This publishes for comment the Report of the Supreme Court Interbranch Advisory Committee on Mental Health Initiatives. This report also will be available on the Judiciary’s internet web site at http://www.judiciary.state.nj.us/reports2013/index.htm.
The Advisory Committee, chaired by Hon. Wendel Daniels, P.J.Cr., was charged with developing advice on how to improve the Judiciary’s response to individuals with mental health needs. The Advisory Committee reviewed existing services and programs and examined various issues surrounding the interaction of mentally ill individuals with the judicial system. Based on that review and examination, the Advisory Committee developed a series of recommendations designed to enable more effective responses to people with mental illness, including the expansion of existing programs and procedures and the establishment of new initiatives.
Please send any comments on the Committee’s recommendations in writing by Wednesday, May 8, 2013 to:
Comments may also be submitted via e-mail to: Comments.Mailbox@judiciary.state.nj.us.
The Supreme Court will not consider comments submitted anonymously. Those submitting comments by mail should include their name and address. Those submitting comments by e-mail should include their name and e-mail address. ??Comments submitted in response to this notice may be subject to public disclosure after the Court has acted on the Advisory Committee’s report.
Glenn A. Grant, J.A.D.
Acting Administrative Director of the Courts
Dated: March 28, 2013
Interbranch Advisory Committee on Mental Health Initiatives: Improving Responses to Individuals with Mental Illness in New Jersey
Submitted to the New Jersey Supreme Court December, 2012
TABLE OF CONTENTS
I. EXECUTIVE SUMMARY
II. INTRODUCTION AND CHARGE.
III. COMPOSITION OF THE COMMITTEE.
IV. DEVELOPMENT OF REPORT AND RECOMMENDATIONS.
A. Mission Statement.
B. Committee Activity.
V. OVERVIEW AND BACKGROUND.
C. Recent History: Responses to Mental Illness.
D. Recent Policy Developments.
E. The Committees Vision.
F. Overview of New Jersey Mental Health Services.
VI. THE COMMITTEE’S DETAILED RECOMMENDATIONS.
Use of the Sequential Intercept Model as an Approach to Decriminalization of People with Serious Mental Illness, by Mark R. Munetz, M.D. and Patricia A. Griffin, Ph.D.
Data on New Jersey Mental Health Services
Outcome data report on Union County Jail Diversion Program
Survey of Mental Health Services in New Jersey Jails
I. EXECUTIVE SUMMARY
The Interbranch Advisory Committee on Mental Health Initiatives was appointed to address important concerns regarding the many individuals with serious mental health needs who intersect with the criminal justice system. The goal of the Committee is to improve the Judiciary’s responses to individuals with mental illness who have become entangled in the justice system. The Committee is committed to the belief that greater communication, cooperation and education will result in substantial improvements. The Committee framed its recommendations to entities outside the Judiciary in the form of suggestions to avoid any appearance of attempting to mandate initiatives to other branches of government. The following is a summary of the Committee’s recommendations.
RECOMMENDATION 1 — It is recommended that the New Jersey Supreme Court establish an Interbranch Mental Health Initiatives Implementation Committee.
RECOMMENDATION 2 — It is recommended that the Judiciary develop and adopt a comprehensive plan of intervention strategies pertaining to individuals with mental illness, including initiatives at various stages along the criminal justice spectrum.
RECOMMENDATION 3 — It is recommended that a local Core Team be established in each county which does not already have one. The team will be the ‘go to’ local group for assuring that the over-arching structure of collaborative initiatives becomes institutionalized in the county.
RECOMMENDATION 4 — It is recommended that cross-systems mapping strategic planning sessions be initiated by the Core Teams in counties which do not currently have such strategic plans.
RECOMMENDATION 5 — It is recommended that a mental health liaison be established in municipal courts throughout the State.
RECOMMENDATION 6 — It is recommended that Prosecutors Offices which are interested in the diversion process be encouraged and supported in the implementation of these programs.
RECOMMENDATION 7 — It is recommended that the New Jersey Probation Specialized Mental Health Caseload be expanded and further funding applications for it be made.
RECOMMENDATION 8 — It is recommended that the Implementation Committee supervise the development of educational programs for New Jersey judges (Superior and Municipal Court), so they are all fully educated on relevant aspects of mental illness.
RECOMMENDATION 9 — It is recommended that the Implementation Committee supervise the development of educational programs for employees of the New Jersey Judiciary who are not judges (including ombudsmen and drug court staff), so they are all fully educated on relevant aspects of mental illness.
RECOMMENDATION 10 — It is recommended that the Implementation Committee offer suggested assistance to law enforcement and first responders in creating and further expanding educational programs to improve responses to people with mental illness (e.g., expansion of Crisis Intervention Team training).
RECOMMENDATION 11 — It is recommended that the Implementation Committee provide suggestions to the State and municipal public defenders’ offices on developing educational programs to improve responses to people with mental illness, encompassing the same issues covered in prosecutorial/attorneys general training, with additional information on dealing with mentally ill clients.
RECOMMENDATION 12 — It is recommended that the Implementation Committee provide training to the Division of Mental Health Services staff and mental health service providers on how the courts work (Superior and Municipal).
RECOMMENDATION 13 — It is recommended that the Implementation Committee structure a comprehensive public information program.
RECOMMENDATION 14 — It is recommended that information sharing procedures be explored and developed to enable mentally ill individuals to receive services in a timely and effective fashion.
RECOMMENDATION 15 — It is recommended that mental health service providers be educated on the benefits of requesting access to judicial computer systems (e.g., the Automated Complaint System and Automated Traffic System), when appropriate, in order for providers to view defendants’ outstanding charges and best advocate for them within the court system.
RECOMMENDATION 16 — It is recommended that the Superior and Municipal Court computer systems be enhanced to include an indicator for defendants who have manifested mental illness, either through participation in a mental health diversion program, participation in DMHAS programs or some other means.
RECOMMENDATION 17 — It is recommended that comprehensive and creative funding strategies be fully explored.
II. INTRODUCTION AND CHARGE
Chief Justice Stuart Rabner convened the Interbranch Advisory Committee on Mental Health Initiatives ("the Committee") in October of 2010. The Committee is composed of 21 diverse New Jersey stakeholders, including representatives from the Judiciary, the Attorney General’s Office, the Public Defender’s Office, several County Prosecutors’ offices, the Division of Mental Health and Addiction Services, and private mental health service providers.
The Committee was charged with reviewing existing services and programs and developing advice on how to coordinate better among different service providers and defendants and how to improve the Judiciary’s response to mental health needs.
The focus of this report is on individuals with serious mental illness, defined in the psychiatric field as major Axis I diagnoses, including schizophrenia spectrum disorders, bipolar spectrum disorders, and major depressive disorders.
