December 2, 2019

National Initiative Updates

Behavioral Health AlertsWe are ready to publish! Please share the December newsletter far and wide and encourage all interested to sign up to receive these Alerts directly. We will be publishing every couple of weeks (or so) to keep the national court community informed about the important work of the SJI funded National Initiative to Improve the Court and Community Response to Mental Illness and Co-Occurring Disorders. Please share with us any news, updates and developments from your court or state. September, October and November Behavioral Alerts are posted on the NCSC Website for reference.

CCJ/COSCA Southern Region “Save the Date” May 13-15 2020 Austin TexasThe CCJ/COSCA Southern Region Summit “Improving the Court and Community Response to Mental Illness and Co-occurring Disorders” will be held in Austin Texas May 13-15, 2020. Chief Justices and State Court Administrators will be compiling multidisciplinary teams to attend this important event. Save the Date!

Eight Additional States Submit a SJI Request for Technical Assistance to Implement State Action Plans following 2019 CCJ/COSCA Regional Summits (West and Midwest)The National Initiative Advisory Committee will be meeting Thursday December 5th to review requests from the following states: Illinois, Indiana, Minnesota, Missouri, North Dakota, Idaho, Utah and Washington. This round of requests is in addition to the five states that were approved earlier: Guam, Hawaii, Colorado, New Mexico and Alaska.

The National Initiative Advisory Committee meets December 5^th, 2019The Advisory Committee will be very busy that day! It will consider reports including the Final Report from the Opioid Task Force, and on its policy priorities (Competency delays, model civil commitment laws, diversion and deflection strategies and the development of national mental health curriculum); its research priorities (national data, high system utilizers guide, tele services, co- location of services, statewide assessment tool and enhanced data measures); website enhancements; strengthening partnerships; opportunities to promote education, government relations strategies; and myriad other significant work underway.

Research and Resources

SAMHSA’S GAINS CENTER INVITES COMMUNITIES TO APPLY FOR SEQUENTIAL INTERCEPT MAPPING (SIM) WORKSHOPS SIM Workshops are designed to bring together a local, cross-system, multidisciplinary group of key stakeholders from a particular jurisdiction to facilitate collaboration and to identify and discuss ways in which barriers between the criminal justice and behavioral systems can be reduced through the development of integrated local strategic plans. SIM Workshop participants are expected to be drawn, in large part, from local criminal justice and behavioral health agencies and organizations. Application deadline: December 20, 2019

Delayed and Deteriorating:  Serious Mental Illness and Psychiatric Boarding in Emergency Departments Treatment Advocacy Center's newest evidence brief details how people with serious mental illness are disproportionately impacted by long wait times in emergency departments, a phenomenon known as "boarding." These individuals experience longer waits than non-psychiatric patients and have more serious consequences, including making recovery less achievable and their treatment more costly to the health care system.

Jury is Out on Paid Peer Support for People with Mental Illness Paid peer support, whereby one person with mental illness provides help and support to someone else with mental illness for money, is widely implemented and heavily promoted by SAMHSA, CMHS, mental health industry advocates, the media, and people who are paid to provide peer support. In spite of being extensively researched, there is little evidence that paid peer support for people with mental illness improves meaningful outcomes or that paid peers provide support better than others.

Solicitation for Applications: SAMHSA’S GAINS Center Seeks Communities to Develop Trauma-Informed Training Capacity SAMHSA is soliciting applications from communities interested in developing a capacity to provide trauma-informed training. The GAINS Center is offering a series of Train-the-Trainer (TTT) events to train local trainers to deliver its How Being Trauma-Informed Improves Criminal Justice System Responses training program. The target audiences for this training program are primarily community-based criminal justice system professionals, including law enforcement, community corrections (probation, parole, and pre-trial services), court personnel, re-entry staff, and human service providers that serve adult justice-involved populations.

