mentally ill offenders, inmate programs, community based corrections by gey12140

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									U.S. Department of Justice                                                   RT
                                                                                    NT OF J


Office of Justice Programs

                                                                     BJ A C E

                                                                                          G OVC
                                                                      OF F



                                                                             O F OJJ D P B RO

National Institute of Justice                                                    J US T I C E P

 National Institute of Justice
 P            r           o     g   r     a   m     F   o    c   u                      s

Services for
Mentally Ill
Offenders: Maryland’s
                                        Community Criminal
                                        Justice Treatment
                                                PROGRAM FOCUS

Coordinating Community Services
for Mentally Ill Offenders:
Maryland’s Community Criminal
Justice Treatment Program
by Catherine Conly

L      ooking around his apartment, 45-year-old Ray Carver can hardly believe
his good fortune.1 Not long ago, he was living in abandoned buildings and drink-
ing cheap whiskey. He had survived like that since he was a teenager, traveling up
and down the East Coast, periodically being arrested for shoplifting or vagrancy
and spending months at a time in jail. In his early twenties, Ray was diagnosed
with schizophrenia by a psychiatrist in a District of Columbia jail. Since then, he
had taken medication sporadically and had been institutionalized twice for his
mental illness. Most of the time, however, he lived on the streets and drank heavily.
  The number of mentally ill individuals in the       q   Local advisory boards composed of local       ders. Criminal justice and treatment profes-
  criminal justice system has grown dramati-              and State decisionmakers who provide on-      sionals credit MCCJTP with improving the
  cally during the past 30 years. Often homeless          going leadership.                             identification and treatment of jailed mentally
  and suffering from other health-related con-                                                          ill individuals, increasing communication be-
                                                      q   Case management services that include
  cerns (e.g., substance abuse, HIV infection),                                                         tween mental health and corrections profes-
                                                          crisis intervention, screening, counseling,
  these individuals may cycle continuously be-            discharge planning, and community             sionals, improving coordination of in-jail and
  tween the community, where they commit                                                                community-based services for mentally ill
  mostly minor offenses, and jail.                                                                      offenders and defendants, and reducing dis-
                                                      q   Services for mentally ill offenders who are   ruption in local jails. Case managers and cli-
  Recognizing this pattern and seeking to inter-          homeless or have co-occurring substance       ents report that MCCJTP’s comprehensive
  vene productively, local policymakers have              use disorders.                                services have improved the quality of many
  worked with officials in Maryland’s Depart-
  ment of Health and Mental Hygiene and with          q   Routine training for criminal justice and     clients’ lives.
  other State officials to establish the Maryland         treatment professionals.                      Independent evaluation of MCCJTP service
  Community Criminal Justice Treatment Pro-           q   Postbooking diversion for qualifying men-     delivery mechanisms and client outcomes is
  gram (MCCJTP), a multiagency collabora-                 tally ill defendants.                         now under way. The investigation will help in
  tive that provides shelter and treatment services                                                     determining whether providing coordinated,
                                                      The MCCJTP model features strong collabo-
  to mentally ill offenders in their communities.                                                       community-based services to mentally ill of-
                                                      ration between State and local providers, a
  Created to serve the jailed mentally ill, the                                                         fenders can significantly reduce recidivism,
                                                      commitment to offering transitional case man-
  program now also targets individuals on pro-                                                          increase residential stability, reduce psychiat-
                                                      agement services, the provision of long-term
  bation and parole.                                                                                    ric hospitalization, and increase voluntary
                                                      housing support to mentally ill offenders, and
                                                                                                        participation in substance abuse treatment.
  MCCJTP operates in 18 of the State’s 24 local       a focus on co-occurring substance use disor-
  jurisdictions and features:

2 National Institute of Justice
                                            PROGRAM FOCUS

When Ray was arrested for shoplifting in       Finding humane, constitutional, and            of coordinated care and treatment. This
Salisbury, Maryland, he reported to the        effective ways to address the needs of         “system cycling” is discouraging to the
Wicomico County Detention Center’s             mentally ill individuals is a challenge        mentally ill offender and costly to the
classification officer that he had been        for local correctional facilities nation-      network of community-based providers.
taking medication for schizophrenia. The       wide. Crowded, outdated, and designed to
officer referred Ray to the mental health      ensure secure confinement, most jails are
case manager assigned to the jail by the       not optimal treatment settings for the
                                                                                              Overview of MCCJTP
county health department through the           mentally ill.7 Nonetheless, the nature of      After years of study and discussion, local
Maryland Community Criminal Justice            jail populations increasingly demands—         corrections officials in Maryland worked
Treatment Program. With that referral,         and numerous court decisions require—          with others in local government, with
Ray Carver embarked on a journey that          that jails respond to the needs of the         State officials, and with representatives
would significantly change his life.           mentally ill.8                                 from the private sector to create MCCJTP.
                                                                                              In various stages of implementation in 18
Thousands of mentally ill individuals pass     Researchers consistently recommend             of the State’s 24 local jurisdictions,15
through local correctional facilities each     correctional strategies that result in early   MCCJTP brings treatment and criminal
year. In 1996, one-quarter of jail inmates     identification and referral of the jailed      justice professionals together to screen
reported that they had been treated at some    mentally ill to the most appropriate treat-    mentally ill individuals while they are
time for a mental or emotional problem.2       ment setting, preferably in the commu-         confined in local jails, prepare treatment
Nearly 89,000 said that they had taken a       nity.9 However, only a few jails have          and aftercare plans for them, and provide
prescription medication for those types of     achieved this goal.10 Even in jails where      community followup after their release.
problems, and more than 51,000 reported        psychiatric services are models for others     The program also offers services to men-
that they had been admitted to an over-        nationwide, a significant proportion of        tally ill probationers and parolees and
night mental health program.3                  the mentally ill can go undetected and/or      provides enhanced services to mentally ill
                                               untreated.11 In addition, many mentally ill    offenders who are homeless and/or have
The dramatic growth of the population of       individuals are released with no plan for      co-occurring substance use disorders (see
jailed mentally ill persons has coincided      community-based care.12                        “MCCJTP: At the Forefront of Efforts to
with the policy of deinstitutionalization
                                                                                              Aid Mentally Ill Offenders,” page 4).
that resulted in the release of thousands of   Mentally ill offenders are poorly equipped
mentally ill people from psychiatric facili-   to serve as advocates for their own wel-       MCCJTP targets individuals 18 or older
ties to the community.4 Additional factors,    fare. They often face multiple challenges,     who have a serious mental illness (i.e.,
including cuts in public assistance, more      including homelessness, unemployment,          schizophrenia, major affective disorder,
stringent civil commitment laws, declines      estrangement from family and friends,          organic mental disorder, or other psy-
in the availability of low-income housing,     substance abuse, and other serious health      chotic disorders), with or without a co-
and limited availability of mental health      conditions such as HIV/AIDS, tuberculo-        occurring substance use disorder. It is
care in the community, are thought to have     sis, and hepatitis.13 In turn, community-      founded on two key principles:
exacerbated conditions for the mentally ill    based providers often find mentally ill
and contributed to their increased involve-    offenders challenging to serve because         q   The target population requires a
ment in the criminal justice system.5 Many     of their “coexisting conditions, noncom-           continuum of care provided by a
mentally ill offenders are charged with        pliance, criminal records, unkempt                 variety of service professionals in
relatively minor offenses (e.g., prostitu-     appearance, and clinically difficult and           jail and in the community that is
tion, shoplifting, vagrancy),6 but are not     challenging presentation.”14 Consequently,         coordinated at both the State and
diagnosed or treated while in jail and are     mentally ill individuals may cycle repeat-         local levels. In this regard, agency
released back to their communities with        edly through the health, mental health,            participants include local mental
no plan for treatment or aftercare.            social service, and criminal justice sys-          health and substance abuse treatment
                                               tems, each with its unilateral focus, and          providers and advocates, local hospital
                                               never become stabilized because of a lack          professionals, housing providers,