III. COMPOSITION OF THE COMMITTEE
Hon. Wendel E. Daniels, Pr.J.C., Chair
Hon. Louis J. Belasco, Jr., Pr.J.M.C.
Hon. Michael R. Connor, J.S.C. (ret.)
Hon. Ramona A. Santiago, J.S.C.
Joseph J. Barraco, Esq. Assistant Director, Criminal Practice Division, Administrative Office of the Courts
Kevin M. Brown, Assistant Director Probation Services, Administrative Office of the Courts
Adriana Calderon, Esq., Municipal Division Manager Somerset/Hunterdon/Warren Counties
Elizabeth Domingo, Trial Court Administrator Union County
Marie Faber, Trial Court Administrator Passaic County
Joseph Fanaroff, Esq., Deputy Attorney General, Office of the Attorney General
Steven M. Fishbein, Coordinator for Mental Health Evidence-Based and Promising Practices, Division of Mental Health and Addiction Services
Raquel Jeffers, Deputy Director, Division of Mental Health and Addiction Services, Department of Human Services
Debra A. Jenkins, Assistant Director, Municipal Court Services Division, Administrative Office of the Courts
Anthony P. Kearns, III, Esq., Prosecutor Hunterdon County
James J. Kelly, Vicinage Chief Probation Officer Ocean County
Joseph E. Krakora, Esq., Public Defender, Office of the Public Defender
Marcia Matthews, Division of Addiction Services, Department of Human Services
Laura Rodgers, LCSW, Jewish Family Service of Atlantic and Cape May Counties
Theodore J. Romankow, Esq., Prosecutor Union County
Carol Venditto, Chief, Drug Court Unit, Criminal Practice Division, Administrative Office of the Courts
Elaine Wladyga, Esq., First Assistant Deputy Public Defender, Office of the Public Defender
Julie Sealander Higgs, Esq., Municipal Court Services Division, Administrative Office of the Courts
IV. DEVELOPMENT OF REPORT AND RECOMMENDATIONS
This report provides an overview of issues surrounding the interaction of mentally ill individuals with the judicial system, sets forth the Committee’s process and issues addressed by each of the three subcommittees and delineates the Committee’s final recommendations.
The recommendations entail various suggestions for developing more effective responses to people with mental illness. They include the suggested expansion of various existing programs/procedures as well as entirely new initiatives. Because of the complex and multi-faceted nature of the issues which the Chief Justice charged the Committee to consider, the recommendations in this report are ambitious and broad in scope. The Committee is cognizant that any recommendation pertaining to entities outside the judicial branch (such as the executive branch) is in the form of a suggestion.
In this report, the interaction of individuals with the criminal justice system has been considered at various points along the continuum of the system. The Committee determined that focusing on initiatives at the earlier chronological end of the spectrum would likely produce the greatest return in terms of effectiveness and financial investment.
A. Mission Statement
The mission of the Chief Justice’s Interbranch Advisory Committee on Mental Health Initiatives is to develop models of research-based, cost-effective intervention processes that can be implemented to improve responses of the criminal justice system to persons with mental illnesses.
B. Committee Activity
The full Committee held meetings on February 23, March 23, April 27, August 17, September 14, October 26, December 7, 2011, September 27 and November 28, 2012. At the first seven meetings the Committee heard presentations from the following speakers: Debra Jenkins (Overview of Mental Health Issues and the New Jersey Judiciary); Steven Fishbein, Division of Mental Health Services (Overview of Justice Involved Services by DMHS and Cross-System Mapping); Dr. Nancy Wolff, Ph.D. (Specialized Mental Health Probation Caseload); Dr. Kenneth Gill, Ph.D. (Union County Jail Diversion Program); Stacey Dix-Kielbiowski, mental health evaluator (Jersey City – Court Liaison Program); Judge Nesle Rodriguez, Chief Municipal Court Judge, Jersey City (Jersey City – Court Liaison Program); Laura Rodgers, LCSW (Jewish Family Service of Atlantic and Cape May Counties, NJ); Judge Belasco (Jewish Family Service of Atlantic and Cape May Counties, NJ).
Judge Daniels created three subcommittees: New Jersey Mental Health Services, chaired by Steven Fishbein; Collaboration of Services, chaired by Debra Jenkins; and Education and Training, chaired by Judge Louis Belasco. The subcommittee members and staff reviewed data, shared information from their various perspectives and evaluated models for improvement in the response to individuals with mental illness who intersect with the criminal justice system.
On September 27 November 28, 2012 the Committee met to discuss the final report.
V. OVERVIEW AND BACKGROUND
The overrepresentation of persons with mental illness in the criminal justice system is a matter of profound and long-standing concern. Individuals with mental illness often cycle in and out of jails and prison, frequently engaging in behaviors which lead to re-arrest and multiple terms of incarceration, while the illnesses which give rise to these behaviors remain untreated or inadequately addressed. This issue significantly impacts public safety, public health, the allocation of government resources and the effective implementation of justice.
There is no precise way to determine the number of mentally ill individuals who interact with the criminal justice system in New Jersey at all points of interception, from pre-arrest law enforcement interactions through post-incarceration/supervisory release. The number of individuals receiving public mental health services was identified by the Division of Mental Health and Addictions Services (DMHAS) by type of program and by county (see Appendix B). There is no method of determining the number of individuals who receive mental health or co-occurring mental health and addiction treatment through the private sector, either reimbursement by insurance or out of pocket.
The courts do not keep track of whether a defendant has been identified with a mental illness. While jails and probation services conduct screenings/assessments for mental health disorders, it is not known how many individuals may have been missed in such evaluations. Some information has been provided by the New Jersey Department of Corrections on one segment of the incarcerated population: according to the medication roster on March 1, 2011, 3,203 inmates, or 13.78% of New Jersey State prisoners, had an Axis 1 diagnosed mental illness and/or were receiving psychotropic medication.
Statistical reports on the volume number of unduplicated defendants charged in Municipal and Superior courts are not available. Therefore, even applying a percentage based upon the rate of mental illness in the general population or from other states’ studies of the mentally ill in the justice system would not produce accurate data for our State regarding the full criminal justice spectrum. The lack of state-specific data inhibits a determination regarding which are the most significant gaps in services to the justice-involved mentally ill in New Jersey. Anecdotally, it is known that many people who interact with the justice system need mental health outpatient and case management services but do receive them.
Outside New Jersey, numerous studies have been conducted on the justice-involved mentally ill which may provide some insight. It has been indicated that individuals with mental illness intersect the criminal justice systems at greater rates than those without mental illness. One study found that 31 percent of arraigned defendants met criteria for a psychiatric diagnosis at some point in their lives and 18.5 percent had a current diagnosis of serious mental illness. It has been estimated that in the United States, as many as 2 million bookings of people with serious mental illnesses may occur each year.
