Improving Case Processing and Outcomes for People with Behavioral Health Needs

updated behavioral health banners

Task Force Activities

The National Center for State Courts (NCSC) joined the Council of State Governments (CSG) Justice Center in leading a virtual peer learning collaborative consisting of three sessions on how to improve criminal case processing for defendants with behavioral health needs as part of the Justice and Mental Health Collaboration Program. The Task Force and CCJ/COSCA Rapid Response Team resource, Improving Outcomes for People with Behavioral Health Needs: Diversion and Case Processing Considerations During a Pandemic, highlights strategies for diversion and case processing particularly during and after the pandemic.

The CSG brief, Improving Case Processing and Outcomes for People with Behavioral Health Needs, presents opportunities to improve caseflow management and outcomes for criminal court defendants who have behavioral health needs.

Research and Resources

Substance Use Disorder Treatment for People with Co-occurring Disorders This new, comprehensive SAMHSA Advisory highlights strategies for counselors and administrators to properly screen, assess, diagnose, and manage the treatment of individuals with co-occurring substance use and mental disorders.

Treatment for Youth and Young Adults with Mood Disorders and other Serious Emotional Disturbances and Co-occurring Substance Use This guide reviews interventions on treating substance misuse and substance use disorders (SUD) in youth with serious emotional disturbances (SED), distills the research into recommendations for practice, and provides examples of the ways that these recommendations can be implemented.

Victims, Witnesses, and Defendants with Mental Illness or Intellectual and Developmental Disabilities: A Guide for Prosecutors People with intellectual and developmental disabilities (I/DD) or mental illness are overrepresented in the criminal justice system, as victims, witnesses, suspects, and defendants. The purpose of this guide is to increase understanding and generate discussion about these conditions or disabilities and their potential impact on resolving cases. This guide provides prosecutors with a synopsis of useful information that can provide strategies that will assist them in their work with those who have I/DD or mental illness.

Kendra’s Law: Equal Access to Care Regardless of Race The independent study concluded: We find no evidence that the AOT Program is disproportionately selecting African Americans for court orders, nor is there evidence of a disproportionate effect on other minority populations. Our interviews with key stakeholders across the state corroborate these findings. Parallel analyses for Hispanics and other minority populations show this same pattern and no appreciable racial disparities are evident in selection of these groups for AOT. Defining the target population as public-system clients with multiple hospitalizations, the rate of application to white and black clients approaches parity.

Racial Injustice and Mental Health The Kennedy Forum stands with the Black community and is dedicated to fighting for change. The attached resources were compiled to address trauma and promote resilience.

Racial and Ethnic Disparities in Mental Health Racial and ethnic disparities in mental healthcare access, utilization rates, and outcomes continue to persist. Many factors play a role in this complex issue including barriers to service access, discriminatory policies, individual and systemic bias, social determinants of health and stigma related to mental health conditions and services.

Reducing Homelessness for People with Behavioral Health Needs Leaving Prisons and Jails Homelessness is a longstanding problem in California, as it is in much of the U.S. While homelessness has many root causes, including an overall lack of affordable housing and lack of coordination between social service systems, incarceration is a major risk factor. This report highlights 5 areas where people with behavioral health needs leaving California prisons and jails experience the greatest challenges in accessing housing. It also provides 10 complementary recommendations for actions that state, county, and local leaders can take to reduce homelessness among this population.

Asian Americans/Pacific Islander (AAPI) Mental Health Resources Racial trauma, or race-based traumatic stress (RBTS), refers to the mental and emotional injury caused by encounters with racial bias and ethnic discrimination, racism, and hate crimes. Due to long standing injustices and the rise in hate crimes against Asian Americans/Pacific Islander (AAPI) Communities, many AAPIs might be experiencing RBTS right now. The impact of pandemic-related stress, coupled with racism-based stress, can lead to many AAPIs feeling anxious or scared. While these feelings are valid, please know that there are resources available to support your mental health during this difficult time.

Consent, Informed: Rethinking Informed Consent & Competency for Patients with Schizophrenia & Anosognosia This law review Note argues that documented anosognosia requires a finding of incompetency, whether people are a danger to themselves or not. Science suggests that a person with severe anosognosia lacks the insight to refuse treatment. This Note proposes a novel statutory definition of competency, encompassing the specific needs of people with anosognosia, and grapples with the significant interests at stake in taking away an individual’s right to choose or refuse treatment, including antipsychotic medication.