TAC RESEARCH WEEKLY: How Does Adding More Beds Affect ED Visits The authors found that the rate of emergency department visits for mental health concerns continued to increase after the expansion of the hospital. Therefore, as a system, the rate of mental health visits for emergency department visits did not decrease by the expansion of the hospital emergency department. However, the opening of more psychiatric emergency capacity in one hospital in the region significantly shifted traffic in the emergency departments to the one that had more space.

Competence to Stand Trial: Opportunities for Diversion The Sequential Intercept Model (SIM) provides a framework for identifying decision points and opportunities to divert individuals with behavioral health conditions out of the criminal justice system and into community-based treatment and supports. This graphic flowchart identifies decision points in the CST process where justice and behavioral health professionals can consider and create diversion opportunities for these defendants.

COMPETENCY RESTORATION: THOUGHTS FROM THE FIELD SAMHSA’s GAINS Center’s Competency to Stand Trial/Competency Restoration Learning Collaborative was an initiative designed to help states address this situation, to identify best practices for competency evaluation and restoration programs, and to build collaborations between state and local agencies. This document summarizes the findings of this project.

STATE CIVIL COMMITMENT LAWS: A WHITE PAPER  American Health Lawyers Association, State Civil Commitment Laws: A White Paper, 13 J. Health & Life Sci. L. 58 (2019) On April 24, 2019, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Health Lawyers Association hosted a convener session on state civil commitment law issues. Experts from around the country gathered for a day-long meeting to identify the most pressing issues and discuss possible solutions. Convener participants were all individuals who handle matters related to state mental health laws, and they presented their individual viewpoints on the subject. (Westlaw link)

Leveraging Telehealth for Justice-Involved Individuals: Expanding Access to Mental and Substance Use Disorder Treatment Many communities are adopting telehealth as one way to address gaps in access to treatment for mental and substance use disorders for justice-involved populations. This webinar, hosted by SAMHSA’s GAINS Center, will present ways to incorporate telemedicine into treatment programming for mental and substance use disorders, including how to expand access to medication-assisted treatment using telemedicine, types of telehealth provider settings, and implementation best practices and barriers. December 11, 2019, 1:00-2:30 p.m. ET

CIT International Releases Groundbreaking Guide to Best Practices in Mental Health Crisis Response “Widespread crisis intervention strategies and techniques are critical to addressing rising rates of overdoses and suicides that continue to devastate families nationwide. Now, more than ever, we have to break the all-too-common cycle of sending those with mental health and substance use disorders through the criminal justice system. This guidebook is an essential resource for communities to do their part,” says Patrick J. Kennedy, a former U.S. Representative and founder of The Kennedy Forum.

Addiction and mental health vs. physical health: Widening disparities in network use and provider reimbursement The federal parity law, which has been in effect for the five-year period covered by this report, has rules that encompass provider payment rates and network adequacy. The findings of this extensive report indicate that disparities exist in both network use and provider reimbursement level when comparing behavioral healthcare to medical/surgical healthcare.

In the News

‘Ernie & Joe: Crisis Cops’ Review: Keeping Calm Is Their Secret Weapon “Ernie & Joe: Crisis Cops,” Jenifer McShane’s nonfiction portrait of two officers working in the San Antonio police department’s mental health unit, arrives at a time of continued debate about what constitutes excessive policing. For Ernie Stevens and Joe Smarro, the goal is to defuse potentially violent encounters with the mentally ill and steer them into treatment instead of jail. Contains a link to the HBO trailer.

With Judicial Commission On Mental Health, Civil And Criminal Courts Join Forces A collaboration between the Texas Court of Criminal Appeals and the Texas Supreme Court aims to educate judges and lawmakers about the mental health needs of Texans who appear in court.

NJ Judiciary Forms Mental Health Advisory Committee A new advisory committee formed by the state Supreme Court focuses on mental health issues facing those who are dealing with the criminal justice system. The formation of the Mental Health Advisory Committee was announced recently by Chief Justice Stuart Rabner, and will include representatives from the legislative, executive and judicial branches of government.

