UPSTREAM: Strengthening Children and Families through Prevention and Intervention Strategies: A Court and Community-Based 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.

UPSTREAM: Strengthening Children and Families through Prevention and Intervention Strategies: A Court and Community-Based Approach Upstream is a community-based approach that leverages judicial leadership and collaborations with child welfare agencies, state and local public agencies, community-based organizations, and community members to increase access to community-based services, prevent child maltreatment and out-of-home placement, reduce court involvement, and support strong, safe, and healthy families.

Task Force Recommendations Implementation - Resources and News

Family-Centered Fridays: Upstream This Family-Centered Fridays session will provide an overview of the Upstream approach and feature panelists who will describe their experiences participating in a community mapping workshop.

Nominations Are Open for the 2024 Judge Stephen S. Goss Memorial Awards To recognize the critical impact of judges and psychiatrists in improving outcomes for people with behavioral health needs in the criminal justice system, the Judges and Psychiatrists Leadership Initiative (JPLI) established The Judge Stephen S. Goss Memorial Award for Leadership in 2021. The award honors the late Judge Goss and celebrates the work of at least one judge and one psychiatrist each year. Recognition is also made for lifetime achievement. To nominate a judge or psychiatrist who has worked to improve the lives of people with behavioral health needs in the justice system, complete this application by the end of the day, March 15, 2024.

Florida Legislature Makes Small Strides on Mental Health After ignoring the issue for years, the Florida Legislature started to address the mental health crisis in the criminal justice system. "Well, certainly there wasn't as much accomplished as I would have liked," noted Cindee Murphy. "But I have really big goals. I think the whole system needs to be fundamentally changed, and that's not going to happen overnight." "It was a very good step in the right direction," noted Miami Dade Judge Steve Leifman. "I particularly like the idea that there's required handoffs and treatment for people coming out of that (civil commitment) system. Right now, most people just get dropped, and that's part of the problem." Leifman, who has pioneered the use of mental health courts around the country, said he has been trying to make these changes for more than a decade.

Research and Resources

Dismiss Upon Civil Commitment With AOT: One Alternative to the Competency Restoration Crisis Dismiss upon civil commitment with AOT is the practice by which criminal charges are dismissed prior to a competency determination or in lieu of competency restoration and held in abeyance while an application for civil commitment is filed in civil court. Once a civil commitment order has been issued, the individual is released to an AOT program for community treatment and monitoring, usually after a short period in the hospital for stabilization. In most states, AOT orders can be continued for as long as needed or until the person voluntarily engages in treatment.

New Resource: Examining the Use of Braided Funding for Substance Use Disorder Services This report includes 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. In addition, the report discusses state and federal laws and policies that encourage braided funding to provide SUD services, best practices for braiding funds, and pathways to sustainability for SUD programs.

Patient Flow and Reutilization of Crisis Services Within 30 Days in a Comprehensive Crisis System Of 41,026 episodes, most (57.4%) began with mobile crisis services or a specialized crisis facility rather than the emergency department. Of the subset with merged EHR data, most episodes (63.3%) were not followed by reutilization. Factors associated with increased odds of 30-day reutilization included Black race, homelessness, stimulant use, psychosis, and episodes beginning with mobile crisis services or ending with inpatient care. Decreased odds were associated with depression, trauma, and involuntary legal status. Most (59.3%) episodes beginning with an involuntary legal status ended with a voluntary status. Conclusions: Crisis systems can serve a large proportion of individuals experiencing psychiatric emergencies and divert them from more restrictive and costly levels of care. Understanding demographic, clinical, and operational factors associated with 30-day reutilization may aid in the design and implementation of crisis systems.

Mental Health Interventions for Individuals With Serious Mental Illness in the Criminal Legal System: A Systematic Review Despite these gaps in the extant literature, this review provides support for both disseminating and implementing interventions for individuals with serious mental illness (SMI) who have criminal legal involvement. While future research is needed to examine how interventions could be delivered utilizing different workforces, at different points of intersection with the criminal legal system, and in other settings, results broadly highlight the promising implications of interventions for individuals with SMI who are criminal legal-involved. In turn, increasing access to evidence-based approaches has the potential to improve outcomes, disrupt cycles of reincarceration, and reduce the disproportionate burden of mental health disorders within the criminal legal system. More RCTs or other studies with fully powered samples, however, are needed to determine effectiveness in mitigating negative mental health outcomes for these populations.

