Behavioral Health and the Courts

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Ten New Members Have Been Named to Serve on the Interdepartmental Serious Mental Illness Coordinating Committee, Task Force Member Judge Leifman Appointed The committee advises federal officials and Congress about mental health and addictions. HHS Secretary Alex M. Azar II and Assistant Secretary of Health and Human Services for Mental Health and Substance Use Dr. Elinore McCance-Katz are responsible for naming advisory members. Those asked will serve a three-year term. The law that created ISMICC requires both federal and non-federal ISMICC members to issue a final report to Congress on December 2022.

Behavioral Health and the Courts The Court Consulting Services Division of the National Center for State Courts (NCSC) will be providing its free remote and virtual consulting service “The Doctor Is In” from October 1st to 16th. Principal Court Management Consultants Patti Tobias and Michelle O’Brien and colleagues will be available to provide you or a team with up to 60 minutes of free consulting and professional advice. Our experts can meet with you to discuss any issues concerning behavioral health and the courts that you and your court may be facing whether as a result of COVID-19 or beyond.

The topic areas include:

  • Mental Health and the Workplace – Addressing the Mental Health and Well-being of Judges and Court Employees
  • Improving Caseflow Management Practices, Policies and Procedures in the Courts and the Community addressing those with Mental Illness and Co-Occurring Disorders
  • Reducing the number of Pretrial Detainees with Mental Illness
  • Examining your Involuntary Commitment / Assisted Outpatient Treatment Practices
  • Leading Mental Health Change in Your Court and Community
  • Addressing Competency Evaluation and Restoration Delays
  • Strengthening Mental Health Courts
  • And any other issues involving behavioral health and the courts, whether adults or children

Please contact Patti Tobias at if you are interested in scheduling a session Thursday, October 1st through Friday, October 16th. We look forward to hearing from you!

Research and Resources

Effectiveness of Police Crisis Intervention Training Programs Given the increasing resources devoted to CIT, efforts to analyze its effectiveness and outcomes relative to other approaches are important.  This article describes the CIT model and reviews several recent systematic analyses of studies concerning the effects of CIT. Studies generally support that CIT has beneficial officer-level outcomes, such as officer satisfaction and self-perception of a reduction in use of force. CIT also likely leads to pre-booking diversion from jails to psychiatric facilities. There is little evidence in the peer-reviewed literature, however, that shows CIT's benefits on objective measures of arrests, officer injury, citizen injury, or use of force.

Incompetent to Stand Trial, Not Restorable, and DangerousThis Journal of the American Academy of Psychiatry and the Law article focuses on the preferred disposition for an individual charged with a serious crime against another person, adjudicated incompetent to stand trial and not restorable to competence, whose original criminal charges are dismissed without prejudice, and who is regarded by the state as dangerous to the general public. Three current models used today in California, Oregon, and Ohio are described. All three rely on modifications of various aspects of civil commitment law, and the authors propose a fourth alternative.

Miami-Dade's Criminal Mental Health Project (CMHP) - YouTube It costs $31K a year to incarcerate a person with a mental health condition. Community mental health services cost $10K a year. Getting people struggling with mental health challenges into treatment instead of prosecuting them makes simple financial sense and reduces incarceration. Five short videos showcase the Miami Model.

Addressing Trauma, Racism and Bias in Behavioral Health Service Delivery As the country continues to grapple with systemic racism and injustice, Covid-19, and a drug overdose crisis, the need for greater access to high quality behavioral health services could not be clearer. Yet, according to a National Institute of Mental Health study, members of racially and ethnically marginalized populations have less access to mental health services, are less likely to use community mental health services, more likely to use inpatient hospitalization and emergency rooms and more likely to receive lower quality care. Many of these disparities are rooted in historical trauma, racism, and bias. Addressing these disparities will require sustained efforts to improve clinical education, reduce clinician implicit bias, and create clinical pathways that meet the needs of marginalized populations.

IMD Exclusion: 1965 Federal Rule That Crushed Psychiatric Bed Capacity The IMD Exclusion, passed in 1965, is Federal Medicaid policy that expressly forbids some psychiatric treatment facilities -- those with more than 16 beds -- from being reimbursed for providing life-saving medical care to people with serious mental illnesses or addictions who are between 22 and 64 years of age. It is named after so-called Institutions for Mental Diseases (IMDs), and policy wonks call it the IMD Exclusion. This Healing Minds NOLA broadcast is scheduled to air on September 18th, 2020 @ 1pm CT/ 2pm ET.