According to a 2006 report by the U.S. Bureau of Justice Statistics, more than half of all prison and jail inmates in the United States had a mental health problem. Mental illness is a likely factor in terms of repetition of incarceration: research has shown that nearly a quarter of both State prisoners and jail inmates who reported they had a mental health problem had served three or more sentences prior to incarceration. The rate of coexisting disorders is also extremely high: about 74% of state prisoners and 76% of local jail inmates who have mental health problems also have substance abuse issues. Mental illness is also a factor in length of incarceration: a 2006 study concluded that mentally ill individuals in prisons spend an average of 15 months longer in prison than other inmates.
From a financial perspective, studies have demonstrated that the monetary cost of incarceration and detention is higher than community-based alternatives. For fiscal year 2012, the per capita cost of incarcerating a person in New Jersey State prison is $42,329 per year. Generally, community-based counseling and treatment can be provided at lower cost than institutionalization.
Additionally, incarcerated individuals with mental illness are at a greater risk of violence in prison and jails. When individuals are released from incarceration back into the community with more aggravated and complicated mental disorders, this produces an even greater burden on the community-based mental health delivery system.
C. Recent History: Responses to Mental Illness
It has been asserted that the large number of individuals with mental illness in the United States criminal justice system developed in great degree because of the "deinstitutionalization" effort that began in the 1960s. Deinstitutionalization was prompted by various factors, including the increasing cost of warehousing the mentally ill in large institutions, the advent of new antipsychotic drugs which held the promise of dramatic improvements in clinical symptoms, as well as the developing civil rights movement with its emphasis on individual rights of marginalized populations.
Reform efforts intended to protect the liberties of people with mental illnesses resulted in the release of many severely ill people from mental institutions. This was aided by major cost-shifting by the states to the federal government following the advent of Medicare and Medicaid and an emphasis on community mental health treatment. However, the community treatment for mentally ill individuals was not properly funded nor provided.
The large number of mentally ill inmates has prompted the description of prisons and jails as "surrogate psychiatric hospitals" and the wide-spread belief that individuals with severe psychiatric illnesses are being criminalized. According to a 2010 study, there are now three times more seriously mentally ill people in jails and prisons than in hospitals.
D. Recent Policy Developments
The multi-faceted problem of individuals with mental illness interacting with the criminal justice system has become more of a focus of policy and practice in recent years. Growing corrections populations, larger court dockets, and the rising number of former prisoners returning to communities have prompted localities to utilize criminal justice resources more effectively. There is growing recognition in the United States that for many offenses, public goals of safety and crime reduction would be equally – if not better – served by alternatives to incarceration, including drug and mental health treatment programs.?? In recent years, numerous innovative programs and collaborative problem-solving approaches have been developed.
In 2002, the Council of State Governments Justice Center developed the Consensus Project, a national effort to help local, state, and federal policymakers and criminal justice and mental health professionals improve the response to people with mental illnesses who come into contact with the criminal justice system. In 2006, the sequential intercept model was developed. This is a now widely-used strategy tool to evaluate points of interception in the criminal justice process. It is used to determine additional intervention strategies to prevent individuals with mental illness from penetrating further into the criminal justice system. In New Jersey, representatives of the DMHAS have been fully trained in how to conduct analyses of court and mental health process/flow according to the sequential intercept model. These analyses are developed through the ‘cross systems mapping’ process and this process has been conducted by the DMHAS in 11 of New Jersey’s 21 counties (see Recommendation 4, infra).
|1. Law Enforcement & Emergency Services|
|2. Post-Arrest: Initial Detention & Initial Hearings|
|3. Post-initial hearings: jail/prison, courts, forensic evaluations, forensic commitments|
|4. Re-entry from jails, state prisons & forensic hospitalization|
|5. Community Corrections & Community Support|
E. The Committee’s Vision
In effectuating the Chief Justice’s charge, the Committee seeks to substantively contribute to positive developments in policy and practice regarding individuals with mental illness who interact with the criminal justice system in New Jersey. The Committee members seek to provide for the Supreme Court’s consideration a vision for a collaborative, effective, and creatively funded response to individuals with mental illness in our State and practical steps to achieve this. In this vision, diverse entities are united in full understanding of the nature of mental illness, the operation of the justice system (and how the system can appropriately accommodate those with mental illness), treatment options, new programs for improvement of the system and the myriad of individual, systemic and society-wide benefits which result from a more effective justice-system response to those who are ill.
F. Overview of New Jersey Mental Health Services
All recommendations to improve or reduce interactions between the criminal justice system and those with mental illness must be considered in light of existing New Jersey mental health services. The following are the primary mental health services in the State:
State Psychiatric Hospitals: TheDMHAS operates four psychiatric hospitals which serve people with persistent and severe mental illnesses who are in need of intensive, inpatient care and treatment. They are accredited health care facilities. They are: Greystone Park, Trenton, Anne Klein Forensic, and Ancora Psychiatric Hospitals.
County Psychiatric Hospitals: The DMHAS funds approximately 90 percent of the cost of indigent inpatient care at six county psychiatric units or hospitals through its State Aid Program. These hospitals include: Bergen Regional Medical Center in Paramus, Bergen County; Buttonwood Hospital, Burlington County in Pemberton Township, Burlington County; Camden County Health Services Center in Blackwood, Camden County; Essex County Hospital Center in Cedar Grove, Essex County; Meadowview Hospital in Secaucus, Hudson County and Runnells Hospital in Berkeley Heights, Union County.
Short Term Care Facility: Short term care facilitiesare locked units to which individuals are involuntarily committed. Individuals have their civil liberties temporarily suspended due to being an imminent danger to themselves or others because of their mental illness. These short term care facility beds are operated by 24 different agencies and serve all 21 New Jersey counties.
Designated Screening Service Programs: The screening and screening outreach program is designed to provide screening, assessment, crisis intervention, referral, linkage, and crisis stabilization services 24 hours per day, 365 days per year, in every geographic area in the State. It is designed to address those citizens who are in an acute psychiatric crisis and need inpatient care; it is where an initial determination of psychiatric commitment is typically made. It is not designed to be the entry to the mental health system.
Early Intervention Support Service: Early intervention support service programs are intended to provide rapid access to short term, nonhospital based crisis intervention and stabilization services for persons with a mental illness. There are seven counties with such programs now and three more are in the development process; it is expected that over time they will be in every county. Community based programs are aimed at offering individuals mental health service options that can divert undue use of emergency room and inpatient programs. Access to this intensive diversionary program is intended to provide a direct alternative to hospital emergency department based crisis services.
Intensive Outpatient Treatment Support Service: Intensive outpatient treatment support serviceprograms operate in 19 counties in order to alleviate strain on the acute mental health system. These new programs are designed to create dedicated access for consumers referred from emergency rooms and other acute settings.
