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Television Program available at http://media.csosa.gov/podcast/video/2016/02/mental-health-and-recovery-in-criminal-justice/
Nancy Ware: Hi, and welcome to DC Public Safety. I’m your host Nancy Ware. Today’s program is on mental health and recovery. There are approximately 700,000 people leaving prisons throughout the country every year and it’s vital for public safety to make sure they successfully reintegrate into society. But reentry is complicated by the fact that so many have either diagnosed or self-reported history of mental health challenges. Today’s program provides an overview of mental health issues within the criminal justice system from the DC Department of Behavioral Health and the Jail and Prison Advocacy Project of University Legal Services, plus we have interviews with two CSOSA experts. What are the lessons learned from research and application? What should society do about mental health within the criminal justice system? My guests for the first half are Stephen T. Baron, Director DC Department of Behavioral Health. Welcome, Steve.
Stephen T. Baron: Thank you, Nancy.
Nancy Ware: And Tammy Seltzer, Director of Jail and Prison Advocacy Project, University Legal Services. And to Steve and Tammy welcome to DC Public Safety.
Tammy Seltzer: Thank you for having us.
Stephen T. Baron: Thank you.
Nancy Ware: We’re really, really excited about this segment, because, as you know, the mental health system is a great partner to the criminal justice system, but we still have many challenges that we’re trying to overcome as we try to address the needs of this population and when they’re reintegrating into the community. So first I wanted to talk a little bit about some of the challenges that we see here in the District of Columbia, and I want, Steve, for you to talk to u about exactly what does the Department of Behavioral Health do and what are some of the challenges that you see as you move forward with your vision and your view of where we need to go.
Stephen T. Baron: Thank you, Nancy, and it’s great to be here. The Department of Behavioral Health is a year old tomorrow.
Nancy Ware: Wow!
Stephen T. Baron: A year ago the mayor and the DC Council created the Department of Behavioral Health as a merger with the Department of Mental Health and the Addictions Prevention and Recovery Administration, which was previously in the Department of Health. So we’re a brand new department, even though we bring a legacy of both APRA and DMH of many, many years of service in the District. But we as the Department of Behavioral Health oversee a network of providers that serve over 20,000, over 30,000 individuals –
Nancy Ware: That many. Wow!
Stephen T. Baron: For both mental health and substance abuse disorders. Our biggest challenge with folks in the criminal justice system is that we need to be there when people need the services and provide the range of services people need. We’ve put a number of things in place in the District. I’m proud to say that one of the most intensive mental health services is called Assertive Community Treatment, or ACT, and nationally probably in most states or most jurisdictions about 2% or 3% of the people in the public systems are getting ACT, which is an evidence-based practice, in the District between 8% to 10% of the enrollees in our public system for mental health are getting Assertive Community Treatment. We also realize we have to have strong partnerships, both of course with your agency, helping work with folks once they leave incarceration, with the Department of Corrections, and also with the Metropolitan Police Department, the District’s police department, where we have worked very collaboratively to establish the District’s Crisis Intervention Team program, CIT –
Nancy Ware: Yes.
Stephen T. Baron: As it’s known nationally. We call it here Crisis Intervention Officer, CIO, and we’ve trained over 600 MPD officers.
Nancy Ware: Now, is that throughout the whole police department or just certain teams?
Stephen T. Baron: No, throughout the whole police department.
Nancy Ware: Which is excellent.
Stephen T. Baron: And at all levels we basically focus on the patrol officers, but their emergency response teams have been trained, sergeants, some operational folks have been trained, and it’s a very popular training, and it’s been going on for five years now.
Nancy Ware: That’s excellent.
Tammy Seltzer: And I would add to that DC is a jurisdiction that has other law enforcement agencies involved and you all are involved in training them as well.
Stephen T. Baron: Yeah. Thank you, Tammy. Also Capital Police have participated, Amtrak Police, Georgetown University Police, Housing Authority Police, I think there’s 30-some police departments in the District and we’re trying to include as many of them as we can.