Dr. Kimberly Arnold on Advancing Mental Health in Black Communities “The history of my ancestors is beautifully complex; it is powerful and painful, traumatic and triumphant. We have made and continue to make significant contributions to humankind. As we commemorate Black History Month, it’s essential to amplify discussions around the psychological wellbeing of Black communities by addressing systemic issues, destigmatizing mental health, advocating for equitable access to mental health resources and celebrating the resilience and contributions of Black people throughout history.” During Black History Month, we can raise awareness of the mental health challenges that many in the Black community may face and support those in need. Here are some specific ways that we can do this.

Prison Decarceration and the Mental Health Crisis: A Call to Action The number of incarcerated people in the United States with mental health treatment needs is inexcusably and unconscionably high. The authors argue that while the justice reform movement has made some laudable efforts to address the overincarceration of people with mental health treatment needs, these efforts have focused almost entirely on the front end of the criminal legal system (e.g., arrest and jail diversion), as well as problem-solving courts and alternative sentencing programs. And while plenty of work to prevent incarceration remains to be done, the authors seek to shine a bright light on how the post-conviction mechanisms of compassionate release, clemency, and sentencing review must be used—in some instances reimagined—to advance decarceration for people with mental health treatment needs in federal and state prison systems.

The Right to Choose and Refuse Mental Health Care: A Human Rights-Based Approach to Ending Compulsory Psychiatric Intervention American laws carve out startling exceptions to the bodily autonomy rights of people with psychosocial disabilities, allowing states to forcibly confine and medicate people labeled with mental illness. Recently, many states renewed efforts to expand forced treatment invoking ableist, sanist, and paternalistic rhetoric suggesting that mentally disabled people are incapable of knowing their own needs, precluding them from making competent healthcare decisions and putting them at perceived risk of future harm. This article will explore the historical trends of misusing psychiatric constructs to pathologize marginalized groups, along with the longstanding pattern of depriving people with psychosocial disabilities of appropriate care.

Too Little Too Late? Executive Orders and the Disappearance of Psychiatric Hospitals Deinstitutionalization of psychiatric hospitals was a complete success, if success is demonstrated by shutting down facilities and preventing the mentally ill from receiving desperately needed psychiatric treatment. However, in terms of successfully treating individuals suffering from a serious mental illness, deinstitutionalization was a complete failure. When the psychiatric hospitals closed, individuals needing inpatient psychiatric care did not disappear. Instead, the luckiest patients often languish in emergency rooms for weeks awaiting transfer to the dwindling number of psychiatric beds, while the unlucky ones are either warehoused in the criminal justice system or abandoned to the streets. This article examines whether the federal government has waited too long to reevaluate the IMD Exclusion policy and what would need to happen for states to reopen or build new psychiatric hospitals.

Upcoming 988 Crisis Jam Webinar The 988 Crisis Jam occurs every Wednesday at 12 PM noon Eastern. The March 20th session features Margie Balfour, MD, PhD, Evolution of a Comprehensive and Collaborative Crisis System.

Pre-Application Webinar: Assisted Outpatient Treatment Program for Individuals with Serious Mental Illness The Substance Abuse and Mental Health Services Administration (SAMHSA) is announcing a virtual webinar for prospective applicants interested in applying for fiscal year 2024 Assisted Outpatient Treatment Program for Individuals with Serious Mental Illness (AOT). The webinar will provide an overview of the NOFO and application requirements.

The Role of Community Health Workers and Peer Support Specialists in Reentry This CSG sponsored webinar will explore the integral role of community health workers and peer support specialists in reentry, highlighting the Los Angeles County Reentry Integrated Services Project's multiyear studies and the lived experiences of Los Angeles County Justice, Care and Opportunities Department program experts.