Involuntary Outpatient Commitment to Treatment Law: The DMHAS implemented the Involuntary Outpatient Commitment program in May, 2012. The intent is to provide supervision in the community for a class of mental health consumers that had not been well-served. This population comprises those who are not willing to receive treatment voluntarily and will become, in the foreseeable future, dangerous enough because of a mental illness to require supervision, but who are not so imminently dangerous that they need to be physically confined in an inpatient program. Community agencies providing the services for Involuntary Outpatient Commitment are required to provide a comprehensive outpatient service, coordination and referral system. The counties using this program are being phased in over time.
Programs in Assertive Community Treatment (PACT): PACT is a model of service delivery in which a multidisciplinary mobile treatment team provides a comprehensive array of mental health and rehabilitative services to a targeted group of individuals with serious mental illness. The program is designed to meet the needs of those who are at high risk for hospitalizations, are high service users and who have not benefited from traditional mental health programs. PACT teams conduct the majority of their contacts in natural community settings and are available for psychiatric crises 24 hours a day.
Outpatient Services: Outpatient services are mental health services provided in a community setting to individuals with a psychiatric diagnosis, including clients who are seriously and persistently mentally ill but excluding substance abuse and developmental disability, unless accompanied by treatable symptoms of mental illness. Periodic therapy, counseling, and supportive services are generally provided for relatively brief sessions; between 30 minutes and two hours. Services may be provided individually, in group, or in family sessions. Medication monitoring consists of medication services provided under the supervision of a licensed physician, certified nurse practitioner or clinical nurse specialist. Psychotropic medications are prescribed, administered, and/or monitored. Outpatient services are the most frequently used services by the criminal justice system although the demand for these services is much higher than the capacity of DMHAS to meet.
Integrated Treatment for Co-occurring Disorders: The goal of the integrated treatment for co-occurring disorders program is to provide combined mental health and substance abuse disorder treatment for adults in order to reduce hospitalization, homelessness, increase independent living, and employment. The program is not mandated throughout the State, although community providers have historically expressed interest in its implementation. It is incorporated in existing services including Integrated Case Management Services Partial Care, and Supported Housing rather than as a stand-alone service.
Supported Employment: Supported employment assists mental health consumers in forming an attachment to the workforce through employment and educational opportunities and is critical to their full inclusion in their community and economic independence. Supported employment provides employment assessment, individual job matching and placement and ongoing support on and off the job.
Supported Education: Supported education programs target individuals with severe mental illness and/or co-occurring disorders who either want to or who currently participate in post-secondary education. DMHAS utilizes Supported Education mobile outreach services aimed to assist people to reach their postsecondary academic goals. Services include: accommodation education, managing disclosure issues, exploring/securing funding options.
Justice Involved Services: Justice involved services are essentially case management services intended to assist individuals in diversion from incarceration. These programs target individuals whose legal involvement may be a result of untreated mental illness or co-occurring disorder. They are designed to help them successfully link to mental health or co-occurring and other services and to avoid or reduce the incidence and length of incarceration.
These services are offered through interventions during pre-arrest, post booking and reentry from county jail. Pre-booking diversion typically involves a police based intervention to avoid arrest for non-criminal, non-violent offenses. Police are trained to identify and de-escalate situations involving the mentally ill and to divert to mental health crisis or pre-crisis services when appropriate. Post booking involves individuals who have been arrested but whom the court may release on their own recognizance or release from jail on bail with the defendants’ guarantee that they will obtain mental health assistance.
Defendants with mental illness who are serving jail/prison sentences or long detention are targeted for re-entry services utilizing the best-practice guideline called the "APIC model" (assess, plan, identify and coordinate). Re-entry services include identification/case finding, pre-release planning and linkage to critical mental health, social service, employment and housing upon release. These same services may be arranged for individuals who are picked up by police but who are not arrested.
There are presently 16 counties which have one or more of these diversionary/re-entry services for justice involved individuals with mental illness. Their scope depends upon funding and the availability of mental health and other social services in the county.
Illness Management Recovery: Illness Management Recovery is a psychiatric rehabilitation practice operated with the objective of empowering consumers with severe mental illness to manage their illness and develop their own goals for recovery. Components include psychoeducation, behavioral tailoring for medication, relapse prevention training, and coping skills training.
Veterans’ Services: The DMHAS provides mental health and related support services to members of the armed forces and veterans as part of its regular behavioral health service delivery system. When possible, the service member is transferred to the VA healthcare system, if eligible.
Projects for Assistance in Transition from Homelessness: There are projects for assistance in transition from homelessness programs (PATH) operating in all 21 counties. These programs conduct outreach to locations known to be frequented by homeless individuals in an attempt to continuously assess and identify individuals with serious mental illness who may benefit from linkage to mental health and housing programs.
Supportive Housing: The DMHAS contracts with approximately 52 supportive housing providers and supervised residential providers in all 21 counties. These services range from completely consumer-driven in the consumer’s leased-based housing to supervised settings with 24/7 staffing. In addition, the State funds 11 residential intensive support teams in 13 of the 21 counties – a supportive housing model with a higher staff-consumer ratio and DMHAS funded rental subsidies serving consumers discharged directly from the State hospital system and those at risk of hospitalization. The focus is on the development of skills and supports which promote community inclusion, housing stability, wellness, recovery, and resiliency. These skills include illness management, socialization, work readiness and peer support, all of which foster self-direction and personal responsibility.
Intensive Family Support Programs: An intensive family support services (IFSS) program is funded in each of New Jersey’s 21 counties. These programs provide families with greater knowledge about mental illness, treatment options, the mental health system, and skills useful in managing and reducing symptomatic behaviors of the member with a serious mental illness. Services include psycho-education groups, family support groups, single family consultation, respite activities and referral/linkage.
Consumer Operated Services: At the state level, the DMHAS involves individuals with mental illness in upper level management decision-making, program development, proposal reviews, community site reviews, state hospital monitoring, and participation in key committees and workgroups. DMHAS provides funding and support for peer providers working in the system. There are also peers working in designated screening centers/psychiatric emergency rooms, and plans are underway to develop peer-operated alternatives to crisis and screening. The DMHAS currently funds and supports 33 consumer operated self-help centers statewide, including a self-help center on the grounds of three State hospitals.
Managed Behavioral Health Organization: The DMHAS is moving in the direction of placing its entire behavioral healthcare services under a managed care umbrella. This will impact how services are accessed and who is eligible for what services. Currently, the eligibility, service array, financing and other details are under development.
VI. THE COMMITTEE’S DETAILED RECOMMENDATIONS
As a result of the Committee members’ experience, the research and evaluation of existing programs in New Jersey and in other states and in-depth discussion/debate, the Committee makes the following recommendations.
