Chief Justice Loretta Rush Addressed the Governor and a Joint Session of the Indiana General Assembly for the Annual State of the Judiciary

Task Force and Task Force Member Activities

Chief Justice Loretta Rush Addressed the Governor and a Joint Session of the Indiana General Assembly for the Annual State of the Judiciary “For our final few moments, I want to talk about a remarkable opportunity all of us in this building have to fix a broken mental health system. But if we’re going to do it, we must work together.”

“Police officers are not social workers, and jails are not treatment centers. And when we ask them to be, we compromise their core function of preserving public safety, which, in turn, puts everyone at risk. This year, you, the General Assembly, will be tasked with considering how to best implement the national mental health hotline, better known as 988. It’s the future of crisis care—a hotline for mental health emergencies where the immediate crisis response is connected to the infrastructure in place.” Chief Justice Rush went on to describe a new cross-branch statewide summit organized by the Indiana Supreme Court, aimed at tackling that implementation.

Opinion | Health Systems, Community Mental Health Must Learn to Work Together Task Force member Milton Mack argues for collaboration. The lack of collaboration between hospitals, mental health service providers, law enforcement and the probate courts results in continuous recycling of persons with serious mental illness through acute care hospital emergency departments, inpatient hospitalizations, jails, and probate courts. Yet, the data clearly demonstrates that AOT can substantially reduce hospitalization, length of hospital stays, and emergency department use as well as reduced involvement with the criminal justice system.

Research and Resources

Vera Institute - Beyond Jails: Community-Based Strategies for Public Safety For decades, the United States has responded to social issues like mental health and substance use crises, chronic homelessness, and ongoing cycles of interpersonal violence with jail. This has disrupted the lives of millions of people—disproportionately harming Black and Indigenous people—without improving public safety. There’s a better way. Communities can instead invest in agencies and organizations that address these issues outside the criminal legal system. The proven solutions highlighted in this multimedia report look beyond jails to promote safe and thriving communities.

"Defunding" the Criminality of Mental Illness by Funding Specialized Police Training: How Additional Training and Resources for Dealing with Mental Health will be Beneficial for All Sides This Journal of Law and Health article demonstrates that effective police training involving crisis intervention and de-escalation techniques equip police officers with knowledge and skills that enable them to contrive more positive outcomes for all involved. With a particular focus on Ohio, this article highlights the significant discrepancy between ideal police training and current Ohio requirements, which glaringly fail to require continual police officer training.

Peer Support for Discharge from Inpatient Mental Health Care Versus Care as Usual in England (ENRICH): A Parallel, Two-group, Individually Randomised Controlled Trial High numbers of patients discharged from psychiatric hospital care are readmitted within a year. Peer support for discharge has been suggested as an approach to reducing readmission post-discharge. Implementation has been called for in policy, however, evidence of effectiveness from large rigorous trials is missing. Findings: This definitive, high-quality trial addresses uncertainty in the evidence base and suggests that peer support should not be implemented to reduce readmission post-discharge for patients at risk of readmission.

National Association of Medicaid Directors Federal Policy Brief: Behavioral Health Medicaid is uniquely positioned to help address this crisis. Today, state Medicaid programs provide health insurance coverage for about 1 in 4 Americans, representing a crucial access point to mental health and substance use services. 28 percent of adults covered by Medicaid have a mental illness, as compared to 19 percent of adults with private insurance. Just as importantly, Medicaid can drive transformations in our systems of care for mental health and substance use. NAMD encourages our federal partners to pursue broader policy changes, like those outlined below, that can improve outcomes across the behavioral health system.

Fitness to Stand Trial and Dementia: Considering Changes to Assessment to Meet Demographic Need Fitness to stand trial assessments conducted by forensic mental health specialists occur on a regular basis. The same standard has traditionally been used for close to thirty years.  We consider here the different interpretations of criteria related to fitness to stand trial, including the ability to communicate with counsel. Potential changes to fitness assessments will also be examined, including the idea of using standardized tools. The importance of these issues is made evident by the fact that Major Neurocognitive Disorder is becoming more prevalent, and these issues will likely be apparent more frequently in the future. A multidisciplinary team approach may be an ideal way to examine the future direction of fitness assessments, including the involvement of allied health professionals.