A SAMHSA-Sponsored Learning Series – Youth Behavioral Health Continuum Services and Supports The National Association of State Mental Health Program Directors (NASMHPD), the National Council for Mental Wellbeing (The National Council) and the Innovations Institute have partnered to develop a four-part series titled Youth Behavioral Health Continuum Services and Supports Learning Series which focuses on the role of multiple sectors in addressing comprehensive youth behavioral health and well-being. Webinar #1 is titled Assuring A Child Welfare Competent Mental Health Workforce: An Overview of the National Adoption Competency Mental Health Training (NTI).

BJA’s Access and Recovery Peer Recovery Support Services Training and Technical Assistance Center – Peer Networking Hour These monthly meetings will be open to BJA Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP) grantees as well as peers within organizations offering peer support services, recovery coach services, or similar services. These sessions offer a safe space for peers to come together and support each other, learn new ideas from colleagues, problem solve, celebrate successes, and collaborate.

SAMHSA’s GAINS Center Webinar: Implementing Complex Care Models to Reduce Frequent Service Utilization among Individuals Experiencing Mental and Substance Use Disorders People with complex healthcare needs, including mental and substance use disorders, can sometimes fall through service gaps and cycle between emergency, criminal justice, and hospital systems. Using a complex care model can provide jurisdictions with the structure and guidance they need to create effective systems that reduce reliance on costly emergency, criminal justice, and hospital resources. This SAMHSA-funded GAINS webinar will present an overview of complex care models that can help improve services for individuals with frequent utilization needs, with a deep dive into two specific models—the Ecosystems of Care model and the Recovery-Oriented Systems of Care model.

CSG Justice Briefing New tool for state leaders; applications now open for Great Lakes Community Responder Program Learning Community; funding opportunities; and more.

In the News

CCBHCs Could Become Permanent Part of Medicaid Proposed legislation in Congress could make certified community behavioral health centers (CCBHCs) a permanent fixture in Medicaid. The bill, H.R. 7545, would make CCBHCs a service option that state Medicaid offices may include in their state plans. Currently, the value-based, care-focused, all-in-one care model is only available through a time-limited waiver demonstration program, making it unavailable as an option that states can consider as a plan benefit within Medicaid.

Maryland Appeals Court Addresses State Delays in Psychiatric Admissions The Maryland Appellate Court has once again weighed in on what the court described as a “recurring problem” — when the Maryland Department of Health fails to timely admit to psychiatric facilities those criminal defendants found incompetent or too dangerous to stand trial. In a reported opinion written by Judge Kathryn Grill Graeff, the court last month ruled that where the department fails to admit a defendant found to be incompetent to stand trial and dangerous to a designated health facility within 10 business days, a party can file an action for constructive civil contempt and file for statutory sanctions (of $1,000 per day).

Saving Lives and Reshaping Futures: Nevada’s Specialty Courts Through our specialty courts, we are able to redirect clients and give them the chance they need to recover and succeed in their lives. Our specialty courts are not just about drugs, alcohol, and mental health challenges, however. In Nevada, we have more than 65 specialty courts, ranging from the most well-known – the adult drug courts – to mental health, veterans, DUI, juvenile drugs courts, gambling diversion, and more.

He Was Sick, so They Sent Him to Prison New York jails can transfer people with mental illnesses to maximum security prisons, even while they’re legally innocent. Across New York, the majority of defendants boarded out to prisons have severe mental health problems or behavioral issues. The thinking, according to authorities, is that while jails have limited resources and offer temporary accommodations, the state prison system has the facilities and 24-hour medical and security staff required to treat and house those with significant needs. In reality, they get funneled into a system notorious for violence and medical neglect.

IL Inmates Stuck in Jail Despite Mental Health Court Orders Dozens of inmates in Illinois are stuck in jails, despite court orders that they instead be treated in mental health hospitals. FOX 2 spoke with sheriffs from southern Illinois to Springfield who are taking action to protect prisoners they claim the state is ignoring. “Over the last couple years, it really got out of hand and at one point, we had 14 inmates declared unfit and still sitting in our jail,” Sheriff Campbell said. “The help they need is not available in our jail…and the State of Illinois needs to do their job and take care of these inmates.”


10 Tips to Boost Wellbeing in the Workplace in 2024 By taking steps to build a more resilient workforce, you can help your employees better manage their high-demanding jobs, stay balanced when faced with strong emotions and support each other in difficult times. Use these tips to move your workplace away from routine stress and toward resiliency.

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