COSSAP Webinar: National Sheriffs' Association ODMAP Webinar ODMAP provides an easy-to-use interface and a set of effective analytical tools and allows jurisdictions to establish “spike alerts” so that immediate responses can be launched based on sharp increases in incidents. This webinar will overview ODMAP, review a case study of an agency that has been using ODMAP for several years, and show analysts the capabilities within ODMAP to support their missions. It will also provide guidance to prospective users on how to get started with ODMAP.

Recovery Capital and Treatment Courts: A New Approach to Improve Client Outcomes This NADCP session will introduce participants to the concept and definition of Recovery Capital. The current research findings on the importance of assessing and building personal, social, and community capital to strengthen long-term recovery (long past the exit from drug court) will be reviewed. Teams will learn how to move these concepts into practice throughout their program, with a specific focus on applying the recovery capital framework in staffing and case management.

September 17 Webinar: Ssshhh - - Don’t Tell: How Federal Privacy Laws Do and Don’t Impact AOT Communication among partners is essential to the practice of AOT. It is critical in identifying individuals in crisis who meet criteria and stand to benefit from the program, as well as in monitoring treatment adherence and ensuring that participants receive quality treatment and services. Unfortunately, these efforts are often stymied by real or perceived legal barriers to the sharing of health information.

CSG Justice Briefing Tips on what it takes to open a crisis center; your thoughts on truancy in the U.S.; and behavioral health learning opportunities including webinars on Advancing Prosecutor-Led Behavioral Health Diversion and Turning One-Off Programs into Systems-Wide Behavioral Health Diversion.

CSG Justice Briefing School is back, and so could be juvenile justice referrals; a lifeline for domestic violence victims during COVID-19; and a virtual workshop on building crisis care systems. Includes an interview with NCSC Task Force member Dr. Sarah Vinson.

Behavioral Health Brief: Certified Community Behavioral Health Clinics — How and Why They Work - Social Work Today Magazine The National Council (2020b) found that “in the first six months of implementation, 87% of CCBHC reported an increased number of patients served, with the majority reporting an increase of up to 25% in total patient caseload.”

PTACC Ticker Wednesday, September 2nd Updates on Deflection with PTACC: Pathways to Diversion, Building an Organizational Culture; Job Opportunities; Recidivism Rates and Drug Offenses.

APA Releases New Practice Guideline on Treatment of Patients with Schizophrenia The American Psychiatric Association (APA) released a new evidence-based practice guideline to enhance the treatment of patients with schizophrenia. Its goals are to reduce the mortality, morbidity and significant psychosocial and health consequences of this psychiatric condition.

Now Available: SAMHSA’s 2019 National Survey on Drug Use and Health (NSDUH) Report The Substance Abuse and Mental Health Services Administration released the 2019 National Survey on Drug Use and Health (NSDUH). The annual survey is the nation’s primary resource for data on mental health and substance use among Americans.

Ending the Death Penalty for People with Severe Mental Illness (How Recent Supreme Court Cases Interpreting Atkins v. Virginia Support a New Death Penalty Prohibition) This article argues that courts or legislatures should prohibit the execution of people with severe mental illness who were significantly impaired by their illness at the time of their crime in light of recent Supreme Court death penalty interpretation of Atkins. Defendants who were significantly impaired by severe mental illness at the time of their crime should not be eligible for the death penalty because they have sufficiently reduced culpability. (Westlaw link)

TAC Research Weekly: Methadone Maintenance Treatment for Co-Occurring Severe Mental Illness and Opioid Use Disorders Methadone maintenance may be an effective treatment for people with co-occurring severe mental illness and opioid use disorder, according to a new study published in Schizophrenia Bulletin Open from researchers at McMaster University.

TAC Research Weekly: Federal Medicaid Inmate Exclusion Policy Harms Individuals with Severe Mental Illness The Federal Medicaid Inmate Exclusion Policy (MIEP) reduces jailed individuals’ access to mental and physical health care after release from jail and increases the likelihood of recidivism, according to a new report written by American University students for the National Association of Counties last week.

