Criminal Justice Behavioral Health Initiative Leah Kaiser Human Service and Public Health Department

The Problem Disproportionate representation of persons with behavioral health needs in jails and correctional facilities Emergency Hospital beds are at capacity serving people with behavioral health needs Ineffective system response to behavioral health needs are driving public safety and health care costs Poor client health outcomes, poor public safety outcomes

The Underlying Reason Ineffective Access Process –Gaps in access to medications, housing, treatment, jobs –Eligibility criteria promotes working the extremes and cycling, instead of promoting a range of responses System Fragmentation/Program Silos –Separate funding streams –Addressing behavioral health needs in controlled, inappropriate settings –Misuse of public safety and health care resources Community Supports Insufficient for Complex Populations –State Operated Services- bottleneck (in and out) –Lack of discharge planning from Jail and Workhouse –Hospital discharges to shelters –Rule 20 - efficiencies and limited treatment options

The Partners Hennepin County Residents & Service Consumers, Local Law Enforcement Agencies, the Hennepin County Sheriff’s Office, City and County Prosecutors, the MN Fourth Judicial District, the Hennepin County Public Defenders Office, the Hennepin County Department of Community Corrections and Rehabilitation, the Human Services & Public Health Department, the Hennepin County Medical Clinic, National Council of Behavioral Health, MN Department of Human Services & MN Department of Health, Hennepin County Community providers.

The Response System Approach –Shared goals across sectors: individual responsibility, collective accountability –Identify and activate partners Two Pronged Approach –System Level Change »Policy Change/Process Change –Service Level Change »Program and Service Development Use Best Practice Approaches –Tailor criminal justice system with behavioral health needs in mind –Tailor behavioral health services with criminal justice issues in mind Resources - ROI model –Think big, start small, move fast –Leverage system funds, grants, redeploy FTEs

The Response (continued) Dedicated Manager to Lead Stakeholder Priority Actions Taken –Integrated Access Team and TJC –Local restoration and services for incompetent clients –Gap Case Pilot Governance Structure: aligning public safety, health and human service partners

Integrated Access Team HSPHD, HCSO, and HCMC partnership Multi-agency oversight Imbedded social service team in jail MOU with 2 navigator agencies Functions: 1.Assist inmates apply for medical care 2.Complete file clearances to determine case involvement and facilitate care coordination 3.Complete mental health assessments 4.Develop individual service plans/transition plans, same day service linkages in the community and support for 90 days post release

Local Competency Restoration Stakeholder agreement of problem and expected end result Data Review shows R20 trending upward Best Practice Models Reviewed Options to consider: –Triage & range of options based on Tx needs & public safety risk 1.Hospital 2.Community 3.Jail

Gap Case Pilot 52 R20 clients since June Initial Results : –38 clients offered pre-trial services, 6 open to short term intensive case management. Housing is the most requested service. Mental Health services are warranted in most cases but few clients believe this is necessary. Other services: coordination with probation, warrant coordination, AP referrals, ES and SSI benefits, and service referrals. Insurance: 15 MA, 16 uninsured, 21 PMAP –Custody Status: 25 Clients were IN Custody, 27 Clients were NOT in custody –18 clients MI Committed –1 DD commit –18 clients Dismissed –12 with No Disposition (waiting) –2 MI Stays –1 found Competent

Desired Goals & Outcomes: Increase health care coverage for high need clients Reduced use of emergency room Increased use of community based services Early identification of BH needs Decrease recidivism Increase coordination and communication across county systems

The Challenges Community Resource Issues –Housing, Forensic ACT, IRTS –Capacity –Appropriateness –Funding for in-custody services Data & Information sharing –health, welfare, public safety data privacy issues –Multiple source systems

Final Thoughts Success will not achieved independently, but will be achieved through the engagement of others with a diversity of perspective, knowledge and experience. The needs of our customers are complex and require innovative, systemic and integrated approaches to solve. Persistence and a strategic focus will ultimately result in the achievement of goals.

Input & Questions Jennifer DeCubellis: Leah Kaiser:

Olmsted County Forensic Mental Health Services

Timeline 1998 – Social Worker in ADC – Social Worker increased to full time on site 2005 – Jail diversion begins 2006 – Second social worker added on site 2007 – 1 st CIT local training held 2009 – Re-Entry program begins 2010 – Rule 20 process defined internally 2014 – WIT Grant

Sequential Intercept Model A conceptual framework developed by Mark R. Munetz, M.D. and Patricia A. Griffin, Ph.D.. Used for decisions around criminalization of people with mental illness and provides interception points for intervention. Ideally people will be intercepted at earlier points with decreasing numbers at each subsequent point, preventing deeper penetration into the criminal justice system.