                                                                                                                 Program Focus 3
                                            PROGRAM FOCUS

                                                  MCCJTP: At the Forefront of Efforts to
                                                  Aid Mentally Ill Offenders
                                                  Efforts to comprehensively address the needs               services that link detainees, on release, to
                                                  of the jailed mentally ill are still relatively            community services are seldom provided
                                                  rare. According to a nationwide survey of jails            in jails of any size.”c MCCJTP is a clear
    members of local law enforcement,
                                                  conducted by researchers at the National                   exception to this trend.
    and representatives of key State crimi-
                                                  GAINSa Center for People With Co-Occurring
    nal justice, mental health, and sub-                                                                 q   Long-term housing support for homeless
                                                  Disorders in the Justice System (see “Sources
    stance abuse agencies.                                                                                   mentally ill offenders. According to
                                                  for More Information” at the end of this re-
                                                                                                             Steadman, “Rarely do you see housing as
                                                  port), “most jails have no policies or proce-
q   Local communities are in the best                                                                        a part of a jail/criminal justice program for
                                                  dures for managing and supervising mentally
    position to plan and implement                                                                           mentally ill or substance abusing indi-
                                                  disordered detainees.”b
    responses to meet the needs of the                                                                       viduals. You may see some use of short-
                                                  Henry Steadman, one of the study’s authors                 term housing vouchers but not the full-
    mentally ill offenders in their juris-
                                                  and a renowned expert on responses to men-                 scale commitment Maryland has made.”
    dictions. To that end, each participat-
                                                  tally ill offenders nationwide, believes the
    ing jurisdiction has developed a local                                                               q   Focus on co-occurring disorders. “Officials
                                                  features that set MCCJTP apart from most
    advisory board to oversee the conduct                                                                    in Maryland,” Steadman noted, “have rec-
                                                  other efforts include:
    of needs assessments, coordinate pro-                                                                    ognized that co-occurring disorders are the
    gram implementation, monitor service          q   Strong collaboration between State and lo-             norm and not the exception.” In his opinion,
                                                      cal providers. “Typically, States don’t coor-          that awareness and the State’s related pro-
    delivery, and expand program options.
                                                      dinate anything in these efforts,” Steadman            grammatic response set MCCJTP apart from
                                                      observed. “In addition, it is very rare for the        many of its counterparts across the Nation.
MCCJTP’s goals are to improve the identi-
                                                      State to do something that the county is
fication and treatment of mentally ill of-                                                               Notes
                                                      receptive to without usurping county author-
fenders and increase their chances of                 ity. It is usually left to the county to address
successful independent living, thereby                                                                   a. GAINS = G–Gathering information,
                                                      the needs of the jailed mentally ill. The          A–Assessing what works, I–Interpreting the
preventing their swift return to jail, mental         integration of funding streams at the differ-      facts, N–Networking with key stakeholders,
hospitals, homelessness, or hospital emer-            ent levels of government and the ongoing           S–Stimulating change.
gency rooms. In some locations, MCCJTP                commitment by State officials involved in
                                                                                                         b. Steadman, H., and Veysey, B., Providing
also aims to reduce the period of incarcera-          MCCJTP make the program unique.”
                                                                                                         Services for Jail Inmates With Mental Disorders,
tion (through postbooking diversion) and          q   Transitional case management services              Research in Brief, Washington, DC: U.S. Depart-
even reduce the likelihood of incarceration           that link detainees with community-based           ment of Justice, National Institute of Justice, April
altogether (through prebooking diversion).            services. Based on their survey of jails na-       1997, NCJ 162207, page 1.
                                                      tionwide, Steadman and his coauthor, Bonita        c. Ibid, 2.
According to data maintained by the Mary-             Veysey, concluded that “case management
land Department of Health and Mental Hy-
giene, almost 1,700 mentally ill individuals
received services through MCCJTP in 1996        and discusses the benefits of and chal-                  generally ignored unless such individuals
(see “The Mentally Ill in Maryland Jails,”      lenges to program operation.                             were suicidal or disruptive. The disruptive
page 5). Funding for the 18 programs totals                                                              ones were usually “locked down,” but not
approximately $4 million annually and           The Roots of the                                         until staff had spent considerable time in
comes from local, State, and Federal            Program                                                  crisis management, trying to subdue them or
sources. In addition, many agencies contrib-                                                             negotiate with mental health agencies for
                                                In the early 1990s, an estimated 600 to 700              emergency commitments. Lacking mental
ute administrative time and support services    mentally ill offenders were confined in local
(see “MCCJTP Funding,” page 5).16 The                                                                    health training, correctional officers were
                                                correctional facilities throughout Maryland.17           frustrated and sometimes insensitive in their
funding supports the provision of case man-     Because they lacked sufficient numbers of
agement services in each jurisdiction and                                                                handling of mentally ill offenders, which
                                                appropriately trained staff to screen and treat          exacerbated an already difficult situation.
other specialized services such as housing to   the mentally ill, jails were neither sensitive,
meet the needs of mentally ill offenders.                                                                Adding to the concerns of corrections offi-
                                                nor especially safe, places for most mentally            cials was the high rate of recidivism among
                                                ill individuals. In those days, according to             mentally ill offenders (see “Assessing Ser-
This Program Focus reviews the history of
                                                several local corrections officials, the spe-            vice Needs,” page 6). One frustrated former
MCCJTP, describes key program features,
                                                cial needs of mentally ill offenders were                warden of a detention facility in southern

4 National Institute of Justice
                                              PROGRAM FOCUS

                                                     The Mentally Ill in Maryland Jails
                                                     According to data main-
                                                                                       Diagnosis                          Diagnosed Jail Detainees
                                                     tained by the Maryland
                                                     Mental Hygiene Adminis-                                                Number* Percentage
                                                     tration, 1,682 jailed men-
                                                                                       Depressed or Bipolar Disorder            51               72
Maryland, who has since become a strong              tally ill individuals re-
advocate of MCCJTP, admits having asked              ceived MCCJTP services            Schizophrenic Disorder                     5               7
publicly about the mentally ill offenders in his     during 1996. The average          Psychotic Disorder                         3               4
jail, “Can’t we shoot them up with something         daily jail population in the      Other**                                  17               23
and just keep them asleep while they’re here?”       MCCJTP sites ranged from          *Some individuals have multiple diagnoses.
                                                     a low of 52 to a high of          ** These include: antisocial personality disorder, attention deficit
In 1991, at the request of the Maryland              1,362, with a median popu-        hyperactivity disorder, conduct disorders, dissociative disorders,
                                                     lation of 237. The propor-        eating disorders, intermittent explosive disorder, learning disorders,
Correctional Administrators Association, the                                           obsessive-compulsive disorder, and personality disorders.
                                                     tion of jailed individuals
Governor’s Office of Justice Administration
                                                     who were mentally ill var-
(GOJA) formed an interagency State and
                                                     ied considerably across the 18 jurisdictions. For (50 percent) had a co-occurring substance use
local task force to help define a strategy for       instance, in the five jurisdictions visited by the disorder.
responding to mentally ill offenders in the          author, prevalence estimates ranged from 8 to
State. After careful review of available na-         21 percent.a                                           Note
tional research and reports on the topic by                                                               a. National estimates of the percentage of jailed popu-
                                                     The following data from Frederick County,
previous State task forces (see “Building on                                                              lations with serious mental illness (e.g., schizophre-
                                                     taken during a 1-day census in June 1997,
Research,” page 7), the GOJA task force                                                                   nia, bipolar disorder, severe recurrent depression)
                                                     indicate the prevalence of mental illness among      range from 6 to 15 percent, depending on the study and
concluded that offenders with serious mental         the jailed population there. Of 341 inmates in       institution. See Torrey, E.F., Editorial: “Jails and
illnesses require a coordinated treatment            the Frederick County Adult Correctional Cen-         Prisons—America’s New Mental Hospitals,” Ameri-
approach that combines the expertise of              ter that day, 71 (21 percent) were diagnosed         can Journal of Public Health 85 (12) (December
criminal justice and treatment professionals.        with 1 or more mental illnesses. Of those, 36        1995): 1612.

The Jail Mental Health                             primary responsibility for the design and              pilot Jail Mental Health Programs (prede-
                                                   implementation of a pilot program to                   cessors to MCCJTP) were launched in
Program pilot
                                                   aid local detention centers in creating a              Cecil, Charles, Frederick, and Wicomico
The State’s Mental Hygiene Administration          multidisciplinary response to the jailed               counties. The pilots resulted in the creation
(MHA), part of the Maryland Department             mentally ill. In 1993 and 1994, with                   of a system for providing case management
of Health and Mental Hygiene, assumed              $50,000 in seed money from MHA, four                   services to mentally ill inmates.

  MCCJTP Funding
  MCCJTP combines Federal, State, and local         q   $340,922 in Edward Byrne Memorial State           q   Administrative and support services
  funds to offer a mix of services within local         and Local Law Enforcement Assistance                  from participating agencies for which cost
  detention centers and in the community.               Program funds to provide substance abuse              estimates are not available.
  Current program funding includes:                     treatment services in conjunction with
                                                        mental health services in seven county            Note
  q   $900,000 in annual Mental Hygiene Ad-
                                                        detention centers and in the community.
      ministration (MHA) funds to hire MCCJTP                                                             a. PATH is part of the Mental Health Services Block
      case managers.                                q   $5.5 million from the U.S. Department of          Grant to the States that is overseen by Substance
                                                        Housing and Urban Development (HUD)               Abuse and Mental Health Services Administration’s
  q   $300,000 in annual Projects for Assis-                                                              (SAMHSA’s) Center for Mental Health Services.
                                                        to provide Shelter Plus Care housing over
      tance in Transition From Homelessness                                                               PATH provides a variety of treatment formula grant
                                                        a 5-year period (1996–2001).
      (PATH)a funds for outreach, case manage-                                                            awards to the States for homeless people with mental
      ment, mental health, and substance abuse      q   $6,557,719 in matching funds and ser-             illnesses and co-occurring substance abuse prob-
      services for homeless individuals with se-        vices from jurisdictions participating in         lems, including treatment, support services in resi-
      rious mental illness and/or co-occurring          MCCJTP, $5.5 million of which supports            dential settings, and coordination of services and
      substance use disorders, and for parolees         the Shelter Plus Care housing program.            housing. See “Sources for More Information” at the
      and probationers on intensive supervision                                                           end of this report for contact information.

                                                                                                                                   Program Focus 5
                                                PROGRAM FOCUS

Within a short amount of time, those
involved in the Jail Mental Health Pro-
gram began reporting improved identifi-
cation of the jailed mentally ill, enhanced
communication between mental health
and corrections staff, and reduced disrup-
tions associated with mentally ill inmates
(see “Screening Mentally Ill Offenders in
Charles County,” page 8).

