Pima County (Tucson Arizona) Leading Change Workshop Focused on Crisis Resources and Diversion


National Initiative Updates

Pima County (Tucson Arizona) Leading Change Workshop Focused on Crisis Resources and Diversion

The National Center for State Courts is pleased to announce that registration will open soon for a workshop on May 4-5, 2020. To provide the best learning environment, registration is limited to the first 30 attendees. Jurisdictions are invited to send a team of 2 to 4 (or more), including both court leaders and behavioral health professionals.

This workshop will (1) equip you with the tools and information you need to encourage collaboration and lead change in your court and community; (2) meet and hear from Presiding Judge Kyle Bryson, Trial Court Administrator Ron Overholt, and other court and county leaders and learn how they have been implementing court responses to mental illness along the Intercepts; and (3) provide the opportunity to tour a model crisis response center, learn about an innovative law enforcement diversion initiative, and observe a cutting-edge pre-trial behavioral health intervention strategy. Pima County has an impressive array of coordinated initiatives that emphasize collaboration, peer involvement, and performance measurement. Registration details will be available soon; contact Darcy Hitt dhitt@ncsc.org to be added to the interest list on a first come, first serve basis.

Chief Justice Bolger

Alaska Chief Justice Joel H. Bolger Convenes Summit on Mental Illness February 27, 2020. The Hon. Chief Justice Joel H. Bolger convened a summit of national experts, Alaska judges, and stakeholders to improve the court and community response to those with mental illness. The Hon. Steven Leifman, Florida, and Dr. Debra Pinals, Michigan, joined Alaska leaders to discuss the use of the Sequential Intercept Model across all intercepts, moving Alaska’s current crisis response model forward, examining Alaska’s 1115 waiver program, outpatient solutions as well as inpatient solutions. The summit was followed by a training for judges the next day. The summit was supported in part by the State Justice Institute.

Current State Court Administrator Milt Mack to Step into New RoleThe Michigan Supreme Court announced that later this month State Court Administrator Milt Mack will step into the role of State Court Administrator Emeritus where he will focus on mental health reform. “Milt’s dedication to helping people with mental illness has already made a difference for so many. This change will allow him to focus on achieving mental health reform faster here in Michigan and nationwide so that more people can get treatment and get back to their families,” said Chief Justice Bridget M. McCormack. State Court Administrator Mack served as the Co-Chair of the national Advisory Committee to Improve the Justice System Response to Mental Illness and Co-Occurring Disorders and is committed to staying involved in the work ahead. He was one of the primary authors of the 2016-2017 COSCA policy paper Decriminalization of Mental Illness: Fixing a Broken System .

Research and Resources

Implementing Behavioral Health Crisis Care: A SAMHSA Best Practices Toolkit This 80-page toolkit provides a plethora of practical resources and research related to implementing a crisis care continuum. There is also a 12-page executive summary.

Improving the Courts’ Response to People with Mental Illnesses “At a time when an increasing number of judicial and legal leaders are recognizing the crisis we collectively face in addressing behavioral health needs in the justice system, we write today to describe how we got here and what leaders around the country are doing and can do going forward to improve justice in their own communities.” This thoughtful piece by Judge Steve Leifman and CSG’s Hallie Fader-Towe gives a broad overview of the increasing criminal justice intersection with behavioral health and how we can move forward more effectively.

Crisis Response Services for People with Mental Illnesses or Intellectual and Developmental Disabilities: A Review of the Literature on Police-based and Other First Response Models A comprehensive Vera Institute of Justice literature review.

AZCourtCare.org The Arizona Supreme Court’s Committee on Mental Health and the Justice System, in partnership with the Arizona Foundation for Legal Services, have established a new website called AZCourtCare (azcourtcare.org) to share information about the involuntary treatment process in Arizona. “Arizona law provides ways to obtain an involuntary mental health evaluation, involuntary treatment, and emergency hospitalization for a psychiatric evaluation.  This website gives you the forms needed and explains the process involved.”

CLOUD: Curated Library about Opioid Use for Decision-makers A searchable library of curated, evidence-based resources on opioids and the opioid crisis.

