SAMI TEAM
CRIMINAL JUSTICE PROFESSIONAL
The New Hampshire-Dartmouth Integrated Dual Disorder Treatment (IDDT) model encourages health and human service professionals who serve consumers with co-occurring mental health and substance abuse (dual) disorders to collaborate with the following criminal justice professionals and agencies:
- Police officers and departments
- Public prosecutors
- Public defenders
- Attorneys in private practice
- Judges and courts
- Probation officers and departments
- Corrections (jail) administrators, personnel, and treatment staff
- Parole officers and departments
Research has shown that the rate of incarcerations and
re-incarcerations (recidivism) for persons with dual disorders decreases
over time when they obtain services from an integrated substance abuse and
mental illness (SAMI) team that includes the criminal justice system. Criminal
justice professionals are important partners in community-based care for
persons with co-occurring disorders, because they are most likely to make
decisions at and after an illegal (or apparently illegal) incident that
determines whether a consumer receives appropriate or inappropriate treatment.
BEHAVIOR
Individuals with mental illness often experience impaired judgement as a result of their illness. Individuals with substance abuse addictions also experience impaired judgement as a result of their illness. Therefore, individuals with both (or co-occurring) disorders have a greater risk of experiencing impaired judgement and, as a result, they are more likely to lose self-control and engage in behavior that is or appears to be potentially harmful to themselves or to others.
CRIMES
Individuals who experience impaired judgment as
a result of substance abuse and/or mental illness have the potential to
commit violent acts; however, they are more likely to commit a wide range
of misdemeanors and minor felony offenses, including (but not limited to)
the following:
- Public disturbance
- Vandalism
- Breaking and entering
- Petty theft
- Forging checks
- Possession of illegal substances
- Possession of guns
- Assault
- Breaking restraining orders
- Breaking rental lease agreements
- Damaging their leased apartment
- Failing to upkeep an apartment
- Driving under the influence of alcohol and other drugs (DUI)
EVALUATION
It is important for criminal justice professionals to know the difference between illegal behavior and a symptom of mental illness and/or substance abuse. A criminal justice professional who has the ability to evaluate accurately can help consumers get connected with community-based care and, thus, contribute to a reduction in unnecessary arrests. For instance, when local police officers are trained to see suicide threats as a mental health problem and not a criminal behavior, they are more likely to apprehend the individual for referral to a mental health agency rather than for an appearance before a judge.
In the event a consumer has, in fact, committed a crime and must be arrested, criminal justice professionals can play a critical role in using the judicial system to connect consumers to appropriate care.
SENTENCING
Professionals who are not familiar with the behaviors
of and challenges confronting persons with dual disorders may refer consumers
to inappropriate and/or ineffective treatment. Common decisions to incarcerate
and/or sentence consumers to a rehab program are often ineffective responses
for persons with dual disorders, mainly because jails and rehab programs
typically do not address the consumers' needs to develop the following skills:
- Self-awareness of their mental illness and substance abuse disorders
- Strategies for managing the symptoms of their mental illness and substance abuse disorders
- Techniques for managing stress and stigma
- Techniques for managing their own behavior (self-regulation)
EDUCATION & TRAINING
Criminal justice professionals can provide help to individuals with co-occurring disorders by obtaining education about symptomatology and behavior disorders associated with the illnesses. They can learn how to respond to consumers who are engaging in problematic behavior and how to call upon available mental health and substance abuse services in their communities for help. They can also learn how to develop partnerships with health and human service agencies for the purpose of developing referral and treatment options.
Education and training may be obtained from the Ohio SAMI CCOE by following the link at the top of this page. Education and training may also be obtained from the Ohio Criminal Justice Coordinating Center of Excellence in Jail Diversion for the Mentally Ill (Ohio CJ CCOE). The CJ CCOE evaluates promising service models and emerging best practices that help persons with mental illness who have entered, or are at risk of entering, the criminal justice system (see Resources section below).
AGENCY COLLABORATION
Criminal justice professionals and agencies can
make significant contributions to the advancement of self-awareness and
self-regulation among persons with co-occurring disorders by encouraging,
welcoming, and actively participating in collaborations with health and
human service agencies and professionals who utilize integrated substance
abuse and mental illness (SAMI) programs. The SAMI programs will include
criminal justice professionals as active members of treatment teams and
as advisors on their implementation steering committees.
