How One Local Judge is Working to Improve Responses to People with Mental Health Needs

updated behavioral health banners

Task Force and Task Force Member Activities

How One Local Judge is Working to Improve Responses to People with Mental Health Needs Task Force member Judge Nan Waller has served in the Multnomah County, Oregon, circuit court system for 30 years. But when she became the presiding judge of the mental health court and competency dockets in 2018, she quickly realized the need to expand her understanding of the mental health care opportunities and challenges for people in the criminal justice system. “People are often scared, understandably, and if they don’t have an idea of what to expect, I think it’s harder for them,” she said. “I wanted to be able to explain to somebody who is being sent to the hospital for restoration, for example, what that’s going to look like.”

Save the Date– New in-person learning opportunities scheduled: Pima County, Arizona: The first two site visits will explore the model Crisis Response Center in Pima County (Tucson) Arizona. In addition to the CRC, we will also learn about the Jail Population Review process to facilitate jail releases by connecting detainees with behavioral health and support services, and we will explore several diversion programs implemented by Pima County. On-site sessions will be held October 7-8, and November 8-9 in Tucson.  Registration will open July 15th.

Additional site visits have also now been scheduled for December 9-10 and January 20-21 in Miami to visit with Judge Leifman to explore the “Miami Model,” and to Hollywood/Los Angeles to observe their same-day competency process, felony diversion program, and supported housing model. For more information contact Rick Schwermer at

Research and Resources

Idaho Behavioral Health Council Strategic Plan On behalf of the Idaho Behavioral Health Council (IBHC), we are pleased to present to the 2021 – 2024 Strategic Action Plan. With representation from all three branches of state government, as well as community partners, IBHC was tasked with developing and implementing a strategic plan designed to improve access to Idaho’s behavioral health resources and provide better outcomes for those who need services. The IBHC is co-chaired by the Administrative Director of the Courts.

Risk Assessment and Management in the Context of Competency Restoration This SAMHSA GAINS Center webinar examined risk assessment tools generally, and specifically looked at issues surrounding recent criticism of the potential racially disparate impact of those tools. The findings may surprise you.

A Matter of Public Health and Safety: How States Can Support Local Crisis Systems The COVID-19 pandemic has aggravated deep-rooted systemic problems related to inequitable access to necessary care and services to address—and prevent—mental health crises in communities. Taking an intentional approach to creating and advancing local crisis care systems can help mitigate these situations, as building local crisis systems has proved to be successful and cost-effective. This CSG brief details five actions state policymakers can take to fund and sustain local crisis systems and provides case examples of how local crisis systems in two jurisdictions have achieved cost savings and positive outcomes.

State Policy Academy on Rural Mental Health Crisis Services: Request for Applications The National Academy for State Health Policy (NASHP) is seeking state applications to participate in its State Policy Academy on Rural Mental Health Crisis Services. This learning opportunity will engage up to five teams of state leaders for one year to develop and/or strengthen policies and strategies that support development, coordination, and delivery of mental health crisis services in rural areas.

JPLI Recent News Stories, Publications, and Resources This Judges and Psychiatrists Leadership Initiative newsletter includes Planning and Ongoing Support for Community Responder Programs, Practitioner Toolkits, the Judge Waller feature, and more.

The Council of State Governments Justice Center Releases Additional Resources to Help Communities Use Stimulus Funding to Advance Justice and Safety Goals The updated digital guide incorporates new federal information and outlines eight key areas where ARP funding—including flexible State and Local Recovery Funds—can be leveraged to expand critical resources for people impacted by the justice system, reduce recidivism, and bolster public safety. The CSG Justice Center also hosted a virtual discussion on ways that ARP funding can support collaborative crisis and early diversion responses to reduce criminal justice contact for people with behavioral health needs.

SAMHSA - Upcoming Webinars SAMHSA's GAINS Center is covering essential topics through its upcoming national and Virtual Learning Community webinars.

SAMHSA Headlines SAMHSA recently posted several webpages containing a variety of videos, factsheets, and broadcast-quality public service announcements to help individuals and their loved ones connect with and remain in treatment for mental and substance use disorders. Each page contains a brief overview of the topic, ways to obtain help, and additional References and Relevant Resources.

Evaluation of Stepping up Efforts to Improve MH Services and Justice Utilization This presentation details a high-level view of the factors that affect the size of a jail population and the capacity for mental health services in and out of jail. The study examines steps taken by 950 counties to better serve individuals with mental illness including jail and community-based efforts.

Early Diversion Virtual Learning Community (Part 5): Supporting Safety through 911 and Crisis Call Line Integration While the majority of communities have a crisis call line, calls for mental health assistance are most often made to 911 call centers, resulting in an over-reliance on law enforcement to respond first. In addition, the National Suicide Hot Line Designation Act (2020) established a three-digit phone number (988), directing callers to trained mental health counselors, to address calls regarding suicide and crisis. This law requires all phone providers to implement the 988 call service by July 2022. Presenters will discuss current integration strategies as well as the implications for the implementation of 988 nationwide.