Help Not Handcuffs: Legislation & Community Models In part two of our webinar series, experts will provide an overview of 988 legislation and an additional model of community crisis response, CAHOOTS (Crisis Assistance Helping Out on the Streets), developed by the White Bird Clinic in Oregon. Part 2 of a 4-part series.

CSG Justice Briefing Improving case processing for people with behavioral health needs; sustaining behavioral health-criminal justice programs; and four steps for using videoconferencing in parole decision-making.

NASMHPD Update Current news and resources from the National Association of State Mental Health Program Directors.

Medicaid Forward: Behavioral Health Framework This National Association of Medicaid Directors resource, created in partnership with Well Being Trust, provides evidence-backed, sustainable policy and program solutions to improve Medicaid members' mental health and well-being and support Medicaid programs during these unprecedented times. The report identifies policy options that would benefit all Medicaid members, as well as specific strategies for children, older adults, individuals who are homeless, individuals who have intellectual or developmental disabilities, and those who are transitioning from the criminal justice system.

You're Invited to Addiction and COVID-19: A Conversation with Dr. Anthony Fauci and Dr. Nora Volkow Addiction Policy Forum invites you to a webinar with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases (NIAID) and Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), both part of the National Institutes of Health, about the intersection of the addiction and the COVID-19 pandemic. Topics covered will include the impact on people with substance use disorders, the latest on safe and effective vaccinations for COVID-19, and the unique challenges that the pandemic has presented for people in recovery.

SAMHSA Headlines Grants for Medication-Assisted Treatment, Prescription Drug and Opioid Addiction, and other resources.

Mental Illness is Not a Crime The Columbia Psychiatry Media Center and the Columbia University School of Journalism presented a panel discussion, Mental Illness is Not A Crime on February 23rd. Judge Steve Leifman and others discussed the intersection of behavioral health and the criminal justice system. YouTube link.

The ABA Criminal Justice Standards on Mental Health: The Greatest Practice Resource You’ve Never Heard Of A rash claim? Not really, because we know that if you can spare five minutes to glance over the standards, you’ll become a believer on the spot. An immodest claim? Not at all, because we weren’t members of the blue-ribbon panel that took the classic 1984 version and transformed it into the up-to-date 2016 version. A self-promoting claim? Not likely, because if the ABA continues to revise the Standards at 32-year intervals, we’ll probably both be retired—even in this economy—by the time the next panel is chosen

Procedural Due Process, Drug Courts, and Loss of Liberty Sanctions This Article highlights the current state of the law regarding procedural due process and liberty sanctions in drug treatment courts and then offers qualitative empirical data regarding how these knotty issues play out in action in the context of one adult drug treatment court located in a Western state.

Justice and Mental Health Collaboration Program Implementation Science Checklist Series Criminal justice and behavioral health agencies are increasingly adopting evidence-based practices (EBPs) to advance behavior change among the people they serve. While EBPs can help reduce recidivism and improve public health and safety, their success is often hindered by lack of capacity to implement them properly. But as people who have behavioral health needs continue to encounter criminal justice and behavioral health systems across the country, there is a greater need to ensure that these EBPs are implemented with fidelity.

Justice Community Opioid Innovation Network Newsletter Includes information about a new project, Teleservices in Judicially Led Diversion Programs: The Impact of COVID-19 on the Adoption of Remote Treatment and Recovery Services, and a Medications for Opioid Use Disorder in Criminal Justice Settings webinar.

Peer Integration into Medication-Assisted Treatment (MAT) and Other Jail-Based Treatment Programs To achieve positive outcomes, peer recovery support services (PRSS) to address opioid and other substance misuse are increasingly offered across diverse criminal justice settings, including within MAT and other jail-based treatment programs. COSSAP webinar.

PTACC Ticker Wednesday, March 10th Police, Treatment and Community Collaborative newsletter with upcoming webinars and other deflection and pre-arrest diversion resources.

