grant program enables eligible applicants from state, local, and tribal jurisdictions to plan, implement, or expand a collaborative initiative between criminal justice and mental health agencies.

JMHCP:

To support both JMHCP grantees and non-grantees, BJA provides intensive, hands-on TTA. In FY 2012, BJA provided more than $1.5 million to the CSG Justice Center for two TTA programs: the Justice and Mental Health Collaboration Training and Technical Assistance Program and the Justice and Mental Health Collaboration State-Based Capacity Building Program.

In FY 2012, the CSG Justice Center, as BJA’s JMHCP TTA provider, accomplished the following:

Preventing Prescription Drug Abuse

The nonmedical use of controlled substances is a serious public health concern and one that continues to grow. Prescription drug abuse poses a unique challenge, requiring a balance between the need for prevention, education, and enforcement and the need for legitimate access to controlled substances. The Harold Rogers Prescription Drug Monitoring Program focuses on providing assistance to states that want to plan, establish, or enhance a prescription drug monitoring  program (PDMP). Program objectives include building a data-collection and analysis system, enhancing the ability of existing programs to analyze and use collected data, facilitating the exchange of collected prescription data between states, and assessing the efficiency and effectiveness of the programs funded under this initiative. Specific activities include grant funding, support for collaborations between state and local jurisdictions, and TTA in the areas of performance measurement, accountability, and capacity building to both competitively awarded states and states that are planning to establish a PDMP.

BJA made 12 awards to states to implement or enhance a PDMP. In addition, BJA awarded two cooperative agreements to Brandeis University to continue to provide the field with TTA and best practice guidance through the National PDMP TTA Center (TTAC) and the PDMP Center of Excellence at the Schneider Institutes for Health Policy. Through these TTA providers, BJA continued to provide intensive, hands-on technical assistance to the 12 FY 2011 grantees.

The TTAC provided guidance and assistance to several states planning, implementing, or enhancing their PDMPs (including New Hampshire, Pennsylvania, and Missouri) and hosted several national meetings and two regional meetings: the West Regional Meeting and the South Regional Meeting. Interstate data exchange was a priority during FY 2012, and the TTAC facilitated the completion of the PMIX architecture for interstate data sharing (see chapter 4 for more information on PMIX). During the reporting period, the TTAC responded to requests for assistance from more than 350 state, federal, and other stakeholders.

The PDMP Center of Excellence staff provided testimony for congressional committees on prescription drug abuse and the role of PDMPs in helping to address abuse and diversion and promote appropriate prescribing; collaborated with states on data analyses and evaluation initiatives, including demonstrating novel applications of PDMP data; analyzed data on grantees’ performance metrics; and advised PDMPs on issues related to legislation, startup, operations, and funding.

Drug Courts

BJA’s Adult Drug Court Discretionary Grant Program (ADCDGP) provides training, financial assistance, and related program guidance and leadership to communities interested in establishing and enhancing drug courts. Through ADCDGP, communities can leverage the coercive power of the criminal justice system to reduce recidivism and substance abuse among nonviolent offenders and increase the likelihood of successful rehabilitation through early, continuous, and intensive judicially supervised treatment, mandatory drug testing, appropriate sanctions, and other rehabilitative services. Through the FY 2012 ADCDGP solicitation, BJA awarded 50 grants totaling more than $15 million.

In FY 2012, one of the priorities for ADCDGP was to build the capacity of existing drug courts to increase participation rates among appropriate target populations and to combine court and treatment resources. To that end, BJA partnered with SAMHSA’s Center for Substance Abuse Treatment (CSAT) to issue a joint solicitation to enhance the court services, coordination, and substance abuse treatment capacity of adult drug courts. One advantage of this initiative is that it allows applicants to compete for access to both criminal justice and substance abuse treatment funds with one application. Under this solicitation, BJA awarded 10 grants totaling more than $2.8 million.

ADCDGP priorities also included meeting the needs of special populations—in particular, returning veterans. In partnership with SAMHSA and the U.S. Department of Veterans Affairs (VA), BJA recommends that drug courts, mental health courts, and other problem-solving courts aggregate their veteran participants so that the full services of the VA may be used. Since 2009, BJA has recognized that an increasing number of returning service members with co-occurring substance abuse and mental health issues were becoming involved in the criminal justice system. In response to this problem, BJA continues to provide services for courts wishing to implement a program under the Drug Court Planning Initiative—which trains teams on starting new drug courts—that focuses specifically on training for Veterans’ Treatment Courts (VTC). Currently, more than 99 VTC hybrid drug and mental health courts use the drug court model to serve veterans struggling with addiction, serious mental illness, or co-occurring disorders, including serious undertreated ailments like post-traumatic stress disorder and traumatic brain injuries, both of which may put people at greater risk of drug abuse, domestic violence, and other criminality.

