National Initiative Updates
Mental Health Facts in Brief – New Educational Series available!
The first two of a series of Facts in Brief are now available! Click on the links below.
The Psychiatric Care Continuum, describes the range of psychiatric services that may be relevant and the specific populations they serve, and includes additional resources and information.
Assisted Outpatient Treatment (AOT) Community -Based Civil Commitment, describes the history, community policies and practices, supporting evidence, considerations, and resources.
The CCJ/COSCA Southern Region Plans its Summit to Improve the Court and Community Response to Mental Illness in Texas May 13-15, 2020 Chief Justices and State Court Administrators are inviting multi- disciplinary teams to learn about exciting efforts across the southern regional states. There are four outstanding educational sessions planned and multiple opportunities for the state teams to develop state action plans.
State Summits and Conferences planned with State Justice Institute (SJI) supportFourteen Western region and Midwestern region states have received SJI awards to begin implementing state action plans developed during their respective CCJ/COSCA Summits. The following Summits and Conferences are planned in 2020 to date: Alaska (February 27-28); New Mexico (April 15-17); Utah (August 17-19); and Idaho (September 21). Congratulations!
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Research and Resources
Estimating the Size of the Los Angeles County Jail Mental Health Population Appropriate for Release into Community Services In 2015, the Office of Diversion and Reentry Division (ODR), an internal department of the Los Angeles County Department of Health Services, was created to redirect individuals with serious mental illness from the criminal justice system. Part of ODR's mission is to identify individuals currently incarcerated in a Los Angeles County jail who are experiencing a serious mental health disorder and, to the extent practical, provide them with appropriate community-based care with the goals of reducing recidivism and improving health outcomes. This RAND research report finds that an estimated 61 percent of the jail mental health population were likely appropriate candidates for diversion.
How to Reduce Repeat Encounters: A Brief for Law Enforcement Executives Law enforcement agencies across the country are facing the challenge of how to efficiently respond to people their officers frequently encounter and spending an enormous amount of time and resources ineffectively responding to these individuals. Often known as “high utilizers,” these individuals are typically well known to law enforcement agencies and many times have serious mental health concerns, substance use disorders, and other significant health and social service needs. This 2-page brief provides four practical steps law enforcement executives can take to address and improve outcomes for people who are high utilizers in their jurisdiction:
NLC - Addressing Mental Health, Substance Use and Homelessness The National League of Cities recently published three issue briefs, all linked here, on Advancing Coordinated Solutions through Local Leadership, Working Across Systems for Better Results, and Emergency Response and Crisis Stabilization.
10 New SAMHSA Funding Opportunities Including: Grants for Expansion and Sustainability of the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances, a National Training and Technical Assistance Center for Child, Youth, and Family Mental Health grant, and a Homeless and Housing Resource Center (HHRC) grant.
Promising Practices for Jail Diversion Across the Sequential Intercept Model In partnership with the Michigan Mental Health Diversion Council and the Michigan Department of Health and Human Services, ten communities across Michigan are conducting jail diversion pilot programs which aim to reduce the number of people with mental illness and/or substance use disorder in the criminal/legal system.
Advancing Justice Amid the Opioid Epidemic The second volume of NADCP’s Journal for Advancing Justice, "Best Practices in the Justice System for Addressing the Opioid Epidemic," tackles this problem head-on. With articles written by both clinicians and justice professionals, the journal acknowledges the very real barriers to implementing evidence-based care within the confines of the justice system while also providing practical examples of what's working across the country in treatment courts, jails, prisons, reentry programs, and more.
SOLICITATION FOR APPLICATIONS: SAMHSA’S GAINS CENTER SEEKS EXPERIENCED TRAINERS TO PARTICIPATE IN TRAUMA-INFORMED RESPONSES TRAIN-THE-TRAINER (TTT) EVENT FOR INDIVIDUALS The GAINS Center is now soliciting applications from experienced trainers (individuals) who are interested in developing their capacity to provide trauma-informed training in their local agencies/communities via the GAINS Center’s How Being Trauma-Informed Improves Criminal Justice System Responses training program. Selected applicants will learn to facilitate the training via a centralized TTT event and subsequently deliver the training program in their local communities across the country.
National Co-Responder Conference information and call for presenters Johnson County Mental Health Center invites law enforcement and mental health agencies, along with stakeholders, schools and partner organizations to attend the first annual National Co-Responder Conference. This event is for any agency that has or would like to have a program that includes a mental health professional embedded within another agency. #CoRCon will take place Monday, March 9 - Wednesday, March 11, 2020 in Olathe, Kansas.
Recovery at Work: Workplace Policies and Practices that Support Employees with Mental Illness and Substance Use Disorder SAMHSA’s Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) invites you to join national experts in a conversation about how employers can support the success of people living with mental illness or substance use disorders in the workplace.