As homeless crisis grows, new law offers forced treatment for mental health, addiction SB1045 was passed by the Legislature last year, and it allows for the creation of a conservatorship for people with severe mental health and substance abuse disorders. Simply put, with court approval, they could take guardianship over people and put them into treatment. Los Angeles County is looking at this right now.

Washington's 'failing' mental health system bleeds onto the street How Washington state handles mentally ill defendants is complicated, cumbersome, and challenging for everyone involved. Bottom line, people who are diagnosed with mental illness cannot be tried for crimes and prosecutors are left with dismissing the case. “The corrections system is heavily funded, not so much the treatment system. We need treatment facilities that people can go to and stay until they are well.”

Woman Detained In Hospital For Weeks Joins Lawsuit Against New Hampshire "And the next thing I know, they're stabbing me in the arms with some kind of sedative," said Meme. "Stab, stab. Next thing, I'm waking up at St. Joseph Hospital." She was then kept in the hospital emergency department for 20 days before being transferred to a psychiatric facility, where two days later she had her first hearing before a judge.

Red-Flag Laws Should Trigger Treatment, Not Just Gun Confiscation New York provides a roadmap for how to do this. In 2013, it passed the New York SAFE Act. Among other provisions, the law required therapists to report to the county mental-health director the names of mentally ill people under their care who they believe to be dangerous and to possess guns. It then charged the county mental-health director with investigating the therapists’ reports and, if appropriate, instructing law enforcement to seize the guns from the individuals in question and enter their names into the federal NICS database, which would preclude them from making gun purchases. It further allowed for an appeals process through which the mental-health director’s determination could be challenged.

PAIR has provided hundreds of second chances: Mental health, judicial officials celebrate 20-year collaboration The Psychiatric Assertive Identification and Referral, or PAIR program is an Indiana diversion program designed to address the needs of people with mental illness who have been charged with misdemeanors. “The program works under the philosophy that people who receive mental health services in lieu of incarceration, can achieve recovery and not reoffend,” said Judge Matthew Sheehan, currently of the Terre Haute City Court. “Ultimately we are working to decrease recidivism, burdens on the courts, and use of tax dollars.”

Justice Zenoff Gets Statewide Behavioral Health Leader Award Illinois' leading behavioral health advocacy group presented one of its top awards to Winnebago County Second District Circuit Court Appellate Justice Kathryn Zenoff in Rockford this week. The prestigious "Lawrence Goodman Friend of the Field Award" was given to Zenoff by the Illinois Association for Behavioral Health (IABH) at the Rosecrance Ware Center on November 19, recognizing her "leadership" on behavioral health care in the criminal justice system.

Bridge Center for Hope's board picks international firm to oversee Louisiana mental health facility Services to be provided in the facility include a mobile assessment team that can respond to law enforcement 24/7 to provide in-person evaluations, a crisis assessment center to treat patients on a voluntary or involuntary basis, sobering beds, a detox program and a care management team that can provide direct services within the community. It will also implement the Crisis Now model, which builds its treatment on a number of guidelines: viewing patient crises as opportunities for growth in comfortable settings where people feel less isolated; utilizing peer support specialists to counsel patients; tailoring treatment based on the type of trauma the patient is suffering; adopting suicide prevention as a core responsibility; and implementing crisis response partnerships with law enforcement.

Bernalillo County New Mexico 24-hour crisis center to provide behavioral health services Bernalillo County on Tuesday opened its first 24-hour crisis triage and treatment center to provide behavioral health services for those who might otherwise end up in a hospital’s emergency department, jail, or be sent back into the community still struggling with severe behavioral and mental health issues.