Fourteen additional counties have since
developed similar programs to respond to             Case managers, MCCJTP clients, and other consumers at Go-Getters, Inc., a psychiatric
mentally ill offenders. Over time, the               day treatment program in Wicomico County, MD, share free time between classes.
focus of the Jail Mental Health Program
has expanded to include greater use of               Key Features of                                     She counseled Ray throughout his stay at
community-based services and diversion.                                                                  the detention center, and together they
                                                     Maryland’s Coordi-                                  developed a treatment and aftercare plan
In addition, mentally ill probationers and
parolees have been added to the client               nated Approach                                      for him that included taking his medica-
base. The program’s title was changed to                                                                 tion, participating in treatment for alco-
                                                     Immediately after Ray Carver was referred
the Maryland Community Criminal Justice                                                                  holism, reinstating his Supplemental
                                                     for a mental health screening, the MCCJTP
Treatment Program in 1994 to reflect its                                                                 Security Income benefits, locating hous-
                                                     case manager reviewed his history of men-
broader scope.                                                                                           ing, and participating in the day program
                                                     tal illness and referred him for medication.

  Assessing Service Needs
  From 1984 through the early 1990s, local task          vide other supportive services within jail,        that during the previous 12 months, 54
  forces and MHA staff studied the capacity of           prepare discharge plans, and offer com-            percent had been in jail, 36 percent had
  existing service delivery mechanisms to meet           munity-based followup.                             received inpatient hospitalization, 35 per-
  the needs of mentally ill offenders and discov-                                                           cent had used an emergency shelter, and
                                                     q   Mentally ill individuals had a high rate
  ered the following:                                                                                       33 percent had seen a substance abuse
                                                         of recidivism. Mentally ill offenders ap-
                                                                                                            counselor.a Investigators concluded that
  q   Most detention centers had extremely               peared to return quickly to correctional
                                                                                                            better service coordination was warranted
      limited access to mental health profes-            settings at least in part because of the lack
                                                                                                            to reduce duplication in services, stabilize
      sionals. Jail medical staff were generally         of appropriate aftercare planning and ser-
                                                                                                            mentally ill offenders in the community,
      not trained to address both the medical and        vices in the community. In addition, many
                                                                                                            and prevent their return to jail.
      psychiatric needs of inmates. If available,        mentally ill offenders were homeless
      psychiatric services were limited to a few         and/or had co-occurring substance use           These findings strongly suggested the need to
      hours per week or month, when only the             disorders that increased the likelihood of      design a program that would increase services
      most severe cases could be evaluated. Jail         their return to jail.                           for mentally ill offenders, coordinate services
      officials also experienced considerable                                                            already in existence, and support mentally ill
                                                     q   Mentally ill offenders tended to cycle
      difficulty with the mental health system                                                           offenders in the community.
                                                         through a variety of criminal justice and
      when trying to relocate individuals whose
                                                         psychosocial service settings, in part be-      Note
      mental illness appeared to warrant admis-
                                                         cause of the lack of coordination among
      sion to a State mental institution. Both in-
                                                         service providers. A survey by MHA staff        a. Gillece, J., “An Analysis of Health, Criminal
      jail and community-based services were                                                             Justice, and Social Service Utilization by Individu-
                                                         of 536 individuals housed in detention cen-
      being compromised by the lack of proper                                                            als Hospitalized, Incarcerated, or Homeless,”
                                                         ters, State psychiatric hospitals, homeless
      staff to screen mentally ill offenders, pro-                                                       unpublished doctoral dissertation, College Park:
                                                         shelters, and substance abuse clinics showed
                                                                                                         University of Maryland, 1996: 52.

6 National Institute of Justice
                                             PROGRAM FOCUS

                                               Building on Research
                                               During the past decade, a number of re-            vices (e.g., university resources), especially
                                               searchers have recommended strategies for          in small jails.e
                                               responding to the needs of the jailed men-
                                                                                                  Some research suggests that services for the
at Go-Getters, Inc., a local psychiatric       tally ill, all of which have been carefully
                                                                                                  jailed mentally ill should also include:
rehabilitation center and partner agency       integrated into MCCJTP.
of MCCJTP.                                                                                        q   Screening, classification, and referral.
                                               Specifically, MCCJTP’s grounding prin-
                                               ciple—that communities must provide a con-         q   Crisis intervention.
The case manager discussed Ray’s crimi-        tinuum of care for mentally ill offenders—is
nal charges with his public defender, the      consistent with 1990 research that concludes       q   In-jail counseling.
assistant State’s attorney, and the district   that the mental health needs of inmates must       q   Discharge planning and community
court judge. Ray pled guilty and was           be viewed as a community problem requiring             followup.
sentenced to a year’s probation. Several       the involvement of an array of service provid-
                                               ers in addition to detention center staff.a        q   Specialized services for subgroups of men-
components of the treatment plan, which
                                                                                                      tally ill offenders, such as those who are
he signed in the presence of the judge,        Although sites around the Nation differ in             homeless and/or have co-occurring sub-
were included as conditions of Ray’s           their approach to such service coordination,b          stance use disorders).f
probation.                                     a 1992 review of research and practice recom-
                                               mended that the following key elements, which      Notes
Because he was homeless before his incar-      are central features of MCCJTP, be part of any
                                                                                                  a. Steadman, H.J. Effectively Addressing the Mental
ceration and willing to quit drinking and      multidisciplinary response to the jailed men-
                                                                                                  Health Needs of Jail Detainees, Washington, DC:
participate in daytime activities at Go-       tally ill:
                                                                                                  U.S. Department of Justice, National Institute of
Getters, Inc., Ray qualified for housing       q   Interagency agreements.                        Justice, 1990: 3.
assistance through the Shelter Plus Care
                                               q   Consensus on defined goals.                    b. Ibid., 3.
grant awarded to Maryland’s Department
of Health and Mental Hygiene by the                                                               c. Landsberg, G. “Developing Comprehensive Mental
                                               q   Delineation of responsibilities.
                                                                                                  Health Services in Local Jails and Police Lockups,” in
Federal Department of Housing and Ur-
                                               q   Interagency communication.                     Innovations in Community Mental Health, ed. S.
ban Development. Prior to Ray’s release,                                                          Cooper and T.H. Lentner, Sarasota, FL: Professional
the MCCJTP case manager helped Ray             q   Cross-training.                                Resource Press, 1992: 97–123.
complete an application for Shelter Plus
                                               q   Ongoing program review.c                       d. Steadman, H.J., S.M. Morris, D.L. Dennis, “The
Care housing, and a representative from                                                           Diversion of Mentally Ill Persons From Jails to
Hudson Health Services, another partner        In a 1995 discussion of strategies for diverting   Community-Based Services: A Profile of Pro-
agency of MCCJTP, located an apartment         the mentally ill out of criminal justice set-      grams,” American Journal of Public Health (De-
for Ray in a relatively low-crime area of      tings, researchers called for:                     cember 1995): 1631.
town, just a few blocks from Go-Getters.       q   Integrated services.                           e. Steadman, H.J., and B. Veysey, Providing Services
The furnishings for Ray’s apartment—a                                                             for Jail Inmates With Mental Disorders, Research in
                                               q   Regular meetings of key agency repre-          Brief, Washington, DC: U.S. Department of Justice,
sofa, bed, table, and chair—were donated
                                                   sentatives.                                    National Institute of Justice, April 1997.
by local church and community organiza-
tions and moved to the apartment by two        q   “Boundary spanners” (individuals who can       f. Steadman, H.J., D.W. McCarty, and J.P. Morrissey,
of the detention center’s work release             facilitate communication across agencies       The Mentally Ill in Jail: Planning for Essential Ser-
inmates.                                           and professions) to coordinate policies        vices, New York: Guilford Press, 1989; Dvoskin, J.,
                                                   and services.                                  “Jail-Based Mental Health Services,” in Steadman,
                                                                                                  Effectively Addressing the Mental Health Needs of Jail
On the day he was released from jail,          q   Strong leadership.                             Detainees, 64–90; Landsberg, G., “Developing Com-
Ray’s MCCJTP case manager spent the                                                               prehensive Mental Health Services in Local Jails and
                                               q   Early identification of the mentally ill in
day helping him get settled in his new                                                            Police Lockups”; Center for Mental Health Services,
                                                   correctional settings.                         Double Jeopardy: Persons With Mental Illnesses in the
apartment. Together, they stocked Ray’s
                                                   Distinctive case management services.d         Criminal Justice System, Report to Congress, Wash-
refrigerator, met with the psychiatrist at     q
                                                                                                  ington, D.C.: Substance Abuse and Mental Health
the County Health Center, and visited          More recently, a 1997 study suggested that         Services Administration, Center for Mental Health
Go-Getters, where Ray was assigned a           traditional jail-based mental health strate-       Services, February 1995; Abram, K., and L. Teplin,
case manager.                                  gies should include court liaison mecha-           “Co-Occurring Disorders Among Mentally Ill Jail
                                               nisms, pre- and postbooking diversion, and         Detainees,” American Psychologist (October 1991):
                                               the use of community mental health ser-

