Hiding In Plain Sight: A Judge’s View on Youth Mental Health & The Justice System

Task Force and Task Force Member Activities

Hiding In Plain Sight: A Judge’s View on Youth Mental Health & The Justice System After 28 years of service, Judge Nan Waller became the presiding judge over the mental health court as well as managing the competency to stand trial docket in Multnomah County, Oregon. She is also co-chair of the Oregon Chief Justice’s Behavioral Health Advisory Council and is a member of the National Judicial Task Force, which examines the State court’s response to mental illness. She wants to change the way things are done in the legal system. Instead of judging a book by its cover, she likes to ask herself first “what don’t I know about this person in front of me, [and] why?” (Forbes)

New Task Force Resources: Pillar II - Early Intervention and Effective Management of Court Cases The following new resources are now available as follow-up to the Task Force publication A New Model for Collaborative Court and Community Caseflow Management

2.1 Screening and Assessment Screening and assessment results should reliably inform all aspects of system responses – early diversion to treatment, pretrial release decisions, pretrial supervision conditions, jail custody classification, medication, treatment plans, including dosage and responsivity adjustments, case supervision plans, eligibility for pre- and post-sentencing treatment and diversion programs, and probation, parole, and reentry conditions.

2.2  Behavioral Health Triage Courts should establish a behavioral health “triage” system to identify individuals with mental health and substance use conditions at the earliest point of court involvement.

2.4 First Appearance and Pretrial Practices Pretrial release decisions regarding those with behavioral health needs must be timely. Incarceration, even for a short period of time can have disproportionately negative impacts on individuals with behavioral health needs.

2.5 Prosecution Practices Prosecutors should ensure that their practices, in the community and in the courthouse, consider the needs of those with behavioral health conditions.

2.6 Effective Defense Representation Defense counsel should provide leadership in the community and in the courthouse to address the needs of those with behavioral health needs.

2.7 Effective Caseflow Management Courts must control case progress and court events through judicial leadership and control of their dockets. Courts should be accountable and hold attorneys and community providers accountable in ensuring that the court process meets the specific needs of the individual.

The Behavioral Health Alerts has a new Wellbeing section!  Many courts are focusing now more than ever on the wellbeing of judges and court employees and the Wellbeing section focuses news and resources that address this important issue.

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Research and Resources

HHS Announces Dramatic Increase in Funding to Expand the Availability of Certified Community Behavioral Health Clinics Across the Nation Today, the Department of Health and Human Services (HHS) through the Substance Abuse and Mental Health Services Administration (SAMHSA) is announcing two Certified Community Behavioral Health Clinics (CCBHCs) funding opportunities to expand and increase access to evidence-based mental health and substance use services for all Americans. The two CCBHC grant programs are:

  • Certified Community Behavioral Health Clinic – Planning, Development, and Implementation (CCBHC-PDI) grants will assist clinics to establish and implement new CCBHC programs.
  • Certified Community Behavioral Health Clinic – Improvement and Advancement (CCBHC–IA) grants will support existing CCBHCs to enhance and improve their programs.

For these two programs, SAMSHA anticipates funding a combined estimated $312 million over four years for up to 156 awards for each Notice of Funding Opportunity (NOFO) in FY 2022. The Task Force resources on CCBHCs is here.

CSG Second Chance Month Webinars Events include Building Effective Partnerships with Continuums of Care to Increase Housing Options for People Leaving Prisons and Jails; Culturally Responsive Behavioral Health Reentry Programming; and Incorporating People with Lived Experience into Behavioral Health Programs.

The Empirical Case for Pretrial Risk Assessment Instruments Pretrial risk assessment instruments are used in many jurisdictions to inform decisions regarding pretrial release and conditions. Many are concerned that the use of pretrial risk assessment instruments may be contributing to worsened, not improved, pretrial outcomes, including increased rates of pretrial detention and exacerbated racial disparities in pretrial decisions. However, the scientific evidence behind these concerns is lacking. Instead, the findings of rigorous research show that the results of pretrial risk assessment instruments demonstrate good accuracy in predicting new criminal activity, including violent crime, during the pretrial period, even when there are differences between groups defined by race and ethnicity. Furthermore, the scientific evidence suggests they can be an effective strategy to help achieve pretrial system change, including reducing pretrial detention for people of color and white people, alike, when their results are actually used to inform decision-making.