TAC Research Weekly: COVID-19 Vaccination and Severe Mental Illness People with severe mental illness are at significantly higher risk for developing serious complications from contracting COVID-19. As we wrote earlier this year, new data suggests schizophrenia is the second largest risk factor for death from COVID-19, second only to age. Therefore, vaccinating this vulnerable population is critical.

Supporting the Mental Health and Treatment Needs of Individuals Experiencing Homelessness During COVID-19 Throughout the COVID-19 pandemic there has been an increase in mental health and substance use disorders in the United States. Join SAMHSA’s Homeless and Housing Resource Center in exploring equitable and culturally appropriate interventions to engage people experiencing homelessness in treatment and deliver services in non-congregate setting

Early Diversion Virtual Learning Community Part 2: Addressing the Critical Need for Housing and Strategies to Overcome Barriers to Improve Housing Access Housing is a critical need for individuals experiencing homelessness who are in crisis and at risk for justice involvement. Services alone cannot address the overwhelming disruption homelessness contributes to well-being and health. Barriers to accessing housing include criminalization of homelessness, lack of partnership development, funding issues, and myths and realities related to securing housing. Presenters will address comprehensive strategies to improve housing access, which is key to early diversion.

Mind the Workplace Mental health America recognizes the psychological impact that workplaces can have on employees. Millions of employees spend a large part of their day, and lifetime, at work, increasing the effect that workplaces have on employees’ mental health and well-being. MHA’s workplace initiatives are part of an ongoing commitment to uncover workplace disparities, promote meaningful change in organizational practices, and develop resources to address the mental health needs of employees.

How to Respond When an Employee Discloses a Mental Health Condition It takes a lot of courage for an employee to disclose that they have a mental health condition, and as a manager, you need to navigate the conversation carefully. Start by thanking them for telling you, but don’t make a big deal about the disclosure. It’s important to treat it like you would any other medical issue.

COSSAP Digest Recent and future resources from the Comprehensive Opioid, Stimulant, and Substance Abuse Program. Racial injustice and systemic racism are a direct threat to the mental health of millions.

Georgia Behavioral Health Reform and Innovation Commission The commission is responsible for reviewing several key areas: behavioral health services and facilities available in Georgia; identification of behavioral health issues in children, adolescents, and adults; the role of the education system in the identification and treatment of behavioral health issues; impact behavioral health issues have on the court and correctional systems; legal and systemic barriers to treatment of mental illnesses; workforce shortages that impact the delivery of care; access to behavioral health services and supports and the role of payers in such access; the impact on how untreated behavioral illness can impact children into adulthood; aftercare for persons exiting the criminal justice system; and the impact of behavioral health on the state's homeless population. This is the first-year report.

In the News

With Pandemic Worsening the Mental Illness and Addiction Crisis, Biden Administration to Provide Nearly $2.5 Billion for Treatment, Prevention Aid The Substance Abuse and Mental Health Services Administration (SAMHSA) will direct $1.65 billion in Substance Abuse Prevention and Treatment Block Grant funding and $825 million in Community Mental Health Services Block Grant funding to states and territories. The Community Mental Health Services Block Grant program allows states and territories to provide comprehensive community mental health services and address needs and gaps in existing treatment services for those with severe mental health conditions. The Substance Abuse Prevention and Treatment Block Grant program allows states and territories to plan, implement and evaluate activities to prevent and treat substance use disorder. This funding will also allow recipients to maximize efficiency in existing treatment and recovery infrastructure, promote support for providers and address unique local needs to deliver substance use disorder prevention.

Justice Reinvestment in Action: Oregon Invests $10 Million Locally to Improve Criminal Justice, Behavioral Health Outcomes The funding will help address a shortage of supports and services in local communities, from supportive housing to crisis stabilization units to medication and care coordination. Jurisdictions are incorporating existing community resources with these new, grant-funded supports to provide comprehensive, sustainable programs that engage people with complex behavioral health needs across different points in the criminal justice system. While the majority of programs focus on increasing supports prior to booking, some will also support people upon reentry or during community supervision.

New bill funds mental health experts, not police, to respond to emergencies: 'mental illness is not a crime' Congress wants to make it easier for state and local governments to defund the police by instead funding mental health services and empowering them to respond to emergency calls instead of armed officers. “We should be connecting people in crisis to care, not tossing them in jail,” Rep. Katie Porter, who reintroduced the bill on Thursday, said in a statement. “Mental illness is not a crime, and we have to stop treating it like one. Most police officers are not trained to care for individuals experiencing mental health crises, which too often tragically leads to unnecessary violence.”