                                                                                                                          Program Focus 7
                                             PROGRAM FOCUS

                                                                                                Screening Mentally
                                                                                                Ill Offenders in
                                                                                                Charles County
                                                                                                When corrections officials in the Charles
For the first month after Ray’s release, the    includes representatives from the local
                                                                                                County Detention Center met with MHA
MCCJTP case manager checked in on Ray           detention center, as well as health and         staff to begin the county’s Jail Mental Health
several times a week. As Ray became more        mental health professionals, alcohol and        Program pilot, they were confident that only
involved in community-based services, the       drug abuse treatment providers, public          three mentally ill individuals were housed in
MCCJTP case manager’s involvement               defenders, assistant State’s attorneys,         the jail. But screening by trained mental health
tapered off. She monitors Ray’s progress        judges, parole and probation officers,          staff resulted in 17 inmates being diagnosed
with his case manager at Go-Getters and         law enforcement personnel, social service       as seriously mentally ill. Among them was an
other service providers and is on-call in the   professionals, local hospital staff, housing    individual who was also deaf. Frustrated by
                                                specialists, mental health advocates, and       his bizarre behavior, but unaware of his deaf-
event of a crisis.
                                                consumers. Additional members are re-           ness, correctional officers had been speaking
                                                                                                loudly to him for days and were becoming
As Ray’s experience suggests, MCCJTP            cruited as particular service needs (e.g.,
                                                                                                increasingly annoyed by his unresponsive-
incorporates key features listed below and      for diversion) are identified.
                                                                                                ness. MHA staff were able to diagnose the
described more fully in the sections that                                                       inmate and, working with corrections staff,
follow:                                         In most counties the advisory boards di-
                                                                                                assist in relocating the individual to a secure
                                                vide their time between reviewing specific      mental health facility.
q   Local partnerships to aid mentally ill      cases and setting or refining policy. In
    offenders.                                  most jurisdictions local health departments     Months later, when the man again arrived at
                                                or related agencies coordinate MCCJTP           the jail, staff were prepared. The protocol
q   Support from State government                                                               that had been developed through the Jail
                                                and supervise the mental health staff as-
    agencies.                                                                                   Mental Health Program ensured that the
                                                signed to the program. Other government
                                                                                                inmate was identified quickly, placed on
                                                agencies and private organizations have         medication, moved swiftly through the cer-
q   A broad range of case management            signed memorandums of understanding             tification process, and transferred to a State
    services for mentally ill offenders         (MOUs) delineating their participation in       mental hospital.
    who are incarcerated or living in the       local advisory boards and their willingness
    community.                                  to provide services as appropriate.            of local policies. In addition, working
                                                                                               together to handle specific cases has
q   Enhanced services for mentally ill          These formal agreements are thought to be      reportedly been extremely beneficial
    offenders who are homeless and/or           essential to ensure the smooth execution       to solidifying relationships among
    have co-occurring substance use

q   Diversion strategies.

q   Training for criminal justice and treat-
    ment professionals involved in the

q   A commitment to program evaluation.

Local partnerships
Each MCCJTP program is guided by a
local advisory board that assesses service
needs, monitors program implementation,
and investigates ways to expand program
services. Although board membership
varies across the counties, it generally        Local and State officials convene the monthly meeting of the Task Force on Community
                                                Criminal Justice Treatment, the advisory council for Wicomico County’s MCCJTP.

8 National Institute of Justice
                                         PROGRAM FOCUS

participating agencies and                                                                              land Correctional Adminis-
organizations. As program                                                                               trators Association. Along
participants have been able to                                                                          with wardens and other local
solve the needs of specific                                                                             advisory board members,
mentally ill offenders, mutual                                                                          MHA staff have met on sev-
trust has grown and formal                                                                              eral occasions with county
organizational agreements                                                                               councils to discuss the merits
have evolved. Shelley                                                                                   of MCCJTP and seek local
McVicker, assistant State’s                                                                             funding for program en-
attorney in Frederick County,                                                                           hancements.
recalls, “At first we worked out
relationships with others in the                                                                        Case management
[MCCJTP] network on a case-         An MCCJTP case manager assists jail personnel in booking an
by-case basis. Then we worked inmate with potential psychological problems.
on organizational MOUs. The                                                                             Each MCCJTP jurisdiction
State’s involvement has helped us cement     Other State agencies, including the Divi-    employs at least one case manager who is
the relationships.”                          sion of Parole and Probation and the Alco- responsible for screening mentally ill
                                             hol and Drug Abuse Administration, made individuals while they are jailed, counsel-
In addition, the willingness of community    formal commitments to ensure the partici-    ing them while they are detained, helping
treatment providers to provide honest        pation of their local representatives in     them develop discharge plans, assisting
feedback to the criminal justice system      MCCJTP.                                      them in obtaining services in the commu-
about offenders’ compliance has resulted                                                  nity, advocating for them with criminal
in support from criminal justice profes-     MHA’s Division of Specific Populations       justice officials and community-based
sionals for placing mentally ill offenders   has primary responsibility for supporting    service providers, and monitoring their
in the community. According to McVicker, MCCJTP, providing nearly $1 million in           progress following release (even if their
“My office has a good relationship with      annual funding for the program. In addi-     criminal charges are dismissed).
Way Station [a local psychiatric rehabilita- tion, MHA staff have worked coopera-
tion facility participating in MCCJTP].      tively with local decisionmakers to          MCCJTP case managers also help link
They share information honestly about        prepare grant proposals for other types of   mentally ill offenders on intensive proba-
those who stay in treatment and those        Federal, State, and local funding to en-     tion or parole with community-based
who don’t. When necessary, we are able       hance program services and create oppor-     services and monitor their progress fol-
to work together to define reasonable        tunities for local MCCJTP participants to    lowing release. Although most mentally
consequences.”                               receive technical assistance and training    ill offenders in the program are contacted
                                             from the National Institute of Corrections   in detention centers, some are not. For
Support from State                           Jails Division and from the National         example, parolees from the State prison
                                             GAINS Center for People With Co-             system may be referred to an MCCJTP
                                             Occurring Disorders in the Justice System.18 case manager by prison or parole officials
A number of State agencies have made                                                      via MHA, or they may refer themselves
strong commitments to local MCCJTP           MHA staff have also been quick to ad-        following release.
programs. In 1994, in an effort to better    dress issues that cannot be resolved easily
serve mentally ill offenders, MHA ex-        at the local level (e.g., regarding inmates  In most jurisdictions, county health de-
panded its priority population to include    who require competency hearings or           partments or equivalent government agen-
MCCJTP participants and gave those           emergency commitment to State mental         cies receive up to $50,000 per year from
individuals the same access to MHA-          hospitals). In addition, MHA staff regu-     MHA to hire a full-time MCCJTP case
funded services and housing as persons       larly participate in meetings of local       manager who is an experienced mental
discharged from MHA inpatient facilities.    MCCJTP advisory boards and the Mary-         health professional with an advanced

                                                                                                              Program Focus 9
                                           PROGRAM FOCUS

degree in counseling. In some jurisdic-        government or private-sector mental health     defendant, or as a result of referrals by the
tions, a portion of the $50,000 is used to     organizations assume primary responsibil-      arresting officer, the classification officer,
increase psychiatric treatment time in jail.   ity for monitoring released individuals,       jail medical staff, the substance abuse
Administrative support and supervisory         which reduces the supervisory responsibili-    counselor, or other jail personnel.
hours are usually contributed by the           ties of the MCCJTP case manager.
recipient agency.                                                                             Screening and needs assessment. The
                                               Though adaptations are necessary to ac-        MCCJTP case manager meets with the
According to MHA, the average MCCJTP           commodate local needs and service capa-        candidates to conduct an in-jail diagnostic
caseload is 35 clients, but caseload size      bilities, each participating jurisdiction      interview and an individual needs assess-
ranges from 10 to 56 depending on the          adheres to the following general case          ment. If an individual qualifies for pro-
jurisdiction and the number of clients         management protocol:                           gram services, he or she may be referred
supervised in the community. In some                                                          for medication.
settings, following a period of close super-   Identification. Preliminary identification
vision by the MCCJTP case manager,             of candidates for program services is made     Counseling and discharge planning.
community-based case managers from             following arrest, after self-referral by the   While in jail, the mentally ill defendant
                                                                                              meets with the case manager for counsel-
                                                                                              ing and development of an aftercare plan.
                                                                                              A typical plan will include mental health
                                                                                              and substance abuse counseling, educa-
                                                                                              tional services, recreational activities,
                                                                                              employment training, and housing place-
                                                                                              ment. Before the individual is released,
                                                                                              the MCCJTP case manager and, in some
                                                                                              cases, a residential rehabilitation specialist
                                                                                              work to identify suitable housing.

                                                                                              Criminal justice system liaison. The
                                                                                              MCCJTP case manager also meets with
                                                                                              assistant State’s attorneys and defense
                                                                                              counsel to advocate for the swift resolu-
                                                                                              tion of criminal charges (e.g., through
                                                                                              diversion or plea negotiation) and for the
                                                                                              return of the MCCJTP client to the com-
                                                                                              munity whenever possible. These negotia-
                                                                                              tions usually succeed when criminal
                                                                                              charges are relatively minor because the
                                                                                              MCCJTP case manager is able to ensure
                                                                                              close supervision of the mentally ill of-
                                                                                              fender in the community and the quick,
                                                                                              honest reporting of any problems.

                                                                                              Referral and monitoring in the commu-
                                                                                              nity. For those who agree or are required
                                                                                              to participate in community followup,19
                                                                                              MCCJTP case managers help link clients
The warden of the Wicomico County Detention Center meets with the MCCJTP case                 to specified services, such as psychiatric
manager to discuss legal issues related to an inmate’s care and treatment.

