Task Force Releases Juvenile Mental Health Diversion Guidance

Task Force and Task Force Member Activities

Task Force Releases Juvenile Mental Health Diversion Guidance Upwards of 70% of young people in the justice system have a diagnosed mental disorder, and 90% have experienced a traumatic life event that can negatively impact their mental health. To assist courts and service providers in addressing the growing mental health crisis, the National Judicial Task Force to Examine Courts’ Response to Mental Illness recently released a set of Juvenile Justice Mental Health Diversion Guidelines and Principles.

JPLI Hosts Train-the-Trainer Event in Washington, DC This September, the Judges and Psychiatrists Leadership Initiative (JPLI) hosted an in-person train-the-trainer event entitled Judicial Work at the Interface of Criminal Justice and Behavioral Health. The event was designed to help establish a cadre of judge-psychiatrist teams who can provide training to criminal court judges on improving outcomes for people with behavioral health needs in the courts. Facilitated in partnership with the National Judicial Task Force to Examine the State Courts’ Response to Mental Illnesses, the event is part of a national initiative to make judicial training that addresses mental illnesses, addiction, and substance use disorders available nationwide.

New Task Force Resources

  • Key Questions at Appearances for Individuals with Serious Mental Illness This bench-card poses questions for judges to consider when a mental illness seems to be a factor with someone appearing in court.
  • Youth Mental Health Crisis The Casey Foundation’s 2022 Kids Count Data Book is a collection of data in four domains that capture the essence of children’s mental health and well-being. Economic well-being, education, health, and family and community are indicators of mental health. It is the hope of the Casey Foundation that policymakers use this data to inform actions aimed at improving the mental well-being of children and families.
  • Oversight of Psychotropic Medications Prescribed to Children in Foster Care Research has described the prescribing of psychotropics to children in foster care as “too many, too much, and too young.” There have been guidelines, recommendations, and resolutions created and shared since the early 2000s, but progress needs to be made and questions remain regarding the court’s role in the oversight of psychotropic medications for children in foster care.

Task Force Hosts Medicaid Briefing Experts from SAMHSA and CMS joined Task Force members to discuss Medicaid issues as they impact courts and individuals with behavioral health. Specific topics included a high-level overview of Medicaid across the states, understanding when justice-involved populations can be covered by Medicaid, and what Medicaid changes might be seen in the future.

Research and Resources

Taking an Evidence-Based Approach to Involuntary Psychiatric Hospitalization The field of psychiatry has placed a growing emphasis on research-based diagnostic and treatment practices related to mental illness. Involuntary hospitalization is a controversial and potentially lifesaving intervention in psychiatric care; yet, to what degree is this practice evidence based? This Open Forum examines the ethical and logistical limitations to traditional research, such as randomized controlled trials and observational studies, surrounding involuntary psychiatric hospitalization.

Trauma and Blameworthiness in The Criminal Legal System Violence can result in trauma, but so too can trauma lead to violence. Neuro-science offers an increasingly sophisticated understanding of the biology of behavior, including the nexus between trauma and criminal behavior. Yet the criminal legal system consistently fails to account for the traumatic backgrounds of many people charged with crimes.

Law & Mental Health Conference on Civil Commitment Sessions include Dr. Sarah Vinson discussing Social (In)Justice and Civil Commitment, Assisted Outpatient Treatment: The Nevada County experience implementing Laura’s Law, Understanding the Ethics of Civil Commitment, and a Day 1 welcome by Congressman Jamie Raskin.

You Can Check Out Any Time You Like, But You Can Never Leave: Forced Mental Health Treatment and Advance Directives (for the title alone). Mental healthcare professionals often have the discretion to override patient requests to leave treatment, even if the patient had functioned relatively well when voluntarily submitting thereto. Because mental healthcare professionals have few incentives to release a patient--and a multitude of incentives not to--the opportunity for patient oppression is concerning. This Article calls for a re-examination of current policies behind physician-mandated psychological treatment under Equal Protection principles. (Westlaw link)

Veteran Intercepts in the Criminal Justice System Webinar Series: Introduction and Overview of the Veterans Sequential Intercepts 0-5 Develop a better understanding of the Veteran Sequential Intercept Model (V-SIM) and the intervention strategies and resources available at each intercept in part one of NIC’s four-part webinar series highlighting reentry, diversion, and desistance alternatives for justice-involved veterans as they progress through the criminal justice system.

