Criminal Justice – Behavioral Health Partnerships Promoting Integrated Healthcare A Program for Governments, Hospitals, Specialty Care Providers and Advocates Creating a New System Dan Abreu, Policy Research Associates Gilbert Gonzales, Bexar County Mental Health Regina Huerter, Division of Behavioral Health Strategies

Sequential Intercept Model People move through the criminal justice system in predictable ways Illustrates key points, or intercepts, to ensure: Prompt access to treatment Opportunities for diversion Timely movement through the criminal justice system Engagement with community resources

Development Mark Munetz MD and Patty Griffin PhD (and Hank Steadman PhD) People move through criminal justice system in predictable ways Illustrates key points to “intercept,” to ensure: Prompt access to treatment Opportunities for diversion Timely movement through criminal justice system Linkage to community resources

The “Unsequential” Model Arrest Community Supervision Initial Hearings Prison Jail Community Mental Health Courts Substance Use Reentry

Sequential Intercept Model

A Series of Points Series of points to potentially intercept individuals Each point has possibilities for intervention Interventions to prevent individuals from entering or penetrating deeper into criminal justice system Community can develop targeted strategies Strategies evolve over time to increase diversion and linkage to community treatment and support services

Introducing Intercept 0

Police Authority to Act Parens Patriae Doctrine Parens patriae is a doctrine that allows the state to step in and serve as a guardian for children, the mentally ill, the incompetent, the elderly, or disabled persons who cannot care for themselves. Police Power The right of states to make laws governing safety, health, welfare, and morals is derived from the Tenth Amendment, which states,

Warrior vs. Guardian Sue Rahr Executive Director Washington State Criminal Justice Training Commission In 2012 we began asking the question, “Why are we training police officers like soldiers?” Although police officers wear uniforms and carry weapons, the similarity ends there: The missions and rules of engagement are completely different. The soldier’s mission is that of a warrior: to conquer.The rules of engagement are decided before the battle. The police officer’s mission is that of a guardian: to protect. The rules of engagement evolve as the incident unfolds. Soldiers must follow orders. Police officers must make independent decisions. Soldiers come into communities as an outside, occupying force. Guardians are members of the community, protecting from within.

Report Findings Disseminate baseline models of CIT Involve peer counselors when appropriate LE should engage multidisciplinary team approaches POSTS should make CIT available for basic recruit and in- service training Congress should appropriate funds to support CIT

Law Enforcement/Emergency Services Cross-Systems Mapping & Taking Action for Change 10/07 Police-based Crisis Intervention Teams Co responder model: MH professionals employed by police department or police-mobile crisis co-response Los Angeles/CA MEU: SMART, CAMP, Triage Unit SAMHSA Early Diversion Grantees, Knoxville, Boulder, CT Houston PD MH Division (Homeless, Consumer Stab. 10 Co- response Teams Population specific models: Atlanta HOT Teams (Homeless) Seattle LEAD Teams (low level drug offenders) Mobile mental health crisis teams Facilitator Note: The next five slides review the five key intercepts Describe each intercept briefly (offer clarification only) Briefly describe innovative programs that operate at each intercept Police-based Crisis Intervention Teams Often referred to as specialized police response Involves police officers with MH training who provide crisis intervention services and act as liaisons to the formal mental health system Memphis, TN Crisis Intervention Team—pioneered development of CIT Resource: Police-based Specialized Mental Health Response MH consultants hired by police departments to provide on-site and telephone consultation to officers responding to mental health crisis Framingham, MA—clinicians based at police headquarters respond with officers to calls where mental illness a factor Mental Health-based Specialized Response Involves mobile crisis teams based in community MH system These operate via special relationship with police department who contact teams to respond to special MH needs at site of incident Knoxville, TN—operates a mobile crisis team, which responds to calls in groups of two, 24/7 NOTES FRANKLIN CO WA What looks encouraging on a national basis You are not going to cure the system today, but you’ll get 400 – 500 CIT programs in the country Specialized police officers, 25j%, 40 hrs of training at de-escalation and crisis skills, to decrease the amount of violence during incidents, and to decrease numbers who go to jail Lower rates of arrest, decreased officer injury, decrease injury to civilians and consumers Example: Philadelphia There is always more than one way to solve issues; there is no one way; you have to do what works best for you locally; there are many ways to approach Another approach … second bullet LA – SMART program; mh & specially trained police officer The population you most want out of jail, winds up staying the longest Diversion – what does cjs do differently AND what does the tx team do differently AND how do they work together differently

Intercept 0 Intercept 1 Intercept 2 Intercept 3 Intercept 4 HIPAA Exemptions HIE with Jails Health Dept. HIE with Jails In-reach reentry Co-location Data Sharing FUSE Initiatives Data Matching to enhance screening ACA enrollment SOAR enrollment Co-Response Teams Health Homes Certified BH CC’s