10 National Institute of Justice
                                          PROGRAM FOCUS

day treatment, substance                                                                                  Shelter Plus Care applicants are
abuse treatment, vocational                                                                               eligible to receive the equiva-
rehabilitation, and educational                                                                           lent of the fair market rate for
services. In addition,                                                                                    rent and utilities in the jurisdic-
MCCJTP case managers meet                                                                                 tion where they live, provided
regularly with community-                                                                                 their incomes do not exceed the
based providers to monitor                                                                                predetermined ceiling for the
client progress.                                                                                          county of residence, they agree
                                                                                                          to pay up to one-third of their
MCCJTP’s community-based                                                                                  incomes in rent, and they par-
partners are essential to the                                                                             ticipate in fulfilling the com-
implementation of aftercare                                                                               ponents of their MCCJTP
plans. In some jurisdictions,                                                                             treatment plans. Shelter Plus
released individuals are able     An MCCJTP case manager helps a jailed inmate develop an                 Care recipients may live alone
to participate in day-treatment   aftercare plan.                                                         or with a roommate. In situa-
programs offered by local                                                                                 tions involving families, the
psychiatric rehabilitation                                                                                spouse and/or children are also
centers. These programs offer                                                                             eligible for housing as long as
an array of work opportuni-                                                                               the adult receiving the assis-
ties, skills development                                                                                  tance will aid in the care and
classes, substance abuse                                                                                  support of the children and the
counseling, and housing assis-                                                                            family’s income does not ex-
tance. They may also assign                                                                               ceed the ceiling for the county.
a case manager to work with
the mentally ill offender in                                                                            The MCCJTP case manager
the community. In other loca-                                                                           and/or other case managers
tions, a mix of providers offer                                                                         available through community-
these services.                                                                                         based service providers are
                                                                                                        responsible for developing
                                                                                                        treatment plans, gathering docu-
Enhanced services
                                                                                                        mentation of homelessness, and
State and local MCCJTP                                                                                  filing paperwork with the appro-
participants have become                                                                                priate county and State mental
increasingly aware of the                                                                               health offices. In some jurisdic-
need to address certain sub-                                                                            tions, case managers are also
populations of mentally ill       A case manager and an MCCJTP client review the rules for              responsible for locating housing.
offenders, including homeless Shelter Plus Care housing.                                                In others, such as Calvert,
persons and those with co-                                                                              Frederick, Prince Georges, and
occurring substance use disorders. State     mentally ill offenders served by MCCJTP.20 Wicomico counties, where MCCJTP partner
and Federal grant funds are being used to    In turn, local service providers participat- agencies work with local realtors, commu-
enhance the response to individuals in       ing in MCCJTP have pledged to provide        nity-based organizations assume substantial
these groups.                                services such as vocational training, sub-   responsibility for locating housing. Rental
                                             stance abuse treatment, and life-skills      agreements can be made with the tenants or
Homeless mentally ill offenders. In 1995, training to ensure that Shelter Plus Care       sponsor based, which means that a credible
MHA was awarded a $5.5-million Shelter       recipients have access to meaningful day-    third party vouches for the tenant and
Plus Care grant by HUD to provide rental     time activities.                             signs the lease.
assistance for up to 5 years to homeless

                                                                                                               Program Focus 11
                                           PROGRAM FOCUS

Case managers are responsible for moni-         in MCCJTP provide transportation for          program, and security staff. In Dorchester
toring tenants to ensure their compliance       program clients. Third, it is not always      County, a full-time case manager is in-
with housing agreements and participation       easy to guarantee that affordable housing     volved in treatment of dually diagnosed
in the daily activities outlined in treatment   will be located in relatively crime-free      inmates; Kent County uses its funds for
plans. To assist in this process, each ser-     neighborhoods, though that is certainly the   community followup of dually diagnosed
vice provider submits monthly documen-          goal. Finally, in locations where sponsor-    clients.
tation of the services clients receive to the   based lease agreements are required, some
MCCJTP case manager.                            clients’ reputations make it difficult to     Other counties that do not receive Byrne
                                                identify an organization willing to sign      funding have taken steps to ensure that
Program implementation has been remark-         their lease agreements. Some counties,        mental health services are coordinated
ably smooth. By all accounts, landlords         such as Frederick, have addressed this        with their jails’ substance abuse treatment
have responded favorably to the program.        concern by involving multiple sponsors        providers. Substance abuse treatment
They appreciate that it guarantees that         in the program.                               professionals in the jails report that, as a
rents will be paid and that tenants will be                                                   result of MCCJTP, mentally ill offenders,
supervised closely. In addition, there has      According to MHA, 216 individuals             who often went undiagnosed or untreated
been no community opposition, probably          and/or families were placed in Maryland’s     in the past, can now benefit more fully
because Shelter Plus Care clients are           Shelter Plus Care Housing Program in the      from substance abuse services and are
housed throughout the community in              first 2 years of operation (April 1996 to     less disruptive in substance abuse treat-
single- or double-occupancy dwellings,          April 1998). At the end of the period,        ment settings.
and because close supervision by case           nearly 90 percent remained in permanent
managers helps to ensure that client prob-      housing. Eleven individuals had been          Diversion
lems are addressed swiftly. Bureaucratic        evicted; 7 were rearrested; and 9 left the
                                                                                              In a number of jurisdictions, diversion is
issues such as creating tracking forms,         program.
                                                                                              included among the MCCJTP’s objectives.
training staff, and developing protocols
                                                Mentally ill offenders with co-occurring      Hoping to reduce the length of confine-
for timely rental payments by State and
                                                substance use disorders. In 1996 MHA          ment for mentally ill individuals who are
county government agencies have arisen,
                                                received nearly $350,000 in Edward            arrested for nonviolent offenses,
but are now mostly resolved.
                                                Byrne Memorial State and Local Law            Wicomico County added postbooking
Other issues have emerged as well. First,       Enforcement Assistance Program funds          diversion to its bank of program services
rental assistance does not cover the costs      from the U.S. Department of Justice’s         soon after implementing MCCJTP.
of such household necessities as furniture,     Bureau of Justice Assistance to hire sub-     According to the county’s guidelines,
linens, dishes, and utensils. Although          stance abuse and mental health case man-      diversion candidates must demonstrate a
these items are often donated by local          agers to aid dually diagnosed offenders in    willingness to participate in the program,
charitable organizations, they must be          seven MCCJTP jurisdictions.21 These           and community-based services must be
moved to the housing locations. In              funds are being used in a variety of ways.    available to meet participants’ needs.
Wicomico County, detention center               For example, Frederick County has hired a     Individuals with a history of violence or
inmates on work release help transport          case manager who provides treatment           arson are not eligible for the program.
furnishings, which has proven a cost-           planning to mentally ill offenders with co-
effective way to reduce the burden on the       occurring substance use disorders while       In a typical situation, the MCCJTP case
MCCJTP case manager. Second, housing            they are confined in the Frederick County     manager works with a diversion candidate
is not always located near public transpor-     Adult Detention Center and community          to develop a treatment plan. The treatment
tation. This is especially true in rural        followup after they are released. The case    plan is then discussed with the assistant
counties where transportation to daytime        manager also coordinates mental health        State’s attorney, the public defender, and
activities is generally limited. In some        services at the detention center with medi-   the judge assigned to the case. When all
locations, community-based participants         cal, inmate classification, substance abuse   parties agree that diversion is appropriate,

12 National Institute of Justice
                                              PROGRAM FOCUS

the judge places the case on the “stet”
docket, which leaves it open for 1 year.
The defendant is then released to the com-
munity to complete his or her treatment
plan. Knowing that released individuals
will be supervised closely by the MCCJTP
case manager, judges have reportedly been
active and enthusiastic participants in the
diversion program.

More recently, Wicomico’s MCCJTP
advisory board has focused its attention
on prearrest diversion. In 1996 the
Wicomico County Detention Center, in
collaboration with the county health de-
partment, received Edward Byrne Memo-
rial State and Local Law Enforcement
Assistance Program funds to establish a
mobile crisis unit. With assistance from           Participants in an art class at Go-Getters, Inc., a psychiatric day treatment program in
the GAINS Center, county planners vis-             Wicomico County, MD.
ited mobile crisis programs in Birming-
ham, Alabama, and Albany, New York. “I
came back really enthused,” says M. Kirk           and ensuring that the mentally ill individual   Training
Daugherty, Chief Deputy in the Wicomico            has a mental health advocate at his or
                                                                                                   Providing training for both criminal jus-
County Sheriff’s Office, about his visit to        her side.
                                                                                                   tice and mental health professionals is
Albany. “It’s always nice to hear from a
                                                   Commenting on the kinds of situations           a key objective of most local advisory
guy who’s done a program already. We
                                                   that prompt calls to the mobile crisis unit,    boards and MHA. With assistance from
started our unit in October of 1997 and it’s
                                                   Daugherty says, “Down here, citizens call       the GAINS Center and the Virginia
been very beneficial.”
                                                   the police for everything—marriage coun-        Addictions Technology Transfer Center,
Staffed by a deputy sheriff and two case           seling—the whole gamut. In situations           MHA offers regional cross-trainings for
managers (one on call 24 hours a day; one          involving the mentally ill, there may not       professionals involved in the criminal
working 2–10 p.m.), Wicomico’s mobile              be a crime, but an emergency petition [to       justice, mental health, and substance
crisis unit is always available to help the        the court to send someone to a State men-       abuse treatment systems. The aim of
sheriff’s office identify the most appropri-       tal health facility] probably won’t work        these trainings is to have professionals
ate placement for mentally ill individuals.        either. For instance, one time we had a         from the three disciplines learn each
If law enforcement officers responding to          guy who wasn’t taking his meds and was          other’s terminology and understand each
an incident involving a mentally ill person        very depressed, but there was nothing we        other’s job duties, roles, and responsibili-
determine that criminal charges do not need        could do. The hospital wouldn’t take him.       ties. Individual counties have also partici-
to be filed, other options (e.g., for shelter or   So we called mobile crisis and they re-         pated in training and technical assistance
emergency room evaluation) are pursued.            lieved our people and surely made the           offered by the GAINS Center and the
The case manager accompanies the men-              family feel a whole lot better. I like it       National Institute of Corrections Jails
tally ill individual to the agreed-upon desti-     [mobile crisis] as a safety net. It gives our   Division. In addition, some counties have
nation, thereby relieving law enforcement          people more confidence that the [mentally       developed their own training modules.
officers of time-consuming interactions            ill] person won’t do anything crazy when
with the health and mental health systems          we’re gone. It’s a very valuable tool.”