The cost of each recommendation was considered and any increase in cost as the result of implementation of the recommendation is noted in the section following each recommendation. Some Committee members representing the executive branch have advised the Committee that the State cannot commit new funding to the recommendations but is interested in working collaboratively with the Judiciary and other partners to explore the identification of other resources.The concepts of communication, cooperation and education are themes which weave through the recommendations. These are the principles which will allow current resources to be maximized to achieve an improvement in the response to individuals with mental illness who are involved in the criminal justice system.
RECOMMENDATION 1. It is recommended that the New Jersey Supreme Court establish an Interbranch Mental Health Initiatives Implementation Committee ("Implementation Committee").
The Implementation Committee will effectuate the recommendations of the original Interbranch Advisory Committee on Mental Health Initiatives ("Mental Health Committee"), once those recommendations are reviewed/approved by the Court. It is suggested that representatives from the entities which participated in the original Mental Health Committee be included in the Implementation Committee.
B. Comprehensive plan
RECOMMENDATION 2. It is recommended that the Judiciary develop and adopt a comprehensive plan of intervention strategies pertaining to individuals with mental illness, including initiatives at various stages along the criminal justice spectrum.
The plan should include Judiciary initiatives as well as suggestions to entities outside the Judiciary. The plan should include programs for diversion before arrest as well as diversion after entry into the judicial system and before adjudication.These various initiatives include suggested training of law enforcement personnel to deal more effectively with mentally ill individuals before arrest and the filing of formal charges, (e.g., Crisis Intervention Team training). These programs also include those in which family members, court staff and others identify certain defendants who may have mental illness, and these defendants are then brought to the attention of trained prosecutors who can arrange for evaluations, craft alternatives to bail and potential deferred dispositions which are contingent on defendants completing mental health treatment (see Recommendation 6, infra). Multiple sources of funding for these various initiatives would be aggressively pursued.
C. Development of Core Teams and Problem Solving Committees
Recommendation 3: It is recommended that a local Core Team be established in each county which does not presently have one. The team will be the ‘go to’ local group for assuring that the over-arching structure of collaborative initiatives becomes institutionalized in the county.
Members will serve as point people to help professionals and mental health consumers build solid working relationships and also will report development and results back to the Implementation Committee and the New Jersey Supreme Court. These Core Teams will be critical to implementing the recommendations of the Mental Health Committee and will provide the important, networking component where key relationships are formed and sustained. There are forms of Core Teams operating in approximately 11 counties presently; they are also known as jail diversion task forces or re-entry task forces. Core Teams should be established in counties which do not already have one in operation.
The Core Team would consist of a Municipal and/or Superior Court judge, representatives from the vicinage municipal and/or criminal division staff, probation, the prosecutor’s office, the public defender’s office and the county mental health administrator. Also included would be the municipal court liaison, DMHAS program analyst for the county, the coordinator for intensive case management services, the program of assertive community treatment team leader, a screening director, the justice involved services coordinator or other representatives of the mental health system. A mental health consumer and a family member of an individual with mental illness would also be participants and representatives of other systems may also be invited as needed.
An important function of each county Core Team will be to establish a subgroup – a county ‘Problem Solving Committee.’ The Problem Solving Committee will meet monthly (or more frequently, if needed) to address court related issues in both Municipal and Superior Court which may result from a defendant’s mental illness and or co-occurring mental health and substance use disorder.
The Core Team is the initial group which will facilitate the foundational relationships between key players and, when necessary, and initiate a systems analysis to establish the collaborative structure for each county. In contrast, the Problem Solving Committee is an outgrowth of the Core Team and will handle ongoing meetings regarding case-specific issues. Every effort will be made to ensure that members of the Core Team and the Problem Solving Committee be comprised of existing staff. The groups will be forums for productive communication and collaborative resolution which should not themselves engender additional costs beyond staff time. However, the associated expenses for mental health and related services may add substantial cost to the effort and presently many services are operating at capacity.
The goal of the monthly Problem Solving Committee meetings would be to avoid or shorten incarceration in favor of community treatment and to explore dismissal or reduction in charges if possible and appropriate. This would be accomplished by reviewing specific cases at the monthly meetings. The committee members would identify options agreeable to all parties which may be recommended to the court and may result in dismissal with stipulations for mental health or co-occurring disorder treatment or some other disposition which maintains the defendant with mental illness in the community.
In some situations, a previous referral to mental health services may have already occurred and was not adequate enough to address the circumstances or there may be new circumstances such as repeat appearances before the court on additional charges related to their illness. The objective of the Problem Solving Committee meetings would be to fully analyze the cases and – when appropriate – enable the defendant to obtain access to personally tailored mental health and recovery support. The goal would be to reduce the impact of their mental illness on offending behavior and reduce the likelihood of repeated criminal justice involvement.
The piloting of a Core Team/Problem Solving Committee would be recommended for counties that currently have a criminal justice or jail diversion task force or where there is presently a regular meeting between criminal justice and mental health or where such meetings have been recently held. These counties include Cumberland, Camden, Burlington, Gloucester, Monmouth, Middlesex, Ocean, Union, Essex, Hunterdon, Warrant, Sussex and Bergen. It might also be initiated in vicinages where there is an established relationship between court staff and mental health providers.
D. Cross-systems mapping
RECOMMENDATION 4: It is recommended that cross-systems mapping strategic planning sessions be initiated by the Core Teams in counties which do not currently have such strategic plans.
A key responsibility of each Core Team is to work with designated facilitators from DMHAS to organize a systems mapping/sequential interception information session which would involve both Municipal and Superior Courts. Currently, 11 of New Jersey’s 21 counties have gone through the cross-systems mapping process and have developed county plans from which they operate. The process should be initiated in counties which have not undertaken it.
The cross-systems mapping process highlights different points at which people may be identified and diverted out of the criminal justice system (points of interception) and it maps the local criminal justice resources and the court flow. It addresses the entire spectrum of criminal justice involvement and includes developing a strategic plan of cross-system collaboration as the basis for a subsequent action plan. Critical to the success of cross-systems mapping is the connection and communication among members of the Judiciary, substance abuse and mental health service providers, other social service groups. Ideally cross-system mapping can help transform fragmented systems, identify local resources/gaps and help identify where to begin interventions.
Funding would need to be fully explored, although since cross-systems mapping involves increasing communication between existing staff, significant costs would likely not be generated.
(see appendix for model of sequential intercept model, upon which cross-systems mapping plans are based)
E. Municipal Court liaison program
Recommendation 5: It is recommended that a mental health liaison be established in municipal courts throughout the State.
