Diversion – A Pathways Approach

Implementation of the National Judicial Task Force to Examine State Courts' Response to Mental Illness Report and Recommendations

The Task Force made a number of important findings with corresponding recommendations supported by over 100 resources for courts and our partner stakeholders. Each Behavioral Health Alerts revisits an original Task Force resource or a new resource that supports a Task Force recommendation.

Diversion – A Pathways Approach The often siloed relationship between the criminal justice, civil, and the mental health treatment systems needs to be redesigned so that all stakeholders work together as partners to use resources more efficiently, make the most effective services the norm, and thereby achieve the best outcomes for this population more consistently. At each point of interaction with each these systems, beginning with crisis response and continuing through reentry, active efforts to find diversion pathways – offramps from the traditional criminal justice road – should be systematically undertaken, and a continuum of diversion options and access to treatment and recovery must be developed and available in every jurisdiction.

Task Force Recommendations Implementation - Resources and News

Champion of New York State Mental Health Court, Five Other Lawyers, Honored by New York State Bar Association Judge Matthew D’Emic, a pioneer who expanded mental health courts in New York State, will receive the New York State Bar Association’s Vincent E. Doyle Jr. Award on Jan. 20 during the association’s Annual Meeting. The Criminal Justice Section is also honoring the Chemung County district attorney and four other attorneys. D’Emic, who serves as the administrative judge for the Criminal Term of Supreme Court in Kings County, has presided over the mental health court for 20 years. The court works to find therapeutic options for defendants in the hope of reducing recidivism. “By successfully diverting defendants out of the criminal justice system and into treatment, Judge D’Emic provided countless New Yorkers a second chance at life,” said New York State Bar Association President Richard Lewis. “His work at the intersection of mental health and criminal justice is a model for others to follow.”

Research and Resources

Prevention Over Punishment: Finding the Right Balance of Civil and Forensic State Psychiatric Hospital Beds The number of state psychiatric hospital beds for adults with severe mental illness has continued to decline to a historic low of 36,150, or 10.8 per 100,000 population in 2023, with a majority of state hospital beds occupied by people who have been committed to the hospital through the criminal legal system. This strategy of prioritizing admission of forensic patients effectively creates a system where someone must be arrested to access a state hospital bed in many states. As the number of state hospital beds continues to decline, finding the right balance of civil and forensic beds is critical. Without considering this balance, people with SMI who need long-term intensive care will continue to be pushed into the criminal legal system at alarming rates. While it is important to provide individuals with SMI who are waiting in jail for a bed with timely access, states must also strive for prevention over punishment. This resource delves deeply into the research and data relevant to making responsible policy choices implicating the right balance.

Trauma, Severe Stress in Childhood Linked to Criminal Legal Involvement in Next Generation A study led by UCLA researchers found that the children of parents who experienced adverse childhood experiences (ACEs)– such as abuse, neglect, violence in the home, or loss of a parent – are at increased risk of arrests and convictions by young adulthood. The authors report that their findings suggest that there is a crucial need for prevention of ACE exposure in the first place, as well as efforts to mitigate the impact of ACEs before they have downstream impacts on the next generation of children who are not yet born. The full study appears in JAMA Network Open.

SAMHSA Celebrates 20th Prevention Day, Releases Updated Overdose Prevention and Response Toolkit SAMHSA’s updated Overdose Prevention and Response Toolkit provides guidance to a wide range of individuals on preventing and responding to an overdose. The toolkit also emphasizes that harm reduction and access to treatment are essential aspects of overdose prevention. The toolkit, designed to augment overdose prevention and reversal training, provides guidance on the role of opioid overdose reversal medications, including naloxone and nalmefene, and how to respond to an overdose. It also contains appendices for specific audiences, including people who use drugs (PWUD), people who take prescription opioids, first responders, healthcare practitioners, and others.

SAMHSA Releases Peer Support Recovery Guide SAMHSA’s recently released consumer guide titled How Can a Peer Specialist Support My Recovery From Problematic Substance Use? offers people with problematic substance use a how-to resource about working on recovery with a peer specialist. Peer specialists are trained professionals with lived experience of problematic substance use, behavior change, and recovery. Peer specialists have long worked at recovery-focused community organizations; they can now often be found in substance use disorder treatment programs and other settings.