The Future of Teleservices in Drug Courts Part 3: Implementing Teleservices for Court Proceedings and Treatment Part three of this three-part Virtual Learning Community will provide detailed guidance on the many considerations for effective implementation of treatment court services delivered in virtual formats, including both court proceedings and treatment services. This event will feature a brief review of essential service elements, policies, and procedures necessary to support effective delivery; strategies for ongoing quality assurance that will inform necessary refinements; and suggestions for tracking appropriate outcomes.

Spotlight on Intercepts 0-1: Creating Community-Based Responses for Behavioral Health Emergencies, Homelessness, and Substance Use Disorders In this webinar, Eugene, Oregon’s Crisis Assistance Helping Out On the Streets (CAHOOTS) and Atlanta, Georgia’s Policing Alternatives and Diversion (PAD) will share information about their local community-based programs for responding to people in behavioral health crisis without law enforcement involvement. Presenters will share strategies for program design and implementation while fostering stakeholder buy-in, offering perspectives from a mobile crisis response program that has been operational for over thirty years, as well as from a newer program that has recently launched its 311 call line, respectively.

New Publication: Telehealth for the Treatment of Serious Mental Illness and Substance Use Disorders This SAMHSA guide reviews ways that telehealth modalities can be used to provide treatment for serious mental illness and substance use disorders among adults, distills the research into recommendations for practice, and provides examples of how these recommendations can be implemented.

Over one-third of Americans live in areas lacking mental health professionals The Census Bureau reported that 30% of American adults had symptoms consistent with an anxiety or depression diagnosis as of May 24. While the pandemic has exacerbated underlying mental health issues for many Americans, barriers to receiving mental health care have existed for years. Wyoming and Utah have the largest proportion of population living in mental health shortage areas, at 96.4% and 83.3%, respectively. New Jersey and Massachusetts have the lowest proportions, at 0.4% and 4.0%, respectively.

Rise in jail deaths is especially troubling as jail populations become more rural and more female In so many communities nationwide, jails act as reception centers for those experiencing poverty, mental health crises, or substance use disorders. The Bureau of Justice Statistics (BJS) recently came out with the 2018 mortality data for local jails. Nationwide, there were 1,120 deaths reported, or a rate of 154 deaths per 100,000 people in jail, the highest levels since BJS’ first report on this topic in 2000. As in past years, suicide was the single leading cause of death for people in jails, accounting for almost 30% of deaths.

An Empirical Assessment of Homicide and Suicide Outcomes with Red Flag Laws This Article empirically illustrates that red flag laws—laws which permit removal of firearms from a person who presents a risk to themselves or others—contribute to a statistically significant decrease in suicide rates, but do not influence homicide rates.

NCSC creates courses for treatment court professionals NCSC’s Institute for Court Management has been working for a year and a half to create online courses to train judges, administrators and others who work in treatment courts. The work, done on behalf of the National Association of Drug Court Professionals and funded by the U.S. Justice Department’s Bureau of Justice Assistance, has so far involved creating interactive courses that focus on 10 areas.

TAC Research Weekly: Women in Rural Jails Disproportionately Impacted by Serious Mental Illness Women in rural jails are more likely to screen positive for a serious mental illness compared to men in rural jails and all individuals incarcerated in urban jails, according to a study published this month in Criminal Justice and Behavior by researchers from Wayne State University. Although many jails have staff available to assess mental health needs among inmates, these screening methods can be inaccurate and result in inefficient use of jail-based mental health resources, which could disproportionately impact women incarcerated in rural areas. The authors suggest investing in better screening mechanisms and providing alternatives to incarceration for those with mental health needs.

Mysteries of Mental Illness explores the story of mental illness in science and society The four-part PBS series traces the evolution of this complex topic from its earliest days to present times. It explores dramatic attempts across generations to unravel the mysteries of mental illness and gives voice to contemporary Americans across a spectrum of experiences.

NASMHPD Newsletter The latest news and resources from the National Association of State Mental Health Program Directors.

CSG Justice Center Justice Briefing The future of virtual mental health care; cross-collaboration and reentry during the COVID-19 pandemic; updated American Rescue Plan justice related resources; and upcoming events.

Mental Wellbeing Weekly Details the reintroduction of Excellence in Mental Health and Addiction Treatment Act of 2021, and a new Child and Family CCBHC Learning Community.

PTACC Ticker This Police, Treatment and Community Collaborative resource includes the latest deflection news and resources.

Mindfulness training for judges Court Review’s Mindfulness Training for Judges: Mind Wandering and the Development of Cognitive Resilience tries to educate and support judges in improving their cognitive capacity and emotional well-being. The concept of mindfulness training took over twenty years to emerge on the judicial scene. As stated in the article: “[a] mindful state can be understood as a mental model characterized by attention to present moment experience without conceptual elaboration or emotional reactivity.”