Nancy Ware: That’s possible.
Stephen T. Baron: But our primary customer has been the Metropolitan Police Department. And they work very closely with, we have a mobile crisis team that’s available seven days a week, every day, for 16 hours a day.
Nancy Ware: Which is, you know, the training across these law enforcement agencies is so critical, as we’ve seen in the news, because you never know who’s going to be the first responder and who will come in contact with someone who has mental health issues, and it’s so critical that we take the responsibility here in the nation’s capital to be sure that we equip our law enforcement and our first responder officers with the tools that they need to recognize some of the symptoms of mental health and mental illness in particular. Tammy, I want to ask you a little bit about some of the challenges that you see in DC, because you’ve worked as an advocate, and we’re very pleased that we have a partnership with you to make sure that we do our due diligence in meeting the needs of this population. As you know, as we talked about earlier, there are approximately 700,000 people coming out of our prisons and jails with mental health issues, and many of them have major depression, manic mania, serious psychosis, so some of those challenges are things that we have to take into account as we deal with reentry. Can you talk a little about your experiences with the District?
Tammy Seltzer: Certainly. The DC Jail and Prison Advocacy Project has been around about seven years and it was created to help DC residents who have serious mental illness, and in that case we’re talking about bipolar disorder, schizophrenia, major depression, to help them with reentry. And initially it was started to help with reentry from the jail and the correctional treatment facility, which is where women are housed here in DC. But DC is a unique animal, we don’t have a state prison, and so DC residents who are serving a longer sentence, more than a year, end up in the Federal Bureau of Prisons. And so their challenge, on top of being incarcerated and having a criminal record and having a mental illness, is also that they are being held in facilities that can be anywhere in the country, there’re over 100 facilities. And this can mean that they’re hundreds or even thousands of miles away from their families. So whatever supports they may have had in the community and with their families, they don’t have that, and then it makes it much more difficult to plan for that discharge planning piece.
I would say that most of the people that we work with, our clients have difficulties with housing. We know nationally that people with serious mental illness are twice as likely to be homeless at the time that they’re incarcerated, and then they also have a difficulty with having some sort of a stable income. Most people with serious mental illness who’re involved in the criminal justice system are not employed and they really depend on disability benefits. So the challenges we see for people are getting them, for some people getting linked to mental health services, some have been linked before, but that link has been severed by being sent so far from home. For other people, like a young man who called me yesterday, he’s in his 20s, he’s been incarcerated for four years, he didn’t know he had a mental illness until the behaviors occurred that caused him to get arrested in the first place, and so he’s never been linked to mental health services, and those are the, we will help him get linked to mental health services. But those are the kinds of challenges that our clients are facing, and some of them are unique to DC, but I think a lot of the reentry issues, people with serious mental illness are coming out of the Federal Bureau of Prisons every day –
Nancy Ware: Yeah. That’s true.
Tammy Seltzer: And so those are issues that apply in every state in the country.
Nancy Ware: Yeah. And I’m really glad you brought up the young man, because we know that sometimes some of these symptoms don’t really materialize until their 20s, their early, late teens, early 20s. And so we’ve had a lot of challenges in dealing with young men and women in our system. Have you seen special issues coming out with women in particular as you’ve been working with that population?
Tammy Seltzer: Absolutely. We have a special project right now to assist women who have mental illness in getting their disability benefits from Social Security before they come out, because it’s really critical. If you don’t have a place to live, you don’t, you’re not, if you don’t have a steady income you’re going to have difficulty finding a place to live. It’s really hard to take advantage of services and treatment unless things are stable for you. So that’s something that we’re working with. And as part of that we’re serving more women. And we had a woman the other day who after coming out of prison she became unexpectedly the custodial parent of her one-year-old.
Nancy Ware: Oh, wow! That’s a whole [INDISCERNIBLE 00:09:56].