New Learning Opportunities from The Council of State Governments Justice Center’s Juvenile Justice Team The Council of State Governments (CSG) Justice Center, in collaboration with the Center for Policing Equity, is hosting a virtual learning community focused on enhancing school-based diversion through public health and youth-centered approaches. The learning community will be led by CSG Justice Center policy staff and include opportunities for mutual learning and presentations from peers and experts. The goal of the learning community is to develop and strengthen school-based alternative responses to law enforcement interaction

SAMHSA Learning Opportunity: Adapting Evidence-based Interventions for Under-resourced Populations This webinar will highlight findings from the Adapting Evidence-based Practices for Under-resourced Populations guide, which explores evidence-based, organization-level strategies and promising practices to adapt and evaluate evidence-based practices in culturally humble and effective ways. Adaptations involve tailoring care, programs, and services to the cultural, social, gender, and demographic contexts of the people served to yield positive outcomes.

Upcoming Webinar: Health Center & Justice System Collaboration to Improve Mental Health Health Centers (HCs), where behavioral health services have increased at a greater rate than health services overall, complete about 14 million mental health visits and 2 million substance use disorder visits a year. In 2021, the Substance Abuse and Mental Health Services Administration, the Conference of State Court Administrators, and the Conference of Chief Justices issued a statement that recognized courts as key behavioral health referral sources and highlighted the need to integrate more behavioral health expertise and evidence into courts. Recognizing the potential link between HCs and the justice system, Shannon Mace and James Teufel worked with a host of key informants to write the 2022 issue brief Connecting Community Health Centers & Courts to Improve Behavioral Health of People & Communities, which explores the further integration of and partnership between health centers, certified community behavioral health clinics, and courts to improve the continuum of care.

SOAR Webinar: SAMHSA SOAR TA Center Answers Your FAQs The SAMHSA SOAR TA Center will provide in-depth answers while giving the SOAR community an opportunity to get to know us and our resources better. We will cover a broad range of topics such as:  completing a specific SSA form, getting a Medical Summary Report co-signed, documenting co-occurring substance use disorders, working with applicants who are involved with the legal system, handling appeals, completing the online courses, entering decisions into OAT, and working while applying for benefits.

HHS Includes Key MIEP Priority in Roadmap for Behavioral Health Integration On September 16, the U.S. Department of Health and Human Services (HHS) released the HHS Roadmap for Behavioral Health Integration (Roadmap), which included a major win for counties and our efforts to reform the Medicaid Inmate Exclusion Policy (MIEP). The Roadmap outlined plans to submit a report to Congress describing innovative strategies and best practices to help individuals who are currently incarcerated and returning community members ensure continuity of Medicaid coverage and seamless transitions back to the community. The findings will inform the design of a Medicaid 1115 demonstration opportunity to improve care transitions and expand coverage to returning community members.

NAMD Federal Policy Brief: Behavioral Health Equity Over the past decade, there have been alarming increases in behavioral health disparities. From 2015 to 2020, there were sharp increases in fatal overdose rates among Black and American Indian/Alaska Native (AI/AN) communities, with the rate tripling for Black men and doubling for AI/AN women; Black men and AI/AN women now experience the highest fatal overdose rates nationally. These trends may be partially driven by racial disparities in substance use and mental health treatment access.

TAC Research Weekly: September Research Roundup 988 has resulted in a 45% increase in call, chat and text message volume. Only one month after the launch of 988 calls have increased from 165,000 last August, when 1-800-273-8255 was the primary service number, to 300,000 this August. There has also been a 72% decrease in service response time since the implementation of 988.

SAMHSA Advisory: Peer Support Services in Crisis Care The purpose of crisis care is to support the individual, engage them in the least restrictive services, and avoid unnecessary hospitalizations or arrest. Peer support services complement clinical services and help individuals in crisis. Some peer support workers specialize in providing services during a crisis, while others without specialized training may assist during a crisis if requested or as needed. Read the complete SAMHSA Advisory to learn more about the benefits of including peers in crisis care.

Signals of Distress: High Utilization of Criminal Legal and Urgent and Emergent Health Services in San Francisco A new report from the nonpartisan California Policy Lab and the Benioff Homelessness and Housing Initiative at UCSF shows that a small number of San Francisco residents are repeatedly cycling in and out of the county’s health and criminal legal systems each year and represent a disproportionately high amount of utilization of these systems.

