Aided by IRETA, the Pennsylvania Dept. of Corrections develops performance measures for prison mental health services
The past five years have seen an increasing number of state initiatives that deal with what have proven to be costly, ineffective, and unjust approaches to incarceration over the last few decades. The Public Safety Performance Project (PSPP), a program of The Pew Charitable Trusts, is a formidable force behind many of these initiatives. Now, with the help of IRETA, the PSPP is working in Pennsylvania to improve the quality of mental health services in state correctional facilities.
The PSPP mission is to aid states in producing evidence-based policies tailored to each state’s needs that decrease prison spending while reducing recidivism rates and promoting public safety.
This work, done in a public-private partnership with the Bureau of Justice Assistance (BJA), is called “justice reinvestment.” State governors who have implemented justice reinvestment programs believe that “it’s a way to be smart—not soft—on crime.”
Justice reinvestment reforms may include adjusting sentencing laws for non-violent, low-level offenders, improving the efficiency of data collection, and providing performance measures and incentives for correctional services, to name a few.
Policy and attitudes towards the role of corrections are in the process of a seismic shift. Adam Gelb, director of Pew Charitable Trusts PSPP, observes that the outcomes of evidence-based justice reinvestment projects have influenced this shift in a big way.
“What’s really motivating the change,” he said, “is the success that states like Texas have had in cutting both crime and costs; supportive public opinion, especially among some conservative leaders; and growing awareness that there are research-based alternatives that cost less than prison and work better to reduce recidivism.”
PSPP has worked with a number of states, including Georgia, South Carolina, Kentucky, and South Dakota, to decrease costs to the state and taxpayers in addition to lowering recidivism rates through tailored evidence-based policy and practice.
What’s at stake
A Pennsylvania State Prison study released last year found that 6 of 10 inmates paroled from Pennsylvania prisons were arrested again within three years. In worse news, parolees released to the streets were reincarcerated less often than those who first spent time in halfway houses, whose goal is preventing such recidivism.
And our rate of imprisonment is increasing more quickly than other states. In 2012, Pennsylvania earned the dubious honor of being among the ten states with the largest imprisonment rate increases in the US. (State-by-state comparisons are captured nicely in Pew’s infographic “States Cut Both Crime and Imprisonment.” Click the image on the right to read–and perhaps share–an enlarged version.)
The problem is bigger than Pennsylvania, though. Data from a 2010 report from the Treatment Advocacy Center, “More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States,” showed that there are now three times as many seriously mentally ill people in prisons and jails than in hospitals.
“It is thus fact,” the report continues, “not hyperbole, that America’s jails and prisons have become our new mental hospitals.”
That point is not lost on public servants. A June 2011 Current Issues in Corrections survey indicates that “Mentally Ill Offenders” ranks among the top issues facing corrections agencies.
One agency laments:
The prevalence of mental illness is disproportionately high among incarcerated individuals. Sadly, it is often only after incarceration that a diagnosis and proper treatment are provided. The impact on the Department is high medication cost, behavior problems driven by mental illness, and the overall need for specialized staff and increased specialized trainings. Utilization of a strict formulary, development of specialized staff through trainings, centralization of acute mental health services, and the development of specialized housing areas (i.e. mental health dorms) [are all necessary to treat mentally ill inmates].
If jails have become the new mental institutions, then it makes sense that recidivism rates are high. If incarcerated persons aren’t receiving adequate mental health services, and then are released from prison or halfway houses, it follows that they are going to end right up back at what amounts to a stand-in for a mental hospital.
The development of performance-based measures for prison mental health services, then, is a substantial response to the realities of recidivism in Pennsylvania, contends IRETA’s Executive Director, Peter Luongo, PhD.
“Creating a basic set of performance measures is a practical step toward reducing recidivism and improving public safety,” he said.
In Luongo’s view, reducing the state prison population is not optional. “It’s clear that we are moving toward the de-institutionalization of prisons as we did mental institutions forty years ago. The costs of imprisoning so many people are too high—both in human and economic terms.”
The question, he says, is whether “states will approach this process using sound methods based in research and a careful analysis of their own data.”
PSPP in Pennsylvania
Last year, the PSPP worked with the Pennsylvania Department of Corrections (PA DOC) to develop and implement evidence-based performance measures for contractors providing mental health services to corrections facilities. IRETA offered technical assistance during the process of developing the measures.
In December, the PA DOC awarded a $91 million, five-year contract to MHM Services to provide psychiatric services to inmates in Pennsylvania correctional facilities. (Psychological services will be provided by DOC staff using the same delivery method previously in place.)
As part of the new contract, MHM Services is required to meet certain incremental standards, including reducing the number of misconducts for mentally ill offenders, reducing the number of inmates recommitted to prison mental health units, and lowering the number of recommitments to prison residential treatment units.
There is incentive to meet these standards in the form of monetary reward. MHM Services must continue to evaluate their performance in accordance with the standards. Failure to meet the standards incurs monetary penalties.
Tying service contracts to performance measures is a new strategy in corrections. “Performance-based contracting is an innovative and potentially powerful strategy to improve results in states and counties across the country,” said Gelb. “There’s no tradition in the field of incentivizing providers to produce better outcomes.”
Corrections Secretary John Wetzel has been an outspoken advocate for justice reforms in Pennsylvania, including the importance of measuring the quality of prison services. “No longer are we issuing contracts for just a service,” he said. “From this point on, our contracts will focus on results.”
What should we expect to see over the next five years if the performance measures are working?
Lower costs, for one, says Gelb: “By creating direct financial rewards for better outcomes, Pennsylvania is encouraging these providers to use evidence-based practices that will boost public safety and ultimately cut costs to taxpayers.”
And the costs that taxpayers do assume should increasingly fund services that provide effective rehabilitation, as Wetzel points out:
“The new contract includes performance measures that will ensure taxpayers are getting what they pay for, including inmates who leave our system better than when they entered it,” he said.
Gelb also believes that Pennsylvania’s model is potentially poised to be a leader in justice reinvestment trends.
“The potential to improve outcomes is enormous,” he said. “If the Pennsylvania model is successful, we could see it spread to other services behind the walls and to services that corrections agencies purchase in the community.”
Justice Reinvestment is key to reforming Pennsylvania corrections by Sec. John Wetzel (3/17/12)
Justice Reinvestment in Pennsylvania, Overview by the Council of State Governments Justice Center (1/26/12)
The problem with Pennsylvania’s system of halfway houses for paroled inmates by WHYY radio (4/9/13)
Inside a Mental Hospital Called Jail by Nicholas Kristof (2/8/14)