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 new resources for courts and our partner stakeholders. Going forward each Behavioral Health Alerts will revisit a Task Force recommendation and an accompanying resource.
Finding: Large numbers of defendants, including many who are charged with misdemeanors or non-violent felonies, spend excessive time in jail awaiting mental health evaluations and competency restoration, often staying longer in custody than they would have if they had been convicted of the crime, creating unnecessary cost that could be reinvested in community treatment. Those that then go through a restoration process often emerge legally competent, but remain untreated, and are returned to their communities with a poor prognosis for the future.
Recommendation: Courts and communities should reserve the competency process, including evaluation of competence to stand trial, for defendants who are charged with serious crimes. Others, especially individuals charged with misdemeanors and assessed as low risk to recidivate and whose clinical conditions are not likely to substantially improve (e.g., individuals with dementia) should be diverted to treatment.
Courts should consider the creation of competency dockets that facilitate access to appropriate diversion and outpatient restoration resources for cases involving competency. Courts should actively manage the progress of a competency case to avoid an individual languishing in jail and decompensating. Hearings should be scheduled and held without delay at every juncture.
In 2021, the Task Force published a comprehensive report on the problems with and changes needed in the competency to stand trial system. All courts are urged to use Leading Reform: Competence to Stand Trial Systems and other resources developed by the Task Force to gain a clear understanding of current system gaps, strengths, and weaknesses as measured against these recommendations.
Chief Justice Calls On State To ‘Join Forces’ To Solve Homelessness, Mental Health Crisis Chief Justice Recktenwald says the state needs more treatment beds and access to crisis intervention centers to provide care for those experiencing mental health problems. “My sense is that we’ve got a long way to go, but areas where we have agreement should be the focus. The state has the resources,” Recktenwald said in a phone interview following his speech. While treatment beds and crisis centers are run by agencies like the state Department of Health and not the Judiciary, Recktenwald said he thought it was important to advocate for programs that could keep people out of the criminal justice system.
Diversion Grant Sites Selected The National Center for State Courts (NCSC), with funding from the Sozosei Foundation, is testing the usefulness of the updated Judges' Guide to Mental Health Diversion. Five applicant jurisdictions have now been selected, and will be provided on-site and virtual technical assistance by NCSC to test the Guide and to assist those jurisdictions to plan and implement jail diversion systems for individuals with behavioral health needs. The selected sites are: Eau Claire, Wisconsin; Montgomery County, Kansas; Montgomery County, Missouri; Letcher County, Kentucky; and Stephenson County, Illinois.
Research and Resources
JPLI Newsletter - The 2023 Judge Stephen S. Goss Memorial Award Nominations Are Open In 2021, JPLI established two awards in honor of the late Judge Stephen S. Goss, presented during the annual JPLI Leadership Summit to one judge and one psychiatrist who have demonstrated extraordinary leadership in improving the lives of people with behavioral health needs in the criminal justice system. Now in their third year, the Judge Stephen S. Goss Memorial Awards will be presented for the first time in person ahead of the American Psychiatric Association annual conference in San Francisco, CA.
CMS Approves Waiver to Enable California to Offer Medicaid Coverage to Incarcerated Individuals The Centers for Medicare & Medicaid Services (CMS) approved the Section 1115 waiver Thursday that helps connect Medicaid beneficiaries to providers before release. It is the first time Medicaid will offer coverage for those who are still in the justice system. Under the waiver, a Medicaid beneficiary can get substance use treatment if they are in a jail, prison or youth correctional facility. California can also help connect the beneficiary to a community-based Medicaid provider 90 days before they get released from the justice system.
Connecting Recently Released Prisoners to Health Care—How to Leverage Medicaid This NCSL report finds that connecting recently incarcerated individuals with health care coverage, specifically Medicaid coverage, may reduce recidivism and improve the health and outcomes of this population. Medicaid is the most common payer of services for recently incarcerated people. A recent study found that the risk of overdose death was highest in the first week after release. Recent changes in federal law incorporate a new exception to the Medicaid Inmate Exclusion Policy for certain eligible juveniles and give states new flexibilities.
