Helping Clients With Mental Illness and Intellectual Disabilities Navigate the Criminal Legal System

Recently, Dallas Crews, the Conference’s Social Work Program Director, provided some guidance for social workers helping our clients who suffer from mental illness and/or intellectual disability, and it is worth sharing whether the attorney has access to a social worker or not.

I: IDENTIFYING THE PROBLEM

First, when working clienwhots  are severely and/or persistently mentally ill, the client often has an underlying intellectual or developmental disability in addition to a mental health diagnosis. While in some cases it may be one or the other, more often than not, both are present.  Here are some useful steps to help identify the nature of the issue.

Step 1: Questions to Ask the Client and/or Their Family Support

• Have you ever been diagnosed with a mental health condition (e.g., anxiety, bipolar disorder, schizophrenia)?
  • If yes, where were you treated for this/these condition(s)?
• Has anyone ever told you that you see or hear things that other people don’t?
• Did you receive special education services in school?
• Did you have an Individualized Education Plan (IEP) or any other support plan in school?
• Do you currently have health insurance?
• Do you receive Social Security benefits? If yes, what are they for specifically?

Step 2: Gather Relevant Records: Obtain as many records as possible. Priority documents include:

• School records – These are often extremely helpful and can reveal early signs of developmental or cognitive concerns.
• Developmental and IQ assessments – Especially those completed before age 18, as they are key to establishing lifelong disability.
  • If you can show an IQ of 70 or below prior to the age of 18, or a developmental delay prior to the age of 22, you can get the department of Disability and Aging (DDA) involved (formally known as DIDDs) – these can often be found in psych, school or social security records.
• Social Security records (if applicable).
• Mental health treatment records – From any facility or provider where diagnoses were given or treatment was received.
• DCS or juvenile records – including group juvenile facilities or group homes.
• Jail medical records – These can show medication compliance or noncompliance and overall mental health management.

Step 3: Prepare Documentation for the Forensic Evaluation (this always needs to be done in consultation with the lawyer)

• Our social workers typically prepare both a records summary and a mental status exam prior to the forensic evaluation.
  • For those without a social worker, a records summary could be done by an investigator, and a mental status exam could be done by a criminal justice liaison (everyone has one in their community, and Dallas can provide a list of these) or psych nurse at the jail.  Keep in mind, though, that a PD social worker is an agent of the attorney and enjoys confidentiality, while professionals employed by other agencies do not.
• Highlight any documented history of suicidal or homicidal ideation, as this can be significant for the evaluator.
• Evaluators often don’t have the time to review all the records in detail, so a well-organized summary can make a big difference in the quality and direction of the outcome.
• Including both the mental status exam and the records summary improves the chances of a thorough and favorable evaluation.
• If you find your client has an IQ below 70 prior to the age of 18 or developmental delay prior to the age of 22, a TNSTART referral (at the link below) could be helpful. They can administer Mental Status Exams and help advocate for your client both in jail and in the community and consult with you as needed:

https://www.tn.gov/disability-and-aging/about-us/divisions/clinical-services/tn-start.html

Step 4: Optional but Recommended – Include a Memo

If you believe all less restrictive alternatives to commitment have been thoroughly explored, it’s helpful to submit a brief memo outlining this position. Include any supporting documentation.

1. FINDING ALTERNATIVES TO INCARCERATION

Once the nature of the client’s particular challenge is more well defined, that identification can help guide your steps going forward in identifying and documenting lesser restrictive alternatives to commitment.  This is useful in presenting a case for release, and, if the client has attempted these alternatives without success, it can significantly influence outcomes such as NGRI, incompetence, or diminished capacity.

