Mental Illness and the Criminal Justice System in

Nevada

 

Nevada Division of Public and Behavioral Health March 2013

Christopher Moore, MPH CandidateSouthern Nevada Adult Mental Health Services Jay Kvam, MSPH, State BiostatisticianNevada Division of Public and Behavioral Health Ihsan Azzam, MD, PhD, State EpidemiologistNevada Division of Public and Behavioral Health 

Pamela Graber, MA, Public Information OfficerOffice of Public Health Informatics and Epidemiology Julia Peek, MHA, ManagerOffice of Public Health Informatics and Epidemiology

Incarceration is increasingly being used to deal with mentally ill individuals

Criminalization hypothesis: Inappropriate use of arrest by law enforcement as a means of dealing with mentally-disordered individuals◦ Deinstitutionalization◦ Reductions in mental health spending◦ Co-occurring diagnoses◦ Socioeconomic and demographic factors

Introduction

Three times as many individuals with serious mental illness (SMI) are incarcerated than receiving hospital-based treatment.

In the last 30 years, the number of inmates with SMI has tripled.

7-16% of inmates have a mental illness.

Introduction

Understand the prevalence and demographic distribution of mental illness in the jails of the three most populous counties in Nevada.

Consider policies and programs that have been, or could be, implemented to reduce the burden the criminalization of mental illness has placed on Nevada jails, and provide a better and more appropriate standard of care.

Objective

Descriptive Statistics: 2011 Division of Mental Health and Developmental Services (MHDS) data were cross-matched with data from three Nevada jails:◦ Clark County Detention Center (CCDC)◦ Washoe County Detention Facility (WCDF)◦ Carson City Jail (CCJ)

Population data from the US Census Bureau were utilized for comparisons with countywide rates for demographic variables

Analytical Statistics: Correlation between number of clinic visits/hospital admissions and frequency of incarceration were analyzed using Spearman’s rank correlation

Methods

2,000,759; 72.5%

429,908; 15.6%

54,838; 2.0%

273,426; 9.9%

Figure 1. Estimated Nevada Population by County, 2012

Clark County Washoe County Carson City Other

Results

CCDC WCDF CCJ0

10,000

20,000

30,000

40,000

50,000

60,000

0%

5%

10%

15%

20%

25%

5,703 2,674 527

49,789

12,7821,758

10.3%

17.3%

23.1%

Figure 2. Prevalence of 2011 Detainees with a History of

Mental Illness Detainee Users of MHDS Services Detainee Non-Users of MHDS ServicesUsers of MHDS Services, (%)

MH

DS

Cli

en

ts

De

tain

ee

Use

rs o

f M

HD

S S

erv

ice

s,

%

CCDC WCDF CCJ0%

10%

20%

30%

40%

50%

60%

70%64.1%

61.1%57.5%

34.6%38.8%

41.9%

1.2%

Figure 3. Individuals with a History of Mental Illness Detained at Nevada

Jails, 2011

Male Female Unknown

County Jail

Pe

rce

nta

ge

of

De

tain

ee

s

17 to24 25 to 34 35 to 44 45 to 54 55 to 64 65 and older

CCDC

0.189374013677012

0.328598982991408

0.252498684902683

0.188146589514291

0.046466771874452

0.003506926179203

93

WCDF

0.217439703153989

0.301298701298701

0.224489795918367

0.195918367346939

0.055287569573283

9

0.005565862708719

85

CCJ 0.324478178368121

0.269449715370019

0.212523719165085

0.159392789373814

0.026565464895635

7

0.004

3%

8%

13%

18%

23%

28%

33%

Figure 4. Detention of Individuals with a History of Mental Illness in Nevada Jails by Age Group, 2011