Sozosei Summit Solution Lab: 988 and Other Numbers – What the Data Tells Us So Far Sozosei Summit Solution Labs — a new series of virtual convenings — enables us to dig deeper into topics that accelerate the decriminalization of mental illness. Please join us for the first convening in this series — “988 and Other Numbers: What the Data Tells Us So Far” — where leading experts will explore recent research findings related to 988 in order to inform the creation of a robust and human-centered crisis care continuum across the nation.

Innovation in Behavioral Health (IBH) Model On January 18, 2024, the Centers for Medicare & Medicaid Services (CMS) announced the Innovation in Behavioral Health (IBH) Model. The Innovation in Behavioral Health (IBH) Model is designed to deliver person-centered, integrated care to Medicaid and Medicare populations with moderate to severe mental health conditions and/or substance use disorder (SUD). The practice participants in the IBH Model will be community-based behavioral health organizations and providers, including Community Mental Health Centers, opioid treatment programs, safety net providers, and public or private practices, where individuals can receive outpatient mental health and/or SUD services. CMS will release a Notice of Funding Opportunity (NOFO) in Spring 2024, and up to eight states will be selected to participate. The model will launch in Fall 2024 and run for eight years.

SAMHSA’s GAINS Center Seeks Experienced Trainers to Participate in Trauma-Informed Responses Train-the-Trainer Virtual Event The target audiences for this training program are community-based criminal justice system professionals, including community corrections officers (probation, parole, and pre-trial services), reentry staff, peers, court personnel, law enforcement officers (including local Crisis Intervention Team trainers), and human service providers who work with criminal justice-involved adult populations. Selected applicants will learn to facilitate the training via a virtual TTT event and subsequently deliver the training program in their local communities.

Convening County, Court & Justice Leaders Rulo Strategies and NACo, in partnership with Praxis Consulting (the Project Team), with funding from the State Justice Institute (SJI), are pleased to announce a peer exchange opportunity for county and court representatives to travel to an innovative site to learn from the hosts and exchange ideas with the other attendees. This initiative builds upon the County, Court, and Justice Leaders Framework, aligning county, court and justice leaders with local and behavioral health and public health stakeholders to create systems change.

Journal Submission Deadline Extended All Rise has again extended the deadline to submit to the peer-reviewed Journal for Advancing Justice Volume V, “Sustaining Long-Term Recovery as Part of Justice Reform.” Take advantage of this opportunity to submit your original manuscript for consideration!

Behavioral Health Equity Best Practices for African Americans – Webinar In honor of Black History Month, SAMHSA's Office of Behavioral Health Equity is hosting the Behavioral Health Equity Best Practices for African Americans Webinar. Joined by leaders in the field, we will discuss strategies, programs, and activities that support behavioral health equity within Black communities, including Success Strategies for Crisis Services, Trauma-informed Approaches to Community Violence, and Training and Technical Assistance for Practitioners.

Center for Health Care Strategies Monthly Update Includes resources on Understanding New Federal Guidance on Medicaid Coverage of Health-Related Social Needs Services, Opportunities to Promote Medications for Opioid Use Disorder in Federally Qualified Health Centers, and Adopting Trauma-Informed Care in Rural Areas: Lessons from a Community Behavioral Health Partnership in Pennsylvania.

In the News

Gov. Michelle Lujan Grisham Announces Legislation that Increases Access to Mental Health Services for Repeat Defendants in New Mexico Key provisions of Senate Bill 16 include: The ability for the judge, prosecutor, or defense attorney to refer a defendant for a mental health evaluation; Individuals that are found competent to stand trial will proceed through the normal channels of the criminal justice system; Individuals that are found incompetent to stand trial will be provided the least-restrictive means to receive mental health treatment (such treatment can also include drug and/or alcohol treatment). After completion of the competency restoration program charges are dismissed, for misdemeanors and non-violent felonies.

Judicial Branch Debuts Plan to Improve Outcomes for People With Mental Illness, Drug Issues The New Hampshire Judicial Branch has launched a series of statewide Sequential Intercept Mapping or SIM workshops with a goal of improving outcomes for individuals currently or potentially involved in the criminal justice system due to mental illness or substance use disorder. SIM workshops are being coordinated for the rest of 2024 in all counties in New Hampshire as part of a broader Mental Health Initiative launched in 2023 under the direction and leadership of Supreme Court Chief Justice Gordon J. MacDonald and Dianne Martin, Director of the Administrative Office of the Courts.

