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: Children, Youth, and Families It is not just a criminal justice issue. The needs of adults, children, and families impacted by serious mental illness touch every aspect of the court system, including child welfare, juvenile, and domestic relations cases. Courts must examine, educate, and advocate for better ways to meet the needs of individuals who enter the justice system and how better to coordinate multiple courts and responses to make a more person-centered system.
Recommendation: Child Welfare Courts should examine Upstream and other Task Force resources to ensure a continuum of behavioral health practices and improve outcomes for children and families with behavioral health needs. State and local courts should use Upstream as a framework to coordinate and align efforts across the child welfare system to promote safe and healthy families and communities and map community resources and opportunities.
Juvenile Justice: Courts should lead efforts to divert youth with mental health needs from juvenile justice involvement, when appropriate. Courts should examine Juvenile Justice Mental Health Diversion and other Task Force resources to support opportunities for youth with mental health diagnoses to be diverted away from deeper involvement with the justice system at multiple points of contact, such as at school when contacted by law enforcement, referral, pre-petition, detention, and pre-adjudication.
Domestic Relations: Courts must promote the well-being of individuals and families, including implementation of trauma-responsiveness for families, throughout the life of their case and the primary desired outcome, utilizing the Understanding Series and other Task Force resources.
Last Chance - Nominations Are Open for the 2023 Judge Stephen S. Goss Memorial Awards In 2021, the Judges’ and Psychiatrists’ Leadership Initiative (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. Anyone interested in nominating a judge or psychiatrist whose work demonstrates excellence and leadership must submit a nomination form by March 17, 2023. Applicants who want to be considered for these awards can also submit the form themselves by the deadline.
Research and Resources
Racial Disparities in Diversion: A Research Roundup Research shows diversion “works”, reducing harmful outcomes and increasing access to social services. However, studies also suggest diversion is routinely denied to people of color, sending them deeper into the criminal legal system. We review the research and remind practitioners that most diversion programs aren’t designed around racial equity — but should be.
Telehealth Flexibilities after the PHE and DEA Proposed Telemedicine Rules CMS released a fact sheet on what to expect at the end of the COVID-19 public health emergency (PHE), including for telehealth services in Medicare, Medicaid and CHIP, and private health insurance; the Drug Enforcement Administration’s (DEA) proposed rules extend many telemedicine flexibilities adopted during the COVID-19 PHE; and New Tips to Put Telehealth Innovations into Practice.
The Push to Bring Medicaid Behind Bars In January, federal health officials for the first time signed off on having Medicaid pay for services for some people in jail, prison or a juvenile facility. The goal is to use the time before someone leaves incarceration to connect them with medical providers in the community and limit any disruption in their care. In 2018, Congress directed federal health officials to help states figure out a better transition plan for people leaving incarceration. Since then, 15 states from across the political spectrum have asked the Centers for Medicare and Medicaid Services (CMS) to let them test what would happen if they turned Medicaid on before people leave jail, prison and juvenile facilities. In January, California became the first state to get the green light. “We hope that what we are approving today is an exciting model for what we are able to partner [on] with states across the country,” said Dan Tsai, Deputy Administrator and Director of the Center for Medicaid and CHIP Services at CMS.
Strengthening Community-Based Service Capacity through the Justice Reinvestment Initiative Through the Justice Reinvestment Initiative (JRI) process, multiple states have established goals, policy structures, and implementation strategies to provide and enhance community-based services related to safety and well-being, such as behavioral health treatment, violence prevention, victim services, and reentry support. This report focuses on 10 JRI states’ strategies for advancing public safety goals by collaboratively building community capacity to provide and enhance vital safety and well-being services. We identify common themes among these approaches and explore lessons learned from the successes and challenges of JRI community collaborations that can inform similar efforts.
TAC Research Weekly: Arrests of Individuals with Co-Occurring Substance Use and Mental Health Disorders Approximately 60 percent of those with a moderate or serious mental illness who are arrested also have a substance use disorder, indicating a co-occurring substance use disorder is a large factor in the criminal justice involvement of individuals with serious mental illness. The Pew Charitable Trusts suggests that integrated treatment for those with co-occurring disorders may help reduce their contact with the justice system. Some studies indicate that more integrated mental health and substance use treatment availability would likely also have positive effects on wages, employment, housing stability, physical and mental health for those with mental illness.
