What does the future hold for drug courts?

• Position: Panel Discussion

PANELISTS

Nahama Broner New York University School of Social Work

Caroline S. Cooper Drug Court Clearinghouse, American University

Michael Jacobson John Jay College of Criminal Justice

Juanita Bing-Newton New York State Office of Court Administration

Deborah P. Small The Lindesmith Center

Nahama Broner New York University School of Social Work

My talk today is going to focus on slightly different than I think the subject heading. I am going to really talk about the population, the crossroads population, that comes into arraignment.

Most of the work that has been done has been on community samples, on jail samples, on prison samples, but not that population, of which about sixty-some percent go back out to the community and become our community samples, and then a certain percentage go into jail and then on to prison.

Today I am going to just sort of focus on some of the population characteristics in order to make that relevant for our discussions about both drug courts and other problem-solving courts.

This work is done with Damon Merrill, who is going to help me with the overheads, and Stacy Leman.

The work I am going to present is based on a small sample of 307 pre-arraignment detainees, men and women who were randomly selected. They had been arrested, they had been brought into the pens, and they were awaiting their arraignment.

Basically, the procedure was sort of logging those that refused or were taken to court or who were ill at the time and having interviewers who were master's levels and Ph.D. levels spend about an hour with structured interviews.

The questions that I am going to focus on today are really about how do rates of mental health and substance abuse differ from rates in the comparable population. Again, the pie gets cut in a number of ways.

Why that is of interest is from a resource perspective, both in terms of thinking about court intervention, but also the multiple points within which people could intervene. And also, when you are talking about a substance abuse population, whether that is really the sort of classic substance-abusing population or it is much more of a mix of needs.

What are the service patterns of this pre-arraignment population? What do they talk about as their service needs? Do criminal justice outcomes for pre-arraignment detainees differ by problem category?

What I am going to do in this presentation is we have divided the sample up based on research diagnoses for those with mental health problems, those with substance abuse problems, those that have co-occurring disorders, and those that did not reach a diagnosis.

And finally, do the criminal justice charges and severity of the charges, both in the lifetime retrospective collateral data collection we did and in fifteen-month follow-ups, provide a screen for mental health and substance abuse disorders? So if you sort of look at the charge, can you then really begin to address a substantial part of the population?

Just to give you a quick overview of the sample, it will be no surprise to any of you. It is an extremely needy sample. They are, on average, twenty-eight years old, with the substance-abusing and MICA populations. I am going to just refer to it as "MICA" today, just for ease, mentally ill chemical abusers.

The MICAs and the substance abusers, as has been known in the literature, are an older population by the time we get them.

This sample was about seventy percent male. The high-female sample had to do with, in the arraignment courts you see more females who are then released into the community.

And the ethnicity is comparable to the borough: 67 percent male, twenty-two percent Hispanic, et cetera.

The years of education: New York, in multiple studies, when you compare it to national data, is often an educated population, so this is about right, about eleven years of education.

And the majority are single.

Also, about half of this population have children, and where that becomes relevant is that as we went through the data, much of this population is also involved with child welfare.

And so, you already see, just even in this kind of very quick, gross, cross-sectional look at who is coming in, you already see the transmission of patterns from substance abusers, mentally ill, living with others that are incarcerated, mentally ill, substance abusing, having children, getting involved in the Family Court system, as well as being abusers and having been abused.

The homelessness in this population is, I think, low. I think we counted it low based on the way we were doing our measurement. It was about twenty-nine percent lifetime, and only 10 percent admitted to current. Their own view was that if they had a bed to sleep in, a friend, a relative, or a shelter, they were not homeless. So these are low numbers.

About half the sample was unemployed at arrest.

Over half the sample earned under $10,000 a year. Much of that was government assistance; about 41 percent were on assistance.

Thirty-six percent overall were receiving Medicaid/Medicare. And even when you look at the more needy populations, the MICA populations, the mentally ill populations, those are low percentages that have any kind of benefits, which again becomes an issue if you are trying to link people into treatment.

And about a third of the population has serious physical disorders and had been hospitalized for medical problems, such as HIV, hypertension, diabetes, and TB.

So to pull this together just briefly, and some things that we haven't shown here, about ten percent were currently homeless; about half percent unemployed; in terms of social services, about forty-one percent receive government assistance; forty percent are uninsured.

In terms of treatment, about a third of those with mental health and substance abuse problems had a history of mental health service use, which included medication, counseling, and hospitalization.

As we look at it, there is this phenomenon again in terms of the mismatch between need and what people are given during the course of their illness. Those with MICA disorders are overwhelmingly treated with traditional substance abuse counseling, and those with severe mental illness only are under-treated.

Thirty-three percent of the sample self-reported a trauma history. Rates are wildly varied in the literature, from a couple of percent to ninety percent. But this was sort of a first take in terms of sexual abuse, physical abuse, and emotional abuse, with mentally ill chemical abusers again and substance abusers leading the way in having experienced abuse histories.

In terms of family support, about fifty-five percent, as I said, had children; seventeen percent of those who had children had ACS involvement; and thirty-eight percent of those with children reported serious childhood trauma themselves; fifty-seven percent of those that had children had mental health or substance abuse problems.

Eighteen percent lived with a substance abuser--that's for the MICAs; fifteen percent lived with somebody of a history of incarceration, particularly if you were mentally ill; and if you were also MICA, you had a fourteen percent chance of living with somebody with a history of mental health treatment.

In terms of first take of rates--and one of my discussions will be about how you can slice the pie just about any way--but when we looked at this, about twenty-five percent of the population had serious mental health problems, meaning a diagnosis of schizophrenia, major depression, and bipolar disorder; twenty-two percent had some sort of co-occurring mental health and substance use disorder; twenty-three percent had only substance use problems; and forty-six percent of the population had no problems at all--again, keeping in mind that those with no problems had actually substance abuse, including crack and heavy use of marijuana; however, they did not reach diagnostic criteria. Similarly, many in the population that was diagnosed without a mental health disorder had been hospitalized for suicide attempts and had family histories of mental illness, so keeping that in mind.

Let's sort of move this on. This slide just sort of shows you the rates within those with serious mental disorders, the major depression as being the highest, bipolar, schizophrenia.

One thing that is also important is that people seem to talk about major depression often as either sort of it makes sense because of the substance abuse, or, of course, because they are getting arrested. I think that we need to keep this in the context that in the last ten years in the general population we have seen a doubling of numbers of major depression, and that and anxiety disorders are some of the most treatable of the disorders and cause very serious dysfunction. So again, when we are looking at these diagnoses, we need to sort of keep that in mind.

In terms of what we called "moderate mental health problems," are actually serious from a person's life and how they can cause dysfunction and recidivism. Those were post-traumatic stress disorder, generalized anxiety, and dysthymia, chronic depression lasting two years or later. There were overlapping diagnoses, so many of the people in the "severe" category has post-traumatic stress disorder and anxiety disorders as well, but an additional seven percent of the population just sort of came up with these disorders.

Also, in terms of prevalence--so the literature in jails and prisons talks about a six-to-fifteen percent rate. Again, we found higher, close to twenty-five percent. Community samples are about 5.4 percent for the severely mentally ill. It drops down to 2.4 percent for SPIMIs.

When we looked at this in different ways to try to understand it from the literature, the co-occurring part of the mentally ill sample, the sixty-seven percent which goes with the Linda Taplin [phonetic] literature, when we looked at symptomatology that in other studies of pre-arraignment samples would lead to acute psychiatric...