HOW SHOULD MENTAL ILLNESS BE RELEVANT TO SENTENCING? (Westlaw link) This Mississippi Law Journal article examines the over-representation of people with serious mental illness in prison and argues that “the higher likelihood of additional harm to inmates with mental illness requires an appropriate sentence reduction for these individuals. The sentence should be reduced by a fixed rate of 10% to acknowledge the reduced blameworthiness associated with having a mental illness at the commission of a crime.”
Screening and Assessment of Co-occurring Mental and Substance Use Disorders for Justice-involved Populations (Part 1): Overview of Evidence-based Tools and Approaches Across the Sequential Intercept Model (SIM) This is the slide deck from the recent SAMHSA webinar on screening and assessment tools across the SIM.
STATEWIDE POLICIES RELATING TO PRE-ARREST DIVERSION AND CRISIS RESPONSE This study reviews and analyzes the primary statewide barriers to and accelerants of pre-arrest diversion and crisis response strategies. It begins by providing an overview of pre-arrest diversion strategies. It then delves into five categories of law or regulation that most directly affect these strategies and often serve as the basis of fully-fledged crisis responses in their own right: emergency mental health hold laws, protective custody statutes, citation authority, substance abuse Good Samaritan laws and ambulance transport destination rules.
NCSL Blog: Increasing Collaboration Between Police and Mental Health Professionals Law enforcement agencies and state lawmakers have been working to improve law enforcement responses and develop alternatives. Recent legislation has required or funded CIT training, authorized and funded crisis triage centers, and otherwise supported law enforcement efforts to deflect individuals with mental health needs away from criminal justice system involvement. Links to a number of collaboration resources are included.
Why Crisis Intervention Training Should Be The Standard CIT is a 40-hour training meant to educate officers on recognizing when individuals have mental illness and are symptomatic, de-escalating the crisis situation and navigating people toward resources and help. The curriculum was a collaborative effort between the Memphis Police Department, NAMI, the University of Tennessee and the University of Memphis.
Joint Guidance on the Application of the Family Educational Rights and Privacy Act (FERPA) And the Health Insurance Portability and Accountability Act of 1996 (HIPAA) To Student Health Records This document updates and expands on prior guidance to help address potential confusion on the part of school administrators, health care professionals, and others on how FERPA and HIPAA apply to records maintained on students. It also addresses certain disclosures that are allowed without the written consent of the parent or eligible student under FERPA or without authorization under the HIPAA Privacy Rule, especially those related to emergency health or safety situations. Note particularly question 13, which addresses mental health issues and parental access to information.
Application for 2020 BRSS TACS Capacity Building Opportunity The Substance Abuse and Mental Health Services Administration's (SAMHSA) Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) is pleased to announce the 2020 Capacity Building Opportunity, which is an intensive technical assistance (TA) opportunity for peer-run or peer-involved organizations, recovery community organizations, family-run organizations, collegiate recovery programs, recovery high schools, and youth- and young adult-run organizations.
Coming Together Again: Therapeutic Courts in WA As judges in Washington state discuss how therapeutic courts work, a recent graduate of Mental Health Court describes his descent into addiction and path to recovery (video).
2019 State of the State Courts Survey Includes findings of a changing perception of the courts’ role in addressing opioid abuse.
Hospitalization Rates High Among Homeless Over half of hospitalizations for homeless individuals in recent years were due to mental illness or substance use disorders, according to a study of Florida, California, and Massachusetts State Inpatient Databases (SID) data from 2007 to 2013. In addition, hospitalization rates of homeless individuals nearly doubled in all three states during the last four years of the study period.
WELL-BEING TOOLKIT FOR LAWYERS AND LEGAL EMPLOYERS This ABA produced toolkit has resources that are relevant to judges and judicial employees as well.
In the News
A bright new day for a building filled with dark memories In Miami, Judge Steven Leifman strides through a behemoth concrete building ringed like a prison by fortress-style walls, an ominous guard tower standing sentry. Inside these dark, cinder block-lined hallways are where people deemed mentally incompetent to stand trial once were housed and ostensibly treated. But not anymore.
Rural Mental Health - The Hidden Crisis in Rural America It’s prohibitively difficult to access mental-health services in rural America. That’s because, relative to urban areas, rural counties have so few mental-health professionals. The majority of non-metropolitan counties in the U.S. don’t have a psychiatrist, and almost half lack a psychologist. The paucity has resulted in a public-health crisis—rural Americans suffering from a psychiatric condition are more likely to encounter police than receive treatment. Each year, 2 million mentally ill Americans, most of whom aren’t violent criminals, end up in jail.