Tammy Seltzer: And so all of the sudden on top of trying to take care of herself and meet her own basic needs for housing and income and making sure she keeps up with her terms of supervision and stays clean and sober and goes to mental health treatment she has to worry about, “How am I going to take care of a baby?” And actually it was really wonderful that her community supervision officer at CSOSA was able to help her with parenting classes, because she said, “I’m getting frustrated.”
Nancy Ware: Don’t know what to do.
Tammy Seltzer: “I’m getting frustrated. I don’t know what to do.” And wonderfully a parenting class was starting that provided childcare and food so that she can attend these series of classes and gain confidence at being a mom, which she hasn’t been –
Nancy Ware: [INDISCERNIBLE 00:10:42] –
Tammy Seltzer: Because she’s been incarcerated.
Nancy Ware: That make or break their success, so that’s excellent. Now, the two of you have really worked closely together, and I know that University Legal Services has also worked very closely with the Bureau of Prisons, as has the Department of Behavioral Health, and we’ve been really as a system here in DC trying very hard to make sure that there’s prerelease planning for folks who are coming out of prison. Can the two of you talk a little but about some of the work that you’ve done together on this?
Stephen T. Baron: Yeah. Well, the most important thing of course is transitions from people leaving incarceration after a couple years, even leaving the DC jail after four or five months these transitions back into the community are just so important, and the more upfront planning you do the better it is, the more likelihood it is it’ll be successful, really putting you heads together to look at housing opportunities. I think in the District the real challenge is around the affordable housing.
Nancy Ware: Yeah.
Stephen T. Baron: We have worked very hard to increase the intensive services, like I spoke about earlier, through assertive community treatment and other types of services. But it is around the housing and having the time to plan for it and have the person participate. I do know we’ve worked with, I’m sure University Legal has been involved, but definitely your office, the Bureau of Prisons, and some of the offsite facilities, like in West Virginia and North Carolina, to do some offsite tele-meeting –
Nancy Ware: Teleconferencing.
Stephen T. Baron: Teleconferencing –
Nancy Ware: Yeah. That’s true.
Stephen T. Baron: To do some planning.
Tammy Seltzer: Yeah. The best situations are when we get advanced notice –
Stephen T. Baron: Yes.
Tammy Seltzer: That somebody is coming out. And we have a great relationship with some of the psychologists, psychiatrists, and social workers who work in some of the Bureau of Prison facilities. Allenwood, for example, we have a psychologist or psychiatrist who calls us practically every week giving us cases with advanced notice. And when we have advanced notice and it’s a situation, a lot of these situations are people who’ve never been successful in the community with their mental health treatment, and so we have taken advantage of the Assertive Community Treatment teams that you’ve been talking about, the ACT teams, Steve. That’s been very important for our clients to be successful, to have that level of intensity in the community. And so when we get advanced notice that we –
Nancy Ware: It makes a difference.
Tammy Seltzer: It really makes a huge difference.
Stephen T. Baron: It makes a big difference. It’s critical, the Friday at four o’clock mandatory release.
Tammy Seltzer: Those are the cases that keep me up at night are when people come out at the last minute –
Stephen T. Baron: Yeah.
Tammy Seltzer: That we don’t know and they don’t have a place to stay and they’re releasing to a shelter and –
Stephen T. Baron: Right.
Tammy Seltzer: And what’s the best thing that we can do. And definitely working together, our three agencies, to try and come up with an emergency plan and then a longer term plan is what we try to do.
Nancy Ware: I want to thank again Steve and Tammy. And, ladies and gentlemen, please stay with us as we continue our discussion on mental health and recovery with two new guests. We’ll be right back.
[ Commercial Break ]
Nancy Ware: Welcome back to DC Public Safety. I’m Nancy Ware. I stated during the first half of the show successful reentry from prison is vital for public safety and strengthening our communities. To continue our discussion on mental health and recovery we have two new guests from our agency CSOSA, Associate Director Thomas Williams and [PH 00:14:21] Ubah Hussein, a social worker in the mental health unit. And to Tom and Ubah, welcome to DC Public Safety.