                                                                                                                    Program Focus 13
                                           PROGRAM FOCUS

Program evaluation                              Project, Wicomico County’s program             large number of mentally ill offenders in
                                                builds on MCCJTP networks to offer 24-         jail and in the community. But sustaining
During the past 4 years, State and local
                                                hour mobile crisis services, secure crisis     financial support is an ever-present
planners have concentrated on program
                                                housing for women and their children, an       challenge.
development; with funding from two
                                                integrated outpatient treatment program,
Federal grants, they are now able to focus                                                     A key concern is whether local govern-
                                                case management services with client-to-
attention on evaluating service delivery                                                       ments will, in the future, assume responsi-
                                                staff ratios of 20 to 1, and transitional
and client outcomes.                                                                           bility for funding services that are now
                                                housing for women and their children.
                                                                                               provided with Federal grant monies. In
Creating a client tracking system and
                                                Participants in the study are being as-        this regard, some MCCJTP advisory board
research database. Eight pilot jurisdic-
                                                signed randomly to the prebooking              members believe that program evaluation
tions are working with MHA staff and
                                                intervention or to the standard MCCJTP         will be essential in persuading local legis-
researchers at the University of Maryland
                                                (postbooking) services available through       lators to make a financial commitment to
at Baltimore to develop a client-tracking
                                                the Wicomico County Detention Center.          MCCJTP.
system that will assess service provision
                                                Women in the intervention group are
and individual client outcomes.22 After                                                        A second concern is that MCCJTP funds
                                                being recruited into the program prior to
helping to create a uniform data-collection                                                    from MHA have remained capped at
                                                arrest but after determination by law en-
instrument, MCCJTP case managers at                                                            $50,000 per site since the Jail Mental
                                                forcement officers that a complaint is
each pilot site began entering data in April                                                   Health Program pilots were launched in
                                                chargeable as a misdemeanor or nonvio-
1998. The database will include intake,                                                        1993. Yet with increased costs due to
                                                lent felony. Interview data on women in
aftercare planning, and community follow-                                                      inflation, and with improved identification
                                                the intervention group will be compared
up information on each MCCJTP client.23                                                        of mentally ill offenders, those funds
                                                with similar data collected from women
It will provide data on the characteristics                                                    cover less of the actual program expenses
                                                involved in the county’s postbooking
of clients who receive MCCJTP services;                                                        each year, resulting in increased adminis-
                                                MCCJTP program. Both process and
the types and amounts of services MCCJTP                                                       trative burdens for participating agencies.
                                                outcome data will be analyzed to evaluate
clients actually use, both in jail and in the                                                  Thus far, those agencies have determined
                                                service provision and client-level out-
community; the costs of services; and                                                          that the increases in efficiency and the
                                                comes (i.e., recidivism, use of treatment
changes in client circumstances within the                                                     improved care provided by MCCJTP
                                                and support services, residential stability,
jail and in the community (e.g., regarding                                                     offset any additional operating expenses
                                                time spent with children, psychiatric
housing, employment, psychiatric hospi-                                                        it creates.
                                                symptomology, and level of substance
talization, arrest, or substance abuse
                                                use). Additional analyses involving the
treatment).                                                                                    Finally, like many other States, Maryland
                                                pre- and postbooking samples will focus
                                                on individual recovery processes, costs,       has adopted a managed public mental
Studying the prebooking diversion of                                                           health care system. Prior to its implemen-
mentally ill women offenders. In July           and child outcomes (i.e., social and behav-
                                                ioral functioning and self-concept).           tation in July 1997, some State and local
1998 Wicomico County launched an ex-                                                           MCCJTP participants expressed concern
perimental prearrest diversion program for                                                     that indigent clients might be “lost” in the
women with co-occurring severe mental           Sustaining Funding:                            new fee-for-service system and that com-
illness and substance use disorders who
face arrest for a misdemeanor or nonvio-
                                                An Ongoing Challenge                           pensation might not be adequate to allow
                                                                                               providers to respond to the diverse—and
lent felony offense. The program is one of      With its substantial base of State and Fed-    often extreme—needs of mentally ill of-
nine research programs funded nationally        eral funding and with matching funds and       fenders. Some feared that if services were
by SAMHSA’s Center for Substance                in-kind services from many local provid-       substantially reduced, mentally ill offend-
Abuse Treatment and Center for Mental           ers, MCCJTP has been able to serve a           ers would be sent back into local detention
Health Services. Called the Phoenix                                                            centers and mental institutions.

14 National Institute of Justice
                                            PROGRAM FOCUS

So far, there is reason for optimism.           before this, I had no one to turn to for real   Other criminal justice professionals have
Because MHA has continued to provide            help.”                                          also benefited from MCCJTP. Judges and
grant funds for MCCJTP, which offers                                                            assistant State’s attorneys have the assur-
support services that are not covered under     When the MCCJTP pilot programs were             ance that treatment plans will be closely
managed care (i.e., screening and case          launched in 1993, program planners had          monitored in the community and can rely
management services for jailed mentally         several goals. By improving the treatment       on case managers for careful assessments
ill inmates and community followup for          of mentally ill offenders in jails and in the   of community placements and individual
released offenders), mentally ill offenders     community, they hoped to improve the            performance. Defense counsels are reas-
do not experience interruptions in treat-       quality of care those offenders received,       sured that clients who are confined in
ment. When mentally ill offenders are           decrease the disruption mentally ill of-        local detention centers receive better care
released from jail, they are linked immedi-     fenders created in correctional and com-        and treatment than in the past and that
ately with community-based mental health        munity settings, reduce “system cycling”        MCCJTP case managers are able to pro-
care providers, ensuring a smooth transi-       by coordinating services, and help men-         vide information helpful to making deci-
tion to the managed care system. MCCJTP         tally ill offenders live productively in the    sions regarding diversion, pretrial release,
case managers and other providers in-           community. Five years later, through the        and case disposition. Probation and parole
volved in the program then continue to          dedication of local advisory boards, the        officers receive support from MCCJTP
work together to provide mentally ill           commitment of case managers and com-            case managers, who monitor and report on
offenders with the full complement of           munity-based service providers, and the         the progress of mentally ill clients in ful-
community-based services they require.          support of MHA, jurisdictions throughout        filling their aftercare and treatment plans.
                                                Maryland have constructed a framework
                                                for achieving these goals. The result, as       MCCJTP appears also to have dramati-
Tallying the                                    summarized by Charlie Messmer, a sub-           cally changed the lives of individual cli-
Accomplishments                                 stance abuse counselor in Washington            ents. Although only careful evaluation of
                                                County, is that “treatment of mentally ill      service delivery and case outcomes will
Ray Carver smiles as he prepares a pot of                                                       demonstrate whether MCCJTP services
                                                offenders has become an ‘our’ problem
spaghetti in his apartment. He is proud                                                         significantly reduce recidivism, case man-
                                                rather than ‘mine’ or ‘yours.’ ”
that he has food in his refrigerator and a                                                      agers around the State report that some
safe place to live. Out of jail for 6 months,   Perhaps the most dramatic changes have          MCCJTP clients have made substantial
Ray now works in the kitchen at Go-Getters      occurred in detention centers around the        progress in improving the quality of their
and participates in life- and social-skills     State. Local corrections professionals          lives and contributing to the communities
classes there. He is also preparing for his     report that early identification and treat-     in which they live. As Maureen Plunkert,
general equivalency diploma. He attends         ment have reduced inmates’ disruptive           a case manager in Wicomico County,
Alcoholics Anonymous meetings nightly           behavior, training has improved the ability     remarked, “Amazing personalities are
and has regular appointments with a psy-        of correctional officers to identify and        revealed as these men and women start
chiatrist at the county health center. He       refer mentally ill inmates for screening,       getting well.”
reports monthly to his probation officer.       and correctional officers now feel sup-
Ray appreciates the support that he has         ported by treatment professionals in the
received from his MCCJTP case manager           jail. According to Barry Stanton, Warden
and other program participants, saying,         of the Frederick County Detention Center,
“In 45 years, this is the only time that        “These changes have made me feel a
people have really cared—have helped            whole lot more relaxed. Mentally ill of-
me, believed in me, and really supported        fenders are no longer the primary issue on
me. I was tired of the life I was living, but   my desk.”