More psychiatric beds means fewer people waiting in ERs As more psychiatric hospital beds come online in Derry and Portsmouth, emergency room wait lists slowly shrink. But advocates say the state still needs 100 more beds for involuntary admission, and patients held indefinitely in emergency rooms still don’t have any legal recourse.
In Reversal, Counties and States Help Inmates Keep Medicaid The number of states that suspend enrollment, making it easier for inmates to reactivate their Medicaid benefits, has more than tripled, from 12 to more than 40, during the past six years. But suspension is viewed as a stopgap measure, and a bipartisan coalition of county sheriffs, commissioners and judges are now lobbying federal lawmakers to change a long-standing policy and let pretrial detainees retain coverage while in custody.
Idaho Chief Justice: 'Need to chart a new course forward' on mental illness He highlighted progress in training Idaho first responders in crisis intervention; establishment of mental health crisis centers; and Idaho's mental health courts. But, he said, "The problem needs more."
What Schizophrenia Does to Families A mother, a son, an unraveling mind — and a mental health system that can’t keep up Over the past 20 years, Aaron has spiraled from a high school star and an academic all-American on the Arizona State University football team to a ward of the state of Maryland. He has been captive not just to a schizophrenic brain but to a perfect storm of factors — underfunded treatment facilities, prisons and jails serving as de facto asylums, a lack of advancements in medication — that has made it generally harder for people with serious mental illnesses to get the help they need.
Proposed Michigan bill would require mental competency exam within 30 days of court order A new bill introduced in the Michigan House of Representatives last week would require the state to complete a mental competency examination to determine a defendant’s competency to stand trial within 30 days of a court order.
Dallas Has Been Dispatching Social Workers to Some 911 Calls. It’s Working. The results have been promising. In 2019, the volume of psych patients at Parkland's ER rose 30%. But the trend has largely been reversed in areas covered by the program, which is called RIGHT Care. The number of psych patients arriving from those areas dropped by 20%.
Two Views: Telemedicine, mental health courts could improve access to treatment Here’s the good news: the Texas Legislature put hundreds of millions of additional dollars into mental health for Texas in the new biennial budget. The state now allocates $8 billion for services ranging from community mental health services to substance abuse treatment, and more. The bad news is it isn’t always about the money. Texas still faces challenges, including its size, which exacerbates the nationwide shortage of mental health professionals, and our continued reliance on jails as our default mental health treatment centers.
Civilian Team May Respond to 911 Crisis Calls Instead of Denver Police The Denver Police Department is rolling out a program in which unarmed first-responder teams of paramedics and mental health professionals will start handling some low-level 911 calls that police would otherwise respond to. The program was inspired by a model called CAHOOTS (Crisis Assistance Helping Out on the Streets), which has been operating for thirty years in Eugene, Oregon.
San Francisco Hopes To Improve Care For People With Mental Illness Living On Streets Dr. Anton Nigusse Bland, most recently the medical director for psychiatric emergency services at Zuckerberg San Francisco General Hospital, was appointed to the newly created position of director of mental health reform. His main role is to help the city improve its mental health and addiction treatment for people experiencing homelessness, largely via a new state law, SB-1045, which establishes pilot programs to expand the use of conservatorship — a controversial practice that allows the city to take people with mental illness or substance abuse issues off the streets without their consent and put them into treatment.
All too often, California’s default mental institutions are now jails and prisons In the past five years, the number of people in California deemed incompetent to stand trial and referred by a judge to state hospitals for treatment has soared—but there are nowhere near enough psychiatric beds to accommodate them. Part I of a series.
“We’ve lost our compass.” For California’s most visible mentally ill, is a return to forced treatment a solution — or a false promise? Last year lawmakers agreed to create a narrow 5-year pilot program that makes it easier for three counties (San Francisco, Los Angeles and San Diego) to conserve homeless individuals with serious mental illnesses or substance abuse disorders. The program allows courts to conserve individuals who have been placed under a 72-hour psychiatric hold at least eight times in a year. A second law, passed this year, expanded the rules to allow 50 to 100 more people in San Francisco to be placed under conservatorship. Civil rights advocates have raised serious concerns: In 2018, Susan Mizner, the disability rights program director for the ACLU, described conservatorship as “the biggest deprivation of civil rights aside from the death penalty” and said the law would incentivize police to repeatedly detain homeless individuals. Part VII of the same series.
California’s homelessness crisis — and possible solutions — explained California’s most vexing issue is also its most shameful: the large and rising number of residents who lack a safe place to call home. In a state with vast amounts of wealth, more than 150,000 of its residents sleep in shelters, cars, or on the street. The United Nations compared the tent encampments of San Francisco to the slums of New Delhi and Mexico City. Nearly 5,000 people live in the half square mile of Los Angeles’ Skid Row. And while the problem is most acute in California’s urban centers, homelessness is now a common fixture in many of the state’s suburbs and rural towns. Here’s what you need to know about California’s homelessness crisis — including possible solutions.