In the News

California Ordered to Halt Prolonged Detention of Inmates with Mental Illnesses A California appellate panel has rejected the state’s policy of detaining individuals with psychiatric and intellectual disabilities in county jails — often for months or even years — while waiting for them to be declared competent to stand trial. Thousands of such people are currently being held in jails across the state because they’ve been found incompetent to stand trial, yet have not received treatment which could enable them to do so. The First Appellate District ruled all persons found incompetent to stand trial — including suspected sex offenders — have had their due process rights violated by the state’s delays in transferring them to a treatment facility within 28 days of receiving their paperwork.

Involuntary treatment for mental illness back before committee Advocates for people with mental illness and those with disabilities lined up Monday afternoon to urge a legislative committee to once again reject legislation that would authorize court-ordered outpatient treatment programs for people with severe mental illness. Massachusetts is one of three states that does not allow outpatient commitment, a civil court process sometimes referred to as assisted outpatient treatment (AOT) under which doctors, hospital officials and family members of an individual with a serious mental illness can petition a court to place the person in a treatment plan overseen by a mental health professional.

Mental Health Experts Assail John Cox's Plan to 'Force' Homeless into Treatment Republican John Cox said Monday he intends to "force" homeless individuals to get mental health treatment by using "the power of the courts" if his bid to become California's next governor is successful. An "overhaul" of the current system would be needed to expedite the process of placing people in mental health treatment centers, Brown said, and would also likely require California to expand its law enforcement and judicial resources.

How a 911-EMS Crisis Intervention Diverts People in Mental Health Crisis In 2013, Grady EMS in Atlanta, Georgia, launched a pilot to provide 911 callers experiencing mental health challenges an alternative to traditional Emergency Medical Services transport to the emergency department. Upstream Mobile Crisis Intervention is akin to law enforcement diversion initiatives and aims to deflect people in mental health crisis from a typical EMS emergency response. Grady EMS found that 90% of the psychiatric patients they transported to the emergency department didn’t require admission.

Calling mental health workers, not police, to deal with mental health crises Since the beginning of 2015, 1,430 people with a history of mental illness have been shot and killed by police in the United States, according to a Washington Post database, almost a quarter of all fatal police shootings. Other bad outcomes are more common. American prisons and jails are filled with people suffering from mental illness. Confrontations between police and people with mental illness also cause nonfatal injuries and consume the time of officers who often lack the training and expertise to de-escalate. When CAHOOTS shows up, “it has a tendency to de-escalate a situation,” Skinner said. “That’s the secret sauce.”

New Howard County Program Will Divert Certain 911 Crisis Calls to Mental Health Professionals Beginning July 1, Howard County 911 dispatchers will be directed to ask questions relating to the safety of those reaching out for crisis response, for example: whether the caller presents an immediate threat or has a plan to harm themselves or others, if they have access to a weapon, are under the influence or are under 18. If none of those factors are at play, dispatchers can ask if they would like to be connected to a mental health professional rather than law enforcement.

Opinion: Now is the time to prioritize mental health services in Virginia Total admissions have doubled at Eastern State Hospital since 2017, with 50% of the census coming from the courts or jails. These “forensic” admissions have more than doubled statewide since 2011 and more than 40% of these admissions involve misdemeanors — trespassing, shoplifting, or petty theft. While families wait to get their loved ones help and law enforcement officers sit in emergency rooms with people for days waiting for an open bed, our state hospitals are full of patients in the process of having their competency restored in order to stand trial. In the misdemeanor cases the charges may be dropped or, by the trial date, the defendant may have been in custody longer than the sentence for the crime and is released.

The Mental Health Budget, agreed on nearly unanimously, remains locked in Legislature as time runs out on July 1 shutdown A large portion of Alaska’s Operating Budget is the Mental Health Budget, which is passed separately and sailed without controversy through Conference Committee this month during Special Session 1. Gov. Mike Dunleavy is now pleading with the House Majority to free the Mental Health Budget, which has not yet been transmitted to him for his signature. The Mental Health programs are required by a court settlement from long ago so that Alaska’s mentally ill or mentally disabled residents would have the care they need.

‘Laura’s Law’ okayed in 30 counties — a major statewide turnaround In a significant policy shift spanning nearly two decades, 30 counties in California – including all of the larger counties, with an estimated 80 percent of the state’s population – have now adopted a 2002 state law giving families a legal avenue to get severely mentally ill relatives into treatment. Rather than being able to quietly “opt out” of AOT, counties now are required by AB 1976 to hold public hearings, which became particularly intense in recent months as counties without Laura’s Law programs faced looming state deadlines to formally “opt out,” with specific reasons why, or be automatically “opted in.”

Mentally ill Columbia-area defendants get more ways to avoid prison by getting treatment An arrangement approved June 16 by South Carolina’s top court official clears the way for nonviolent Midlands defendants who live with a mental illness to have felony charges dismissed if they agree to receive treatment.

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