TAC Research Weekly: Evaluating Assisted Outpatient Treatment Participants’ Satisfaction Assisted outpatient treatment is a community outpatient treatment program for people with severe mental illness who have a history of difficulty with treatment engagement. Key findings:
- AOT participants reported high levels of satisfaction and feelings of empowerment with regard to both their treatment team and the courts. More than three-quarters of participants agreed that they were satisfied with their treatment team and with the courts.
- Most AOT participants felt they received benefits from the AOT court order and from participating in the program.
- Black participants were significantly more satisfied with their treatment team and with the courts than white participants.
- The aspect of the program AOT participants liked best was the people. For some, this was their treatment team, whereas for others, this was the judge or magistrate.
New Federal Guidance Improves Access to Opioid Treatment in County Jails Two new reports from the Office of National Drug Control Policy (ONDCP) and U.S. Department of Justice (DOJ) offer guidance on improving the provision of medication-assisted treatment (MAT) for opioid use disorders (OUD) in correctional facilities as well as clarifies disability protections of people on MAT for OUD. New guidance from DOJ clarifies that people on MAT for opioid use disorder are protected by the Americans with Disabilities Act (ADA). The guidance provides information on enforcing the ADA to protect individuals in recovery from OUD who are not engaging in illegal drug use from discrimination, including those who are taking legally prescribed medications to treat their OUD.
Expanding Access to and Use of Behavioral Health Services for People Experiencing Homelessness This SAMHSA guide provides strategies and implementation considerations for behavioral health providers and others practitioners to:
- Engage people currently experiencing homelessness
- Build strong relationships with these individuals
- Offer effective mental health and/or substance use disorder treatments
- Improve retention in recovery efforts
Federal Funding Sources for Addressing Homelessness Tool For cities looking to comprehensively address homelessness at the local level, there is an array of federal funding sources available for a wide variety of eligible uses. This new tool offers a searchable list of federal grant programs designated for homelessness support, intervention or prevention, and those that are particularly relevant to support people at high risk of experiencing homelessness.
SAMHSA Announces Funding Opportunities for Grants Addressing Substance Misuse, Substance Use Disorder Treatment on Multiple Fronts The U.S. Department of Health and Human Services, through SAMHSA, has announced Notices of Funding Opportunities (NOFOs) for five grant programs aimed at preventing substance misuse and treating substance use disorder (SUD) throughout the nation. The grant opportunities total about $73.4 million and align with the Biden-Harris Administration’s efforts to address the nation’s addiction and overdose crises.
BJA Adult Treatment Court Solicitation Webinar The Bureau of Justice Assistance will host a webinar for the adult treatment court solicitation on Wednesday, February 15 at 2:30 p.m. ET. This presentation will provide a detailed overview of the solicitation and allow an opportunity for interested applicants to ask questions.
BJA Releases FY23 Veterans Treatment Court Grant Solicitation A webinar will be held on Thursday, February 16 at 2:00 p.m. Eastern to provide more information and answer questions about the solicitation.
VA to Pay for all Emergency Mental Health Care Starting Next Week Starting Jan. 17, all veterans will be able to access emergency mental health care free of charge at any Veterans Affairs medical facility or outside clinic, regardless of whether they are already enrolled in department health care services. Department officials announced the new policy on Friday as part of nationwide efforts to prevent suicide among veterans. According to the latest department data, about 17 veterans a day die by suicide.
Site Snapshot: How Five Jurisdictions Are Rethinking Crisis Response with the 988 Suicide and Crisis Lifeline Six months after the Substance Abuse and Mental Health Services Administration (SAMHSA) transitioned to a national 988 dialing code for the Suicide and Crisis Lifeline, call takers have directly connected hundreds of thousands of people to trained crisis responders within the National Suicide Prevention Lifeline Network. This snapshot highlights five jurisdictions starting this important work.
