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.
Treatment Considerations in Correctional Settings This Mental Health Facts in Brief provides an orientation to circumstances that have led jails to be used as therapeutic settings for individuals with mental illness who become criminal justice-involved; the distinctions between true therapeutic settings and the realities of jail mental health care; and clinical outcomes related to their use. Alternatives to correctional settings for individuals who enter the criminal justice system as a result of unaddressed mental health conditions are identified.
Task Force Recommendations Implementation - Resources and News
Mobile Leaders Study 'Miami Model' to Manage Offenders With Mental Illness Public and private leaders in Mobile, Alabama are studying alternatives to incarceration to better deal with vulnerable populations such as those experiencing a mental health crisis. A city that has made strides in handling and assisting its citizens with crises in mental health and drug addiction is Miami, Fla. The city and Dade County put on a conference called “Decriminalizing Mental Health: The Miami Model.” Mobile leaders in public safety, community affairs and Municipal Court went to Miami with other community partners who regularly serve residents with mental health and substance abuse issues. AltaPointe Health, the local court system, and the Mobile County District Attorney’s Office all attended the conference. Maybe the "Miami Model" could be “Alabama-ized” and adapted here to better serve mental patients, public safety and the taxpaying public.
Dates for Decriminalizing Mental Illness: The Miami Model These two-day workshops in Miami provide an opportunity to hear directly from Judge Steve Leifman and his colleagues about Miami’s innovations in crisis response, diversion, civil off-ramps, competence to stand trial alternatives, and the effective use of peers. Attendees also visit the new model wraparound services facility, the Miami Center for Mental Health and Recovery. Most importantly, attendees learn how to engage in meaningful system change and leave with a plan to implement new strategies in their jurisdictions. The new dates: February 6-7, and May 8-9. Contact Rick Schwermer to hold a spot for you or your team at rschwermer@ncsc.org.
Research and Resources
Applying a Trauma-Informed Care Framework to Courtroom Practice: An Analysis of Judges' Perspectives Analysis of in-depth interviews with eight district court judges in North Carolina revealed over 40 practices that judges can adopt to become more trauma-informed in their work. These practices map onto SAMHSA's framework for a trauma-informed approach, demonstrating that abstract principles can translate into concrete actions in the courtroom setting. Analysis revealed an additional core principle of trauma-informed judicial practice—Rehabilitation and Healing—and several areas where judges can deepen their commitment to trauma-informed care—engagement with peer support programming; greater attention to cultural, historical, and gender issues; and application of trauma-informed practice in adult criminal court.
Homelessness and Serious Mental Illness The causes of homelessness among people with SMI are multifaceted and will require a range of solutions. Increasing infrastructure for services such as psychiatric hospital beds, supported housing, substance use treatment programs, individualized placement and support, and other programs that divert people from the criminal legal system, may help decrease homelessness among people with SMI. To decrease homelessness among people with SMI, it may also be necessary to implement policies that divert people with serious mental illness from the criminal legal system such as crisis-response teams, mental health courts, or assisted outpatient treatment. These policies can help people who are experiencing serious mental illness and homelessness to access treatment and avoid a criminal record, making it easier for them to obtain housing and employment.
Bringing Data to the Debate on Risk Assessments Our updated systematic review synthesized available articles that investigated the real-world impact of juvenile and adult risk assessments on racial/ethnic disparities in legal decision making. The key takeaways:
- Current evidence overall signals that risk assessments are not resulting in harsher treatment for individuals with minoritized racial and ethnic identities.
- More than one third of articles in this systematic review found that risk assessments helped decrease pre-existing racial and ethnic disparities in legal decision making.
- Most of the included articles focused on pretrial-related outcomes and a narrow type of risk assessment (e.g., brief pretrial risk screening tools).
- Overall, most studies tended to be methodologically weak. More gold-standard (i.e., pre-post comparison) studies are needed.
Matching Care to Need: 5 Facts on How to Improve Behavioral Health Crisis Response Jurisdictions across the country have started implementing best practices in crisis response, including investing in behavioral health responses that are evidence-based and promote long-term recovery and community safety. Recent federal guidance backs up these practices, and also details the legal responsibilities established by the Americans with Disabilities Act (ADA) and provides resources to support community efforts. Here are five facts about behavioral health crisis response as detailed in the guidance, and how they can be put into practice to improve community response efforts.
Crisis Systems Coordination and Collaboration: Leveraging Strengths and Opportunity of 988 and 911 The transition to the 988 Suicide & Crisis Lifeline in July 2022 was a major step toward creating an effective behavioral health crisis services system that can serve all people in the United States. Critical next steps include ensuring the collaboration between the 988 Suicide & Crisis Lifeline and 911 Public Safety Answering Points. Across the country, collaboration, organization, and partnership is variable and in different stages. Achieving fluidity between systems will ultimately help connect Americans to care when and where they need it, a key priority identified by policymakers and leaders. Decades of reliance upon 911 for behavioral health crises have led to the current need to develop technology, policy, protocols, and staffing to help ensure that anyone calling 988 or 911 will get the right response, at the right time, delivered in a way that eliminates disparities. This technical assistance brief will review many aspects of crisis system collaboration, incorporating stakeholder input gathered during this exciting transition from a default emergency medical and law enforcement response to a more intentional, varied continuum of behavioral health crisis responses.
Advising People on Using 988 Versus 911: Practical Approaches for Healthcare Providers This SAMHSA Practical Guide provides key considerations for guiding people in the appropriate use of 988 and 911. It offers practical steps for integrating crisis care into daily practice, real world scenarios, sample scripts, and de-escalation techniques.