BJA continued its formal partnership with OJJDP, the National Highway Traffic Safety Administration, and CSAT via a memorandum of understanding (MOU). This MOU provides a framework for these federal agencies to plan, coordinate, and share the design and implementation of interagency efforts that will improve the response to people with substance abuse disorders who are involved or at risk of involvement with the criminal and juvenile justice systems. Another strong federal partner is ONDCP, which continues to support this problem-solving court approach as part of its National Drug Control Strategy. To gauge the needs of and provide responsive TTA to the drug court field, BJA continues to work with its national partners, including the National Association of Drug Court Professionals (NADCP), American University, CCI, NCSC, the Tribal Law and Policy Institute (TLPI), and the National Development and Research Institute.

Second Chance Act Substance Abuse Treatment Programs

The SCA provides a comprehensive response to the increasing number of incarcerated adults and juveniles who are released from prison, jail, and juvenile residential facilities and returning to communities. Within the context of this initiative, “reentry” is not envisioned as a specific program, but rather it is a process that begins when the offender is first incarcerated and ends with his or her successful community reintegration, evidenced by lack of recidivism. This process should provide the offender with appropriate evidence-based services—including addressing individual criminogenic needs—based on a reentry plan that relies on a risk/needs assessment that reflects the risk of recidivism for that offender. (See Chapter 5 for more information about BJA’s SCA activities.)

BJA administers two SCA programs that focus specifically on substance abuse treatment: the Family-Based Adult Offender Substance Abuse Treatment (Family-Based) Program and the Adult Offenders with Co-Occurring Reentry Substance Abuse and Mental Health Disorders (Co-Occurring Disorders) Program.

Family-Based Program: Section 113 of the SCA authorizes grants to states, units of local government, and Indian tribes to improve the provision of substance abuse treatment in prison and jail and after reentry for inmates who have minor children. It also includes outreach to families and the provision of treatment and other services to children and other family members of participant inmates. This program identifies eligible applications to plan, implement, or expand such treatment programs. In FY 2012, BJA made five awards to eligible applicants under the Family-Based Program, for a total of approximately $1.5 million.

Co-Occurring Disorders Program: Section 201 of the SCA authorizes grants to states, units of local government, and Indian tribes to improve the provision of drug treatment to offenders in prisons, jails, and juvenile facilities during incarceration and through the completion of parole or other court supervision after release into the community. The goal of Section 201 is to provide support to eligible applicants for developing and implementing comprehensive and collaborative strategies that address the challenges posed by reentry to maintaining public safety and reducing recidivism. In FY 2012, BJA made nine awards to eligible applicants under the Co-Occurring Substance Abuse Program, for a total of approximately $5.3 million.



Success Stories

SAN FRANCISCO SHERIFF’S DEPARTMENT (CALIFORNIA)
The San Francisco Sheriff’s Department received a FY 2010 Second Chance Act Family-Based Prisoner Substance Abuse Treatment award to serve 145 sentenced probationers incarcerated in the county jail who had a history of substance abuse and are parents to minor children. Under this project, the No Violence Alliance—One Family Reentry Initiative uses a family-based treatment model that provides a coordinated, comprehensive response to address the needs of offenders, their children, and other family members and caregivers. The Sheriff’s Department provided assessments, treatment services, and reentry case planning to participants while they were incarcerated, followed by 6 months of community-based case management and supportive services. As a result of the grant, the Sheriff’s Department strengthened the services they provided to the parent and family as a whole—including through the use of the “Parenting Inside Out” program—and created child-friendly visitation space for contact visits with parents.




Success Stories

GASTON COUNTY, NORTH CAROLINA
Gaston County, North Carolina received a FY 2010 Second Chance Act grant to provide co-occurring disorder treatment and reentry services to 100 indigent men from the West Gastonia area incarcerated in the Gaston County Jail. The Gaston County Sheriff’s Department partnered with Alternative Community Penalties Program, Inc., to bring integrated substance abuse and mental disorder treatment services to Gaston County Jail inmates. This project’s comprehensive services focused on individually tailored programming facilitated by a multidisciplinary team, including post-release planning (which focused on housing, employment, and treatment) and case management that coordinated care for each participant for 18 months. As a result of the grant, Gaston County now screens for criminogenic risks and needs, and incorporates the results into programming decisions. It has also strengthened its reentry approach through the use of several key evidence-based practices, including a standardized curriculum for the treatment of co-occurring disorders, cognitive-behavioral interventions, and motivational interviewing. Overall, this Second Chance Act award provided an important boost to the county’s first program to provide jail-based reentry services, which did not exist prior to 2006.