                                                                                                                 Program Focus 15
                                              PROGRAM FOCUS

 Sources for More Information
 The Maryland Department of Health and             BJA primarily makes funding available             coupled with a range of supportive services
 Mental Hygiene’s Division of Specific             through the Edward Byrne Memorial State           funded by other sources. Grantees must match
 Populations fosters the development of in-        and Local Law Enforcement Assistance Pro-         the rental assistance with supportive services
 novative programs for recipients of mental        gram. Under this program, BJA is authorized       that are at least equal in value to the amount of
 health services with special needs, such as       to make formula grants to States and territo-     HUD’s rental assistance. States, local gov-
 individuals with psychiatric disabilities who     ries, which award subgrants to local units of     ernments, and public housing agencies may
 are homeless, are in jail but could be appro-     government. States are required to contribute     apply. HUD awards Shelter Plus Care funds
 priately served in the community, have co-        a 25-percent cash match toward overall fund-      as annual competitive grants. For more infor-
 occurring substance abuse disorders, and/or       ing. For more information, contact:               mation, contact:
 are deaf. The Division of Specific Popula-
 tions sponsors MCCJTP. For more informa-          Mary Santonastasso                                Allison Manning
 tion, contact:                                    Director, State and Local Assistance Division     U.S. Department of Housing and Urban
                                                   Bureau of Justice Assistance                      Development
 Joan Gillece                                      810 Seventh Street N.W., 4th Floor                Office of Community Planning and
 Assistant Director                                Washington, DC 20531                              Development
 Division of Specific Populations, Mental          Telephone: 202–305–2088                           Office of Special Needs Assistance Programs
 Hygiene Administration                            Fax: 202–514–5956                                 451 Seventh Street S.W.
 201 West Preston Street                           E-mail:                    Washington, DC 20410
 Baltimore, MD 21201                                                                                 Telephone: 202–708–0614, ext. 4497
 Telephone: 410–767–6603                           The American Jail Association (AJA) pro-
 TTY: 410–767–6539                                 vides regional training seminars, onsite tech-    The Substance Abuse and Mental Health
  Fax: 410–333–5402                                nical assistance, and training materials re-      Services Administration (SAMHSA) is part
                                                   lated to inmate programming, direct supervi-      of the U.S. Department of Health and Hu-
 The National Institute of Justice (NIJ) is        sion, and other corrections topics for a modest   man Services. Its mission is to improve the
 the principal research, evaluation, and devel-    fee. The Association also sponsors an Annual      quality and availability of prevention, treat-
 opment agency of the U.S. Department of           Training Conference & Jail Expo. Contact:         ment, and rehabilitation services to reduce
 Justice (DOJ). For information about NIJ’s                                                          the illness, death, disability, and cost to soci-
 efforts in corrections and program develop-       Stephen J. Ingley                                 ety that result from substance abuse and men-
 ment, contact:                                    Executive Director                                tal illness. SAMHSA comprises the Center
                                                   American Jail Association                         for Mental Health Services (CMHS), the Cen-
 Marilyn C. Moses                                  2053 Day Road, Suite 100                          ter for Substance Abuse Prevention (CSAP),
 Program Analyst                                   Hagerstown, MD 21740–9795                         and the Center for Substance Abuse Treat-
 National Institute of Justice                     Telephone: 301–790–3930                           ment (CSAT). The Phoenix Project, which
 810 Seventh Street N.W., 7th Floor                Fax: 301–790–2941                                 involves the pre-arrest diversion of mentally
 Washington, DC 20531                              E-mail:                       ill women offenders in Wicomico County,
 Telephone: 202–514–6205                           World Wide Web site: http://                      MD, is funded jointly by CMHS and CSAT
 Fax: 202–307–6256                                                  under the Federal Knowledge Development
 E-mail:                                                                         and Application Program. For more infor-
                                                   The National Institute of Corrections (NIC)
 The National Criminal Justice Reference           Jails Division coordinates services to im-        mation on that program, contact:
 Service (NCJRS) was established by NIJ in         prove the management and operation of jail        Susan Salasin
 1972. It serves as the national and interna-      systems throughout the United States and its      Director of Mental Health and Criminal
 tional clearinghouse for the exchange of crimi-   commonwealths and territories. Technical          Justice Programs
 nal justice information. For more information     assistance, training, and information are pro-    Center for Mental Health Services
 about topical searches, bibliographies, cus-      vided in many areas, including medical and        5600 Fishers Lane, Room 11C–26
 tom searches, and other available services,       mental health services and suicide preven-        Rockville, MD 20857
 contact:                                          tion. For more information on technical assis-    Telephone: 301–443–6127
                                                   tance and training activities, contact:           Fax: 301–443–0541
 P.O. Box 6000                                     NIC Jails Division                                E-mail:
 Rockville, MD 20849–6000                          1960 Industrial Circle, Suite A                   CSAT Office of Communications and
 Telephone: 800–851–3420 (8:30 a.m. to 7           Longmont, CO 80501                                External Liaison
 p.m. Eastern time, Monday through Friday)         Telephone: 800–995–6429                           5600 Fishers Lane, 6th Floor
 E-mail:                        Fax: 303–682–0469                                 Rockville, MD 20857
 The Bureau of Justice Assistance (BJA), a         HUD’s Shelter Plus Care program pro-              Telephone: 301–443–5052
 component of DOJ’s Office of Justice Pro-         vides rental assistance in connection with        Fax: 301–443–7801
 grams, supports innovative programs that          support services from other providers to          Established in 1995, the National GAINS
 strengthen the Nation’s criminal justice sys-     homeless people with disabilities. The pro-       Center for People With Co-Occurring
 tem by assisting State and local governments      gram allows for a variety of housing choices,     Disorders in the Justice System serves as
 in combating violent crime and drug abuse.        such as group homes or individual units,          a national locus for the collection and

16 National Institute of Justice
                                                   PROGRAM FOCUS

dissemination of information about effective
mental health and substance abuse services
for people with co-occurring disorders who
come in contact with the justice system. The
GAINS Center is a Federal partnership be-           NIJ Publications on                           The Effectiveness of Treatment for Drug
tween NIC and the Office of Justice Programs        Offender Health Care                          Abusers Under Criminal Justice Supervi-
within the U.S. Department of Justice and                                                         sion, Research Report, 1995 (NCJ
CSAT and CMHS within the U.S. Depart-               and Transitional                              157642).
ment of Health and Human Services. The
GAINS Center is operated by Policy Re-              Services
search, Inc., through a cooperative agreement                                                     Evaluation of Drug Treatment in Local
with the Federal partners that is administered      The National Institute of Justice has spon-   Corrections, Research Report, 1997
by NIC. For more information, contact:              sored a number of publications related to     (NCJ 159313).
The GAINS Center                                    the issue of offender health care and tran-
Policy Research, Inc.                               sitional services. To get a free copy of      The Americans With Disabilities Act and
262 Delaware Avenue                                 these publications, write the National        Criminal Justice: Mental Disabilities and
Delmar, NY 12054                                    Criminal Justice Reference Service, P.O.      Corrections, Research in Action, 1995
Telephone: 800–311–GAIN
Fax: 518–439–7612
                                                    Box 6000, Rockville, MD 20849–6000;           (NCJ 155061).
                                                    call them at 800–851–3420; or send e-mail
Projects for Assistance in Transition from          to                        Managing Mentally Ill Offenders in the
Homelessness (PATH) is part of the Mental                                                         Community: Milwaukee’s Community
Health Services Block Grant to the States that
is overseen by SAMHSA’s CMHS. PATH                  Case Management in the Criminal Justice       Support Program, Program Focus, 1994
provides a variety of treatment formula grant       System, Research in Action, 1999 (NCJ         (NCJ 145330).
awards to States for homeless people with           173409).
mental illnesses and co-occurring substance
use problems. Services covered include              The Women’s Prison Association: Support-      Notes
treatment, support services in residential set-
tings, and coordination of services and hous-       ing Women Offenders and Their Families,       1. Ray Carver’s history is a composite of those
ing. For more information, contact:                 Program Focus, 1998 (NCJ 172858).                reported to the author in interviews with 14
Center for Mental Health Services                                                                    Maryland Community Criminal Justice
Homeless Programs Branch
                                                    The Delaware Department of Correction            Treatment Program participants.
5600 Fishers Lane, Room 11C–05                      Life Skills Program. Program Focus, 1998
Rockville, MD 20857                                 (NCJ 169589).                                 2. Harlow, C.W., Profile of Jail Inmates 1996,
Telephone: 301–443–3706                                                                              Bureau of Justice Statistics Special Report,
Fax: 301–443–0256                                   Chicago’s Safer Foundation: A Road Back          Washington, DC: U.S. Department of Jus-
Funded by SAMHSA, the Virginia Addiction            for Ex-Offenders, Program Focus, 1998            tice, Bureau of Justice Statistics, April 1998,
Technology Transfer Center has developed a          (NCJ 167575).                                    NCJ 164620. In 1996, there were 507,026
1-week cross-training curriculum on offenders                                                        jail inmates. Men were less likely than
with co-occurring disorders. Offered to correc-     Texas’ Project RIO (Re-Integration of            women to have ever been treated for a mental
tions officers, substance abuse counselors, and                                                      or emotional problem. The author notes that
mental health treatment counselors, the training    Offenders), Program Focus, 1998 (NCJ
                                                    168637).                                         24 percent of male inmates and 36 percent of
consists of 15 modules that may be used sepa-
rately or in conjunction with each other as                                                          female inmates reported having received
needed. For more information, contact:              Successful Job Placement for Ex-Offend-          mental health services.

Scott Reiner                                        ers: The Center for Employment Opportu-       3. Ibid., 12.
Criminal Justice Coordinator                        nities, Program Focus, 1998 (NCJ 168102).
Virginia Addiction Technology                                                                     4. Palermo, G.B., M.B. Smith, F.J. Liska, “Jails
Transfer Center                                     Providing Services for Jail Inmates With         Versus Mental Hospitals: A Social Di-
Division of Substance Abuse Medicine
                                                    Mental Disorders, Research in Brief, 1997        lemma,” International Journal of Offender
Medical College of Virginia
1112 East Clay Street                               (NCJ 162207).                                    Therapy and Comparative Criminology 35
P.O. Box 980205                                                                                      (2) (Summer 1991): 97–106; Judiscak,
Richmond, VA 23298–0205                             The Orange County, Florida, Jail Educa-          Daniel L., “Why Are the Mentally Ill in
Telephone: 800–828–8323                             tional and Vocational Programs, Program          Jail?” American Jails (November–December
Fax: 804–828–9906                                   Focus, 1997 (NCJ 166820)                         1995): 11–15.

