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On behalf of the National Initiative Advisory Committee, and as we near 2020, THANK YOU for your interest and commitment to improving the court and community response to those with mental illness and co-occurring disorders. We also thank the State Justice Institute (SJI) for its support of this important work, the Advisory Committee members for their time and guidance, and the National Center for State Courts (NCSC) for its leadership and service. With your help and the leadership of the state courts, we are well positioned to help stop the revolving door of jails, involuntary commitments, court cases, emergency rooms, state hospitals, and homelessness of those with serious mental illness.
Hon. Paul Reiber, Chief Justice, Vermont
Hon. Milt Mack, State Court Administrator, Michigan
Co-Chairs, National Initiative to Improve the Justice System Response to Mental Illness
Please Share this Newsletter Far and Wide!
Sign up to receive these Behavioral Health Alerts AND share the Alerts far and wide within your state and/or jurisdiction. The Alerts will include updates from the National Initiative, Research and Resources, and News from around the nation. Also, remember the Advisory Committee wants to hear from you! Please send us your news and developments, and or concerns and challenges by emailing ptobias@ncsc.org.
Research and Resources
Frequent Emergency Department Users: Focusing Solely on Medical Utilization Misses the Whole Person The study compared medical, mental health, substance use, and social services use among non-elderly non-frequent, frequent, and super-frequent ED users in San Francisco County, California. “Our findings point to the need for shared knowledge across domains, at the patient and population levels. Integrated data can serve as a systems improvement tool and help identify patients who might benefit from coordinated care management.”
SAMHSA’S GAINS CENTER ANNOUNCES CRIMINAL JUSTICE COMMUNITIES OF PRACTICE SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation, operated by Policy Research Associates, Inc., and known nationally for its work regarding people with behavioral health needs involved in the criminal justice system, is convening four topical Communities of Practice to work intensively with select communities on the following topics:
Competence to Stand Trial/Competence Restoration
Equity and Inclusion in Adult Drug Courts
Using the Sequential Intercept Model (SIM) to Guide Medication-assisted Treatment Implementation in Adult Drug Courts
Improving Recovery Support Services for People with Substance Use Disorders Returning from Jail or Prison
Early Psychosis Program in Washington State Shows Promise People with first-episode psychosis (FEP) who received services through a coordinated specialty care program in Washington state called New Journeys experienced significant improvements in symptoms and quality of life after 12 months, according to a report in Psychiatric Services in Advance.
Grant Opportunity - Assisted Outpatient Treatment Program for Individuals with Serious Mental Illness The Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), is accepting applications for fiscal year (FY) 2020 Assisted Outpatient Treatment Grant Program for Individuals with Serious Mental Illness (Short title: Assisted Outpatient Treatment [AOT]). This four-year program is intended to implement and evaluate new AOT programs and identify evidence-based practices in order to reduce the incidence and duration of psychiatric hospitalization, homelessness, incarcerations, and interactions with the criminal justice system while improving the health and social outcomes of individuals with a serious mental illness (SMI). This program is designed to work with courts to allow these individuals to obtain treatment while continuing to live in the community and their homes.
HOW THE STATES CAN FIX SELL: FORCED MEDICATION OF MENTALLY ILL CRIMINAL DEFENDANTS IN STATE COURTS (Georgetown Law Review, Westlaw link) In Sell v. United States, the Supreme Court announced a constitutional standard permitting involuntary medication of mentally ill criminal defendants to render them competent to stand trial. Lower federal courts have struggled to apply the Court's balancing test, reading the same Sell language to impose different requirements.
While much ink has been spilled debating whether the Sell standard is sufficiently rights-protective, less attention has been devoted to the state court implementations of Sell. But because many more criminal prosecutions take place in state court than in federal court, it stands to reason that significantly more Sell requests should arise in state court. This Note provides the first comprehensive review of Sell in the states.
INDIGENT CRIMINAL DEFENDANTS ARE ENTITLED TO A DEFENSE TEAM MENTAL HEALTH EXPERT (Journal of Gender, Race and Justice, Westlaw link) The United States Supreme Court had the opportunity to provide more justice for the poor and mentally ill when it decided McWilliams v. Dunn in the summer of 2017. Instead, it chose to avoid this opportunity. This Note explores this lost opportunity and argues that an indigent criminal defendant has the right to the assistance of a mental health expert in his case, independent of the prosecution.