T HE EMERGING PUBLIC HEALTH ROLE OF PUBLIC SAFETY PROFESSIONALS IN IMPROVING ACCESS TO SUBSTANCE USE TREATMENT IN THE COMMUNITY Some law enforcement agencies have grown frustrated witnessing the seemingly endless cycles of arrest and incarceration as well as a dramatic increase in law enforcement calls involving overdoses linked to the opioid epidemic and the resurgence of drugs such as methamphetamines and cocaine. This frustration has prompted a recognition that better outcomes may be achieved by applying public health approaches to reduce reliance on the criminal justice system.

National Association of State Mental Health Program Directors Weekly Update A rich compendium of news and resources for the behavioral health field.

RETHINKING JAILS AND BEHAVIORAL HEALTH: STRATEGIES, CHALLENGES, AND SUCCESSES MIDWAY THROUGH THE MACARTHUR FOUNDATION’S SAFETY AND JUSTICE CHALLENGE As part of their participation in the SJC, Network Sites developed formal implementation plans containing multiple jail reduction strategies. Many sites included strategies that focused on the over-incarceration of individuals with behavioral health needs. This report examines Network Sites’ behavioral health strategies, challenges, and successes as the initiative enters its 5-year mark.

Register Now for Webinar: Trauma-Informed Care Across the Intercepts As criminal justice and behavioral health professionals encounter high rates of trauma while performing their job duties, agencies are exploring practices to improve responses by increasing awareness of trauma-informed care (TIC). This webinar will give an overview of the core principles of TIC, provide best practices for using it at each intercept point within the Sequential Intercept Model, and review research that supports the use of TIC practices for obtaining better outcomes among people in the criminal justice system who have behavioral health needs.

JTC Resource Bulletin - Teleservices for Courts Teleservices is the delivery of services from a distance using telephony and/or digital technologies. There are a growing number of innovative utilizations with a track record of success in both the public and private sectors. Teleservices can be more widely utilized for some court processes, saving courts and the public time and money, better meeting client needs, reducing security risks to medical and behavioral health providers and the public, and improving the public’s access to justice.

Screening and Assessment across the Sequential Intercept Model (SIM) Part Two: Applications in Real Life Scenarios This PowerPoint slide deck is from a February webinar on the topic.

SELL v. UNITED STATES: HAS THE SPLIT BETWEEN THE LOWER COURTS CREATED A SUBSTANTIAL LIKELIHOOD OF INJUSTICE? (Westlaw link) In Sell, the Supreme Court established a four-factor test to determine whether a defendant can be involuntarily medicated to restore competency. First, “a court must find that important governmental interests are at stake.” Second, “the court must conclude that involuntary medication will significantly further those concomitant state interests,” and that the court “must find that administration of the drugs is substantially likely to render the defendant competent to stand trial.” This article examines the split in lower court approaches as they try to define “substantially likely.”

The Prevalence of Mental Illness in California Jails is Rising: An Analysis of Mental Health Cases & Psychotropic Medication Prescriptions, 2009-2019 The study finds that the share of the California statewide jail population either with an active mental health case or a prescription for a psychotropic medication increased significantly between 2009 and 2019,and it examines the implications of those increases.

New SAMHSA Funding Opportunities Recently announced grants include grants to implement Zero Suicide in Health Systems (Zero Suicide), Comprehensive Opioid Recovery Centers (CORC) grants, and Certified Community Behavioral Health Clinics Expansion Grants (CCBHC Expansion Grants).

FLAME OUT: PREVENTING BURNOUT IN THE LEGAL PROFESSION (article begins at p. 97) Judges, lawyers, and law students experience mental health and substance use issues at unusually higher rates than the general population. In May 2019, the World Health Organization (WHO) expanded the definition of “burnout” in its medical diagnosis handbook, the International Classification of Diseases, known as the ICD-11, and recognized it as an “occupational phenomenon.” The implication of recognizing burnout as a workplace hazard is a step in the right direction and adds legitimacy to the emotions that so many people experience in the workplace but particularly in the field of law.