                                                                                                                      Program Focus 17
                                                 PROGRAM FOCUS

5. National Coalition for Jail Reform, Removing           n.16, 545 (1979); Bowring v. Godwin, 551             1036–1045; Peters, R.H., W.D. Kearns, M.R.
   the Chronically Mentally Ill From Jail: Case           F.2d 44 (4th Cir 1977).                              Murrin, and A.S. Donente, “Psychopathol-
   Studies of Collaboration Between Local                                                                      ogy and Mental Health Needs Among Drug-
   Criminal Justice and Mental Health Systems,        9. Snow, W.H., and K.H. Briar, “The Conver-              Involved Inmates,” Journal of Prison and
   Rockville, MD: U.S. Department of Health              gence of the Mentally Disordered and the Jail         Jail Health 11 (1) (Summer 1992): 3–25;
   and Human Services, National Institute of             Population”; Steadman, H.J., S.M. Morris,             Martell, D.A., R. Rosner, and R.B.I. Harmon,
   Mental Health, 1984; Janik, J., “Dealing              D.L. Dennis, “The Diversion of Mentally               “Base-Rate Estimates of Criminal Behavior
   With Mentally Ill Offenders,” Law Enforce-            Ill Persons From Jails to Community-Based             by Homeless Mentally Ill Persons in New
   ment Bulletin 61 (7) (July 1992): 22–26.              Services: A Profile of Programs,” American            York City,” Psychiatric Services 46 (6) (June
                                                         Journal of Public Health 85 (12) (December            1995): 596–601; Gillece, J., “An Analysis of
6. Haddad, J., “Managing the Special Needs of            1995): 1630–1635. For more information on             Health, Criminal Justice, and Social Service
   Mentally Ill Inmates,” American Jails 7 (1)           existing models for screening and linking             Utilization by Individuals Hospitalized,
   (March-April 1993): 62–65; National Coali-            mentally ill jail detainees with community-           Incarcerated, or Homeless,” unpublished
   tion for Jail Reform, Removing the Chroni-            based services, see Veysey, B.M., H.J.                doctoral dissertation, College Park: Univer-
   cally Mentally Ill From Jail: Case Studies of         Steadman, J.P. Morrissey, and M. Johnson,             sity of Maryland, 1996: 2–42.
   Collaboration Between Local Criminal                  “In Search of the Missing Linkages: Continu-
   Justice and Mental Health Systems; The                ity of Care in U.S. Jails,” Behavioral Sci-       14. Gillece, J., “An Analysis of Health, Criminal
   Center on Crime, Communities and Culture,             ences and the Law 15 (1997): 383–397, in              Justice, and Social Service Utilization by
   Mental Illness in U.S. Jails: Diverting the           which the authors discuss program strategies          Individuals Hospitalized, Incarcerated, or
   Nonviolent, Low-Level Offender, Research              in seven city and county jails.                       Homeless,” 4.
   Brief, Occasional Paper Series, No.1, New
   York: The Center on Crime, Communities             10. Steadman, H., and B. Veysey, Providing           15. The following counties participate in
   and Culture, November 1996.                            Services for Jail Inmates With Mental Disor-         MCCJTP: Allegany, Anne Arundel, Balti-
                                                          ders, Research in Brief, Washington, DC:             more, Calvert, Caroline, Carroll, Cecil,
7. Wilberg, J.K., K. Matyniak, and A. Cohen,              U.S. Department of Justice, National Institute       Charles, Dorchester, Frederick, Harford,
   “Milwaukee County Task Force on the                    of Justice, April 1997, NCJ 162207;                  Kent, Prince Georges, Queen Annes, St.
   Incarceration of Mentally Ill Persons,”                Muzekari, L.H., E.E. Morissey, and A.                Marys, Washington, Wicomico, and Worces-
   American Jails (Summer 1989): 20–26; Snow,             Young, “Community Mental Health Centers              ter. Several of these commenced program
   W.H., and K.H. Briar, “The Convergence of              and County Jails: Divergent Perspectives?”           planning in February 1997.
   the Mentally Disordered and the Jail Popula-           American Jails XI (1) (March–April 1997):
   tion,” in The Clinical Treatment of the Criminal       50–52.                                           16. Precise administrative cost figures are not
   Offender in Outpatient Mental Health Settings,                                                              available. In each jurisdiction, a portion of
   ed. N.J. Palone and S. Chaneles, New York:         11. Teplin, L.A., K.M. Abram, and G.M.                   supervisory, fiscal, and secretarial staff hours
   The Haworth Press, 1990: 147–162; Torrey,              McClelland, “Mentally Disordered Women               are contributed to support MCCJTP staff.
   E.F., J. Stieber, J. Ezekiel, S.M. Wolfe, J.           in Jail: Who Receives Services?” American            These costs are thought to vary considerably
   Sharfstein, J.H. Noble, and L.M. Flynn,                Journal of Public Health 87 (4) (1997):              across jurisdictions because of variation in
   Criminalizing the Seriously Mentally Ill: The          604–609.                                             pay scales and in the complexity of MCCJTP
   Abuse of Jails as Mental Hospitals, Washing-                                                                programs.
   ton, DC: Public Citizen’s Health Research          12. Steadman and Vesey, Providing Services for
   Group, 1992; Landsberg, G. “Developing                 Jail Inmates With Mental Disorders, 5.           17. Governor’s Office of Justice Administration,
   Comprehensive Mental Health Services in                                                                     Report of the State/Local Criminal Justice/
   Local Jails and Police Lockups,” in Innovations    13. Correctional Association of New York,                Mental Health Task Force, Baltimore, MD:
   in Community Mental Health, ed. S. Cooper              Insane and in Jail: The Need for Treatment           Governor’s Office of Justice Administration,
   and T.H. Lentner, Sarasota, FL: Professional           Options for the Mentally Ill in New York’s           January 1995: 12.
   Resource Press, 1992: 97–123.                          County Jails, New York: Correctional Asso-
                                                          ciation of New York, October, 1989; Abram,       18. The GAINS Center is run by Policy
8. See for example, Estelle v. Gamble, 429 U.S.           K., and L. Teplin, “Co-Occurring Disorders           Research, Inc., a not-for-profit branch of
   97 (1976); Bell v. Wolfish, 441 U.S. 535,              Among Mentally Ill Jail Detainees,” Ameri-           Policy Research Associates in Delmar, NY,
                                                          can Psychologist 46 (10) (October 1991):             a research firm studying issues in mental

18 National Institute of Justice
                                                   PROGRAM FOCUS

    health, substance abuse, criminal justice, and   21. These include Baltimore, Calvert, Caroline,          and finances, prior alcohol and drug use,
    homelessness.                                        Dorchester, Frederick, Kent, and Queen               alcohol and drug treatment history, prior
                                                         Annes counties. The counties provide a               psychiatric treatment, medical treatment, and
19. As might be expected, not all mentally ill           25-percent cash match.                               legal circumstances. Two standardized in-
    individuals who are counseled in detention                                                                struments—the Multnomah County Commu-
    centers agree to take part in community-         22. Seven of the counties—Baltimore, Calvert,            nity Abilities Scale, which assesses a client’s
    based followup. Case managers report that            Caroline, Kent, Queen Annes, Dorchester,             level of social functioning across multiple life
    some individuals participate only after they         and Frederick—receive Edward Byrne                   domains and the Lehman Quality of Life
    fail repeatedly to make it on their own.             Memorial State and Local Law Enforce-                Interview (TL–30S), which includes objec-
                                                         ment Assistance Program funds to aid                 tive and subjective measures of quality of life
20. To ensure sufficient numbers of participants,        dually diagnosed offenders. That funding             across eight life domains—are also included
    the target population was subsequently               also supports the 3-year database develop-           in the intake data module. The Service En-
    expanded to include parolees and probation-          ment and research effort. In addition,               counter Module includes information on the
    ers on intensive supervision caseloads and           Wicomico County has been included among              type, amount, and duration of services pro-
    participants in PATH, a Federal formula              the pilot sites. Data collection in that county      vided to jail-based clients. This module will
    grant program that funds outreach, case              will aid in the evaluation of the Phoenix            support analysis of level of services and
    management, mental health, and substance             Project.                                             service costs. The Aftercare Module includes
    abuse services for homeless individuals with                                                              data on the aftercare service plan, client
    serious mental illness and/or co-occurring       23. The tracking database has three modules. The         contacts with referral agencies, and self-
    substance use disorders.                             Intake Module includes information on each           reported changes in client circumstances
                                                         client’s demographic characteristics, current        (e.g., in residence, employment, psychiatric
                                                         living situation, family history, employment         hospitalization, arrests, and substance abuse
  About this study
  This Program Focus was written by Catherine Conly, Associate at Abt Associates                            The National Institute of Justice is a compo-
  Inc. In preparing the report, Ms. Conly met at length with Joan Gillece and other                         nent of the Office of Justice Programs, which
  staff of Maryland’s Mental Hygiene Administration. She also interviewed officials                         also includes the Bureau of Justice Assistance,
  who participate in the MCCJTP programs in Allegany, Charles, Frederick, Wash-                             the Bureau of Justice Statistics, the Office of
                                                                                                            Juvenile Justice and Delinquency Prevention,
  ington, and Wicomico counties; observed local advisory board meetings; and inter-                         and the Office for Victims of Crime.
  viewed MCCJTP clients both in jails and in the community. In addition, Ms. Conly
  participated in a 3-day, multisite cross-training for mental health, substance abuse,
  and corrections professionals involved in the MCCJTP.                                                    This and other NIJ publications can be
                                                                                                           found at and downloaded from the NIJ
Findings and conclusions of the research reported here are those of the author and do not                  Web site (
necessarily reflect the official position or policies of the U.S. Department of Justice.
                                                                                                           NCJ 175046                           April 1999
All photos courtesy of Gary Marine Photography, Inc., Delmar, MD.

                                                                                                                              Program Focus 19

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