Breaking the Cycle: Justice Reform for the Mentally Ill

Task Force and Task Force Member Activities

Breaking the Cycle: Justice Reform for the Mentally Ill Task Force member Christopher Goff, an associate justice of the Indiana Supreme Court, spoke with members of the National Association of Counties’ Justice and Public Safety Committee Saturday, Feb.12 about some of the Task Force findings. Commissioner Janet Thompson of Boone County, Mo. and Principal Court Management Consultant Patti Tobias of the National Center for State Courts also spoke to county officials, discussing the importance of collaboration with community partners, reforming the structure of the courts to enable flexible responses for the mentally ill and encouraging the education of the community on these vital topics.

Certified Community Behavioral Health Clinics (CCBHCs) and the Justice System From police departments to courts of law, the CCBHC model provides a mechanism to coordinate, deliver – and often pay for – mental health and substance use services for justice-involved persons. At the request of the National Center for State Courts (NCSC) National Judicial Task Force to Examine State Courts’ Response to Mental Illness (Task Force), the National Council for Mental Wellbeing (National Council) outlines examples in this report of how states and localities utilize the CCBHC model to partner with various divisions of the justice systems, with recommendations for states as more policymakers begin to implement the model through legislative and executive actions. The report was also discussed at a recent webinar.

CCJ COSCA Regional Summit Spurs Kansas Follow-up “What can I do?” That was the question I kept asking myself as I traversed an icy interstate road through the Badlands while returning from Deadwood, South Dakota, in the fall of 2019. I had just attended a regional summit as a member of the Kansas delegation that also included Chief Justice Marla Luckert, Hon. Patty Macke Dick, Hon. Timothy McCarthy and former Office of Judicial Administration Director of Education Denise Kilwein. The summit was part of the national initiative to improve the court and community’s response to mental illness issues in the justice system. This initiative is a collaboration of the National Center for State Courts, the Conference of State Court Administrators, the Conference of Chief Justices and the State Justice Institute.

New Task Force Resources Now AvailableThe following resources have been approved and added to the Task Force website:

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Research and Resources

President Biden to Announce Strategy to Address Our National Mental Health Crisis, As Part of Unity Agenda in his First State of the Union The President is announcing a national mental health strategy to strengthen system capacity, connect more Americans to care, and create a continuum of support –transforming our health and social services infrastructure to address mental health holistically and equitably.

NASMHPD's Revised Model Bill for Core State Behavioral Health Crisis Services Systems This final version of NASMHPD’s model 988 legislative language, released just last week, provides a template for state legislatures to consider in anticipation of the rollout of 988 this summer. This version also includes as a recommended member of the model oversight and implementation advisory body a representative of “state courts appointed by the Chief Justice.”

Public Safety Performance Project A recent study found that only 1 in 13 people with drug dependencies receives treatment in jail. This PEW resource includes How One Jail Is Increasing Access to Treatment, and a survey showing that 2 in 3 Americans said crimes driven by substance use disorder or mental illness should be met with treatment—not jail.

JPLI Newsletter This edition of the Judges and Psychiatrists Leadership Initiative includes links to new APA Foundation resources, a competency to stand trial microsite, and a Mental Health Language Guide to address stigma around mental illness and equip users with person-first language and a better understanding of how to discuss mental health concerns with youth.

HHRC February Newsletter: New Resources, Updates, and Upcoming Trainings New resources from the Housing and Homeless Resource center include a toolkit for helping individuals experiencing homelessness obtain identification documents, and a Supportive Housing Models That Work learning community opportunity.

Housing First for Homeless People with Severe Mental Illness: Extended 4-year Follow-up and Analysis of Recovery and Housing Stability from the Randomized Un Chez Soi d'Abord Trial Housing First (HF), a recovery-oriented approach, was proven effective in stabilizing housing situations of homeless individuals with severe mental disorders, yet had limited effectiveness on recovery outcomes on a short-term basis compared to standard treatment. Conclusion: Data at 4 years were consistent with 2-year follow-up data: similar improvement in personal recovery outcomes but higher housing stability, autonomy and lower use of hospital services in the HF group compared to the TAU group, with the exception of an ongoing alcohol issue. These sustained benefits support HF as a valuable intervention for the homeless patients with severe mental illness.

Best Practice Standard VI: Complementary Treatment and Social Services Added to NADCP's E-Learning Center NADCP's E-Learning Center is a dynamic online learning hub that provides self-paced training courses designed to be engaging and informative to practitioners at any experience level. All courses are FREE and led by renowned experts in the treatment court field. We just added a new course on the Adult Drug Court Best Practice Standards, Standard VI: Complementary Treatment and Social Services.

PRA eNews Resources include an Equity in Action webinar series and links to both MacArthur Safety and Justice Challenge and SAMHSA Service Members, Veterans, and their Families Technical Assistance resources on equity.