This strategy involves a qualified mental health specialist employed by DMHAS who is stationed at a municipal court(s). There are several programs of this type operating in the State; the ideal model is a post-booking, pre-adjudication assessment and case management intervention upon which this recommendation is based. In this model, the specialist acts as a consultant and liaison between the court and the mental health system regarding defendants who appear to have severe mental illness. The goal is to identify mentally ill defendants involved in the justice system and reduce the length of time spent in jail by offering the courts alternatives to incarceration, typically involving treatment options. It is different from the Problem Solving Committee method discussed in Recommendation 4. It is recognized that establishment of such programs would be contingent upon a new allocation of federal, state or county mental health resources to the DMHAS.
Defendants in the Municipal Court with non-indictable charges that may result in a sentence of incarceration are eligible for referral. Acceptance for services requires that the defendant be an adult diagnosed with a severe and persistent mental illness (i.e. schizophrenia, bipolar disorder, major depressive disorder). Defendants with co-occurring substance abuse disorders also qualify for services. Participation in the project is voluntary and a defendant must be willing to agree to services and treatment.
Referrals are accepted from the courts, community mental health providers, family members, and law enforcement based on an individual’s psychiatric history or current symptoms, direct observations of behaviors indicating mental illness, the nature of the charge or arrest incident and/or involvement with current mental health treatment.
Once a defendant has been identified as exhibiting symptoms of a possible mental illness, the mental health specialist is contacted by the court administrator, and responds to the courtroom to conduct a clinical interview of the defendant, if the individual is agreeable to participate. A mental health assessment is completed based on the clinical interview and collateral information obtained, and the findings are verbally presented to the court with the consent of the defendant.
If a defendant is determined to suffer from a qualifying psychiatric illness or co-occurring disorder, and meets all other criteria for service acceptance, a treatment plan is developed with the mental health specialist, which would include a referral to a treatment provider, if not currently receiving treatment.
Possible avenues for diversion are explored with attorneys and the judge, with an initial focus on release of a defendant from incarceration, if currently detained, to allow for linkage to appropriate community based treatment after release. Diversionary alternatives may include reduction of bail amounts (including release on own recognizance), deferred prosecution, reduction of imposed sentences, and dismissal and amendment of charges.
If a defendant’s release from custody is not deemed suitable, then a referral to the county jail’s mental health services is made and the mental health specialist will coordinate the care. A community based treatment referral would be provided at the time of the defendant’s release into the community. Additionally, general case management services are coordinated, tailored to an individual’s needs, which may include service referrals to medical providers, housing resources/shelters, entitlement/benefit agencies, and education or employment programs.
Once a defendant is in the community, the municipal court will typically continue to schedule monthly or bi-monthly status hearings to allow for periodic treatment updates. Other diversionary alternatives such as deferred prosecution/adjournments, reduction of imposed sentences (i.e. suspended sentences, probation with a condition of mental health treatment), and dismissal and amendment/downgrade of charges are reviewed for suitability as the case continues. The mental health specialist attends all scheduled court hearings to provide information to assist the court with case adjudication, and to offer possible options. The specialist continues to actively monitor and assist a defendant throughout the duration of the court case, and generally over the course of six months to one year.
A defendant’s active treatment involvement provides the court with an indication of rehabilitative and preventative steps being taken to address potential future behaviors that may be a symptom of a mental illness and lead to criminal behavior. The success of the clients in the program relies on the collaboration established among the criminal justice system, including law enforcement, judges, and attorneys. The project serves as a liaison between these legal entities and mental health services.
The total yearly cost of a municipal court liaison program would vary depending on the nature and extent of the services required by defendants. One case manager can serve upwards of 25 individuals a year and consult with the court on an additional number. Very often, individuals with severe and persistent mental illness require multiple services which increase the overall expense, although the total expense is unique to each individual. For example, one defendant may need a medication evaluation and monitoring and 20 outpatient treatment visits which may cost $2,000 while another defendant might need partial care at an annual cost of $20,000 or specialized supported housing at over $27,000.
It is recommended that the piloting of municipal court liaison programs occur in vicinages which have expressed interest and in municipalities where a larger number of individuals with mental illness tend to reside. It is recognized that establishment of such pilots would be contingent upon a new allocation of federal, state and/or county mental health resources to the DMHAS.
F. Superior Court prosecutor diversion process
RECOMMENDATION 6: It is recommended that Prosecutors Offices which are interested in the diversion process be encouraged and supported in the implementation of these processes.
The model for this recommendation is a collaborative effort between mental health provider agencies and the Prosecutors Office. The purpose is to provide evaluation and intensive case management services to non-violent offenders facing probationary, county jail and state prison terms who are suspected of having a severe and persistent mental illness. Diversion from county jail and state prison custodial sentences as the result of successful completion of acquired treatment services may be recommended to the Court. When appropriate, successful completion of treatment conditions may result in the dismissal of or a reduction in charges. This model is suggested for consideration by Prosecutors Offices interested in offering diversion alternatives within their counties; any implementation of the program would necessitate an additional allocation of federal, state and/or county funding for mental health resources to the DMHAS??and may also require funding and/or training of Prosecutors Office staff.
The overall objective of this diversion program is to prevent recidivism which results in re-incarceration and re-hospitalization of this population.
The comprehensive judicial education program described in Recommendation 8 below would enable the Superior Court Judges involved in a Prosecutor Diversion process to fully understand and assess the proposals presented to them.
To be eligible for this process, a defendant must have a serious mental illness and be someone whom the prosecutor, defense counsel and designated mental health evaluator/provider agree is expected to comply with regular participation in ongoing mental health services and who will maintain a stable mental status for at least three months. Referrals may come from local police departments, either pre- or post-booking, Municipal and Superior courts, Public Defender’s Offices, the defense bar, mental health treatment providers and case management agencies, inpatient hospitals, county and local jails, psychiatric emergency rooms and probation.
The program services include comprehensive clinical and psycho-social evaluations at the time of referrals to establish the presence of severe mental illness. If accepted, treatment plans are individually tailored to include therapy, family counseling, medication management, substance abuse counseling, and career planning, housing and related advocacy services. The enrollee should also be eligible for case management services, depending upon the nature of the case and the needs of the participant. The determination of who would provide these services would be made at the local level.
These services could function as initial conditions of bail pre-dispositionally with the ultimate resolution to include continued program participation as a condition of dismissal or probation as part of a plea bargain agreed to by the prosecutor, defense counsel and defendant and accepted by the court.
Several County Prosecutors have expressed a strong interest in establishing programs of this type. It would require that an Assistant Prosecutor spend time establishing eligible charges and conditions, the public defender and private bar be informed and the local mental health system and providers be engaged.
This recommendation does not provide for extensive Judiciary involvement. Although participants may report back to the judge who directed the diversion, all judges will be fully educated regarding the various aspects of mental illness, treatment and diversion so that they are prepared to appropriately evaluate diversion the proposals fashioned by the prosecutors/defense counsel/mental health service providers (see Recommendation 8). The time and resources allotted may vary from vicinage to vicinage. The vicinages will make appropriate determinations as to the implementation of the process.
