Testimony delivered at “Behavioral Health and the Criminal Justice System: Examining New York City’s Action Plan”

Trish Marsik, Executive Director for the Mayor's Task Force on Behavioral Health and the Criminal Justice System - May 12, 2015

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Statement of Trish Marsik

Executive Director, Mayor’s Task Force on Behavioral Health and the Criminal Justice System

New York City Council

Committee on Fire and Criminal Justice Services
Committee on Public Safety
Committee on Courts and Legal Services
Committee on Mental Health, Developmental Disability, Alcoholism, Substance Abuse, and Disability Services

May 12, 2015

Good morning, Chairperson Crowley and members of the Committee on Fire and Criminal Justice Services as well as members of the Committees on Public Safety, Courts and Legal Services, and Mental Health, Developmental Disability, Alcoholism, Substance Abuse and Disability Services. My name is Trish Marsik and I am the Executive Director of the Mayor’s Task Force on Behavioral Health and the Criminal Justice System.

Thank you for the opportunity to testify today. The Task Force on Behavioral Health and the Criminal Justice System is embedded in the Mayor’s Office of Criminal Justice, which advises the Mayor on public safety strategy and, together with partners inside and outside government, develops and implements policies aimed at achieving three main goals: reducing crime, reducing unnecessary arrests and incarceration and promoting fairness.

These three goals are at the heart of the Task Force’s work. In June of 2014, Mayor de Blasio launched a robust effort to address how the criminal justice and health systems can work together better to ensure that we are reserving criminal justice resources for the appropriate cases and deploying treatment and other proven effective remedies to interrupt those needlessly cycling through the system. Under the leadership of Deputy Mayor of Health and Human Services Lilliam Barrios-Paoli and Director of the Mayor’s Office of Criminal Justice Elizabeth Glazer, the Task Force’s executive committee included commissioners from City and State agencies, experts from the private sector, representatives from law enforcement and behavioral health agencies, district attorneys, defenders, judges and other court representatives, academics and service providers. The Task Force brought together over 400 leaders and participants in this work from across the City and the nation. Over a 100-day period, this group developed a comprehensive strategy to ensure that, when appropriate, people are diverted from the criminal justice system and that justice-involved individuals with behavioral health needs are connected to care and services at every point in the criminal justice process. The result is an unprecedented $130 million, four-year investment in targeted solutions that look not only at individual points in the system, but how the system as a whole operates. In implementing this plan, we are reducing the number of people with behavioral health needs cycling through the criminal justice system and connect them instead to interventions that could change the course of their lives.

I will discuss with you today the strategic imperatives driving these reforms as well as the mechanisms we are using to ensure that reforms are being fully and effectively implemented. Over the last twenty years, New York City has experienced the sharpest drop in crime anywhere in the nation. As crime has fallen so has the City’s jail population – on the last day of 2014, there were fewer than 10,000 individuals detained at Rikers for the first time since the mid-1980s. While many factors contributed to this extraordinary achievement, at its heart, the success was due to a focused effort to identify who was committing crimes and where and then tailoring strategies to address those specific problems.

Despite our success in reducing the overall jail population, the number of people with behavioral health issues has stayed largely constant, with individuals with behavioral health issues comprising a bigger and bigger percentage of the total number incarcerated. While in FY 2010, people with mental illness were only 29% of the NYC jail population, today they represent 38% of the overall jail population; approximately 7% of the jail population is made up of individuals with serious mental illness, meaning that they suffer from diseases such as schizophrenia and bipolar disorder. In addition, approximately 46 percent of inmates in the NYC jail system report that they are active substance users, although we believe the actual prevalence of substance use to be much higher. Many justice-involved individuals with behavioral health needs cycle through the system over and over again, often for low- level offenses. For example, a group of approximately 400 individuals has been admitted to jail more than 18 times in the last five years. This same group accounted for more than 10,000 jail admissions and a collective 300,000 days in jail.

To address this population more effectively and efficiently, the Task Force’s recommendations are rooted in the recognition that these kinds of entrenched and recurring problems can only be addressed if the system is looked at as a whole and if the strategy recognizes that each part of the system has an effect on the other. The goal of these strategies is to ensure that, when there is no public safety risk that individuals with behavioral health disorders: do not enter the criminal justice system in the first place; if they do enter, that they are treated outside of a jail setting; if they are in jail, that they receive treatment that is therapeutic, rather than punitive; and that upon release, they are connected to effective services. A key component of this approach involves plugging into Medicaid expansion, which gives us an opportunity to expand funding for supportive programming and treatment in the community while ensuring that those services lead to both better health outcomes and declining justice involvement. To that end, throughout the Task Force’s work, we are focused on increasing enrollment in Medicaid, ensuring that Health Homes engage and retain those justice involvement and that we measure the success of the range of new Medicaid initiatives not only by how they reduce reliance on health crisis services but also the crises of justice involvement.