Understanding Correctional Mental Health Services Hear a thorough overview of mental health services within correctional environments and the importance of coordinating care with community-based clinicians to improve care for individuals who have serious mental illness (SMI) with this on-demand SMI Advisor resource.

Adult Psychiatric Bed Capacity, Need, and Shortage Estimates in California—2021 California, much like many parts of the United States, is confronting a shortage of psychiatric beds. In this RAND report, the authors estimated California's psychiatric bed capacity, need, and shortages for adults at each of three levels of care: acute, subacute, and community residential care. They used multiple methods for assessing bed capacity and need in order to overcome limitations to any single method of estimating the potential psychiatric bed shortfall. The authors identified statewide shortfalls in beds at all levels of inpatient and residential care.

Stepping Up Strategy Lab The Stepping Up Strategy Lab is an interactive library of programs, policies, and practices that jurisdictions across the country have implemented to help reduce the prevalence of people with mental illnesses in their jails. With these interventions in one place, Stepping Up planning teams can explore, identify, and pursue those that are most likely to address local drivers of the problem.

SMI Advisor: Myth v. Fact on Serious Mental Illness There are many myths around serious mental illness (SMI) that are not always accurate. Let’s take a look at common myths around SMI and technology, psychopharmacology, and treatment.

TAC Research Weekly: Severe Mental Illness and Violence, Revisited Violence risk in individuals with severe mental illness can be a divisive topic. On the one hand, advocates and the media respond to violent incidents involving someone with severe mental illness as evidence of the substantial risk for violent acts and need for better treatment access to prevent violence. On the other, advocates proclaim that such associations are stigmatizing and the vast majority of people with serious mental illness are not violent and are, in fact, more likely to be victims of violence than perpetrators. According to the research, both are true.

Race, Mental Illness, and Restorative Justice: An Intersectional Approach to More Inclusive Practices Black people are disproportionately incarcerated in the United States, and correctional facilities are the nation’s largest mental healthcare providers. Although jails and prisons provide the most mental healthcare, they are among the worst places to receive those services. Therefore, Black incarcerated persons with SMI face a compounded discrimination resulting in subpar mental healthcare services.

Ready to Respond: Mental Health Beyond Crisis and COVID-19 With the ongoing COVID-19 pandemic, the pre-pandemic rising suicide rates, the opioid crisis and numerous challenges in meeting demands for mental health services across the country, SAMHSA’s 2021 Compendium of Ready to Respond: Mental Health Beyond Crisis and COVID-19, comes at a critical time. With the impact of COVID-19 still front and center, and the planning for a system involving a 988-crisis response, there is much work ahead.

Eviction Prevention and Mental Health While eviction is a universally stressful event, people with mental health conditions can face unique obstacles with housing retention for reasons related specifically to their disability. This paper provides a review of housing settings and specific risks of eviction for individuals with mental illness before focusing on housing court and the challenges these individuals and court personnel face therein.

Applying New COVID-19-Related Funding to Address the Housing Needs of Individuals with Serious Mental Illness, Substance Use Disorders, and Co-occurring Disorders This paper highlights newly available federal funds that can be utilized for housing and paired with supportive services funding for individuals who are experiencing or at risk of homelessness and who have a serious mental illness, a substance use disorder, or co-occurring disorders. The paper also notes several ways for state and local leaders to promote cross-system partnerships that pair housing resources with physical and behavioral healthcare and supportive services.

Investing ARPA Funds in Behavioral Health Crisis Response With the recent infusion of resources from the American Rescue Plan Act (ARPA), counties have a unique opportunity to invest funds into behavioral health crisis response systems to strengthen their effectiveness, equity and accessibility. Many are leveraging ARPA State and Local Fiscal Recovery Funds to expand or develop new programs and practices, such as crisis hotlines, mobile crisis teams and crisis stabilization units. Effective and high-quality crisis response plays a key role in providing services to people with a mental health condition and/or substance use disorder and preventing future crises. This NACo webinar will feature counties that have allocated ARPA funds for this priority and the lessons they’ve learned so far.

Offering buprenorphine medication to people with opioid use disorder in jail may reduce rearrest and reconviction A study conducted in two rural Massachusetts jails found that people with opioid use disorder who were incarcerated and received a medication approved to treat opioid use disorder, known as buprenorphine, were less likely to face rearrest and reconviction after release than those who did not receive the medication. After adjusting the data to account for baseline characteristics such as prior history with the criminal justice system, the study revealed a 32% reduction in rates of probation violations, reincarcerations, or court charges when the facility offered buprenorphine to people in jail compared to when it did not.