The total yearly cost of a Prosecutor Diversion process would vary depending on the nature and extent of the services required by defendants. Mental health services can range from median, annual costs per client of $3,300 for the necessary case management services plus single or multiple mental health services from $2,600 for outpatient services, up to $16,500 for partial care services, upwards of $22,000 or more for specialized supported housing services and $16,000 for Programs of Assertive Community Treatment (PACT) without housing subsidies. Very often, individuals with severe and persistent mental illness require multiple services which increase the overall expense. The profile of services needed by any specific defendant is unique, hence the need for new, additional mental health resources.
G. Specialized probation caseloads
RECOMMENDATION 7: It is recommended that the New Jersey Probation Specialized Mental Health Caseload be expanded and further funding applications for it be made.
This successful program links probationers, through the Judiciary’s Probation Service Division, with mental health services. In 2009 the Division was awarded $5.4 million in federal stimulus funding to hire 30 probation officers to establish adult mental health caseloads statewide, establish collaborative partnerships between Probation and community agencies in the State and reduce the average caseload size of other agency adult caseloads. These probation officers, many with an educational background in mental illness, receive specialized mental health training prior to going into the field.
H. Educational programs
RECOMMENDATION 8: It is recommended that the Implementation Committee supervise the development of educational programs for New Jersey judges (Superior and Municipal Court), so they are all fully educated on relevant aspects of mental illness.
This education will include:
a. The general background of mental illness
b. Methods of best dealing with individuals in crisis in the courtroom (including de-escalation)
c. Referral options (including all available NJ resources, state and county-wide). This may include distribution of an information referral package (similar in format to the "Intoxicated Driver Resource" packet).
d. Legal issues, including civil commitment
e. Connections between other entities
These educational programs will be offered for both experienced and new judges at annual conferences/retreats and various new judge trainings. Continuing legal education credit may be offered for each training. A booklet explaining commonly- used terms relating to mental health will be distributed to every judge in the State ("Judges’ Guide to Mental Health Jargon: A Quick Reference for Justice System Practitioners").
RECOMMENDATION 9: It is recommended that the Implementation Committee supervise the development of educational programs for employees of the New Jersey Judiciary who are not judges (including ombudsmen and drug court staff), so they are all fully educated on relevant aspects of mental illness.
This education will include:
a. The general background of mental illness
b. Resources for the mentally ill and their families: national, state and county-wide
b. The best immediate methods of dealing with individuals in crisis in all relevant environments (including the use of de-escalation techniques)
c. The best responses to individuals with mental illness, beyond immediate crisis-management (e.g., referrals, interactions with the court)
d. Connections between other entities
These educational programs will be offered at new employee orientations and continuing education trainings. Continuing education credit will be offered for each training when appropriate (e.g., for mandatory training required of municipal court administrators). A document explaining commonly-used mental health jargon will be distributed to all these court employees.
RECOMMENDATION 10: It is recommended that the Implementation Committee offer suggested assistance to law enforcement and first responders in creating and further expanding educational programs to improve responses to people with mental illness (e.g., expansion of Crisis Intervention Team training).
These programs should be provided (and appropriately tailored) to:
b. Deputy attorneys general
c. Local police officers (and police management)
d. Police and EMT dispatchers
e. State police officers (and State police management)
f. First responders such as emergency medical technicians
RECOMMENDATION 11: It is recommended that the Implementation Committee provide suggestions to the State and municipal public defenders’ offices on developing educational programs to improve responses to people with mental illness, encompassing the same issues covered in prosecutorial/attorneys general training, with additional information on dealing with mentally ill clients.
RECOMMENDATION 12: It is recommended that the Implementation Committee provide training to the Division of Mental Health Services staff and mental health service providers on how the courts work (Superior and Municipal).
This training would enable mental health professionals to better advise their clients about options/processes and would include an overview of the criminal justice process, information on landlord/tenant, family and other non-criminal matters in which mentally ill individuals would tend to become involved, opportunities for diversion, and advice on negotiating with the prosecutor. The Committee should also provide vicinage-specific information on the judicial process for local, mental health service providers. This training will be provided in the form of:
a. An annual "Mental Health Symposium" to which mental health professionals would be invited, with various presentations on relevant aspects of the justice system. Invitations would be extended to families of the mentally ill and patient support groups. County mental health boards in each county have the most connections to the community and would be effective at publicizing this training. These symposiums should be held in a central location and could then serve as models for separate, regional program which could provide more specific, local information.
b. Standard PowerPoint presentations on the operation of the justice system, distributed to mental health professionals
c. Directions on how to access existing information on the Internet and InfoNet (e.g. "Criminal 101" on the Criminal Division website, educational resources on the Municipal InfoNet page)
RECOMMENDATION 13: It is recommended that the Implementation Committee structure a comprehensive public information program.
This program will encompass:
a. The courthouse public (including brochures offered in every NJ courthouse, which generally explain the legal process and provide information on local, State and national organizations and government entities which can help the mentally ill)
b. The general public. General public information will be conveyed via:
i. Internet site with concrete information and links to resources
ii. Internet public service videos on YouTube — these would explain important components of the justice process (including videos of the informational presentations provided to DMHS staff and mental health service providers, above) as well as explanations of important mental health service complex processes and resources (including videos of informational presentations made to Judiciary staff). These videos will be effectively tagged so that they will turn up in common searches conducted by the public.
iii. Inviting the public to attend the annual Mental Health Symposium (described above), with particular emphasis on outreach to families of mentally ill individuals.
I. Information sharing
RECOMMENDATION 14: It is recommended that information sharing procedures be explored and developed to enable mentally ill individuals to receive services in a timely and effective fashion.
It should be suggested to jails that information regarding daily admit lists be conveyed to local mental health service providers and advocacy groups so that individuals who have been receiving local services might be flagged by service providers, who will then be better able to assist them early in the criminal justice process or upon release from incarceration. This procedure is currently in place at several correctional facilities throughout the State. This type of initiative would not appear to involve added costs. Cross-systems mapping programs (as described in Recommendation 2, above) would also facilitate information sharing.
RECOMMENDATION 15: It is recommended that mental health service providers be educated on the benefits of requesting access to judicial computer systems (e.g., the Automated Complaint System and Automated Traffic System), when appropriate, in order for providers to view defendants’ outstanding charges and best advocate for them within the court system.
Mental health service providers in certain counties have requested and obtained such access, enabling them to examine an individual’s offense history, coordinate payment of fines and communicate with the public defender and prosecutor about arranging for treatment as part of disposition.