Individuals with Mental Illnesses in the Criminal Legal System: Complex Issues and Best Practices Individuals on probation who have severe and persistent mental illnesses face complex challenges related to housing, substance use, unemployment, trauma, and comorbid physical health challenges, as well as symptoms of mental illnesses that make them more difficult to supervise. The authors review evidence-based interventions designed to improve outcomes for justice-involved individuals with mental illnesses, including motivational interviewing, housing first, assertive community treatment, and supported employment.

Racism and Mental Health Racism is a mental health issue because racism causes trauma. And trauma paints a direct line to mental illnesses, which need to be taken seriously. Past trauma is prominently mentioned as the reason that people experience serious mental health conditions today. But obvious forms of racism and bigotry are just the tip of the iceberg when it comes to racial trauma.

PRA E-News This edition contains several important resources: Advancing Fairness and Transparency: National Guidelines for Post-Conviction Risk and Needs Assessment; Trauma-Informed Approaches Across the Sequential Intercept Model; and information about an upcoming event hosted by the Service Members, Veterans, and their Families Technical Assistance Center Innovations Conference to Advance Suicide Prevention Strategies.

NRI Newsletter This edition included a spotlight on an Evaluation of Competency to Stand Trial: Use of State Hospitals, Community-Based, and Jail-Based Approaches, Nation’s First Medicaid Mobile Crisis Intervention Services Program, To Be Launched in Oregon, and more.

NCSL Behavioral Health Policy Series: Increasing Access to Health Care Services This four-part series explores the national behavioral health landscape and a variety of state legislative actions to increase access to mental and behavioral health-related services, including preventive interventions for all ages and innovations related to suicide prevention.

CSG Justice Center Newsletter Resources include an Explainer: Creating Housing Opportunities for People with Complex Health Needs Leaving Incarceration, Data Digest: Issue 1 – Treatment Court Funding, and How to Connect People in Crisis to the Care They Need.

Biden-Harris Administration Awards More Than $1.6 Billion in Funds for Communities Addressing Addiction and Overdose Crises The investments made through SAMHSA’s State Opioid Response (SOR) and Tribal Opioid Response (TOR) grant programs and HRSA’s rural communities opioid response programs will help communities looking to leverage every tool at their disposal—from prevention to harm reduction to treatment and recovery supports for people in need. “Providing access to evidence-based, person-centered care is a central part of HHS’ strategy for ending the overdose crisis,” said Secretary Becerra.

In the News

Kentucky Judicial Commission on Mental Health meets for first time to discuss charge, next steps The KJCMH is charged with exploring, recommending and, when applicable, implementing transformational changes to improve systemwide responses to justice-involved individuals dealing with mental health issues, substance use or intellectual disabilities. The commission will take into consideration the vision, values and goals of the multiyear assessment by the Kentucky Court of Justice to enhance the practice, quality and timeliness of the judicial response to cases involving these needs. Chief Justice John D. Minton Jr. established the commission based on the undeniable prevalence of these issues in our society. He commended the members, who have a wide range of backgrounds and expertise, for coming together to take on this challenge.

A Federal Judge Has Ordered the Release of More Than 100 Patients From the State’s Locked Psychiatric Hospital. No One Is Sure What Happens Next On Aug. 29, U.S. District Judge Michael Mosman ordered state health officials to follow the recommendation of an outside consultant to fix the backlog: release pretrial patients early. While state law previously required the hospital to release defendants within three years, the new order reduces that to a maximum of 90 days for misdemeanors and a year for violent felonies. Depending on the circumstances, defendants could be turned over to “community restoration” programs or simply let go. In extreme circumstances, prosecutors can ask for a defendant to be declared “extremely dangerous,” and if a judge agrees, they will be returned to the state hospital.

San Diego County seeks shift away from locked psychiatric units. ‘The change that we need in behavioral health is dramatic’ Two out of every five psychiatric hospital admissions can be prevented. That is the conclusion of a new report coming before the county Board of Supervisors Tuesday that provides the greatest detail yet on how the region’s overwhelmed behavioral health system can be reshaped. Overall, the report suggests that having more low-key resources available to people early on in their course of illness will significantly reduce the need for the most-restrictive kinds of care, meaning a large increase in hospital-level resources would be a bad investment.