APPR’s Framework for Pretrial Justice APPR’s Framework for Pretrial Justice provides a comprehensive roadmap and approach to improving your pretrial policies and practices in ways that enhance community safety and well-being and make the system more fair and equitable.

What Happened to Defunding? The Migration of Law Enforcement Funding and Building the Right Response Prompted by heightened cries for police reform across the United States since 2020, many jurisdictions quickly pledged to and made significant changes to local law enforcement budgets, including allocating or reallocating funds to community-based services. However, many cities that made reductions in local law enforcement spending in 2020 either funded department budgets at the same levels the following year or increased police spending. This publication goes beyond the headlines to explore what happened in jurisdictions around the country.

TAC Research Weekly: Availability of Walk-in and Crisis Outpatient Treatment Services in the United States Analysis indicated that nearly half (42.6%) of all U.S. mental health facilities did not offer any mental health crisis services between 2014 and 2018. A third of all facilities offered emergency psychiatric walk-in services and just under one-half provided crisis services. Only 25% of all facilities in the United States provided both emergency psychiatric walk-in services and crisis services.  Between 2014 and 2018, walk-in and crisis services availabilities declined by 15.8% and 7.5%, respectively.

The New and Improved samhsa.gov/988 Section of SAMHSA's Website is Live We are pleased to share that the Substance Abuse and Mental Health Services Administration (SAMHSA) has rolled out a new 988 website today – available at samhsa.gov/988. The 988 website is designed to serve as your one-stop-shop for 988 resources from SAMHSA. Notably, we want to make sure you’re aware that the site contains a 988 partner toolkit. The partner toolkit is intended for SAMHSA’s 988 implementation partners (crisis call centers, state mental health programs, substance use treatment providers, behavioral health systems, and others) to provide key messages, FAQs, and more information about what 988 is and how it will work.

Addiction and Working with Clients: Enhancing Motivation When None Exists When working in the addiction field, we frequently encounter clients who appear unmotivated to change. During this webinar, we will explore the concept of motivation and provide you with practical skills to develop intrinsic motivation toward long-term behavior change.

State and Policy Efforts to Improve Justice-Involved Populations Individuals leaving prison or jail have complex medical and social needs. The chronic and behavioral health needs of justice-involved individuals is also greater than the general population. Since the Affordable Care Act (ACA) was passed, the majority of states have expanded Medicaid eligibility providing coverage to populations such as individuals leaving prison or jail. However, state health leaders realize there is more that can be done to help address the health needs of the justice-involved. This policy brief discusses some of the efforts and policy changes that can be enacted to reduce recidivism rates, lower correctional health care costs and help the justice-involved population manage their health.

2022 National AOT Symposium and Learning Collaborative Registration is now open. Please join us for this one-of-a-kind gathering of national, state, and local assisted outpatient treatment (AOT) champions, implementers, and practitioners. Together, we will learn from one another, build on what we know, and celebrate the lives we are transforming through AOT. October 13-14 in San Antonio, Texas.

The Continued Indefinite Incarceration of Indiana’s Incompetent Defendants Post-Jackson This Note advocates for the use of community-based, i.e., outpatient, programs in Indiana for competency restoration services. Pointedly, this Note argues strict adherence to the Indiana Code's procedures regarding competency determination and restoration of criminal defendants is unworkable, specifically with regard to the Indiana Code's statutory gap concerning the appropriate course of action for unrestored defendants whose petitions for civil commitment pursuant to Indiana Code section 12-26-7 are denied by Indiana's probate courts.