NNED Virtual Roundtable: Understanding Behavioral Health Needs in Refugee, Immigrant, and Asylee Communities The National Network to Eliminate Disparities in Behavioral Health (the NNED) is pleased to offer a Virtual Roundtable to discuss trauma, culture, and culturally responsive approaches to addressing behavioral health needs. The event will feature a discussion of the unique experience of refugee, immigrant, and asylee communities, with a focus on the layers of trauma throughout and beyond the migration process, as well as on healing and resilience.

Criminal Justice and Equity Webinar Series Session 2: Behavioral Health Equity and Incarceration The Kennedy-Satcher Center for Mental Health Equity (KSCMHE), in partnership with WellPath Care, will host a series of virtual round-tables to address the landscape of inequities that affect justice-involved individuals. The invited panelists will represent a diverse, inclusive, and unique set of voices in the field, to speak on a myriad of issues that influence outcomes for individuals affected by the criminal justice system. A recording of Session 1 is also available.

Peer-Led Innovations in Reentry Support Programming: Towards Holistic Recovery Reentry peer specialists are equipped with unique knowledge and expertise from lived experience, enabling them to provide critical supports to individuals reentering the community after incarceration. Recent peer-led developments in the field offer more opportunities to advance the work of reentry peer specialists and address the critical needs that people face upon reentry. This webinar will provide information about supporting reentry peer specialists and reentry peer support programs by providing certification, training, and the knowledge and resources needed to effectively serve people in transition from incarceration to the community.

Texas Dispute Resolution: Mediation and Mental Health Best Practices Handbook This handbook serves as a quick reference guide for mediators working with parties who may be experiencing different mental health related challenges. Further, this handbook is intended to prepare mediators and professionals (with practices and techniques) for productive engagements with parties. It will link mediation and Court ODR or alternative dispute resolution (ADR) practices with pertinent practices employed for those encountering mental health issues.

NRI Demonstrates New State Mental Health Agency Profiles Website NRI rolled out its new State Mental Health Agency (SMHA) Profiles website with information about the organizations, policies, services, clients, and funding of state mental health systems. This new website includes a series of short topical public reports detailing high priority issues being addressed by SMHAs and a restricted access page designed for SMHA staff to access detailed state-level information.

CSG Justice Center Justice and Mental Health Collaboration Program resources, an Expanding First Response video, training materials for 911 dispatch-first responder teams, and more.

CSG Justice Briefing 10 Ways We Met Challenges with Resilience in 2021, and a look at embedding clinicians in the criminal justice system.

In the News

Transition to 988 Offers Opportunity to Transform Crisis Care Only a handful of states and communities now offer these types of comprehensive crisis services. Without new laws and supporting infrastructure, police officers will continue to be the ones to respond to behavioral crisis calls, leading to traumatizing use of handcuffs, arrests, jail stays, and long waits in emergency departments for people in crisis, or worse. Rafla-Yuan believes that involving lethally armed agents in psychiatric emergencies criminalizes crisis encounters; deviates from the clinical standard of care; and increases the risk of violence, particularly against people of color.

Success is reducing jail population and improving public safety Jail population reduction and alternatives to incarceration such as housing, addiction recovery programs, psychiatric facilities, mental health rehabilitation centers, job training and placement, and family supports are mechanisms to maintain public safety, support communities and address public health concerns while eliminating the harm many people may experience in our county jails.

Hundreds of mentally ill patients are stuck in Missouri jails as state struggles with staffing issues Nearly 160 people are awaiting admission to the state’s psychiatric hospitals under orders from judges to receive “competency restoration,” according to the Missouri Department of Mental Health. The backlog, which is averaging about six months, has forced the department into a triage mode, pushing some with acute mental health issues to be treated in jails via mobile teams, if those teams are available.

Tech Can Help Solve Our Mental Health Crisis. But We Can’t Forget the Human Element Unlike other areas of health that require in-person procedures or extensive lab testing, mental health does not. Diagnosis is based on an interview, and treatment is either via medication or psychotherapy. Interviews are easy to put online, medication can be dispensed remotely, and teletherapy is effective and more convenient than sitting in a brick-and-mortar office. But my experience in both big companies and startups taught me that better software and hardware only go so far.