Breaking the Cycle: Wayne County, MI Probate Court Behavioral Health Unit In 2021, the Wayne County Probate Court established a Behavioral Health Unit (BHU) within the court to convene the stakeholders in the community to improve the justice system response to mental illness. The BHU created the opportunity to connect silos to ensure that persons receive the appropriate treatment when and where they need it. The BHU program is focused on the civil justice system. By intervening early and coordinating care, it helps to break the cycle of repetitive emergency care, hospitalization, and engagement with the criminal justice system.
New Funding Opportunities from SAMHSA The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released several new funding opportunities to support the mental health of children, youth, and young adults. Funding is available for Assertive Community Treatment, Treatment for Individuals with Serious Mental Illness, Serious Emotional Disturbance or Co-Occurring Disorders Experiencing Homelessness, and Mental Health Awareness Training.
Steering in the Right Direction: Diversion and Supports for Transition-Age Youth in the Criminal Justice System The Steering in the Right Direction: Diversion and Support for Transition-Age Youth in the Criminal Justice System Virtual Summit will feature innovative programs and implementation strategies to support transition-age youth (TAY) prior to and throughout involvement with the criminal justice system. The three presentations will include Mobile Response and Stabilization for Transition-Age Youth, Alternative Solutions Supporting Diversion from the Criminal Justice System, and Preparing Transition-Age Youth for Successful Reentry to the Community.
Planning for Certified Community Behavioral Health Clinic Program Sustainability: Lessons from State Medicaid Leaders This brief, authored by the Center for Health Care Strategies (CHCS) and funded by the National Council for Mental Wellbeing, draws on interviews with current and former Medicaid leaders to explore how two other programs providing states with temporary enhanced federal funding — ACA Primary Care Fee Bump and Medicaid Health Homes — may offer potential lessons for how states can plan for CCBHC sustainability. The brief highlights four key themes: (1) defining how CCBHCs advance state priorities; (2) engaging stakeholders to build support; (3) using data to measure program impact; and (4) aligning CCBHCs with value-based payment efforts.
Law Enforcement Response to People with Developmental Disabilities: Steps for Deflection or Pre-Arrest Diversion This resource provides insights into the developmental disability community, offers suggestions for successful interactions, and outlines options for safe and effective deflection and pre-arrest diversion when people with developmental disabilities encounter law enforcement and may be experiencing a crisis or are otherwise in need of services.
CSG State of Justice La Crosse County considers joining nationwide effort to reduce number of people in jail with mental illnesses, a new investigation into the Pennsylvania competency system, and more.
NRI Newsletter Includes new research, Overflowing Demand for Mental Health Care Stretching Hospitals, New Data Shows, and The Workforce Crisis: How States Are Responding to Shortages in the Health Care Workforce.
Justice For Vets Podcast: When Thank You Is Not Enough Episode 1, Part 1 explores the effects of trauma and post-traumatic growth on our military veterans with guest Jaymes Poling, the creator of Modern Warrior LIVE, an immersive music and narrative experience that chronicles his journey through three U.S. Army deployments in Afghanistan and subsequent transition back home.
In the News
NY State of Our Judiciary Address Highlights Mental Health Best Practice Efforts New York Acting Chief Judge Anthony Cannataro announced plans to study and implement best practices for state courts to promote systemic and community-level change in response to mental and behavioral health issues with criminal defendants. “Once these individuals are before our courts, we have an obligation to provide effective and appropriate competency procedures and diversion options to reduce the likelihood of incarceration and increase the rate of recovery,” he said.
Hawaii Senate Committee on Ways and Means passes four behavioral health bills Senators unanimously passed SB 1594, which would establish a crisis intervention and diversion program within the Department of Health (DOH) to divert those with mental health issues to appropriate healthcare services. It would authorize a person believed to be imminently dangerous to themselves or others by a law enforcement officer to be assisted by a crisis intervention officer, and transported to a designated crisis center. Brandon Kimura, deputy administrative director of the courts for the state Judiciary, provided written testimony supporting SB 1594. “Behavioral health crisis centers that provide care, diagnosis, or treatment of persons experiencing a mental illness or substance use disorder crisis could provide extraordinary value to individuals, families, communities, and public and private systems,” Kimura said.
Wayne County Jail sees dramatic population decline. Here’s why Moving as many people as possible to alternatives outside the jail where mental health and substance use disorders can be addressed is “a more humane way to treat individuals,” Pullano added, and it is more cost effective for taxpayers than relying solely on jails. The county launched a Navigator program in 2018, which works to move people from the jail to mental health and substance use disorder treatment. The agency interviews candidates within hours of when they are booked in the jail to see if they’re a good fit for treatment, Smith said. Those inmates are then assigned a navigator to support them through the court process and with finding a job and staying employed through treatment.