Ubax Hussein: Thank you, ma’am.
Tammy Seltzer: Well, glad to be here.
Nancy Ware: Glad you’re here. To start off, Ubah, I’d like to ask you to talk a little about what you’re seeing in terms of mental health issues among our clients who’re coming into our system on probation and parole and supervised release.
Ubax Hussein: I think that people are coming home with a lot of co-occurring behavioral health conditions, some of which Director Baron has already talked about. The other subpopulation of concern is that as is happening with the rest of society the returning citizens are also aging. So we’re seeing a higher number than I remember last year of people that have onset of dementia, for example, and who are needing nursing home services. So the coordination of reentry planning has really focused on those people that have age related dementia, the population that we’re familiar with working with that have the co-occurring schizophrenia and maybe a PCP addiction or something, and then another population of people that are coming home with significant medical conditions, renal failure, diabetes, HIV disease. And so planning around all of those service needs, both behavioral health, age related services, and medical services, has been a challenge that I think CSOSA is meeting very well in terms of partnering with our community providers.
Nancy Ware: That’s quite a menu.
Thomas Williams: Yeah. And I think one of the reasons that we’re seeing this change or this shift in the population has to do with the number of previous periods of incarceration that happen over time, five and seven year periods of incarceration, and then the individuals are coming back. We’re trying to do the best that we can when they are in the community and then something else will happen and they go right back again.
Nancy Ware: So they go in and out of the system.
Thomas Williams: So there’s almost, you hate to kind of say revolving door kind of a situation, but the multiple periods of incarceration are leading to the things that we’re seeing now in the population. That makes it a little bit more challenging for us to try to address adequately and then try to get the service needs accomplished, both on the mental health or the behavioral health side, as well as on the physical health. Now they got two different issues that we’re trying to address simultaneously.
Nancy Ware: So what is our best approach as a supervision agency to all of these challenges that you’re seeing with this population coming out of prisons and jails?
Thomas Williams: Well, first and foremost it’s the qualities of staff that we’re able to bring within the organization, and we can’t say enough about the quality of the staff that we have working for us. Number one, they have, several of them have advanced degrees, they’re really dedicated to the population, and they have a passion to work with the groups that we are charged to supervise, and I think that’s one of the key things. The second thing that we have to do is to ensure the level of training is at a level which is highly functioning, so that we’re able to identify the help that is needed for the population and then make sure with that training and the passion that the staff will bring to the job, that we can then identify what is actually needed at the appropriate time and then have a strategic plan to work with that individual through the course of the supervision period. And we can’t stop without having first the assessment, that’s so fundamentally important and getting information from the institution or the jail that the person was in, in terms of what was happening while they were there, and then making that plan consistent when they actually come out, so it’s not a disjointed effort, but something that’s really consistent.
Nancy Ware: So that continuity of care, are you seeing some changes now over the course of the last several years? We heard from our guest from the first segment some of the work that they’ve been involved in, in trying to help CSOSA, which is Court Services and Community Supervision Agency, to better meet the needs of this population. Ubah, do you want to speak to some of the things that you’ve seen?
Ubax Hussein: Sure. I think one of the most important things that’s happened is we’ve always had reentry planning in place as an informal kind of setup, but two and a half years ago Mr. Williams took the initiative really formalize that into a working group. And so within that working group we do a monthly telephone conference, we have a forecast, for example, our October telephone conference is going to be on who’s coming home February 2015.
Nancy Ware: And this conference is within whom again?
Ubax Hussein: The conference is with the Bureau of Prisons; it’s with Department of Behavioral Health, and CSOSA.
Nancy Ware: Excellent.