Column: Pressure grows to crack down on homeless to protect public ‘quality of life’ A proposed statewide initiative would set up courts to channel homeless into mental health, drug rehab or housing programs rather than jail.
More Care, More Support: NYC Unveils Public Safety and Public Health Reforms Recommendations set forth by the Health Department and NYPD will provide new ways for City agencies to reach the narrow population of New Yorkers with untreated mental illness who may pose a danger to themselves or others.
“Bedlam”: Film Shows How Decades of Healthcare Underfunding Made Jails “De Facto Mental Asylums” Are prisons and jails America’s “new asylums”? A new documentary looks at how a disproportionate number of under-served people facing mental health challenges have been swept into the criminal justice system, where they lack adequate treatment.
Why you should learn Mental Health First Aid One in five adults in the US lives with a mental health problem according to the National Institute of Mental Health, but most don't seek out professional help. That's where Mental Health First Aid - an eight-hour workshop - hopes to fill the gap. The class trains citizens how to recognize the signs and symptoms of various mental illnesses -- from depression to anxiety disorder and substance abuse disorder. Participants also learn how to listen non-judgmentally and de-escalate in crisis situations. In addition, they receive a list of mental health and substance abuse resources.
Op-Ed: DA Lacey Continues To Praise Diversion Over Jail For The Mentally Ill, But Her Prosecutors’ Actions Tell A Different Story For prosecutors like Lacey, knowing when not to use the criminal justice system is just as important as knowing how to improve it.
Marketing Psychiatric Drugs to Jailers and Judges For most of the twentieth century, pharmaceutical companies expressed little interest in inmates. People in need of mental-health treatment often received it at state-run psychiatric hospitals. But in the 1950s and ’60s, states began shuttering many of America’s psychiatric hospitals, pushing patients toward treatment in their communities. Then, in the 1980s and ’90s, lawmakers passed “tough on crime” policies that dramatically expanded the nation’s corrections population. Taken together, those developments had the unintended consequence of turning jails and prisons into warehouses for the mentally ill. By 2005, more than a million adults behind bars had some form of mental illness, according to the Bureau of Justice Statistics. So, drug companies are now courting jails and judges through sophisticated marketing efforts.
He thought it was God's money so he stole it. Does he belong in prison? Dillon McCandless took a shotgun into a tribal casino in July 2017 and used it to steal $7,619. As police were arresting him, he insisted the money belonged to God, his mother says. He told his mother he needed to pay tithing on it. McCandless’s family knew he was unstable and tried to get him help. The judge who oversaw his sentencing lamented his inability to do anything but send McCandless to prison. And in the past year, prison doctors have tried to get him to take medications, but he refuses and has the right to do so.
Wayne County Jail's mental health misdemeanor problem Wayne County Jail has a $93 million misdemeanor problem. That was the cost of incarcerating inmates serving time for misdemeanors or ordinance violations from 2015 to 2017, said Robert Dunlap, chief of jails for the Wayne County Sheriff's Office, which operates Michigan's largest county jail. A new collaboration between the sheriff's office and the Detroit Wayne Integrated Health Network unites the institutions in a common mission: address people's mental health needs before they turn into a revolving door of legal trouble or jail stays.
North Carolina Chief Justice Randolph wants to add mental health and veteran courts to state system "The legislature last year said the courts are doing such a good job with drug court, why don't we help out the state and do veterans courts and mental health courts?” Randolph said. “We said we'd be happy to do that. The revisiting rate with drug courts is only 15 percent. “The successes are in the thousands and changing people’s lives, and we can do the same thing with the veterans and mental health courts."
People with mental illness less likely to get cancer screening People with mental illness get screened for cancer at much lower rates than the general population, which may contribute to higher rates of cancer deaths among the mentally ill, researchers say. The authors say better coordination between case managers and other mental health specialists and primary care professionals could help to close screening gaps.
White House Summit: Trump Speaks About Mental Health Reforms Trump used his appearance to announce an increase of $328 million in new spending for mental health programs, including $19 million for Assisted Outpatient Treatment and $7 million for Assertive Community Treatment programs.
How Michigan shortchanges foster children facing life as adults Nearly three-fourths had at least one mental health diagnosis. A third had three or more mental health disorders, such as post-traumatic stress or depression. Making matters worse, a fractured state mental health treatment system is failing to reach the children who need care.
Affordable treatment for mental illness and substance abuse gets harder to find Eleven years after Congress passed a law mandating that insurers provide equal access for mental and physical health care, Americans are actually finding it harder to obtain affordable treatment for mental illness and substance abuse. The barriers to parity continue despite a bipartisan consensus that more must be done to confront the nation’s devastating opioid epidemic, rising suicide rates and surging rates of teen depression and anxiety.