The Current Evidence on Telemedicine-Delivered Treatment for Opioid and Other Substance Use Disorders This presentation will describe background on current challenges with substance use disorder (SUD) treatment access and delivery and present evidence for telemedicine for SUD treatment based on a recent systematic review published by the speaker and describe gaps in the research knowledge to date.

Webinar: How to Develop a Competitive Grant ApplicationSAMHSA’s Office of Financial Resources will be conducting a webinar on how to develop a competitive grant application. The webinar will be offered on September 17, and October 22 at 2 pm (ET).

Update: Training and Technical Assistance Related to COVID-19 SAMHSA is committed to providing regular training and technical assistance (TTA) on matters related to the mental and substance use disorder field as they deal with COVID-19. Our TA programs are delivering great resources during this time. View the updated available TTA resources to assist with the current situation.

What Can We Learn from Crisis? Leadership, Post-traumatic Growth and COVID-19 on the National Council for Behavioral Health’s Behavioral Health Training Institute (BHTI) for Health Officials and the Association of State and Territorial Health Officials (ASTHO) on Thursday, September 24 from 3-4 p.m. ET.

How Telehealth Connects People with Mental Illnesses in Jails to Services COVID-19 is pushing communities to rethink their approach jails. For many, telehealth or telemedicine has become an essential practice for connecting people with mental illnesses from jails to treatment. This short CSG video describes how that can happen.

In the News

'CAHOOTS': How Social Workers And Police Share Responsibilities In Eugene, Oregon: NPR You call 911, you generally get the police. It's a one-size-fits-all solution to a broad spectrum of problems from homelessness to mental illness to addiction. Protesters are urging cities to redirect some of their police budget to groups that specialize in treating those kinds of problems. Now we're going to look at one model that's been around for more than 30 years. NPR audio and transcript.

How to Redefine Dangerousness: How New York Can Wield Kendra’s Law Far More Effectively The path to enrollment in a Kendra’s Law program starts at the door to a hospital, and for many, that door has been closed when it should not have been. Nobody qualifies for Kendra’s Law without a history of prior hospitalizations — and major roadblocks to admission remain unaddressed in state law. Until New York updates its overly restrictive standard for inpatient commitment, Kendra’s Law will reach only a small number of those who could benefit from these services.

Mental Health as Crime On March 23, just a day after having gone to the hospital for mental health problems, a 41-year-old man named Daniel Prude bolted out of his brother Joe’s home in Rochester, N.Y, wearing few clothes. Joe was scared about what might happen to his brother. So he did what many Americans do when facing an emergency involving mental illness. He called 911.

NYT Columnist Asks: Would Daniel Prude Be Alive If His Brother Had Called Medical Professionals – Not The Police The Rochester N.Y. police department’s response to Daniel Prude is calling attention to the deaths of not only people of color, but those having a mental health/drug crisis, as noted in The New York Times. Eugene, Or., is cited as an example of alternatives to having police always be the first responders. Compare that community’s approach to the horrific police killing of Patrick Kenny in Springfield, Oregon.  What makes Kenny’s death even more appalling is that all the officers involved had undergone CIT, yet none used any of the de-escalation tools taught to them.

Rochester Officials Announce Police Reforms after Death of Daniel Prude The city of Rochester, New York, is moving crisis intervention out of the police department amid outrage and protests over the death of Daniel Prude, a Black man with mental health issues who died after officers placed a spit hood over his head and restrained him.

Incarcerated Instead of in Treatment Assisted outpatient treatment would allow a team to work with a judge and the person who is averse to treatment and it would change the standard for involuntary commitment. The Pennsylvania Legislature authorized the use of AOT in 2018, but the mental health programs are actually administered by the counties and none of the counties have made any effort to use this program.

Power to Speak | More and Better Support Needed for Mentally Ill The unwritten Ventura County plan for the seriously mentally ill is to invest in a law enforcement and jail-centered system, one which will continue to incur great economic and human health costs and fail to promote wellness and function.  With one of the worst inpatient bed-to-population ratios in the state and a system that houses more mentally ill in jail than in all its inpatient acute and sub-acute residential facilities combined, this county’s priority is not to help people get better. Instead, its priorities are to send individuals out of the county away from family support or to lock them up in jails, one of the worst environments for people with serious mental illness. This approach passes the buck of responsibility to law enforcement, hospitals, jails and communities.