Ubax Hussein: And so this three core working group, we know what the needs are, we know what the deficits are, and when appropriate someone might need the advocacy services, for example, of ULS. So we’re able to get – early planning is the best. So we get the releases of information signed, we get in contact with families, we confirm the releasing address, we have them in many ways initiate Medicaid before they come into the community, referral to ACT teams, all of that paperwork, which takes time to work its way through the system, we can get started on individual reentry planning 120 days ahead of their release date.
Nancy Ware: That is critical.
Thomas Williams: It is. But one of the things that, with the process that Ubah just discussed is a real challenge for us is that the system itself within the District of Columbia is one that were dependent upon to try to help this transition smoothly, because unfortunately a lot of times the family members aren’t there –
Ubax Hussein: That’s right.
Thomas Williams: To try to pick up – as Ubah had mentioned, some of the population is aging a little bit and some of the activities that happened while the individual was in the community –
Ubax Hussein: Yeah.
Thomas Williams: The families are saying, “I love him, but he can’t stay here.”
Nancy Ware: Right.
Thomas Williams: Or –
Nancy Ware: And this population is particularly challenging alone without being involved with the criminal justice system. Many families abandon family members who are having mental health problems, because they’re so difficult to manage, and then you couple that with being in the criminal justice system.
Thomas Williams: Justice System itself.
Nancy Ware: It puts a lot more weight on I guess the probation, parole [OVERLAY].
Thomas Williams: It does. And that’s, as I mentioned, that’s one of the challenges that the staff are facing is that the person needs to live somewhere, and a shelter is not the appropriate place for any individual who has mental health issues, and we had, would be worried about medication management. It’s not an environment for which we could have that’s supportive enough to support the individual in some of the things that they’re actually facing.
Nancy Ware: So, Tom, tell me a little bit about what CSOSA has done to address this population.
Thomas Williams: Yes.
Nancy Ware: I know you’ve had some innovation over the last few years. So what are some of the things that have been put in place to address this population better?
Thomas Williams: Well, one of the things we did we hired Ubah, and that was something that was on the planning stages for a long while, because what we recognized is that the line staff, the CSOs, the community supervision officers, albeit while meaning and compassionate about the work, we were needing someone else to help them in terms of being a consultant to what they were doing.
Nancy Ware: So Ubah’s job is to…?
Thomas Williams: Ubah’s job is to bridge the gap between the agency and the stakeholders and –
Nancy Ware: She’s like a coordinator?
Thomas Williams: Yes. And also it’s to act as a consultant to the line staff as they are dealing with difficult cases. So pretty much what Ubah will do for us, as the staff are working out assessment issues with the individual in terms of what that plan is, they will then call Ubah and then use her as the consultant and say, “Look at this plan. Does this plan make sense based on this individual?” And we’re looking at the prior history of the individual in terms of the prior episodes that the individual may have had with regards to hospitalization, medication management, and all of them Ubah will then give input into the plan. And then what the staff will do will coordinate with Steve Baron’s group, the Department of Behavioral Health, in terms of what is the best plan for this individual while he’s in the community and what do we see as potential barriers for that person in terms of trying to get that individual healthy enough to operate basically on your own, and that’s really the goal that we’re trying to get to. There’s one if the person can navigate within the society on their own with some assistance or they need to identify where they need to go to get assistance when they need it and also to have a supportive environment to help them when they do have difficulty.
Nancy Ware: So, Ubah, you work with who in the, within CSOSA? Do you have teams that you’re working with? And talk a little bit about that.
Ubax Hussein: I work closely with the behavioral health supervision teams for the men and women, and I partner with the treatment specialist for the sex offender teams sometimes, because the population’s needs overlap. In the community really my primary partnership is with DBH, Department of Behavioral Health. There’s two cases that actually we’re working on. There’s a lady we’re trying to bring home, her release has been delayed from September to November, 71 years old, wheelchair bound, onset of dementia, only family member is her older brother.
Nancy Ware: Wow!