Safety and Justice Challenge Milwaukee County Update Using the technical assistance and resources provided by the MacArthur Foundation, the Milwaukee Community Justice Council worked to safely reduce the average daily jail population (ADP). Work began in 2016 and by December 2019, Milwaukee County surpassed the target ADP, reaching a 20% reduction in its jail population without compromising public safety.

TAC RESEARCH WEEKLY: The Risk of Criminal Convictions in Co-Occurring Substance Use and Severe Mental Illness Substance use disorders have a large impact on criminal justice involvement of individuals with severe mental illness, according to a recent Australian study on criminal offending, substance use and mental illness. The contribution of substance use on criminal offending was the strongest in people with psychotic illnesses, including schizophrenia, severe bipolar disorder, and other non-organic psychosis, according to the results.

RURAL COMMUNITY ACTION GUIDE PROMISING PRACTICES SUPPLEMENT Each of the practices described in this supplement have been built and launched by State and local leaders across the country. Practices are listed by state in each section, and includes, where available, links to find further information online. After travel and dozens of stakeholder interviews, these activities were identified as promising practices to showcase because they are something that another community can replicate or use to inspire their own action.

TASC-CHJ Treatment Capacity Expansion Series As communities across the country face crises of drug addiction and overdose, the need for timely access to quality, evidence-based treatment for people with substance use disorders is clear and pressing. This series of six briefs is offered to help communities develop treatment capacity, address gaps in services, and deliver coordinated care.

Mental Health By The Numbers A NAMI factsheet with statistics about prevalence and implications of mental illness.

In the News

Letter to Mental Health Commissioners re use of mental health block grant funds This important clarification about the permissible uses for these funds makes clear that they can be used for “the care and treatment of individuals with serious mental illness who have interactions with the criminal justice system including incarceration or who have a criminal case pending.”

LA County officials grapple with inmates suffering from mental health issues This NPR piece examines conditions in the LA County Jail mental health facility and highlights the county’s ODR felony diversion program. (audio as well as text)

California Governor wants lower bar for forced mental health care California should lower the legal bar for providing forced treatment to the mentally ill and building more homeless shelters, Gov. Gavin Newsom said Wednesday in his second State of the State address. He took the unusual step of devoting most of the annual speech to just two related issues: affordable housing shortfalls and homelessness.

Inside the governor’s bid to fix homelessness: changing how California deals with mental illness An in-depth look at the range of solutions being proposed by Governor Newsom.

As suicide rates climb, Crisis Centers expand Nationwide, most people picked up by police for a misdemeanor while in a psychiatric crisis are taken directly to a hospital emergency department, where they typically are held for hours or days, often involuntarily confined, according to emergency department surveys. Many are charged and held in jail with no mental health professional to talk to and no access to psychiatric medicines. The same goes for people with drug addiction. In the past five years, that’s become a rarity in Arizona.

FINDING HOPE: Officials launch statewide Behavioral Health Council Idaho Governor Brad Little, all five Idaho Supreme Court Justices, and several legislators gathered Wednesday to sign documents establishing and supporting the Idaho Behavioral Health Council, what officials are calling a new three-branch approach to improve care for Idahoans with mental health and substance use disorders.

Homeless, mentally ill and suffering: How to attack New York’s crisis Challenges like mental illness and homelessness — so often intertwined within a gnarly nexus of emergency rooms, prisons and shelters — require innovative strategies and collaborative approaches. We can learn from leaders in the clinical treatment, law enforcement, faith community, supportive housing and community health systems. Equally as important is to engage advocates, individuals and family members who have lived experience with serious mental illness and disabilities. There is no “one size fits all” solution.

Forbidden knowledge: Denying health info to and from families is hazardous to the mentally ill H.R. 2646, “The Helping Families in Mental Health Crisis Act.” It is also a bipartisan effort, co-authored by Pennsylvania Republican Tim Murphy and Texas Democrat Eddie Bernice Johnson. The bill seeks to clarify existing sections of the HIPAA Privacy Rule and to “assure that doctors and caregivers can communicate during a mental health crisis.” It permits a “caregiver” to receive protected health information when a mental health care provider reasonably believes such disclosure is necessary to protect the health, safety or welfare of the patient or the safety of another. The definition of “caregiver” includes immediate family members.