Announcing a New Award in Memory of Georgia Judge Stephen S. Goss The Judges and Psychiatrists Leadership Initiative has established an award in recognition of the late Georgia Judge Stephen S. Goss and his tireless efforts to rethink how to handle cases for defendants with behavioral health needs. The award will recognize one judge and one psychiatrist who have demonstrated extraordinary leadership in improving the lives of people with behavioral health needs in the criminal justice system. Please submit nominations by March 24, 2021. Winners will be announced in May as part of Mental Health Awareness month.

CSG State of Justice Includes information about Hawaii’s crisis response system, restorative justice for juvenile offenders, and prison versus drug treatment.

Why Self-care Isn't Enough: Resilience for Trauma-Informed Professionals The well-established finding that a majority of youth in the juvenile justice system have been exposed to trauma has led to a clarion call for the implementation of trauma-informed practices. However, to date, less attention has been paid to the importance of providing juvenile justice staff with the tools needed to carry out trauma-informed practices in ways that protect them from the potential risks associated with this work.

Center to study mental health, criminal justice The University of Arkansas for Medical Sciences on March 2 announced the opening of a new Public Health and Criminal Justice Research Center focusing on the mental health issues and drug addiction in the Pulaski County criminal justice system. According to program director and UAMS professor Nick Zaller, the program will collect information from people in the system to analyze the exact effects of mental illness and drug addiction on them and how best to help them with addiction issues.

Leaving mentally ill inmates untreated carries a heavy cost for them and for taxpayers Shamefully, we have allowed our prisons and jails to be a depository for our most vulnerable citizens. Even though such inmates do receive some form of treatment or therapy during incarceration, most, if not all, of our prisons and jails are not equipped with the personnel, training or facilities to provide them with the treatment or therapy they need.

Criminal Justice Reform Means Reforming the Mental Health System NAMI has long engaged in the conversation around how to keep people with mental illness out of our nation’s criminal justice system. With this new energy in the public discourse, we are prepared to help mold an innovative model of safety for our communities. In order to reform the criminal justice system, we must reform our nation’s mental health system.

Alternative Courts Not A Catch-All Fix For Mental Illness Crisis Data also shows that mental health courts do reduce recidivism, meaning those participants with mental illness aren't repeatedly imprisoned and cycled in and out of jails and prisons. According to a 2017 meta-analysis of 17 studies published by Psychiatric Services in Advance, mental health courts reduce recidivism by 20%. However, some judges and advocates say that people who commit low-level offenses and have mental health problems should be identified and directed to mental health services without being arrested and filtered through the court system at all.

Long-Term Psychiatric Beds Are Needed: Are State Hospitals The Solution? “I am in favor of repealing the IMD Exclusion that prevents most psychiatric facilities from getting Medicaid if they have more than 16 beds. We are in the midst of a national psychiatric bed shortage. As was pointed out last week in a Manhattan Institute analysis, it’s obvious that many individuals with serious mental illnesses, such as schizophrenia, are not getting treatment in community settings because they need longer term care. Plus, a lack of long-term beds contributes to jails and prisons housing individuals whose only real crime is that they got sick.”

Alaskans in crisis often get tangled in the criminal justice It doesn’t take much for a behavioral health emergency to lead to criminal charges, but professionals on the front lines say it doesn’t need to be that way. Over the years, new approaches have demonstrated success, among them a therapeutic court alternative to the traditional criminal court process and, more recently, a specialized police team that incorporates an experienced mental health clinician. Now there’s a new approach to behavioral health crisis on the horizon, and proponents say it has the potential to help even more Alaskans stay out of jail and get into recovery.

Texas Study Shows Diversion Curbs Recidivism, Strengthens Job Prospects Increased use of diversion is a key feature of America’s new age of criminal justice reform. Whether administered informally by prosecutors or under the auspices of courts, diversionary dispositions aim to resolve cases without a conviction—and in so doing, conserve scarce legal resources, provide supportive services, reduce recidivism, and provide defendants with a chance to avoid the lingering stigma of a conviction record.

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