Ubax Hussein: And she has a senior apartment, but she’s not at a place where she can live independently. I mentioned that because I think regardless of the innovations and the planning and the collaboration that we’re doing, there’s a limit to the available community resources in terms of continuum of housing services, supported housing, and especially in terms of sometimes we have another gentleman whose release has been retarded more than a year, because the recommendation from his BOP team, Bureau of Prisons team, is that he needs to be in a secure setting, based on his high risk, as well as his high need.
Nancy Ware: Now, let me ask you about secure settings. Does CSOSA have a secure setting that addresses co-occurring disorders? You’ve talked a lot about that being a challenge. Tom, can you talk about that?
Thomas Williams: Sure. We have been fortunate in terms of the funding that we receive from Congress to have a reentry sanctions center, and basically that’s a location on the grounds of DC hospital, DC jail complex that is there, and we’re able to address mental health issues, as well as those individuals who are in the community and having some difficulty. Instead of having the court or parole commission revoke that individual, we actually can kind of do like a timeout, if you will, work on those things that got that person into difficulty with precaution and noncompliance and then bring them back.
Nancy Ware: That’s great.
Thomas Williams: Unfortunately for us though, the group that Ubah is talking about, which is a subset, are those that we classify as severe and persistent mental health, these are persons who have very severe issues with regards to their mental health functioning and they have some physical issues as well. And we don’t have a facility, a really secure facility currently in the District that can handle that and that’s not a negative for the District, it’s like national –
Nancy Ware: Yeah.
Thomas Williams: That the severe and persistent mental health population unfortunately we don’t have a place for them to go.
Nancy Ware: So we’re still working with DBH, Department of Behavioral Health, and others to figure out how we can get through that.
Thomas Williams: Yes.
Nancy Ware: So you have two units in the Residential Reentry and Sanctions Center?
Thomas Williams: Actually it’s five floors. We have two for males and then one for females.
Nancy Ware: Okay. And that’s where co-occurring?
Thomas Williams: That’s correct.
Nancy Ware: Okay.
Thomas Williams: And one of the innovations that we did within the organization several years ago is that we, as Ubah mentioned, we split the population. We recognized that the female population –
Nancy Ware: Yeah.
Thomas Williams: With mental health needs is a little bit separate and needs to be separate from the male population. So we had three teams, one is general supervision, and two are mental health or behavioral health for the female population, and we have five teams for males. And unfortunately, as Ubah had mentioned, with the increase that we’ve seen in the mental health population we had to create another male team. So we’re going to have eight teams all total.
Nancy Ware: So let me ask you. Within the total population under supervision are you seeing an increase in the behavioral health needs of that population?
Thomas Williams: We are. We have about 18,000 cases under supervision with the new organization and about 20% of that population –
Nancy Ware: Yeah.
Thomas Williams: Is now, have behavioral health issues.
Nancy Ware: My goodness.
Thomas Williams: So I’ll be able to have units; our branch basically has really expanded. And about a year and a half ago we actually split that behavioral health branch, because it was becoming too large.
Nancy Ware: Yeah.
Thomas Williams: So our average we have about a seven to one ratio, one supervisor to seven staff members working with the population.
Nancy Ware: Good. And in closing, Ubah, can you just tell us very briefly what some of the challenges are with the women that you’ve been working with, very briefly?
Ubax Hussein: Research shows and our experience shows that women come with really complex psychosocial needs, including history of childhood sexual trauma, many of them may have lost their children, custody of their children, and so in addition to supervision and behavioral health needs, there’s family rebuilding that they’re engaged in, and that requires a lot more support.
Nancy Ware: Well, I want to thank our two expert guests from CSOSA. We’re very proud of the work that you’re doing in our agency and we look forward to some of the new innovations that you come up with as you meet the challenges of our population. Ladies and gentlemen, thank you for watching today’s show on mental health and recovery. Please watch for us next time as we explore another important topic in today’s criminal justice system. Please have yourselves a very pleasant day. Thank you for joining us.