CONSENSUS WORKGROUP POLICY RECOMMENDATIONS TO THE 116TH CONGRESS & TRUMP ADMINISTRATION ON BEHAVIORAL HEALTH ISSUES IN THE CRIMINAL JUSTICE SYSTEM: NEXT STEPS The Consensus Workgroup on Behavioral Health Issues in the Criminal Justice System includes national organizations representing individuals with behavioral health needs and their families, providers, correctional systems and administrators, criminal justice reformers, state and local governments, state and local program directors, and researchers. Participating organizations recognize that the intersection of behavioral health issues and criminal justice necessitates coordinated, collaborative, and sustained efforts.
Inside America’s Psychiatrist Shortage An in-depth look at why it’s happening, how bad it is, where it’s worst, and how to find the mental health help you need, despite it.
Several articles in the October issue of Prosecutor focuses on the role of the prosecutor viz defendants with mental illness. The links below are to Westlaw versions of the articles.
COLLABORATIVE APPROACHES TO MENTAL HEALTH DIVERSION IN MIAMI-DADE With over 500 counties passing resolutions in support of the Stepping Up initiative to reduce the number of people with mental illnesses in jails, more and more communities are seeking to develop viable “off-ramps” from various steps in the criminal justice process to community-based treatment and supports through “diversion” programs. Judge Steve Leifman and State Attorney Katherine Fernandez Rundle have worked together to lead change in Miami for over two decades.
WAYS PROSECUTORS CAN BOLSTER THE LOCAL CONTINUUM OF BEHAVIORAL HEALTH CARE AND ACCESS TO MENTAL HEALTH SERVICESProsecutors are not traditionally considered leaders in reducing the justice system involvement of individuals with mental health disorders, but they can play a critical role in increasing access of justice-involved individuals to treatment and services, as well as supporting the development of the entire local behavioral health care continuum.
UNDERSTANDING HOW MENTAL ILLNESS IMPACTS THE DELIVERY OF JUSTICEToday, the responsibility of a prosecutor goes well beyond just prosecuting the case. Prosecutors are responsible for promoting public safety and reducing recidivism in the communities they serve. This development is seen in the criminal justice system, most notably through bail reform and Drug Court initiatives sweeping the country. Equally important but sometimes less understood is how mental illness impacts the criminal justice system. As Warren County Prosecutor Richard T. Burke has said, “[k]nowledge and understanding of mental illness is essential to anyone working in the criminal justice system today. If our purpose is to do justice, all stakeholders ... prosecutors, law enforcement, treatment providers and the courts must collaborate to address the unique issues of those with disabilities, whether they be perpetrators or victims.”
In the News
12/19 White House Mental Health Summit (C-SPAN broadcast link) The White House hosted a summit on efforts to deliver mental health treatment to people experiencing homelessness, violence and substance use disorder. Speakers included Alex Azar, Secretary, Department of Health and Human Services, Ben Carson, Secretary, Department of Housing and Urban Development, and Jim Carroll, Director, Office of National Drug Control Policy, White House, among others. President Donald Trump also appeared and spoke.
There were also panel discussions on “The Need for Reform,” “State and Community Reform,” and a “Federal Leader Perspective” panel. Our own Judge Leifman was an invited guest, and while the focus was less on the courts’ role, there was discussion about drug and mental health courts, and diverting from the criminal justice system generally.
While the conversation was generally at the 30,000-foot level, the fact that multiple cabinet members are paying attention to the issue is important for future reforms.
Supreme Court Declines to Consider Homeless Camping Ban Case The U.S. Supreme Court on Monday said it will let stand a case that protects homeless people from being prosecuted for sleeping on the streets. Concerned with the growth of homeless encampments, and the health and safety issues they pose, dozens of cities and states had asked the high court to hear the case in the hopes it would clarify, if not overturn, a lower court ruling.