Pe

rce

nta

ge

of

Ind

ivid

ua

ls

White Black Asian/Pacific Is-lander

American In-dian/Alaskan

Native

Other Unknown

CCDC 0.491 0.208 0.021 0.002 0 0.293

WCDF 0.876 0.092 0.01 0.018 0.013 0.003

CCJ 0.966 0.019 0 0.011 0 0

5%

15%

25%

35%

45%

55%

65%

75%

85%

95%

Figure 5. Detention of Individuals with a History of Mental Illness in Nevada Jails

by Race, 2011

Nu

mb

er

of

Ind

ivid

ua

ls (

%)

CCDC WCDF CCJ0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

66.2%

82.0%

70.6%

26.4%

10.8%

24.7%

8.9% 10.8% 8.2%

Figure 6. Detention of Individuals with a History of Mental Illness in Nevada Jails by

Ethnicity, 2011

Non-Hispanic Unknown Hispanic

County Jail

Pe

rce

nta

ge

of

Ind

ivid

ua

ls (

%)

Did Not Graduate

High School

Graduate/GED

Vocational/Technical

School

Some Col-lege

Under-graduate Degree

Some Graduate

School

Graduate Degree

Other

CCDC 0.295 0.431103234381923

0.0294638901196278

0.190518387239699

0.027027027027027

0.0046521931767833

4

0.0132919805050953

0.0093043863535666

8

WCDF 0.2644 0.4252 0.0504 0.1844 0.0256 0.0232 0.014 0.0128

CCJ 0.333333333333333

0.466101694915254

0.0338983050847458

0.11864406779661

0.019774011299435

0.0056497175141242

9

0.0084745762711864

4

0.0141242937853107

3%

8%

13%

18%

23%

28%

33%

38%

43%

48%

Figure 7. Detainees with a History of Mental Illness in Nevada County Jails by Educational

Attainment, 2011

Pe

rce

nta

ge

of

De

tain

ee

s

Unem-ployed,

Looking for Work

Unem-ployed, Not Looking for

Work

Retired Other Inmate Employed Full-Time

Employed Part-Time

Student Homemaker Unknown Military

CCDC 0.302647729265299

0.247764334560758

0.0049096966508855

0.0797825705768894

0.00140277047168157

0.0601437839733474

0.0471681571102928

0.011572856391373

0.00683850604944766

0.235840785551464

0.001

WCDF 0.464125560538117

0.251494768310912

0.0085949177877429

0.0242899850523169

0.00149476831091181

0.0680119581464873

0.0437219730941704

0.023542600896861

0.0216741405082212

0.0911808669656203

0.001

CCJ 0.250474383301708

0.148007590132827

0.00379506641366224

0.032258064516129

0 0.0683111954459203

0.0398481973434535

0.0740037950664137

0.0246679316888046

0.349146110056926

0.00379506641366224

3%

8%

13%

18%

23%

28%

33%

38%

43%

48%

Figure 8. Detainees with a History of Mental Ill-ness in Nevada Jails by Employment Status, 2011

Nu

mb

er

of

Ind

ivid

uals

(%

)

CCDC WCDF CCJ0

10,000

20,000

30,000

40,000

50,000

60,000

1.0%

1.2%

1.4%

1.6%

1.8%

2.0%

2.2%

2.4%

2.6%

2.4%

2.2%

1.8%

Figure 9.Detainees with a History of Ad-mission to an MHDS Psychiatric Hospital,

2011Detainees with MHDS Admission Total DetaineesDetainees with a History of Admission, %

484, 19.5%105, 4.2%

16, 0.6%

1881, 75.7%

Figure 10. Prevalence of Clients Admitted to an MHDS Hospital and

Detained in a Nevada Jail, 2011

CCDC WCDF CCJ Not Detained

2138; 12.1%

910; 5.2%

160; 0.9%

14,460, 81.8%

Figure 11. Prevalence of MHDS Outpatient Clients Detained by

Nevada Jails, 2011CCDC WCDF CCJ MHDS Outpatient Treatment

1 2 3 4 5+0

50

100

150

200

250

300

0%

10%

20%

30%

40%

50%

60%56.4%

20.7%

9.7%5.9%

7.2%

Figure 13. Individuals Who Were Both Ad-mitted to an MHDS Hospital and Detained at