Olmsted County Adult Detention and Forensic Behavioral Health Programs Crisis Intervention Team (CIT) Post-Booking Jail Diversion Forensic Commitments WIT Grant Re-Entry Services Community Supports

Pre- Booking Diversion/ CIT Crisis intervention training provides police and probation officers, social workers, detention deputies and other professionals who recognize and respond appropriately to people in psychiatric crisis. Local program is a self-sustaining collaboration between Olmsted Count Social Services, Sheriff’s Office, Rochester Police Department, and community providers. CIT training for police officers began locally in 2007, as of 2014 over 120 local officers and 24 dispatchers are now trained. A 2015 training is currently being planned.

Post Booking Jail Diversion & Forensic Commitments Rule 20 – Collaboration with County Attorney, court services, and Competency Restoration to streamline Rule 20 commitments and timelines. Forensic Commitments – Case management for SDP and MI&D commitments and competency cases from admission to discharge. “Whatever It Takes” (WIT Grant) – The WIT grant was provided by DHS in June of 2014 to provide an array of wrap around services including flexible funds, necessary to obtain and retain community tenure and stability for individuals discharged from Anoka Metro Regional Treatment Center (AMRTC) or Minnesota Security Hospital (MSH) St. Peter. – Modeled after AMRTC liaison which reduced hospital days beyond medically necessary by 30%. – Liaison case management for CREST region (Dodge, Fillmore, Goodhue, Houston, Mower, Olmsted, Rice, Steele, Wabasha, and Winona counties).

Jail Diversion Decrease in jail diversions Reduction in time spent in jail prior to diversion Possible causes: – Beginning of CIT training in 2007 increasing CIT officers each year – Increased collaboration with mental health, court services, and law enforcement

Mental Health Services in ADC Services – Full time mental health professional – Psychiatry (4 hours per week) – Full time forensic social worker – Full time behavioral health social worker – Part time discharge planner – ADC program Sgt/deputies Population – May 2013 and July detainees assessed half met the criteria for Serious Mental Illness (SMI) or Serious/Persistent Mental Illness (SPMI) – January through July offenders with an assessment, 47% met SMI/SPMI criteria. 63% of females met SMI/SPMI criteria compared to 42% of males

Re-Entry (ROC) Sentenced adults in Olmsted County Detention Center with at least 30 days before release Adults diagnosed with severe mental illness (SMI) or severe persistent mental illness (SPMI) Areas ROC can provide help with: – Case Management – Short and long term goal planning – Referrals to community providers/services/ supports – 14 people participated in ADC ROC – 8 people are still in community ROC – 1 has not yet been released – 5 people have been discharged 3 to prison 1 moved with probation transferred out of county 1 now in Assertive Community Treatment – Two years after release: Re-Entry clients (14) – average of 1.6 visits to jail – averaging only 22.9 days (321 total days) Non-re-entry clients (10) – average of 2.1 visits to jail – averaged 99.6 days in jail (996 total days)

Goals Expand CIT into more community agencies Increase Re-entry services Improve Rule 20 tracking and commitment process in CREST region Reduce hospital days at St. Peter due to lack of placements, resources, and system gaps

Ramsey County Mental Health Court: Working with the Mentally Ill Defendant Judge John H. Guthmann Judge William H. Leary Judge Theresa Warner Brandi Stavlo, MSW, Program Coordinator

RCMHC Background

Goals

Important Considerations for Eligibility

RCMHC works closely with: Ramsey County Mental Health Center Ramsey County Pretrial Conditional Release Agency (Project Remand) Ramsey County Adult Probation Ramsey County Correctional Facility Second Judicial District Research Department Collaboration

How it Works

How it Works continued…

Mental Health Supports

Recent Program Statistics [through December 2013]

RCMHC COMPARISON GROUP Recidivism and Jail Impact RCMHC COMPARISON GROUP Recidivism and Jail Impact In both a one year and three year follow-up, RCMHC graduates have been less likely to be charged with a new offense and spend time in jail than those in a comparison group. Comparison GroupGraduates of RCMHC One Year After RCMHC New Charges 60%17% New Convictions 45%9% Jail Time 65%9% Three Years After RCMHC New Charges 71%30% New Convictions 60%26% Jail Time 68%25%

Awards and Recognition

Invest in Better Mental Health Services

Final Thoughts….