Criminal Justice and Equity: Bridging the Gaps Roundtable Series Join the Kennedy-Satcher Center for Mental Health Equity (KSCMHE), in partnership with the WellPath Cares Foundation, for Session 3 of our "Criminal Justice and Equity: Bridging the Gaps Roundtable Series," where our expert panelists will discuss how trauma impacts outcomes for the justice-involved, and means to imagine what a trauma-informed system could be for this population. This discussion will be by the Director of KSCMHE, Madhuri Jha, LCSW, MPH. A recap of Session 2 is also available.

Equity for All Families: Practice Interventions to Provide Equitable Access and Prevent Disparate Outcomes in Family Treatment Courts Family treatment court (FTC) practitioners seek practice and policy interventions to ensure equitable access for all families involved in the child welfare and court systems who are affected by substance use and mental disorders. Focusing on early identification and assessment, access to treatment and services, and supporting sustainable behavior change, three presenters will explore the research and share practice solutions to improve outcomes for all FTC parents, children, family members, and families as a whole in this SAMHSA GAINS center webinar.

Transform911 Convenings This March 2-4, Transform911 will host its second virtual convening to share and discuss draft recommendations that holistically transform the nation’s emergency response and 911 systems—from call taking and first response through dispatch and final resolution. Over three days, the project’s six workgroups will share ideas and solicit input. Final recommendations will provide state, local, and federal policymakers with a roadmap to promote more equitable responses to crises and expand access to comprehensive emergency services.

Evidence-Based Strategies for Preventing Opioid Overdose Provisional data from the CDC’s National Center for Health Statistics shows that there were over 100,300 drug overdose deaths in the United States from April 2020 - April 2021, a nearly 30% increase from the year prior. Given this increase in overdose deaths across the U.S., it is more important than ever to understand the evidence-based strategies that are available to address opioid use disorder in our communities. Join us on March 7th from 1-2:30 p.m. (ET) for a webinar and Q&A to discuss key strategies to preventing opioid overdose with experts from the Centers for Disease Control and Prevention (CDC).

Changing the Beat of Mental Health: Amplifying Our Voice Ujima is a group of Black and Brown young men, ages 14 to 21, that came together to research the issue of mental health among young men across Chicago. One recommendation: Create change to child and family facing care systems, including child protective services and mental health systems, through the leadership of youth of color and families. The youth identified that the mental health system is often inaccessible, and when available can compound distress and be harmful through bureaucracy and a focus on institutionalization.

Building an Effective County Behavioral Health Care Continuum The National Association of Counties is exploring the challenges and opportunities related to the behavioral health continuum of care in partnership with the Safety and Justice Challenge (SJC). This year we are producing a series of webinars and reports outlining the important work counties are undertaking in this space.

The Starkest Madness: Massachusetts' Failure to Protect the Rights of People with Mental Disabilities Section 12 of Massachusetts' mental health laws fails to limit the detainment period for individuals suspected to be having a mental health crisis. As part of the state's commitment procedure, section 12 detainments often serve as preludes to civil commitments, but involve reduced or no process. This Boston University Public Interest Law Journal Note explores how every branch of Massachusetts' government has contributed to the construction and preservation of this facially unconstitutional law. Furthermore, it addresses why section 12 is indicative of a much larger problem in Massachusetts commitment legislation. (Westlaw link)

CSG Justice Briefing Spotlight on Atlanta's Policing Alternatives and Diversion Initiative; insights from emerging and established community responder models; and Minnesota reviews policy options to inform legislation.

Children’s Mental Health: Understanding an Ongoing Public Health Concern A new CDC report on children’s mental health used data from different sources to describe mental health and mental disorders in children during 2013–2019. Poor mental health among children continues to be a substantial public health concern.

In the News

Chief Justice Randolph pushing for expansion of intervention courts as an alternative to incarceration Mississippi Supreme Court Chief Justice Mike Randolph believes that non-violent offenders who find themselves in trouble with the law over drugs, mental health issues or veterans’ issues should have alternatives available to them that eclipse the old “lock them up and throw away the key” variety. He recognizes the waste of locking people away who are guilty of nothing more than addiction. Along with the waste of lives and human potential, that strategy carries with it a huge cost in terms of taxpayer support for incarceration.

Mental Health America Releases First-Ever Dashboard with Results of 2.6 Million Mental Health Screens Taken During Pandemic This new dashboard geographically maps at-risk rates of suicidal ideation, severe depression, PTSD, trauma, and psychosis and provides first-of-its-kind view of state and county-level risks. The analysis shows states with the greatest need for additional mental health resources are Oklahoma, Indiana, Alaska, and Utah.