Iowa mental health care needs addressed in legislative proposals Iowa House Republicans have introduced four bills that would aim to add more mental health beds at state-run mental health facilities, establish more psychiatric residencies in the state, and create a loan repayment program for mental health care workers.

Southern lawmaker pushes for jail, mental health reform Scott's H.B. 853 would allow anyone eligible for public mental health services due to a previous diagnosis or previously eligible for SSDI benefits to petition for a sentence that includes mental health treatment. The bill would allow the court to order defendants to serve all or part of their sentences in a mental health treatment facility instead of prison or jail, as long as the court determines the defendant doesn't pose a risk to public safety.

Why Adams must build a new psych hospital for the mentally-ill homeless on Rikers Whether the Rikers jail is replaced by lockups elsewhere, or simply by new structures on the island, it’ll leave ample room for other buildings. And as the mentally ill shove subway riders on to the tracks, the need is obvious for a new city inpatient psychiatric hospital — a modern facility to make up for the tens of thousands of treatment beds lost since the 1950s in the misguided deinstitutionalization movement.

New York City needs a sanity check: Simon Martial, Michelle Go and all of us There are presently about 1,500 individuals under AOT in New York City, with about 12,000 served since the program’s inception in 1999. AOT has surely prevented many tragedies over 23 years. And yet preventable tragedies involving individuals not on AOT keep mounting, while lost souls in florid psychosis remain a heartbreakingly routine spectacle across the city.

Dr. Madelyn Gould on How Automation Creates a Crisis-Intervention Feedback Loop With 988 going “live” in less than 6 months, Dr. Gould says the need for close oversight will be greater than ever. She highlights that communities must have a mechanism for real-time, ongoing assessment of their call center’s effectiveness. Automated assessment tools, which crisis centers could easily adopt, provide a data feedback loop, letting the Lifeline know whether the service meets callers’ needs and can potentially help identify trends and shifts.

Homelessness and Crisis: Who Will Answer the Call? It’s not just behavioral health and housing services that must partner to address crises but also law enforcement. Community leaders have increasingly focused on the criminalization of people experiencing mental health or substance use crises and the risk of a police interaction turning deadly. What’s frequently less emphasized is that how a community’s law enforcement interact with the homeless population similarly shapes whether people in need are criminalized or matched with care and services.

Denver successfully sent mental health professionals, not police, to hundreds of calls Previously, Denver 911 operators only directed calls to police or fire department first responders. But the Support Team Assistance Response (STAR) pilot program created a third track for directing emergency calls to a two-person team: a medic and a clinician, staffed in a van from 10 a.m. to 6 p.m. on weekdays. The STAR program, which launched in June, reported promising results in its six-month progress report. The program aims to provide a "person-centric mobile crisis response" to community members who are experiencing problems related to mental health, depression, poverty, homelessness, or substance abuse issues.

Hospital backlog has mental health patients sitting in county jails According to a recent issue brief from the Colorado Legislative Council Staff, under a 2012 federal settlement with the State, no defendant may wait more than 28 days for admission to the Colorado Mental Health Institute for a competency exam or restoration services. However, a review of public data shows that's not always happening. On a state level, 347 inmates are in jail awaiting admission, and 138 patients who have been ordered to the state hospital have been waiting in jail for more than 90 days.


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.

Can lawyers who are natural pessimists learn to channel optimism? Speaker at well-being conference says it’s time to try When handling legal matters, lawyers often have to envision the worst possible outcomes for their clients and work to protect against them. But Martin Seligman, a psychology professor at the University of Pennsylvania, said attorneys’ comfort with catastrophizing can frequently carry into their personal lives with negative ramifications. The results include lawyers experiencing high rates of depression, burnout, alcoholism and divorce.

Living With COVID Requires a Sharper Focus on Workplace Mental Health During the pandemic, we’ve seen a startling increase in people experiencing symptoms of depression and anxiety. Substance abuse and suicide attempts are also up dramatically. At One Mind at Work, we believe one of the best places to begin addressing this new global mental health crisis is the workplace.

Burnout: Small Changes Lead to Big Results While there isn’t a standard “roadmap” for addressing burnout in an organization, here are some simple steps employers can take in the six (6) areas to make a positive difference.

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