Here are a few examples of the Task Force’s work to date:

  • Achieving the Task Force’s goals begins on the streets, where police and other first responders encounter those with behavioral health issues. The NYPD is currently finalizing curriculum that will expand training for police officers to enable them to better recognize the behaviors and symptoms of mental illness and substance use. The training will ultimately be integrated into the police academy curriculum. In the short term, it will be a stand-alone 36 hour training for 5,500 officers in the two areas where we will pilot public health diversion centers to provide an option that is not hospitalization or jail for people who do not pose a public safety threat.

Additionally, on April 14, Mayor Bill de Blasio and Chief Judge Jonathan Lippman announced Justice Reboot, an initiative to modernize NYC’s criminal justice system so it is fairer and more efficient. Central to this first round of reforms is a robust strategy to significantly reduce case processing times, a goal of the Behavioral Health Task Force. In developing better scheduling tools, more comprehensive databases of case information, and in creating borough-specific and city-wide workgroups, the City is well poised to reduce case processing backlogs. The Mayor and Chief Judge have committed to clearing half of all cases that have been going on for more than a year within the first six months of the initiative.

  • Behavioral health screening at arraignments will launch later this summer during selected hours in Manhattan. Nurse practitioners and other health professionals will pilot a process to identify those with immediate behavioral health needs, as well connecting to their treating providers for care and potential diversion.
  • Efforts are also underway to adapt the questions currently used to screen veterans who enter the criminal justice system. Those identified will be flagged for Veterans Affairs (VA) so case management support and linkage to care can be activated.
  • To date, the city has created two new specialized units to provide preventative services to inmates

with behavioral health issues. The two sites have shown preliminarily promising results, and the following two sites are scheduled to be opened mid-2015. Additionally, expansions to substance use disorder treatment will launch in June, providing discharge plans to an additional 4,000 individuals. The Department of Corrections has successfully implemented the eight additional hours of training for all uniformed officer recruits in working with inmates experiencing mental health issues. Current officers will also receive this training as well.

  • The City is currently engaging in extensive planning to make sure that discharge of individuals with behavioral health issues sets them up for successful re-entry through linkages with appropriate public benefits and supports, including public health insurance. The Task Force anticipates completion of expansions to existing discharge planning contracts (I-CAN) for 4100 slots will occur in May 2015. Further, to ensure minimal disruptions in public health insurance coverage, the City is identifying the various processes by which Medicaid enrollment occurs for those leaving jail. HRA and DOHMH are in the planning phases for additional staff to be added to these efforts and to create a Medicaid implementation team.
  • Beginning in October, DOHMH is adding 120 permanent housing slots dedicated to justice-involved individuals to the Department’s portfolio. A similar model, the Frequent Users System Engagement or FUSE program, was found to significantly decrease shelter, hospital and jail stays, generating an annual $15,000 public cost savings per housed participant when measured against a comparison group.
  • Additionally, the Department of Probation is close to launching in-house behavioral health teams and will provide advisory services in the screening and assessment of the behavioral health needs of individuals on probation, connecting them to clinical and concrete community-based services.

Measuring impact and refining approach is baked directly into the DNA of the Task Force. Since the action plan was announced in December, the Mayor’s Office has been leading multi-agency teams to ensure 1) implementation of both the projects outlined in this report as well as the ongoing planning efforts in several areas, 2) measurement of progress, and 3) accountability in achieving the goals laid out in the report. To ensure effective oversight and accountability, the Office of the Deputy Mayor for Health and Human Services and the Mayor’s Office of Criminal Justice will be responsible for the oversight of this plan and will convene the leaders of the agencies directly charged with implementation and key stakeholders, including representatives from the provider and consumer communities, to monitor the performance of the initiatives. The Mayor’s Office will publish quarterly reports on the progress of the initiatives and related efforts. To ensure that we are using the right metrics to evaluative impact, implementation of all of the actions in the report will include establishing measures for process and substance outcomes as well as targets. These performance measures will be published in the second progress report and systematically monitored and reviewed. And to ensure that the City is getting the greatest public safety return on its investments, the City will conduct an ongoing cost-benefit analysis to ensure that the lives of people with behavioral health needs are improving, that the criminal justice system becomes more efficient at diverting people out of the system, and that as a result, costs for unnecessary incarceration decline and benefits to public health and safety are calculated. In addition, the pilot programs that are to be initiated will be evaluated to determine whether they should be adopted City-wide, modified, or replaced with alternative approaches.

The Task Force is one way in which this administration is enacting its commitment to continue to drive down crime, reduce unnecessary arrests and incarceration, and promote fairness. I am happy to take your questions.

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