Hitting Snooze Amidst Virginia’s Mental Health Crisis: The Shortcomings of the Bed of Last Resort and the Need for a Continuum of Crisis Care This Comment examines the history, structure, and unintended consequences of the Bed of Last Resort law by tracking its development and how it currently operates within Virginia’s broader mental health system. This Comment also evaluates the efficacy of the Bed of Last Resort law by comparing it to best practices for treating those experiencing mental health emergencies, focusing specifically on the Crisis Now model for a continuum of crisis care. This Comment concludes with proposals for improving the Bed of Last Resort law without completely overhauling the legislation.
Community Stabilization Programs May Reduce Psychiatric Boarding Among Youth Youth who experience a mental health crisis and participate in a community stabilization program are significantly less likely to return to an emergency department (ED) or inpatient psychiatric unit, according to a study issued yesterday in Psychiatric Services. “This study suggests that community-based crisis intervention programs with an array of services and that focus on bridging youths to longer-term services may represent a safe and effective alternative to ED boarding for some youths with high-acuity behavioral health needs,” the researchers concluded.
Now Released: Two New Reports From the Federal Coordinating Council on Juvenile Justice The Coordinating Council on Juvenile Justice and Delinquency Prevention (Council) has released two new reports to Congress representing input from multiple federal agencies and practitioners in the field:
- Report to Congress and The White House Fiscal Year 2023-2024. This report issues recommendations in support of a federal response to justice-involved youth. It is based on nearly two years of work by the Council listening to youth and families with lived experience, hearing from juvenile justice stakeholders, sharing information across Federal agencies, and visiting jurisdictions to see best practices in action. These recommendations and action plan are grounded in the Juvenile Justice and Delinquency Prevention Act and focus on OJJDP's Continuum of Care for Communities framework.
- Independent Practitioner Report on Youth Justice. This report by Council practitioners complements the full report of the Council by underscoring where additional opportunities may exist to meet critical needs of youth and families in their communities.
Treating People Who Use Meth or Other Stimulants: Leveraging Contingency Management in Criminal Justice Settings Contingency management is an evidence-based behavioral intervention proven effective in treating individuals with stimulant use disorders. This method leverages positive reinforcement to encourage specific target behaviors that reflect progress in treatment, such as attending sessions or maintaining abstinence. The webinar will address the scientific foundation of contingency management, common challenges associated with its implementation in criminal justice settings, and strategies for overcoming these barriers. Sustainable solutions for integrating contingency management into drug court and reentry programs, with an emphasis on its long-term benefits for individuals in recovery and the community will also be discussed.
SAMHSA Releases Substance Use Disorder Treatment Month Toolkit SAMHSA has released a toolkit for the first Substance Use Disorder Treatment Month to be observed January 2025. Treatment Month raises awareness of the benefits and availability of evidence-based treatments for people with a substance use disorder; addresses barriers to treatment, including stigma; and normalizes seeking help. The toolkit includes information about weekly themes, social media graphics and messaging; a webinar background; and resources that public health organizations, treatment providers, professional associations, and others can use to spread awareness of Treatment Month.
TAC Research Briefly: What in the World is Anosognosia? TAC is pleased to premiere Research Briefly, a periodic blog focused on timely research and pertinent information surrounding severe mental illness (SMI), with “What in the World is Anosognosia?” by renowned clinical psychologist, author, speaker, and subject matter expert on anosognosia, Dr. Xavier Amador.
In the News
How Are States Spending Opioid Settlement Cash? We Built a Database of Answers In the past few years, state and local governments across the U.S. have begun spending billions in opioid settlements paid by companies accused of fueling the overdose crisis. But where is that money going, who is getting it, and is it doing any good? Among the findings:
- States and localities received more than $6 billion in opioid settlement funds in 2022 and 2023. According to public records, they spent or committed about a third of that amount and set aside about another third for future use. The final third was un-trackable, as many jurisdictions did not produce public reports on the funds.
- States allotted, on average, about 18% of their funds for addiction and mental health treatment; 14% for recovery services such as housing, transportation, and legal aid; 11% for harm reduction efforts such as overdose reversal medications; and 9% for prevention programs that aim to stop people from developing substance use disorders.
Courts Face Growing Backlog of Defendants Waiting for Mental Health Treatment to Stand Trial Over the past five years, the number of people in Wisconsin who need to be evaluated for competency has increased by 50%, and the number of people who need treatment so they can be restored to competency has nearly doubled, according to state health department data. As a result, Milwaukee County Circuit Judge David Borowski said, people are being left to sit in jails, sometimes for months while their conditions linger or grow worse. Over those five years, the number of people ordered to undergo treatment to be restored to competency nearly doubled from 467 to 904. For them, the average wait time is 43 days.
New California Laws Going Into Effect in 2025 If a defendant is charged with a drug offense, courts are required to order an available drug treatment or education program (AB 2106). Under SB 1323, courts are now allowed to make competency determinations based on written evaluations by licensed psychologists or psychiatrists. Additionally, courts may refer incompetent defendants charged with felonies to mental health diversion programs. Furthermore, under SB 1400, if a defendant is incompetent to stand trial in a misdemeanor case, the court must consider referral to diversion or other options and subsequent dismissal at certain timeframes; and Under SB 910, treatment courts in California will need to operate in accordance with state and national guidelines, and the Judicial Council will be required to revise drug court standards of administration by Jan. 1, 2026.
Wellbeing
Countdown to the New Year: 10 Ways to Ring in Your Mental Health Mental Health First Aid (MHFA) has brainstormed 10 ways you can focus on your mental health in the coming year. Some are tangible actions while some are more philosophical. Whether you pick one, a few, or all, you’re taking a step toward fostering your overall wellbeing.
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