Behavioral Health Triage

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.

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. Triage should involve screening and assessment; processes for consideration and enrollment in diversion, pretrial, or treatment court programs; and connections to community-based treatment, recovery support, and care coordination in alignment with the needs of the individual.

Task Force Recommendations Implementation - Resources and News

Common Themes Emerge in 2023 ‘State of the State Judiciary’ Addresses Our review of the 22 speeches delivered as of August 1, 2023, three found several recurring themes across the states:

Mental Health: Sixteen chief justices mentioned or focused portions of their speech on the impact of mental health illnesses in the courts. Many chiefs noted that mental health services in their states are inadequate and decried the large numbers of people suffering from untreated mental illnesses. For example, Indiana saw 19,000 cases involving mental health illnesses, a record for that state. Several chief justices also noted the relationship between mental health and co-occurring substance use disorders.

Some chiefs proposed solutions, such as the creation or expansion of treatment courts and collaboration with agencies like law enforcement, prosecutors’ offices, and social welfare services to better address the mental health crisis in jails. Several chief justices also highlighted judiciary-based commissions created in the past several years to address these issues, such as the New Mexico Commission on Mental Health and Competency and the Texas Judicial Commission on Mental Health. Both commissions were created by their respective states’ courts of last resort.

Missouri Chief Justice Calls for Action as Hundreds Wait in Jails for Mental Health Services The number of people languishing in county jails for court-ordered mental health treatment before trial is a problem that must be addressed, both for the wellbeing of the inmates and their communities but also to make sure justice is fairly administered, Missouri Supreme Court Chief Justice Mary Russell told a joint session of the state legislature Wednesday. “The longer inmates with mental health problems remain detained — without treatment or without being tried for a crime, let alone convicted — the worse they get,” Russell said. In her speech, Russell said the problem needs a comprehensive solution that involves “all branches of government, at the state and local levels, and with the nonprofit and private sectors.” One measure that would help, she said, would be for lawmakers to include money to expand pretrial services so inmates across the state can be evaluated for possible enrollment in diversion programs.

Model Legal Processes for Court Ordered Mental Health Treatment – A Modern Approach The United States Conference of Chief Justices and Conference of State Court Administrators established the National Judicial Task Force to Examine State Courts’ Response to Mental Illness in 2019. As part of its overall efforts, the National Judicial Task Force then partnered with the Equitas Project of Mental Health Colorado to appoint a select workgroup to develop model statutory language for court-ordered mental health treatment, emergency psychiatric intervention, medication over objection, and criminal matters involving persons with mental illness. This Model Legal Processes Workgroup included judges, psychiatrists, medical school professors, law professors, and others whose goal was to draft model civil and criminal mental health laws that could be promoted for broad adoption across the country. A primary purpose of the workgroup’s three-year undertaking was to produce legislative language to recognize modern brain and behavioral research, while still being mindful of an individual’s rights to due process. This article discusses and analyzes the workgroup’s recommendations, includes comparisons to existing laws in many states, and urges states to consider adopting the recommended statutory approaches.

Research and Resources

Roadmap to Black Mental Health February is Black History Month, a time to come together to celebrate the achievements and history of Black Americans. The Mental Health Coalition is excited to honor this month with the launch of our Roadmap to Black Mental Health. This comprehensive guide provides an understanding of the specific mental health strengths, challenges, methods of healing, and resources for those in the Black community.

FY24 Adult Treatment Court Program With this solicitation, the Bureau of Justice Assistance seeks to provide financial and technical assistance to states, state courts, local courts, units of local government, and federally recognized Indian tribal governments to plan, implement, and enhance the operations of adult treatment courts. This includes management and service coordination for treatment court participants, fidelity to the adult treatment court model, and recovery support services. Solicitation Categories:

Category 1: Planning and Implementation

Category 2: Enhancement

Category 3: Statewide. Note - for Category 3, the following entities are eligible to apply: State agencies such as the state administering agency, the administrative office of the courts, and the state substance abuse agency, and State criminal justice agencies and other state agencies involved with the provision of substance use and/or mental health services, or related service.