*Note: All placements in these categories are for clients that are agreeable to community placements. *

IF: (1)  Your client has a Severe and Persistent Mental Illness (SPMI) only:

PROCESS 1.1 – If your client has entered incarceration with active social security and insurance and has been incarcerated for less than 1 year:

Connect with Insurance to find a Group Home

• Find out what insurance client has and get a release of information (ROI) signed by your client. It must be an ROI printed off from their specific insurance website. It cannot be an ROI from your office.
• Call your client’s insurance company and request to speak to a case manager. Request a list of group homes that are in network with your client’s insurance.
• If you are unsuccessful in finding placement for your client through insurance, connect with Christy Spangler, Assistant Director of with the Office of Housing Homelessness for the most updated list of behavioral housing homes at 615-253-8162 or 615-499-3973, [email protected].

*Note:

-Some of these placements are affiliated with HUD grants. This means if your clients have had a felony in the past 7 years, they will not qualify for some placements.

-Additionally, be mindful of when your client will be incarcerated for 1 calendar year. If they pass that time frame, they will lose their social security and be unable to enter a group home unless they are able to get that restarted. If you need to get that restarted for them, it can potentially take 6-12 months if the resources are available in your area. See next step on how to access that resource.

PROCESS 1.2 – If your client has entered incarceration without social security or insurance or has entered incarceration with active social security and has now been incarcerated for over 1 calendar year:

Connect your client to Social Security. If you can do this, insurance will follow.

• Reach out to your Regional SOAR Provider to get your social security.

Once your client has social security. Follow the steps in Process 1.

*Note:

-SOAR applications take an average of 100 days and have a 65% approval rate.

-Most of the SOAR trained specialists across the state do not take SOAR referrals, due to working with individuals who are in programs provided within their organization only.

-Your Social Workers are unable to provide SOAR services. The Department of Mental Health will request they do this. However, the training course is like taking a mini law course. Additionally, The Department of Mental Health estimates “that each SOAR application will take 20-40 hours to complete.” This is not a feasible task on top of their caseloads.

-It is unfortunately common that we are unable to connect our clients that have an SPMI and zero substance use with long term placement prior to release. If this happens, please give them resources to the nearest “PATH” (Projects for Assistance in Transition from Homelessness) program or other housing and homelessness resource connection in your area. This is not housing and is only case management and wrap around resources for homeless clients:

https://www.tn.gov/behavioral-health/housing/path.html

IF (2) Your client has an Intellectual or Developmental Disability (low IQ) OR your client has both an Intellectual or Development Disability (low IQ) and a Severe and Persistent Mental Illness (SPMI):

PROCESS 2.1 – If your client has entered incarceration with active social security and insurance, and is connected to the Department of Disability and Aging Resources (DDA) – (formerly known as DIDDs):

Connect with “ECF Choices” (Employment and Community First Choices)

• Request to be connected to your client’s case worker by calling one of the numbers below:

DDA Regional Intake Office Contact Information:

West TN Regional Office: (866) 372-5709

Middle TN Regional Office: (800) 654-4839

East TN Regional Office: (888) 531-9876

• Once you’re connected to your client’s case worker, request a group home placement for your client.

*Note:

-You will not be able to call a group home and refer your client there. That referral must come from their DDA case worker through ECF Choices. Your social worker can work as a liaison between DDA and your office to advocate for your client.

PROCESS 2.2- If your client has entered incarceration without social security or insurance and is not connected to DDA resources:

Connect client to ECF Choices

• Fill out an online application for your client at https://perlss.tenncare.tn.gov/externalreferral
• Be able to provide records that your client was given an IQ score below 70 prior to the age of 21 (these can usually be found in school records or old social security records if your client was previously on social security).
• If you are unable to produce records, you can have a family member or family friend write a letter about the client’s abilities prior to the age of 21. These usually get denial letters, but often get overturned if you appeal the initial denial.
• Once your client gets connected to ECF Choices follow the steps in process 3 above.

*Note:

-Once your client is set up with ECF Choices, Social Security and Insurance will follow. It can take anywhere from 3 weeks to 3+ months for this process to go through. Once the referral is made, we are at mercy of the state on how quickly they process their applications, interview our clients and then connect them to services.

-To request social security records, you must request those records from the initial placement your client received social security. For example: if your client now lives in Dyer County, but your client originally signed up for social security in Sullivan County, your record requests will have to through the Sullivan County Social Security office.