DA’s office: Diversion programs are under utilized Adolfo Mendez, chief of Policy and Planning with the 2nd Judicial District Attorney’s Office, said they have been “raising the alarm” that diversion programs and specialty courts “are way under capacity” and are taking action to change that. He said the DA’s Office has eliminated logistical and financial barriers to diversion, having a diversion officer in court to do intake “then and there,” eliminating fees associated with the diversion program for public defender clients and removing the “admission of guilt” requirement.

New report recommends 'significant changes' to improve mental health services in Indiana The 61-page report from the Behavioral Health Commission addresses several gaps it found with services and acknowledges some recommendations have a "significant price tag." It also estimates untreated mental illness costs the state $4.2 billion annually. Recommendations include: Create 988 call centers for people to contact; Create mobile crisis teams to respond; Create crisis stabilization units to provide a safe place for people to get help. The commission said this, and increasing the number of mental health courts, would help ease the burden of mental illness on the criminal justice system.

Government-wide mental health summit to be held next month Leaders from each branch of Indiana government will come together next month to discuss ongoing statewide efforts for addressing the mental health needs of Hoosiers. Nearly 1,000 attendees — representing each of Indiana’s 92 counties — are expected to meet Oct. 21 for a mental health summit at the Indiana Convention Center in downtown Indianapolis. Among the speakers are Indiana Chief Justice Loretta Rush as well as other justices from the Indiana Supreme Court, Gov. Eric Holcomb and Lt. Gov. Suzanne Crouch, and House Speaker Todd Huston and Senate President Pro Tem Rodric Bray.

Judges train to better address individuals with behavioral health needs At least sixty-four percent of inmates in state and federal prison met the criteria for mental illness at the time of their booking, or during the 12 months leading up to their arrest. That’s why North Dakota judges are training to more effectively deal with individuals with mental and behavioral health needs. District Court Judge Brad Cruff was one of 15 judges in the U.S. chosen by behavioral health program directors to participate in the Judges and Psychiatrists Leadership Initiative this month. After training, he’ll co-teach the subject to all state court judges in North Dakota. Advocates say the goal of helping those struggling with behavioral health issues is to reduce recidivism rates and save taxpayer money in the long run.

Murder charge against Edmonds man dismissed due to mental health treatment delays After two 90-day sessions of restoration treatment, which included psychotropic medications, a psychologist determined that his condition had improved, but cautioned that if he stopped taking the medications his condition would likely revert. Citing acute side effects, he then voluntarily stopped his medication. He remained in custody until April 2022, when the court ordered that he receive additional competency restoration treatment to commence within 14 days of the court order. Beds were not available at Western State Hospital, and according to hospital officials none would likely become available for at least six months – leaving Fry in continued custody in the Snohomish County Jail. Judge Janice Ellis on Sept. 22 noted that while “the nature of the charge…indicates that the defendant presents a significant danger to the community…the remedy after this time is not to simply keep him in jail.”

What’s Behind the Increased Use of Kendra’s Law in New York City? When Mayor Eric Adams was on the campaign trail last year, he repeatedly called for city and state officials to step up the use of Kendra's Law – a state law that allows court-ordered outpatient mental health treatment for people deemed dangerous to themselves or others. As of September 22, the number of individuals under AOT in New York City had risen to 1,655, close to half of the state total, and a remarkable 19% increase over the same day last year.


A Look at Leaders Top Priorities To Support Mental Health At Work A recent survey by Lyra Health found that employee mental health is at an all-time low. A stunning 84% of workers reported at least one mental health challenge over the last year, with issues including stress, burnout, anxiety, depression, PTSD, and bipolar disorder all prevalent. To help companies navigate these times, and understand how to better protect, promote, and provide services that support the mental well-being of their employees, last week One Mind at Work convened a group of CEOs, CHROs, academic experts, individuals with lived experience and healthcare organization leaders to discuss the most effective strategies for creating a workplace environment that meets employee’s needs.

Well+Being: 12 questions to measure your workplace happiness To assess your own workplace well-being, take this 12-question survey, created by Gallup and based on research from 2.7 million workers across 50 industries worldwide. Read each of the following statements and ask yourself if you strongly agree or strongly disagree — or if you fall somewhere in between.

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