BJA FY24 Justice and Mental Health Collaboration Program With this solicitation, BJA seeks applications for funding programs that support cross-system collaboration to improve public safety responses and outcomes for individuals with mental health disorders (MHDs) or co-occurring mental health and substance use disorders (MHSUDs). For the purposes of this FY24 solicitation, JMHCP will focus on pretrial, prosecution, courts, probation/parole, and addressing the needs directly related to the criminal activity of adults with mental health conditions, living in homelessness or marginalized communities with minimal access to treatment, needing wrap around services, in the criminal justice system and leaving incarceration.

Grants to Expand Substance Use Disorder Treatment Capacity in Adult and Family Treatment Drug Courts The purpose of this SAMHSA program is to expand substance use disorder (SUD) treatment and recovery support services in existing drug courts. The program recognizes the need for treatment instead of incarceration for individuals with SUDs. Recipients are expected to provide prevention, harm reduction, treatment, and recovery services for individuals with SUD involved with the courts. With this program, SAMHSA aims to improve abstinence from substance use, housing stability, employment status, social connectedness, health/behavioral/social consequences, and reduce criminal justice involvement.

Funding Opportunity – Screening, Brief Intervention, and Referral to Treatment The purpose of this program is to implement the screening, brief intervention, and referral to treatment public health model for children, adolescents, and/or adults in primary care and community health settings (e.g., health centers, hospital systems, health maintenance organizations (HMOs), preferred-provider organizations (PPOs) health plans, Federally Qualified Health Centers (FQHC), behavioral health centers, pediatric health care providers, children’s hospitals, etc.) and schools with a focus on screening for underage drinking, opioid use, and other substance use.

The Definition of Insanity at the DCJCC-February 25, 28, 29 Join us in Washington D.C. for a documentary screening that explores a novel approach to decriminalizing Serious Mental Illness followed each evening by discussions on different topics featuring filmmakers and prominent mental health experts. The Definition of Insanity is a documentary film that immerses audiences in the Miami-Dade Community Mental Health Project — a novel approach to solving the mental health crisis that could be a model for America. From Judge Steve Leifman's shock at how people with mental illness were being treated in Miami jails, an innovative mental health model was born. Guided by Judge Leifman's vision, we follow a team of dedicated public servants, as well as former adversaries in the criminal justice system, as they help people with mental illness navigate from lives of tragedy to possibility.

HHS Approves New Mexico’s Request to Expand Access to Critical Behavioral Health Services Through Mobile Crisis Intervention Teams The U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), approved a proposal from New Mexico for community-based mobile crisis intervention teams to provide Medicaid crisis services. With this approval, the state will be able to provide Medicaid services through mobile crisis teams by connecting eligible individuals in crisis to a behavioral health provider 24 hours per day, 365 days a year.

How a Crisis Receiving Center Stopped Saying No and Got Commercial Insurers to Pay Up For a crisis receiving center to function properly, it must have a no-refusal policy, accepting all drop-offs from law enforcement and EMS. That wasn’t happening, pointed out Crisis Services Director Kevin Curtis. Instead, the center’s staff defaulted to wanting first responders to call first and get the person medically cleared. Requiring medical clearance may sound appropriate and safer, but it often only creates a barrier for first responders and those needing crisis care. Staff also believed that law enforcement would drop off highly combative, assaultive people, making it more likely that they’d require medical clearance before police could do so. Curtis used the center’s data to combat the misperception. “They were perceiving this as a 20% of all drop-offs problem when it was more like .01%,” he said, adding that sending people off for medical clearance was a far bigger problem, statistically, than people being combative.

What appealed to commercial insurers is that the center’s diversion rates, from inpatient hospitalization and people returning to the community, were higher than the emergency room. “We showed cost comparisons between those who show up to the ER versus those we serve in our small receiving center,” said Curtis. Not only was the center more successful at diverting people from inpatient care but it did so at a lower cost. “We’re hoping communities across the nation take this on and get commercial insurers to see crisis receiving as a valuable service and reimburse,” said Curtis, “because that makes the model more resilient, more sustainable.”

Competence for Criminal Adjudication: Client Autonomy and the Significance of Decisional Competence After a brief review of the historical and conceptual foundations of the competence requirement, this article focuses on two decisions in which the Supreme Court has addressed decisional competence. In Godinez v. Moran (1993), the Court ruled that a pretrial finding that a defendant was competent to stand trial established that he was competent to waive representation by counsel and plead guilty because the test for competence is the same in the two contexts. However, in Indiana v. Edwards (2007), the Court held that a defendant who was found competent to stand trial while being represented by counsel may nonetheless be found to be incompetent to represent himself at trial. Although these decisions are not strictly contradictory, they are in deep tension with one another. This article attempts to set the law on a coherent path by highlighting the significance of doubts about decisional competence in both cases and formulating a coherent approach to guide state and federal courts in the future.