Who Are We Afraid of? Indiana's Criminal Reform and How it Fails to Address Those with Mental Illness and Substance Use Disorder This Note argues that Indiana’s criminal reform fails to address individuals with mental illness and substance use disorder. As a result, county jails are overcrowded, and Indiana is not addressing the driving factor leading to these crimes. While Indiana has sought remedies to address the unintended effects of HEA 1006, both the Indiana legislature and Indiana Supreme Court have failed to establish adequate reform that encompasses individuals with mental illness and substance use disorder. Even Rule 26 may not reduce jail overcrowding because these individuals experience bias during pretrial screening and may reoffend when on pretrial release.

In the News

A landmark legal ruling in the fight for mental health equity has been overturned his week, the federal Ninth Circuit Court of Appeals issued a devastating ruling in the Wit v. United Behavioral Health (UBH) case that, once again, sets America back while struggling to cope with increasing mental health challenges—especially among youth—and historic fatal overdose rates. The appeals court overturned the trial court’s determination that UBH was liable for making medical necessary determinations for mental health and substance use disorder (MH/SUD) services in a manner that was inconsistent with generally accepted standards of MH/SUD care.

A deep dive into Newsom plan to overhaul mental health policy If approved by the Legislature, Newsom’s plan would create an entirely new system of civil court supervision, connecting individuals with intensive treatment and, equally important, housing. In a March 7 interview with Capitol Weekly, Judge Manley said treatment facilities and staff must be increased at the local level. “I see these individuals every week, who cannot survive in the community in the condition they’re in, and they’re in jail,” he said. “I have 110 mentally ill individuals sitting in jail whom I’ve ordered released, but there is nowhere for them to go because there are no open beds. I’ve seen this number skyrocket during the pandemic.” Newsom’s plan is a civil court proposal which seeks to intervene before an arrest.

‘People don’t think clearly in crisis:’ California law enforcement turns to mental health clinicians on toughest 911 calls California law enforcement agencies are embracing new approaches to mental health crisis calls. But some activists still want a solution without police, including volunteers in Nevada County who came together after a fatal shooting.

Oklahoma drug courts help destigmatize mental illness and substance abuse Support of mental health and substance use programs doesn’t have to be in opposition to programs available for people involved in the court system, but I’ve noticed that it is often presented that way. It is important to reduce the stigma of substance use and mental health disorders and this is especially true for those also involved in the court system. As a service provider for Oklahoma County Drug Court, I’ve seen how the court helps fill that role in our community.

Is Current Mental Health Funding Helping Anyone? Three Doctors Argue About Mental Health Research The debate about whether the National Institute of Mental Health should spend more of its $2 billion budget on clinical studies (behavior studies) versus pure brain research continues in today’s blog with NIMH critic Dr. E. Fuller Torrey claiming that NIMH Director Dr. Joshua Gordon recently misspoke during an interview with a New York Times reporter.


40 wellness tips to help lawyers cope with job pressure It’s no wonder two long-running stereotypes are that lawyers drink and hate their jobs. A 2016 study by the Hazelden Betty Ford Foundation and the ABA Commission on Lawyer Assistance Programs found 20.6% of responding lawyers scored at a level consistent with problematic drinking, compared with 11.8% of respondents in comparable fields. The study also found nearly half of respondents were concerned about depression at some point in their careers, with 28% of all respondents experiencing it at mild or high levels.

Measuring Progress on Workplace Mental Health Throughout the Covid-19 pandemic, many companies have ramped up their mental health benefits to address the trauma, stress, anxiety, and isolation many employees have felt. An estimated 40% of employers have expanded their offerings in some way. Yet it’s not enough to simply offer more programs. Employers need to apply the same rigor to measuring results in mental health as they do for more traditional business milestones.

Mental Health Coalition's Guide to Addressing Workplace Mental Health Although it can be difficult to talk about mental health in the workplace, doing so benefits everyone. When employers and managers address mental health, employees are happier, productivity improves, and the workplace becomes a healthier environment.

What are some digital tools for stress management? Join us for a discussion around Digital Tools for Stress Management reviewed by PsyberGuide. Clinicians, developers, people with lived experience, and everyone in between. All are welcome!

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