Western States Decision State Group
Phoenix AZ April 4 - 7, 2001

Thinking over a presentation on mentally ill offenders ...
The crime is not the untreated mentally ill.  The real crime is unpunished child abuse.
"Cross-system collaboration and communication, in tandem with preventive strategies, may decrease the illegal acts of individuals with SMI and provide treatment in the least restrictive environments possible."  (Offenders with Serious Mental Illness Case Study, CO)  " ... a national trend toward incarceration of offenders with mental illnesses ..."

AZ - linked databases facilitate the notification of mental health when ever a client    is arrested.

www.has.state.az.us  Finding: only 6 % of those with co-occurring disorders need a fully integrated system.   60% of people with serious mental illness have a co-occurring substance abuse disorder.  language: pre-motivational means not yet ready to withdraw from substances, still in the "engagement" phase; co-occurring is preferred now to dual diagnosis.   "Individuals with co-occurring psychiatric disorders (SMI) and substance disorders have a high prevalence of trauma histories and trauma related symptoms, women (85%) more than men (50%)."    (These are SAMHSA numbers, so we might say that SAMHSA says about 40% of people with serious mental illness have trauma histories and trauma related symptoms. This is lower than the rate of the Auschlander research: 50 - 80  %.  S.)  A process that was successful in developing a consensus approach to integrated treatment was to table items where there wasn't consensus in order not to get "bogged down" in debate.   Significant attrition in consumer participation.  (Mightn't that lead to a product which has group buy in which didn't look at all at the difficult issues, a pragmatic non-reflective tool?) 

Terros program - harm-reduction focus with a long-term goal of sobriety for dual-diagnosis clients.  Focus on positive non-judgmental attitude from staff.  Reported significant positive outcomes. 

Consumer Recovery Panel: Sheila Lopez, Jean Esplin, Dann Huff
(Max Dine joined for the afternoon)
Huff: works in the system, spoke of stages of recovery, person before the illness, belonging, prejudice, ... clear presentation in balanced language supporting holistic recovery instead of "dependent client" model.  And he endorses assertive community treatment as a way to get there. 
Lopez: recovery is a personal choice; support is needed for going to work
Esplin: consumer culture and community is key to recovery, exceptionalizing is divisive, difficult first step in becoming aware that she too could be a consumer employed in mental health. 
A sophisticated and impressive panel!  It felt good to me to meet others carrying on the work in a way I was comfortable with.

Cross-Drew, CA DMA State Project Research Director:  Help reduce the social and fiscal costs via integrated treatment of co-occurring disorders.  Santa Cruz, San Diego, Contra Costa (act team), Merced (still no good model for delivering rural services).  Possible act self-reported assessment scores inaccurate because client wants to please team.  All programs have high relapse and drop out rates, in terms of both disorders.  In terms of characteristics known at admission, relapse could not be predicted.  Survey showed extremely high crime victimization rates.  It is expected that the programs will reduce the high victimization rates and police contacts so there will be cost savings.  Housing has to be part of the solution.  CA governor insists on separation of other health from mental health and Cross-Drew insists on using word physical.

There was a long discussion of the data standards and uniformity that will be required by the Health Insurance Portability and Accountability Act (HIPAA).    The end result will be insurance portability and the price will be a national linked database.  It is likely that the privacy protections originally included will be modified, possibly eliminated along with the patients' rights provisions.

Sheila Cooper added and edited.