New Federal Guidance for Alternatives to Police for People with Behavioral Health or Other Disabilities In guidance and public findings issued last year, the United States Departments of Justice (DOJ) and Health and Human Services (HHS) have made clear that federal law requires that people with behavioral health and other disabilities receive a health response—not a law enforcement response—in circumstances where others would receive a health response. As the guidance explains, as many as 10 percent of police calls involve people with mental illness, who account for 20 to 25 percent of individuals killed by law enforcement. Although representing only 22 percent of the population, persons with disabilities may account for 30 to 50 percent of incidents of police use of force. BIPOC people with disabilities are disproportionately harmed in these encounters with the police. Black men with behavioral health disabilities are killed by law enforcement officers at significantly higher rates than white men who exhibit similar behaviors.

Public Health in Action: New Harvard Series Spotlights Fountain House as a Mental Health Innovation That Drives Real World Impact On Wednesday, Harvard Public Health magazine and the Harvard Chan Studio launched “Public Health in Action,” a new event series spotlighting mental health innovations that drive real world impact. For the inaugural discussion, experts chose to highlight Fountain House, the first and largest example of a mental health clubhouse. From their inception 75 years ago, these community-based programs have reimagined what mental illness recovery can look like, breaking free of the entirely medical model that existed at the time to offer people holistic resources, social supports, and the self-determination to ensure their long-term success.

Join SAMHSA’s Webinar on Examining the Use of Braided Funding for Substance Use Disorder Services On February 29, SAMHSA will host a webinar to discuss innovative ways to use braided funding for substance use disorder (SUD) services to help optimize resources, improve patient outcomes, promote funding sustainability, and address service gaps. This webinar will coincide with the release of a new report, Examining the Use of Braided Funding for Substance Use Disorder Services.

Biden-Harris Administration Marks Two Years of Advancements in HHS’ Overdose Prevention Strategy with New Actions to Treat Addiction and Save Lives The U.S. Department of Health and Human Services (HHS) marked two years of its Overdose Prevention Strategy (Strategy) by announcing bold new actions to combat overdoses. These actions include finalizing a rule that will dramatically expand access to life-saving medications for opioid use disorder, announcing that certain grant funds may now be used to purchase xylazine test strips (XTS), and releasing the Substance Abuse and Mental Health Services Administration’s (SAMHSA) updated Overdose Prevention and Response Toolkit. Actions announced today build on President Biden’s National Drug Control Strategy and his Unity Agenda call-to-action to address the overdose epidemic and save lives.

Harnessing the Power of Family Treatment Courts New three-part series of briefs:
Brief 1: Funding and Sustaining Crucial Services for Families

Brief 2: Using Data as a Tool for Change

Brief 3: Considerations for Meeting the Needs of Families Based on Community Population Density (urban vs. rural)

Each brief covers key strategies to improve practice along with tools and resources for more in-depth information. Download a copy today to learn how your Tribe, state, or county can harness the power of family treatment courts to improve services and outcomes for families affected by substance use.

Office for the Advancement of Telehealth Announcements Telehealth Community Story on Mobile Clinics for Substance Use Disorder, Health Equity in Telehealth, and many more OAT announcements and resources.

CSG Justice Briefing Meet newest team members; North Carolina joins Reentry 2030; Maryland shows increase in unsolved violent crimes; and more.

In the News

DHHS Putting $5.5 Million Into Behavioral Health Program for Formerly Incarcerated People The North Carolina Department of Health and Human Services will award $5.5 million to a program that provides psychiatric and physical health care services to people coming home from jail or prison, the agency announced this week. The initiative helps imprisoned people with serious mental health conditions as they try to navigate life outside the confines of a cell, helping them with their health needs and, once they’re free, connecting them with community supports like housing and transportation.