Legal group files class action lawsuit against state agency on behalf of people with mental illness languishing in Oklahoma jails 'without trial or treatment' The Oklahoma Disability Law Center filed a civil rights class action lawsuit March 1 in federal court on behalf of four plaintiffs with severe mental illness who are incarcerated in Oklahoma’s county jails for months awaiting court-ordered mental health services known as competency restoration treatment. The lawsuit claims that more than 100 people are currently, in the words of a press release sent to The City Sentinel, “caged” in Oklahoma county jails awaiting competency restoration treatment. Plaintiffs ask the Court, among other things, to order the Department of Mental Health and Substance Abuse Services to “develop a remedial plan to reduce wait times for competency evaluations and competency restoration treatment to within constitutional limits.”
LA is Locking up More Mentally Ill People, Despite Diversion Efforts In 2015, Los Angeles County created a program to reduce the number of mentally ill people in its jails. Since then, the number of incarcerated people with mental illness has grown by 54%. While the creation of the Office of Diversion and Reentry has been a major step forward for the county, experts say it is not being funded at the pace of the problem. The office has successfully gotten thousands of people with mental illnesses out of jail, but absent significantly more funding or fewer arrests, the number of incarcerated people suffering from mental illness will likely continue to rise. Los Angeles County’s most recent adopted budget was $44.6 billion. The Office of Diversion and Reentry accounted for around half a percent of that.
What the World Can Learn From an Italian City’s Approach to Mental Health Recognized by the World Health Organization as demonstrating a global best practice in community-based mental health care, grounded in accoglienza (the Italian word for hospitality), Trieste Italy is a North Star for the world. Trieste’s community mental health program does not define people by their mental illness; they understand that a diagnosis is just one piece of information. Housing is integrated into the program, ranging from independent living to supportive family-style arrangements with 24/7 staff support. In a crisis-response situation, community mental health center staff steer people away from the trauma of hospitalization, or worse, incarceration, through short-term housing in a home-like setting managed entirely by peers.
Mass. lawmakers to wade into fierce debate over court-mandated mental health care Massachusetts is one of three states that does not allow judges to mandate outpatient mental health care, a process sometimes called "assisted outpatient treatment" or "involuntary outpatient commitment." State Sen. Cindy Friedman, a Middlesex Democrat, has renewed a legislative push to allow court-ordered outpatient mental health care in Massachusetts. Her bill, "An Act to Provide Critical Community Services," is expected to prompt fierce debate at the State House.
New centers offer care for mental health and addiction, but leave out most privately insured patients Mobile response is one of the services offered here and at 24 other community behavioral health centers or CBHCs that opened across Massachusetts in January. It’s a new statewide experiment in addressing mental health and addiction issues by funding a comprehensive range of services for patients. For now, though, insurance coverage issues prevent roughly three-quarters of patients from accessing much of the care these new centers provide.
Democratic mayors lead course correction on psychiatric commitments The new strategies represent a remarkable shift in mental health policy, coming half a century after the U.S. began shuttering or downsizing state psychiatric institutions as liberal policymakers condemned the facilities as inhumane and conservatives sought to cut down on their exorbitant cost. Now leaders of some of the nation’s most progressive cities say it is inhumane to leave people languishing without mental health treatment — even if it is involuntary.
SAMHSA Seeks $10.8 Billion in Fiscal Year 2024 to Bolster Mental Health and Substance Use Services Across the Nation The President’s Budget for Fiscal Year (FY) 2024 includes $10.8 billion for the Substance Abuse and Mental Health Services Administration (SAMHSA), $3.3 billion over the agency’s FY 2023 enacted budget. Investments will fund critical needs in key priority programs that address crisis care, youth mental health, and overdose prevention.
Wellbeing
Study confirms lawyer mental health concerns, highlights importance of connections A recent study from the American Bar Association is confirming years of research into lawyer mental health: Lawyers are twice as likely as the general population to experience thoughts of suicide. The study released last month — “Stressed, Lonely, and Overcommitted: Predictors of Lawyer Suicide Risk” — examined the relationship between thoughts of suicide and various factors like stress, loneliness, work over-commitments, work-family conflicts, alcohol use and prior mental health diagnoses.