When Mental Illness Becomes a Jail Sentence Arrestees who are mentally incompetent to stand trial are supposed to be sent for treatment. But thousands are being warehoused in jails for months without a conviction.
Report: Hospital calls about ‘unwanted’ people trespassing leads to jail, criminalizing mental illness The report found that homeless people, people of color and people suffering from mental health problems were disproportionately represented among those arrested for trespass at hospitals. While nearly all landed in jail, only a quarter appeared to present a risk of violence, the report said. Officers found alternatives to jail in only a handful of calls, the report noted.
On Tuesday, the federal Centers for Medicare and Medicaid Services granted a “waiver,” allowing the state to use federal money to pay for short-term mental health care in the state’s larger institutions. The existing funding source was set to run out.
Treatment Advocacy Center criticizes National Institute of Mental Health five-year strategic plan. TAC details how the plan would fail those with severe mental illness and identifies sixteen examples of research initiatives the NIMH should be pursuing. The NIMH is soliciting public comment on the plan here until January 2.
State needs more resources for local mental health treatment Reforms to Oregon's system for dealing with those unfit to stand trial aren't working as planned, with judges challenged to find local treatment options for those they used to send to the Oregon State Hospital.
Judge orders Alaska to stop jailing mentally ill people A judge has ruled Alaska must end the practice of detaining mentally ill people in jails when the Alaska Psychiatric Institute is unable to provide treatment, court records said.
Broad effort to reform Georgia’s mental health treatment underway The state’s Behavioral Health Innovation and Reform Commission met for the first time Monday in Decatur to start a four-year examination of Georgia’s mental health treatment system, which remains under federal oversight following a 2010 court settlement.
Pre-filed legislation in KY aims to give people with mental illness access to more help Pre-filed legislation in Frankfort to create the Kentucky Mental Health First Aid training program would allow people with mental illness get access to the help they need. People who go through the program will learn how to identify and assist those who may have a mental illness, substance use disorder or may be experiencing a mental health crisis.
Health P.E.I. says it contacted two provinces about mental health assessments Delays have become the norm for court-ordered mental health assessments in P.E.I. leading to concerns being raised whenever they are ordered. Chief provincial court Judge Nancy Orr also recently warned the government could find itself in contempt of court if an assessment she ordered wasn’t carried out.
Sick & alone: Jailing the mentally ill in Arizona Most of America’s county jails escape lawsuits seeking reforms for inmates with serious mental illness. Now Arizona’s Cochise County has joined hundreds of other small counties innovating ways to keep people with serious mental illness out of their jails. But it comes too late for Adrian Perez, who has spent the past 13 years cycling in and out of jail, and solitary confinement, which only makes him sicker.
Navigating The System: Innovative Improvements To Mental Health Care at ECHC The Erie County Holding Center and the Erie County Department of Forensic Mental Health implemented a series of changes to adapt to their changing population in the decade since the Department of Justice took on the oversight of the facilities. "Think of the criminal justice system as something where there are multiple points where interventions can occur," said Michael Ranney, former Erie County Commissioner of Mental Health. “It's called the sequential intercept model.”
Undercover on Skid Row; FOX 11 embeds with county mental health team to expose 'broken system' There are an estimated 58,000 homeless people living on the streets in Los Angeles County, and more than sixty percent of them are believed to be suffering from mental illness. The county department of mental health’s Homeless Outreach & Mobile Engagement (HOME) team is tasked with doing something about it, seeking out the most severe mental health cases on Skid Row, and they invited FOX 11 along to observe their work.
SMI Advocate Pushing His Agenda With White House & Democrats: AOT, HIPAA Reform, More Hospital Beds Advocate and Author D. J. Jaffe is pushing an agenda with both the White House and Democrats that calls for creating more hospital beds for the seriously mentally ill, increasing the use of Assisted Outpatient Treatment, and revising HIPAA regulations that often prevent caregivers from obtaining information.
A PROJECT ON BEHALF OF THE NATIONAL INITIATIVE TO IMPROVE THE JUSTICE SYSTEM RESPONSE TO MENTAL ILLNESS
Please share any news or resources from your state or jurisdiction with the National Initiative by emailing ptobias@ncsc.org.