Bill Aims to Free Up Mental Health Beds, End ER Waits by Increasing Housing A bill advocates say could reduce, even eliminate, emergency room waits for psychiatric beds cleared its first hurdle Wednesday. Senate Bill 410 would allot $3 million to transitional, supportive housing for people who no longer need in-patient behavioral health treatment but are not ready to live independently. Mental health advocates estimate there are 40 to 50 people who could be discharged from New Hampshire Hospital if there was sufficient transitional housing. That would open more than enough beds to accommodate the 23 adults in mental health crisis waiting Tuesday for in-patient treatment.

Virginia's Mental Health Crisis: Urgent Call for Community-Based Reform Virginia's mental health care system is buckling due to hospitalization over-reliance, causing significant strain on law enforcement. Governor Youngkin's 'Right Help, Right Now' initiative proposes a community-based system to alleviate the burden and enhance patient care. However, advocates express concerns over the pace of reform implementation.

Health Department, DOC Collaborate to Revamp Jail Diversion Programs for Mentally Ill Offenders The Hawaii Department of Health (DOH) and the Department of Corrections and Rehabilitation are proposing solutions on how to keep mentally ill criminal defendants out of prison. Both departments are working together to create a better jail diversion system by incorporating more mental health services. The goal is to help with jail overcrowding and decrease recidivism. The DOH notes that the current jail diversion programs are not effective because only 1% of inmates who are eligible participate in the program.

Lawmakers Seek Changes to Mental Health Law Oklahomans with mental illness or substance abuse conditions can be detained for stabilizing treatment if they pose an immediate threat of harm to themselves or others. But the requirement that harm be immediate disqualifies many in need of help, leaving them to further deteriorate, often resulting in homelessness, incarceration, serious injury or death. A Tulsa lawmaker aims to change that with House Bill 3451. The proposal expands who is eligible for commitment to include someone who has a history of threatening or posing physical harm to themselves or others as a result of mental illness or substance abuse.

Marion County Judge Takes New Approach With Defendant Unable to Assist in His Defense A Marion County Circuit Court judge on Friday ordered a man charged with attacking three Salem-Keizer Public School employees to remain in jail with weekly treatment at the Oregon State Hospital until he is able to aid and assist his lawyer in his defense. Typically a defendant who had reached the end of their jurisdiction at the psychiatric hospital would enter a community restoration program to continue learning legal skills, take prescribed medication, and sometimes stay in a treatment bed provided by the Psychiatric Crisis Center in Salem. But Judge Audrey Broyles said she found Charly Josh Velasquez-Sanchez, 27, of Keizer, a public safety risk and unable to engage in community restoration "at this time." Broyles' order means Velasquez-Sanchez will continue to get psychiatric care but remain in a secure facility.

Dying for Help | Mental Illness Behind Bars Alan Thibodeau was behind bars at the Bamberg County Detention Center for almost five months. During that time, he lost nearly 80 pounds and eventually also lost his life. He was not supposed to be behind bars. A judge ordered him to be sent to a mental health facility, but Thibodeau never made it. Alan Thibodeau died at a hospital days before he was finally set to be transferred. Alan was supposed to be in a mental health facility. The South Carolina Department of Mental Health deemed him incompetent to stand trial during a court-ordered evaluation. Southern Health Partners oversees medical care at the Bamberg County Detention Center. Overall, Southern Health Partners touts on its website that it has contracts in more than 240 correctional facilities in 14 states.

Lawsuit Challenges Law Enforcement Response to Mental Health Emergencies in Washington County, Oregon Civil and disability rights organizations filed suit in federal court today on behalf of individual and organizational plaintiffs against Washington County, Oregon and the county’s 911 dispatch center, the Washington County Consolidated Communications Agency, over their practice of dispatching armed law enforcement officers rather than qualified mental health professionals as first responders to mental health emergencies.


Wellness Tools for Personal and Professional Practice Behavioral health programs and providers recognize the importance of using strengths-based wellness programs in their work with people who face mental health substance use, medical and trauma related challenges, but do not know where to start. This SMI Advisor session will introduce a variety of user friendly publicly available accessible wellness tools based on the 8 dimensions of wellness. The session will also outline tools to measure wellness as part of a program evaluation, and how to use wellness tools to promote provider wellness self-care.

People are Comfortable Discussing Mental Health at Work—Just Not Their Own A new poll finds that while more employees and employers feel that mental health discussions have a place at work, people are still reluctant to share their personal struggles in the workplace—and most managers haven’t received training on how to address these concerns.

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