Culturally Competent & Trauma-Informed Crisis Management Different stimuli result in crises for different people with culture playing a strong role in how meaning is attributed to a stressor, how a crisis is interpreted, and how individuals and communities express reactions to crises. In this SMI Advisor webinar possible stressors, including those that may be linked to traumatic experiences, will be identified along with signs of a mental health crisis and trauma informed approaches for de-escalation. Components of culturally competent crisis response including acknowledgment and acceptance of cultural differences to facilitate immediate trust and rapport will be reviewed.
Does Bail Reform Lead to More Crime? What 2 Loyola University Professors Found Examined data from 11 jurisdictions nationwide that enacted bail reform -- from Alabama, where 78 municipalities eliminated bail for misdemeanors, to New Jersey, where the entire state eliminated cash bail for most offenses -- to see how it affected crime rates. Their findings? "The increase in pretrial release had a minimal effect on the overall rates of crime in the community, and in some communities, during these periods of reform, crime was actually going down."
County Guide for Reducing Jail Populations Identifying the drivers of a local jail population is the first step in reducing the number of people in jail. This toolkit helps county officials lead local efforts to understand jail population drivers and implement data-driven solutions to manage these factors and associated costs. The charts below outline key policies and/or practices that address each jail population driver and their potential impacts beyond jail reduction, as well as key resources and county examples to help support local decision making.
CSG Justice Briefing Includes Community-Driven Crisis Response: A Workbook for Coordinators, and a BJA video, The Life-Changing Impact of Reentry Housing.
TAC Research Weekly: Varying Policy Definitions of Serious Mental Illness Data was collected between October 2020 and May 2021 by reviewing governmental websites and publicly available legislative administrative codes for all 50 states. Many states have extreme differences in how they define serious mental illness, with some states even using more than one definition in legislation. This makes it difficult to craft effective public policy to address the unique needs of this population, according to the study authors. It also complicates service funding and allocation, as a lack of a standardized definition of serious or severe mental illness may impact grant eligibility.
Service Fees, Equity, and Funding 988 It’s been over two years since the United States Congress passed the National Suicide Hotline Designation Act of 2020, allowing states to implement a monthly telecom service fee for 988 crisis system costs. Yet, only five states have enacted one, said Hannah Wesolowski, chief advocacy officer of the National Alliance on Mental Illness. The 988 fees are about equity, she said. “With mental health crisis care, we are trying to build that system where it doesn’t exist in most places,” she emphasized. Educating policymakers and telecom industry members on 988 has been critical to decrease conflating the intent of 911 and 988 fees.
New Dataset on State Laws Directing Opioid Litigation Proceeds The dataset examines key features of laws that direct the use of opioid litigation proceeds across all 50 states and the District of Columbia in effect as of August 1, 2022. These data can be used to assess states’ progress in enacting the Opioid Litigation Proceeds Model Act, identify gaps in existing state laws, and demonstrate the utility of policy surveillance methods for assessing adherence and diffusion of model legislation.
In the News
Hospitals want court fines to force state expansion of mental health beds On Jan. 10, a group of 15 New Hampshire hospitals filed a motion for summary judgment against the commissioner of Health and Human Services. The motion claims the Department of Health and Human Services continues to dodge its responsibilities to mental health patients facing involuntary commitment for psychiatric care. “There have to be some fines,” he said, “and they have to be substantial enough that the state will decide it costs more money to pay the fines than to hire the necessary staff.”
WA still too slow with mental health services for people in jail, judge told A federal judge is being asked to weigh in on whether Washington state’s social services agency should face consequences for major delays in providing mental health services to people in jail. Disability Rights Washington has filed a motion in federal court alleging the Department of Social and Health Services is in breach of a 2018 settlement to provide timely competency restoration services to thousands of people waiting in jails. The nonprofit civil rights group is asking the court to consider reinstating fines and using other means to compel DSHS into compliance.