RECOMMENDATION 16: It is recommended that the Superior and Municipal Court computer systems be enhanced to include an indicator for defendants who have may have manifested mental illness, either through participation in a mental health diversion program, participation in DMHAS programs or some other means. Prior to implementation, the confidentiality aspect of this recommendation will be fully explored to ensure that privacy concerns and any other legal considerations pertaining to defendants are completely addressed. This will include an analysis of the process by which such an identifier would be attached to a defendant and the security of data. This indicator will enable the Judiciary to gather data regarding the number of mentally ill individuals involved in the criminal justice system and facilitate the development of programs to assist the justice-involved population.
RECOMMENDATION 17: It is recommended that comprehensive and creative funding strategies should be fully explored.
This exploration should include:
a. an aggressive investigation and review of grants and other funding sources, including full assessment of monies available for co-occurring disorder initiatives and options available from the Criminal Justice/Mental Health Consensus Project coordinated by the Council of State Governments Justice Center
b. a request that the Judiciary’s legislative liaisons collaborate with the Implementation Committee on any legislative initiatives which could produce funding for mental health/diversion programs
c. an investigation of whether new court assessments could be a source of funding
e. an exploration of expanding the use of mental health service user fees (for those who have the income and/or insurance to fund their own treatment)
f. an offer of guidance to mental health entities to work more effectively at obtaining funding for which individuals may be qualified for, on a case-by-case basis (e.g., assisting with the application for SSI or veteran’s benefits)
g. obtaining quantifiable data regarding the beneficial outcome of various mental health initiatives which will assist with the successful implementation of these funding strategies.
FN:1American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. (4th ed., text rev. 2000). Any references to ‘mental illness’ in this report will refer to this more serious subspecialty of mental illness.
FN:2. Report of the New Jersey Public Defender to the New Jersey State Advisory Committee to the United States Commission on Civil Rights (2011), available at http://www.state.nj.us/defender/news/DisabilityPanelUSCivilRights.pdf
FN:3. Information provided on September 24, 2012 by Steve Fishbein, Coordinator for Mental Health Evidence Based & Promising Practices, DMHAS, Department of Human Services.
FN:4. Mark R. Munetz, Jennifer L. S. Teller, The Challenges of Cross-Disciplinary Collaborations: Bridging the Mental Health and Criminal Justice Systems, 32 Cap. U. L. Rev. 925, 938-39 (2003-2004).
FN:5. Nahama Broner, Stacy Lamon, Damon Mayrl, and Martin Karopkin, Arrested Adults Awaiting Arraignment: Mental Health, Substance Abuse, and Criminal Justice Characteristics and Needs, 30 Fordham Urban Law Review 663–721 (2002–2003).
FN:6. Henry J. Steadman, Fred C. Osher, Pamela C. Robbins, Brian Case, & Steven Samuels, Prevalence of Serious Mental Illness Among Jail Inmates, 60 Psychiatric Services 761–65 (2009), available at. consensusproject.org/publications/prevalence-of-serious-mental-illness-among-jail-inmates/PsySJailMHStudy.pdf
FN:7. William J. Sabol, Todd D. Minton, Jail Inmates at Midyear 2007, Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2008. This is the most recent information from the Bureau of Justice Statistics; in March, 2012, representatives reported that workers are currently in the field collecting additional data on incarcerated mentally ill individuals, as part of a larger study on sexual violence in prison.
FN:8. Doris James and Lauren Glaze, Mental Health Problems of Prison and Jail Inmates, Bureau of Justice Statistics special report, (September 2006, revised December 14, 2006.).
FN:10. Ibid. See also, Mentally Ill Offender Treatment and Crime Reduction Act of 2003: Hearings on S. 1194 Before the S. Judiciary Comm., 108th Cong. (2003) (testimony of Dr. Reginald Wilkinson, director, Ohio Department of Rehabilitation and Correction), available at http://www.judiciary.senate.gov/resources/transcripts/108transcripts.cfm
FN:11. This figure provided by a representative of the New Jersey Department of Corrections, Allison delVecchio. This number does not include fringe benefits
FN:12. Ibid. See also, Bernstein, R., Criminal Justice Reform: Lessons from the Deinstitutionalization Movement, White Paper, Bazelton Center for Mental Health Law (2007), available at http://www.bazelon.org/LinkClick.aspx?fileticket=AremSqYTGyM%3d&tabid=319
FN:13. Nancy Wolff, Cynthia L. Blitz, Jing Shi, Rates of Sexual Victimization in Prison for Inmates with and without Mental Disorders, 58 Psychiatric Services, 1087–1094 (2007). See, Bureau of Justice Statistics, Sexual Victimization in Prisons and Jails Reported by Inmates, 2008–09 (August 2010).
FN:15. Chris Koyanagi, Learning From History: Deinstitutionalization of People with Mental Illness As Precursor to Long- Term Care Reform, Kaiser Commission, Medicaid and the Uninsured (2007).
FN:16. Robert Bernstein, Criminal Justice Reform: Lessons from the Deinstitutionalization Movement, White Paper, Bazelton Center for Mental Health Law (2007), available at http://www.bazelon.org/LinkClick.aspx?fileticket=AremSqYTGyM%3d&tabid=319
FN:19. New York Human Rights Watch, Ill-Equipped: US Prisons and Offenders with Mental Illness (2001), available at www.hrw.org/reports/2003/usa1003)
FN:20. E. Fuller Torry, Aaron Kennard, Don Eslinger, Richard Lamb, James Pavle, More Mentally Ill Persons Are in Jails and Prisons than Hospitals: A Survey of the States, National Sheriff’s Association and Treatment Advocacy Center (May 2010).
FN:21. The Criminal Justice System and Mentally Ill Offenders before the Senate Committee on the Judiciary, 107 Congress (2002), available at http://www.gpo.gov/fdsys/pkg/CHRG-07shrg86518/html/CHRG-107shrg86518.htm
FN:23. National Association of Pretrial Services Agencies, Promising Practices in Pretrial Diversion, Bureau of Justice Assistance, available at http://www.pretrial.org/Docs/Documents/PromisingPracticeFinal.pdf
FN:24. Justice Center, The Council of State Governments, Active Projects (YEAR) available at: http://consensusproject.org/
FN:25. Mark Munetz and Patricia Griffin, Use of the Sequential Intercept Model as an Approach to Decriminalization of People with Serious Mental Illness, 57 Psychiatric Services 544-549 (2006). See, Appendix A, infra. Also available at http://ps.psychiatryonline.org/article.aspx?Volume=57&page=544&journalID=18
FN:27. Information provided on September 23, 2012 by Steven Fishbein, Coordinator for Mental Health Evidence Based and Promising Practices, DMHAS, Department of Human Services.
FN:28. Public Defender Joseph E. Krakora has also created a summary of mental health services provided in New Jersey Jails. See, Appendix D.
FN:29. This model is based on the Union County Jail Diversion Program. Appendix C provides a detailed analysis of the Union program, by Kenneth Gill, Ph.D. and Ann Murphy, M.A.