Bill Would Provide Alternatives to Defendants With Mental Health Crises A Seattle lawmaker is proposing to let judges send defendants accused of some lower-level crimes to alternatives, such as mental health or substance use treatment, instead of jail. Farivar says her bill takes aim at the root causes of the Trueblood lawsuit, which challenged the state’s failure to quickly provide competency evaluation and restoration services to defendants. The lawsuit has been settled, but a federal monitor is evaluating whether the state is complying with timelines set by the court to provide basic mental health services. In July, a judge found Washington was out of compliance and fined the state $100 million for violating the due process rights of defendants. Prosecutors argue that only they should be able to dismiss charges before trial, pointing to the state constitution, court rules and the code of judicial conduct. But “I believe once a case is filed in court, it is up to the court to decide how it is disposed of,” Goodman said.

Involuntary Commitment Laws Could Change in Tennessee. A Forensic Psychiatrist Weighs the Pros and Cons. A new proposal in the state House would automatically commit anyone judged unfit to stand trial, establishing a presumption that a person who’s charged with a criminal offense and found incompetent to stand trial is likely to cause serious harm. “That’s a presumption that is unlikely to be true in a very large number of cases,” says Paul Appelbaum, a forensic psychiatrist at Columbia University. “Many people who are suffering from serious mental disorders and are arrested, are arrested on relatively minor charges, such as trespassing or shoplifting, and are in no way likely to be dangerous to other people.”

Justice Department Expands Claims Against Pa. Courts in Opioid Addiction Treatment Case The U.S. Department of Justice has broadened its accusations that Pennsylvania courts discriminate against people with opioid use disorder by restricting access to medications widely seen in the medical community as life-saving. The case was brought under the Americans with Disabilities Act. In one hearing, a DOJ attorney made a distinction between a decision a judge might make about an individual defendant versus the "blanket banning of treatment,” which the attorney argued is not allowed. The case focuses on the three federally approved medications for opioid use disorder: buprenorphine, methadone, and naltrexone.

Most People Petitioning Mental Health CARE Court in San Diego County are Qualifying for Help In the first few months of operation, the vast majority of people who have petitioned the state’s new CARE Court to get someone mental health help are qualifying in San Diego County, judicial officials said Friday, but it’s been challenging connecting with those who need the assistance. In an update given to the state’s Judicial Council on Friday, San Diego Superior Court Judge Kimberlee Lagotta said about 70 CARE Court petitions had been filed locally. Only three involving individuals without a qualifying diagnosis were dismissed, she said. Of the petitions,15 people have been set up with a treatment plan complete with services and other forms of support called a CARE Agreement. Lagotta said some had declined to participate in the program but that those people were still provided with referrals for services. Court officials also released information about the people petitioning San Diego’s newest court for the first time Friday. Most of the 69 petitioners — 42 — were spouses or family members. First responders filed 14 petitions, licensed behavioral health professionals submitted six, a director of a hospital filed four and another three came from public guardians or conservators.

On Hawaii Island, They’re Bringing Psychiatric Services to the Streets — One Patient at a Time “A lot of his behaviors are suggestive of schizophrenia and lack of insight,” said Dr. Chad Koyanagi, the only psychiatrist in the state that takes his practice to the streets. He’s worked with the homeless for more than two decades. He also heads up a successful psychiatric street medicine team on Oahu. Over the years, Koyanagi has treated scores of patients, providing them with psychiatric medication that allows them to regain control of their lives so they can get off the street and into housing. It’s that work that caught the attention of Hope Services, Hawaii Island’s largest homeless service provider. With their help, the doctor is now traveling to Hawaii Island every other Wednesday to head up the agency’s new psychiatric street medicine program.


The Impact of Burnout: Compassion Fatigue & Secondary Trauma Faces & Voices of Recovery invites you to this free training offered in partnership with ORN. Compassion Fatigue is real and prevalent for those working in the human services field or any other role that is focused on caring for others. It is now considered an organizational contagion and if not recognized and addressed, can lead into complete burnout. This training is essential for anyone working with vulnerable populations. Many people who have chosen to work in this field have experiential expertise in trauma. This elevates the potential for developing compassion fatigue. Compassion Fatigue can be detrimental to their emotional, physical and mental health. Learn about the risks, symptoms and solutions to keep you healthy and balanced while you help others.

Wellbeing that Works: Diving into Unmind The CMBA and its Women in Law Section want to underscore the importance managing your mental health, so be sure to tune into this CLE to learn about the CMBA's newest member benefit, Unmind. Unmind is a platform that offers a range of evidence-based tools and resources that can help attorneys improve their mental health and wellbeing. With Unmind, you can access a wide range of resources that can help manage stress, anxiety, and other mental health issues that are common in the legal profession.

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