Residential Substance Abuse Treatment for State Prisoners Program

Created by the Violent Crime Control and Law Enforcement Act of 1994, the Residential Substance Abuse Treatment for State Prisoners (RSAT) Program enhances the capacity of states and units of local government to provide incarcerated inmates with residential substance abuse treatment, incorporate this treatment into their reentry planning, and deliver community-based treatment and other broad-based aftercare services.

RSAT funds support three types of correctional programs:

  1. Residential programs are required to (1) operate for at least 6 months and no more than12 months; (2) provide residential treatment facilities set apart from the general correctional population; (3) focus on the substance abuse problems of the inmate and develop the inmate’s cognitive, behavioral, social, vocational, and other skills to resist drug use and criminal behavior; and (4) require drug and alcohol testing for program participants.
  2. Jail-based programs must (1) last at least 3 months, and (2) focus on the substance abuse problems of the inmate and develop the inmate’s cognitive, behavioral, social, vocational, and other skills to resist drug use and criminal behavior. If possible, jail-based programs must separate the treatment population from the general correctional population, and program design should be based on practices scientifically demonstrated to be effective.
  3. Aftercare services must involve coordination between the correctional treatment program and other social service and rehabilitation programs, such as education and job training, parole supervision, halfway houses, and self-help and peer group programs.

In FY 2012, BJA awarded RSAT formula grants totaling more than $8.5 million to 55 states and U.S. territories.

BJA continued to provide an array of TTA to the RSAT community. The RSAT TTA National Resource Center faculty visited a dozen states across the country to provide direct and hands-on TTA, enhance and improve RSAT programming, and provide evidence-based treatment for inmates suffering substance use disorders. In December 2012, RSAT TTA assisted the Hawaii DOC to plan and implement a dramatic expansion of its RSAT programming.

With assistance from the RSAT TTA National Resource Center, the Hawaii DOC will triple the number of inmates who will receive treatment for substance abuse by the start of 2013. RSAT TTA faculty reviewed Hawaii’s state policies and procedures, toured the state’s two prison facilities, and met with the Hawaii DOC RSAT staff to assist them successfully navigate this impressive expansion.

BJA is also improving the RSAT program through the creation of a BJA RSAT Learning Community and monthly webinars. The BJA RSAT Learning Community is a web site that provides the latest evidence-based curricula and training, including its first eLearning course to the RSAT community. The web site’s goal is to ensure that all RSAT programs are up to date on the latest evidence-based treatment for adult and juvenile inmates suffering from substance use disorders. The monthly RSAT webinars provide to the RSAT community the latest in evidence-based programming for the treatment of inmates suffering from substance use disorders. In 2012, these webinars kept 1,389 RSAT counselors up to date and helped them maintain their professional accreditations, which is often difficult for RSAT counselors working in isolated prisons and jails scattered across the United States and its territories. In addition, the RSAT TTA faculty awarded 962 certificates of attendance to correctional officers and administrators who participated in the webinars. On average, an estimated 300 RSAT staff participate in the monthly presentations. The webinars enhanced professionalism on the job and fulfilled institutional training requirements.

Improving Outcomes for Children Exposed to Substance Abuse

The National Alliance for Drug Endangered Children (National DEC), a BJA grantee, works to improve outcomes for children living with adults who manufacture, sell, possess, or use illicit drugs, or who abuse other substances. These children are an underserved population, and National DEC raises awareness about the risks they face; provides TTA in developing partnerships between law enforcement and other professionals; and works to institutionalize a collaborative, multidisciplinary approach to breaking the cycle of abuse and neglect.

With BJA support, National DEC has created a national infrastructure that includes a network of 24 affiliated state DEC alliances and more than 100 volunteer DEC experts who work to develop and implement effective problem-solving techniques and promising practices. National DEC provides leadership, strategic planning, and TTA to its alliances and network members and hosts an online resource center ((www.nationaldec.org) that features a searchable library of hundreds of research reports, articles, training presentations, and protocols.

Program accomplishments for FY 2012 included:

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