Least Once in a Nevada Jail, 2011

CCDC WCDF CCJ

Number of Detentions

Nu

mb

er

of

Ind

ivid

ua

ls

Pe

rce

nta

ge

of

Ind

ivid

ua

ls

1 2 3 4 5 to 9 10+

CCDC (n=2138)

0.592609915809167

0.235266604303087

0.0841908325537886

0.0397567820392891

0.0411599625818522

0.0070159027128157

2

WCDF (n=911)

0.551042810098793

0.21953896816685

0.109769484083425

0.0614709110867179

0.0548847420417124

0.0032930845225027

4

CCJ (n=162)

0.524691358024691

0.234567901234568

0.191358024691358

0.0308641975308642

0.0185185185185185

0

-5%

5%

15%

25%

35%

45%

55%

Figure 12. 2011 Users of MHDS Outpatient Services Detained by Nevada Jails by Number

of Detentions

Nu

mb

er

of

Ind

ivid

uals

(%

)

Psychotic Mood Substance Use

Personality Adjustment Other Deferred None

CCJ 0.482 0.143 0.268 0.018 0 0.054 0.036 0

WCDF

0.403061224489796

0.306122448979592

0.122448979591837

0.0306122448979592

0.0408163265306122

0.0561224489795918

0.0357142857142857

0.0051020408163265

3

CCDC

0.504424778761062

0.300884955752212

0.113569321533923

0.0103244837758112

0.0162241887905605

0.0471976401179941

0.0044247787610619

5

0.0029498525073746

3

5%

15%

25%

35%

45%

55%

Figure 14. Most Common Diagnoses Among Those Frequently Admitted and

Detained in Nevada Jails, 2011

Pe

rce

nta

ge

of

Ind

ivid

ua

ls

Table 1. Correlation Between Number of Hospitalizations or Clinic Visits and Number of Detentions in 2011.

CCDC WCDF CCJ

MHDS Hospital Admissions and Detentions

rs[487] = .095, p < .05

rs[105] = .214, p < .05

Non-significant

MHDS Outpatient Clinic Visits and Detention

rs[2138] = .059, p < .01

rs[910] = .147, p < .05

Non-significant

*Correlations calculated using the Spearman’s Rank Correlation Coefficient in SPSS (version 20).

Table 2. Legal Holds Placed by the LVMPD and Detainment by CCDC, 2011-2012.

2011 2012

Legal Holds 5,989 6,185

CCDC Detainees with Mental Illness

5,703 Not Available

Note: Total may include individuals counted more than once due to multiple legal holds. 248 individuals were placed on legal holds from CCDC

Misdemeanor Gross Midemeanor Felony Unassigned

CCDC 0.819 0.07 0.111 0

WCDF 0.961 0.006 0.011 0.022

CCJ 0.654 0 0.038 0.308

5%15%25%35%45%55%65%75%85%95%

Figure 15. Charges Filed Against Those with Multiple Admissions and Deten-

tions, 2011

Pe

rce

nta

ge

of

Ind

ivid

ua

ls

Criminalization of Mental Illness

Trespass, 4972, 87.4%

Other, 716, 12.6%

Figure 16. Charges Against Those with Multiple MHDS Admissions and

CCDC Detentions in 2011

Financial incentive for criminalization 2001 Report by the Bureau of Justice

Statistics◦ Annual operating costs per prisoner in Nevada

were $48.14 per day VERA Institute of Justice study

◦ States spent an average of $76.03 per inmate per day in 2010

◦ Nevada prison expenditures had increased by 9.39 percent between 2006 and 2010

Criminalization of Mental Illness

Table 3. Comparison of Treatment and Incarceration Costs, FY 2012

NNAMHS SNAMHS LVMPD

Admission/Incarceration (Per bed day) $1383.71 $656.10 $144.00

OP Clinic Visit $197.84 $166.54 N/A

Expansion of existing jail diversion programs, such as Mental Health Court, to include service provision for more mentally-disordered individuals.