Call Police for a Woman Who is Changing Clothes in an Alley? A New Program in Denver Sends Mental Health Professionals InsteadSince its launch June 1, the STAR van has responded to more than 350 calls, replacing police in matters that don’t threaten public safety and are often connected to unmet mental or physical needs. The goal is to connect people who pose no danger with services and resources while freeing up police to respond to other calls. The team, which is not armed, has not called police for backup.

Mental Health And Homelessness In The Wake Of Covid-19: The Path To Supportive And Affordable Housing Those who are considered “chronically homeless,” meaning that they have been homeless for one year or more, are far more likely to experience mental health issues and involvement with the justice system than those who experience homelessness on a transitional or episodic basis. Being chronically homeless also means that people with mental illnesses are more likely to experience catastrophic health crises requiring medical intervention or resulting in institutionalization within the criminal justice system.  Finally, they are also most at risk during a major health crisis, such as the COVID-19 pandemic.

SAMHSA SOAR September E-news SSI/SSDI Outreach, Access, and Recovery newsletter.

Capitol Connector: Final Chance to Apply for HHS Provider Relief Funds and More Policy News Demand for behavioral health services has increased significantly as the COVID-19 pandemic continues to weaken the financial viability of behavioral health treatment organizations and reduce the availability of lifesaving treatment services, according to new polling released by the National Council and Morning Consult.

Judge Wolff Sends Open Letter to Bexar Co. Residents on How to 'Fix Flawed Justice System' Our criminal justice system is systematically flawed to the extent that it fails to administer justice to the poor, the homeless, minorities, and to the mentally ill and drug dependent citizens. Police and deputies should not take mentally ill and drug addicted people who have committed non-violent offenses to jail. Individuals should be taken to the Center for Health Care Services’ (CHCDS) twenty-four-hour crisis care facility where medical, psychiatric, and social work professionals are located.

Mental Health Court Would Benefit Bucks County, Mentally Ill Defendants, Report Says Researchers at Penn’s Quattrone Center for the Fair Administration of Justice concluded that a mental health court would provide a pathway for treatment and recovery, aim to reduce the recidivism rates and improve the quality of life for participants, which would improve the community as a whole.

What Can Happen When Police Respond to A Mental Health Crisis In DC? D was placed under arrest for "assault with a dangerous weapon (teeth)," two counts of assault on a police officer, three counts of "contempt of court (release violations)," and resisting arrest. Despite this list of charges, the prosecutor only filed one charge in the associated court case: assaulting or interfering with a law enforcement officer. Unlike D's previous cases, this one was logged at the felony level and placed on the accelerated felony trial calendar, awaiting a grand jury. Unlike the previous arrests, D was not released. He was sent to D.C. Jail without bail on July 6 and the jail confirmed he was still there at the time of publication.

Personally Speaking: Take Mental Illness Seriously I needed a hospital and treatment, but I was thrown in jail where I hallucinated for a year straight while awaiting trial without comprehensive treatment. I was later found not guilty by reason of insanity.

California Takes a Real Step Toward Helping the Mentally Ill Laura’s Law, which creates a pathway to AOT, is an effective policy solution that could help correct this misallocation of resources. The legislation being sent to Governor Newsom aims to do so by both making Laura’s Law permanent and requiring all counties in California to adopt AOT programs, as currently only 19 have done.

Santa Clara County Struggles to Breathe Life into Mental Health Services for Ex-inmates Santa Clara County supervisors are vowing to save a critically underfunded mental health program that often is a last resort for hundreds of former inmates in need of medical help.

Community Awaiting Placement Supervision (CAPS) helps place former Santa Clara County inmates into mental health treatment programs. They are ordered, upon release, to receive outpatient counseling or be placed in transitional housing.

Join Us! Five Years of Stepping Up Webinar Since its launch, more than 500 counties across 43 states have joined the Stepping Up initiative and made incredible progress toward reducing the prevalence of mental illness in jails. To build on this momentum, the Stepping Up partners are preparing to unveil the next step of the initiative. Join us for a special virtual event on September 30, to commemorate five years of Stepping Up and hear more about the future of the initiative.

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