The Stumbling Block to One of the Most Promising Police Reforms Durham officials wanted to understand just how many 911 calls the city was getting that could be diverted to someone other than police, so they asked the research organization RTI International to analyze 1 million calls for service over three years to assess how much work a mental-health unit would have, part of a review involving seven cities. The results stunned them. RTI found that operators had categorized only 1 percent of the calls as mental-health-related at the time of dispatch. Other cities that have studied their own data have identified similar undercounts. The best alternative responders or co-responders in the world can help only if emergency dispatchers know when to deploy them. If first responders don’t recognize that a call is mental-health-related until cops arrive, it’s too late.

Tucson's Crisis Response Center expanding urgent care, adding services to meet demand Tucsonans struggling to access mental health treatment will soon have a new option regardless of their ability to pay, through the Crisis Response Center's upcoming expansion of urgent care services. The expansion comes in advance of July's nationwide designation of "988" as the new three-digit dialing code that will route callers to the Nationwide Mental Health Crisis and Suicide Prevention Number. The number is a 24/7, free and confidential support line for people in distress and those who care for them.

Connecticut police departments add mental health professionals to help deescalate, meet needs An estimated 20% of police calls for service nationwide involve a mental health or substance use crisis, and for many departments, the demand is growing, according to the American Psychological Association. In a nationwide survey of more than 2,400 senior law enforcement officials, about 84% said mental health–related calls have increased during their careers and 63% said time spent on mental illness calls also has increased. More than half of the respondents cited an inability to refer people to needed treatment, according to the APA.

Mental health calls with No guns or badges “We’re not going to be sending an ambulance, and we’re not going to be sending police officers,” Muecke told the man. “We’re happy to talk to you today and support you today. How does that sound to you?” Less than 30 minutes later, Muecke and two other crisis responders, all in purple polo shirts, arrived at the man’s home in a siren-less minivan. After speaking with him, they determined immediate treatment wasn’t necessary and promised to return to check in on him. It’s the type of interaction reformers have long called for — one that replaces armed officers with mental health clinicians.

Arlington builds call system to divert people in mental health crises from jail The aim of the system, dubbed the Marcus Alert, is to keep people in crisis — due to a mental illness, substance use disorder or intellectual and developmental disabilities — from being arrested and booked in jail. Once operational, the system would transfer people who call 911 or 988 — a new national suicide and mental health crisis hotline — to a regional call center where staff determine whether to de-escalate the situation over the phone, dispatch a mobile crisis unit or send specially trained law enforcement.

Ensuring a Better Crisis Response in 2022: Answering the call of 988. By July 16, 2022, 988 will go live for all citizens seeking help during a mental health crisis. Establishing such a bespoke alternative crisis response can avert both jail bookings and emergency room crowding. And because people with serious mental illness are more likely than those without mental illness to be involved in a police shooting, 988 can literally save their lives.

$76 million could fix Colorado’s youth mental health system, study finds as kids are sent out of state for care “We don’t do this to kids with cancer.” Residential treatment centers for youth have warned for years that they’re headed for collapse. Suicidal kids are waiting weeks, sometimes months, in hospital emergency rooms for a bed at a treatment center. Child welfare caseworkers are sleeping in county buildings or hotel rooms with children and teens when they can find no safe place for them to go. Dozens of kids are going to treatment centers out of state because Colorado’s options are so slim.

I’ve written about L.A.’s mental illness crisis for almost 20 years. We have to do better Estimates vary, but a Times analysis two years ago found that roughly half of L.A. County’s homeless people were dealing with a mental illness, and last June, about 40% of L.A. County jail inmates were diagnosed with a mental illness. Mental Health Court Judge Jim Bianco told me mentally ill defendants in county jail have to wait six to nine months for a spot in a psychiatric hospital, but he applauded the successes of the county’s Diversion and Reentry housing program, which is helping keep released inmates from returning.


Many courts are focusing now more than ever on the wellbeing of judges and court employees. This new section of Behavioral Health Alerts will highlight timely news and resources that address this important issue.

Work-Life Balance: What Does it Look Like in 2022? For the first time in the history of America’s court system, large numbers of employees are teleworking, many are frightened of catching the Coronavirus in the office, others are concerned over losing their personal freedom, and we all seem to be working and living with incomplete and often rapidly changing information. This NACM podcast explores work-life balance and how COVID has affected courts and court employees.

Workplace Mental Health Blogs In leveraging our 27+ years of brain health advocacy and researcher advancement work and our One Mind at Work program, we are writing weekly to share the latest insights and best practices for mental health in the workplace, along with other brain health news.

Making Workplaces Psychologically Safe What is a psychologically safe workplace? It means employees feel comfortable being their authentic selves without fear of stigma among peers. A place where people can share their mental health challenges with a manager without negative career consequences. Where strong support systems are available when people need them most. A psychologically safe workplace requires leaders to take concrete actions within their organization.

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