Development of government and community partnerships to provide seriously mentally ill individuals with case management services and the social supports necessary to successfully transition from incarceration to community living.

Potential Solutions

Community-based program involving multiple Nevada government and local partnerships

Diverts non-violent offenders with mental illness into treatment programs

Goal: Reduce or eliminate offender recidivism by treating mental illness  

Mental Health Court (MHC)

One Year Prior During One Year After Two Years Af-ter

2007 (n=106) 5011 1086 230 813

2008 (n=82) 4723 1119 230 NaN

2009 (n=63) 2820 569 858 NaN

500

1,500

2,500

3,500

4,500

5,500

Figure 18. Mental Health Court Graduate Jail Days, 2007-2009

Jail D

ays

One Year Prior During0

5,000

10,000

15,000

20,000

25,000

$0

$500,000

$1,000,000

$1,500,000

$2,000,000

$2,500,000

$1,060,279

$224,305

$1,090,676

$2,322,941

Figure 19. 2007-08 Mental Health Court Candidate Jail Days and CostsMHC Enrollee Jail Days (n=169) MHC Non-Enrollee Jail Days (n=164)MHC Enrollee Jail Costs MHC Non-Enrollee Jail Costs

Jail

Da

ys

Jail

Co

sts

Authorizes involuntary court-ordered admission of certain adults with mental illness to programs of outpatient services.

◦ History of treatment noncompliance◦ Able to live safely in the community◦ Admission necessary to prevent further disability

likely to result in harm to self or others◦ Limited ability to comply voluntarily with

treatment◦ Least restrictive treatment option

2013 Legislative Session: Assembly Bill 297

Rawson Neal Behavioral Health Center◦ Seamless transition to outpatient care◦ Intensive case management services◦ Housing provision

Dependent on strengthening partnerships between Mental Health and Criminal Justice professionals

Drop-in Center◦ Integration into the community◦ Peer support◦ Vocational training◦ Community resource and service access

Seamless Transitions to Outpatient Services

Treatment Advocacy Center Study

Figure 20. Prevalence of Mental Health Diversion Practices: A Survey of the States (2013)

Table 4. Nevada’s Grade for Mental Health Diversion Practices

Percentage of

population served by a

Mental Health Court

Percentage of

population served by

Crisis Intervention

Team

Average Percentage Grade

88% 37% 63% B+

Criminalization of mental illness has placed a high burden on the criminal justice system in Nevada

An approach involving multiple programs ranging in levels of intensity is needed to reduce this burden

Longitudinal data need to be collected to evaluate the effectiveness of each of these programs

Conclusions

Cross-matched data does not account for those individuals utilizing private services ◦ Underrepresentation of mental illness in jails

Misclassification◦ Prevalence rates sometimes total over 100 percent

Individuals may not be current utilizers of psychiatric services

MHDS clients may have been detained elsewhere◦ Actual prevalence of incarceration may be higher◦ Study of incarceration statewide is recommended

Limitations

For more information, contact:◦ Christopher Moore◦ Southern Nevada Adult Mental Health Services

Telephone: (702)486-6447 Email: chrismoore@health.nv.gov

Contact Information

The CCDC results of this study have also been presented in a Nevada Division of Public and Behavioral Health Report:◦ Moore, C., Kvam, J. Azzam, I., Graber, P., & Peek, J.

(2013, March). Mental Illness and the Criminal Justice System: Clark County, Nevada. http://health.nv.gov/publications.htm

The authors thank Jodie Gerson, Sharon Dollarhide, Kurt Green, and Adrian Ramirez for providing MHDS data. The authors also thank Dr. Patricia Cruz for providing guidance in the development of this presentation.

Acknowledgements

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McKnight, T. (2012). Nevada's Division of Mental Health and Developmental Services 2012 Needs Assessment. State of Nevada Division of Mental Health and Developmental Services.

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United States Census Bureau. (2010). American Fact Finder: Clark County, Nevada Retrieved March 14, 2012, from United States Census Bureau: http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=DEC_10_DP_DPDP1.

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