New York City announces opening of the East Harlem Support and Connection Center, with Bronx Center to open later this winter Previously called a diversion center, the facility will offer short-term, stabilizing services for people with mental health and substance use needs who come into contact with the police, giving officers an alternative to avoidable emergency room visits or criminal justice interventions.

This mental health law passed with broad support. Why aren’t counties using it? When Act 106 was passed into law in October 2018, lawmakers said it would help people with some of the most severe mental illnesses by allowing judges to set up “assisted outpatient treatment” plans. However, state records show that none of the state’s 48 county mental health agencies made use of the program in 2019, and none are implementing the program this year, either.

Utah bill seeking $21 million to build new mental health ‘crisis centers’ advances That bill — if its substantial fiscal note of over $21 million is approved — could help build several new crisis centers up and down the Wasatch Front. Those 24-hour facilities would be where people experiencing mental health episodes in need of emergency care could go, rather than being sent to hospital emergency rooms or jail cells. The same bill would also expand “mobile outreach teams,” or what Eliason called “mental health ambulances,” into rural parts of Utah. The teams could meet people experiencing crisis in their homes or on the streets for treatment, rather than relying on police for emergency response.

A broken system: Colorado struggles to uphold laws requiring timely mental competency service for detainees, despite losing lawsuits and years of failure The state of Colorado has failed for almost a decade to provide mental health services, including evaluations to determine mental competency, to thousands of people in jail who are awaiting trial and presumed innocent. Despite multiple court orders to reduce the backlogs, pre-trial detainees who require mental competency evaluations and treatment are consistently languishing in Colorado jails or the state mental hospital in Pueblo, often for weeks or even months at a time, in violation of state laws and the U.S. Constitution.

S.D. Senate OKs using outpatient services and jails in mental-competency criminal cases The state Senate wants services more broadly available in South Dakota for criminal defendants with mental-competency challenges. Senators agreed jails and outpatient services could be used. Two of four sections at the state Human Services Center in Yankton are closed because of hiring difficulties.

Ohio jail to tackle mental Illness as opioid crisis abates On any given day, there are about 750,000 people in jails across America. “Every jail in our country, somewhere in the neighborhood of 30 to 40 percent of the people … are diagnosed mentally ill,” said National Sheriffs’ Association president Sheriff Daron Hall of Davidson County, Tennessee. Adding in the number of inmates addicted to drugs, the proportion shoots to at least 90 percent, Hall said. Drug addiction and mental health-related issues are often coexisting and it’s difficult to parse out which is driving which.

AG Barr taps New Mexico Sheriff to lead mental illness group Bernalillo County Sheriff Manuel Gonzales said he was surprised but honored to be appointed by Attorney General William Barr to be chairman of the Mental Illness Working Group, a subcommittee of a commission created by President Donald Trump to explore the issues that affect law enforcement’s ability to reduce crime.

Psychiatric hospitals can still force patients to accept shock treatment. One Connecticut patient has been shocked 500 times in five years Despite concerns about efficacy and side effects, courts are slow to act on behalf of patients who don’t want the treatment.

Mental illness: Washington Lawmakers propose plan to treat without consent The bill places people who are incapable of caring for themselves because of a mental health disorder in an executorship, and requires that the counties provide services, such as housing and treatment. The executorship may be renewed after one year if a petition is made to do so.

Mental health woes swamp Rhode Island justice system The Rhode Island mental health system is in crisis – a crisis caused by the failure of our courts to address behavioral health issues. Unfortunately, the judiciary has approached this crisis in a piecemeal and haphazard fashion. Many mentally ill individuals are not identified. Many patients feel as though they are treated as criminals. Competency evaluations are being used as substitutes for planned treatment at tremendous cost to the state. The system is overwhelmed.

Psychological tests used in court are often ‘Junk Science’ New research suggests courts often admit psychological tests as evidence that are not scientifically valid. Yet they can play a role in determining parental fitness for child custody, assessing the sanity or insanity of a person at the time of a crime, and judging eligibility for capital punishment.