Policing the homeless problem: Cities spent $8.6 million on police to deal with homeless shelter impacts In 2022 the Utah Legislature more than doubled the funds in its Homeless Shelter Cities Mitigation Fund. The account distributes grants to cities with homeless shelters and resource centers to help them deal with the impacts on their communities. The fund allows cities to spend the money either on police or on social services and other expenses to address the root causes of homelessness. Since more than $10 million was doled out in the summer of 2022, eight cities across the state have overwhelmingly spent the grant funding on police. Over $8.6 million, or 91% of the funds, went to public safety expenditures. Another 5%, or just under half a million dollars, went to social services and another 4%, just under $400,000, went to support for communities and neighborhoods.
Civil rights groups file lawsuit to block Newsom’s plan for treating people with mental illness A coalition of disability and civil rights advocates filed a lawsuit Thursday asking the California Supreme Court to block the rollout of Gov. Gavin Newsom’s far-reaching new plan to address severe mental illness by compelling treatment for thousands of people. The groups argue that the sweeping new CARE court system will violate due process and equal protection rights under the state constitution, while “needlessly burdening fundamental rights to privacy, autonomy and liberty.”
Idaho Supreme Court State of the Judiciary Highlights Behavioral Health Collaboration “The judiciary continues to support the mission of the Idaho Behavioral Health Council, our collaboration across the three branches of government focused on better solutions for those in this state who live with mental illness and addiction. One piece of the Council’s work that the Judicial Branch directs is an exercise that brings together stakeholders from across a community’s behavioral health and justice systems to better understand how those systems overlap. These discussions lead to solutions that address gaps in behavioral health services. We have previously relied on national facilitators to lead these exercises. In an important development, we now have skilled Idaho facilitators who can conduct this work, leaving us more flexible and capable of deeper conversations on potential gaps.”
New program reduces waitlist for court-ordered treatment A new program created by the Colorado Office of Civil and Forensic and Mental Health (OCFMH) has restored 25% of clients to competency without the need for inpatient hospitalization since it began in July 2022. The pre-restoration education program pilots a new strategy that partners with Colorado’s jails to offer competency restoration education while clients are waiting for admission to the mental health hospitals. The program, which is funded through the federal American Rescue Plan Act, has served 57 clients in the past six months. Throughout that time, it has restored 25% of those clients to competency, placed 31% in inpatient services and placed 6% in outpatient services. Twenty-five percent of cases were dismissed by the court, and the remaining 13% declined to participate.
With lack of options in Oregon, some wait for weeks for mental health treatment: 'Not enough support' Nan Waller, a Multnomah County Circuit Court judge who handles the mental health docket, told KGW that incompetency cases are increasing each year in Oregon. Waller explained upwards of 5,000 people a year in Oregon face similar limbo.
Wellbeing
Law is the most stressful profession, newspaper's analysis finds The Washington Post looked at a subset of well-being data collected in four American Time Use Surveys between 2010 and 2021. The surveys asked respondents how meaningful their activities were or how happy, sad, stressed, pained and tired they felt on a six-point scale. Lawyers were the most stressed, although their professional grouping of professional, scientific and technical workers was on the whole second most stressed, with a rating of 2.7 on the six-point scale.
Managers Have Major Impact On Mental Health: How To Lead For Wellbeing According to 69% of people, their managers had the greatest impact on their mental health, on par with the impact of their partner. And this was more than the impact of their doctor (51%) or therapist (41%). This is according to a new study by The Workforce Institute at UKG which included 3,400 people across 10 countries.
5 tips for mind & body wellness in 2023 Mental health is an important, but sometimes overlooked, component of overall health and well-being. What better time than the start of a new year to find ways to promote your mind-body wellness? Practicing mindfulness and having a good work-life balance, as well as incorporating a healthy diet, exercise and good sleep habits, can lead to better mental and physical health.