When Mental Illness Is Severe Programs‌ ‌called‌ ‌assertive‌ ‌community‌ ‌treatment‌ ‌provide‌‌‌ ‌the‌ ‌kinds‌ ‌of‌ ‌services‌ ‌offered‌ ‌in‌ ‌psychiatric‌ ‌hospitals‌, ‌within‌ ‌a‌ ‌home‌ ‌setting. Nationally, ‌ ‌a‌ ‌growing‌ ‌number‌ ‌of‌ these ‌programs‌ ‌provide‌‌‌ ‌the‌ ‌kinds‌ ‌of‌ ‌services‌ ‌offered‌ ‌in‌ ‌psychiatric‌ ‌hospitals‌ ‌but in‌ ‌a‌ ‌home‌ ‌setting, ‌which‌ ‌works‌ ‌for‌ ‌“a‌ ‌certain‌ ‌percentage”‌ ‌of‌ ‌those‌ ‌with‌ ‌severe‌ ‌mental‌ ‌illness, ‌said‌ ‌Kim‌ ‌T. ‌Mueser, ‌director‌ ‌of‌ ‌psychiatric‌ ‌rehabilitation‌ ‌at‌ ‌Boston‌ ‌University. ‌ ‌

CMS approves D.C. waiver of Medicaid IMD ‘exclusion rule' D.C. becomes the first Medicaid program in the country to score approval for a demonstration that will use federal Medicaid money to pay for treatment of patients with severe mental illness in "Institutions for Mental Diseases," which Medicaid currently prohibits under its exclusion payment rule. The IMD exclusion rule bars Medicaid from paying for treatment for adults under age 65 in psychiatric residential facilities with more than 16 beds.

How Silos Broke a Promising Child Mental Health Settlement In 2011, Rick Saletta was asked by the federal courts to work out a settlement in Katie A. v Bonta, a long-running lawsuit over California’s mental health services for children known to its child welfare system. Lawyers represented a handful of children and youth, alleging massive gaps in mental health care services available to children in the child welfare system. It didn’t work.

Mental Health Center of Denver Starts Pilot Program for Community-Based Competency Restoration Clients will be able to live independently or with family members, and case managers will see them at least three times a week to help connect them and transport them to services from Mental Health Center of Denver and other providers, including benefits, employment, education, psychiatry and medication management. The Center will also help create a housing plan for those who don't have family or financial support.

County nixes guilty plea requirement for behavioral health docket after community concern During a meeting organized by activists in August, one mental illness policy expert panelist noted that if the docket “requires a guilty plea it literally can’t decriminalize mental illness.”

Mental Illness Behind Bars: The Hard Lessons of Orleans Parish Critics say jail is no place to treat mental illness. The Orleans Parish correctional system is one good reason why. “There is no way to provide good mental health care in a jail,” said John Snook, executive director of the nonprofit Treatment Advocacy Center. “Even the best-funded jail, with the most effective mental health services in the country, is still a failure.”

Loved Ones of Mentally Ill Concerned With Civil Commitments Josephine County Circuit Judge Pat Wolke is chairman of the state Work Group to Decriminalize Mental Illness, a state task force looking at ways to make the civil commitment process easier. He has researched civil commitment standards in all 50 states. Wolke says changing Oregon's laws could prevent tragedies.

Why it’s so hard to force people to get mental-health treatment in Pennsylvania Most states have revised their commitment laws to increase treatment and care options. But Pennsylvania’s remain largely unchanged, the result of a lack of political motivation, access to funds, and a long-running debate within the mental-health community.

Miami-Dade County builds center for mental health and recovery Associate Administrate Judge of the Eleventh Judicial District Steve Leifman has had a significant influence in championing to find ways to divert individuals with mental illness away from jails. Construction started for the 181,000-square-foot facility in May 2019. The facility will have 208 beds, 16 crisis stabilization beds for 3-5 day stays and 24 beds in short-term residential units for 90-day stays. The building will offer a wide variety of services including crisis stabilization, outpatient programs and transitional housing. With a capacity to admit 1,800 individuals, the facility will have activity programs and the addition of a “living room,” a crisis respite center which will look like a residential living room. The facility is expected to open in March 2021.

A PROJECT ON BEHALF OF THE NATIONAL INITIATIVE TO IMPROVE THE JUSTICE SYSTEM RESPONSE TO MENTAL ILLNESS

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