Through these team-based collaborations, criminal justice professionals and health and human service professionals educate and train each other about their respective roles in society and their involvement with persons who have dual disorders. They also collaborate to develop systems of intake, referral, and ongoing treatment that will achieve the following:
- Divert consumers with dual disorders away from inappropriate incarceration and treatment
- Provide jailed offenders with integrated mental health and substance abuse treatment, pre-release planning, and post-release help and support
There are several different types of criminal justice
collaborations that are successful in Ohio. One is the SAMI Court (see Resources
section below). Consumers enter this program as a condition of sentencing
after pleading guilty. They remain in the community under the supervision
of a SAMI team and the SAMI team's probation officer. The SAMI team meets
regularly (usually twice per month) in the judge's chambers to discuss each
case, progress, and treatment strategies. Short-term jail sentences are
sometimes imposed for accountability and as a way to direct consumers back
to the goals they set with their treatment teams.
TEAM WORK
SAMI treatment teams that involve the criminal justice system typically include the following professionals:
- SAMI program director/coordinator
- Nurse (provides medication education and medication
monitoring)
- Psychiatrist (provides medication somatic services)
- Case managers
- Consulting psychologist (provides diagnostic assessment
services, primarily for new referrals)
- Probation officer
- Magistrate
- Judge
Team members work together and with the consumers to
develop treatment plans. Team members meet regularly (usually once per week)
to discuss the progress of each consumer and next-steps for treatment. The
meetings enhance communication. Together, the team members find creative
ways to minimize jail sentences and to communicate consistent messages to
the consumers. The sharing of information in the weekly meetings has an
additional benefit. It prevents consumers from "splitting" the
SAMI team. Consumers are less likely to tell different stories to different
people. This reduces the likelihood of confusion for the treatment team
members.
TREATMENT
The goal of treatment in IDDT-based SAMI programs is to help consumers live as independently as possible without involvement in the criminal justice system. Treatment plans are individualized and typically provide ongoing community support and small amounts of external legal control as a way to provide consumers with incremental increases in personal freedom and responsibility.
Treatment plans in IDDT-based SAMI programs help consumers become more aware
of the behaviors that have led them to arrest and jail in the past. They
also help consumers become more aware of the thoughts and feelings that
preceded the behaviors. A consumer who is more self-aware is more likely
to have the ability to pick up the phone and call for help before
an incident occurs. With increasing self-awareness comes increasing independence.
For many consumers, self-awareness and independence would be very difficult
without the ongoing support of family, friends, and the entire SAMI team
network, including criminal justice professionals who work in their local
communities.
CONTRIBUTORS
This section of the Ohio SAMI CCOE Web site was written by referencing and excerpting content from pages 175 to 195 of Substance Abuse Treatment for People with Severe Mental Disorders: A Program Manager's Guide, by Carolyn Mercer-McFadden and Robert E. Drake, et al, New Hampshire-Dartmouth Psychiatric Research Center, Concord, NH, 1998. Send purchase requests to: New Hampshire-Dartmouth PRC, 105 Pleasant Street, Concord, NH 03301.
This section of the Web site was also written with information obtained
through interviews with the following service providers and trainers in
the State of Ohio:
Jo-Ann Harris, J.D., Director of the Ohio Criminal Justice Coordinating Center of Excellence in Jail Diversion for the Mentally Ill (2001)
James D. Kinnan, LPCC, Former Director of Professional Services at the Butler
County Mental Health Board, Butler County SAMI Court program (2001)
Ric Kruszynski, MSSA, LISW, LICDC, Assistant Director of Clinical Training, Ohio SAMI CCOE (2002)
RESOURCES
To learn more about the SAMI Court in Butler County, Ohio, visit the following hyperlink:
www.ohiosamiccoe.cwru.edu/news/samimatters2002winter.pdf
For information about training that pertains to the criminal justice system in the State of Ohio, contact the following:
Criminal Justice Coordinating Center of Excellence
Northeastern Ohio Universities College of Medicine (NEOUCOM)
330-325-6162 (phone)
harrisj@admboard.org
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