1. Stepping Up: A National Initiative to Reduce the Number of People with Mental Illnesses in Jails
Institute for Behavioral Healthcare Improvement
January 30, 2017
Introduce yourself
Thank you for inviting me
I want to talk with you today about a very important issue and an initiative that NACo helped to start to help address this issue: mental illness in jails
Stronger Counties. Stronger America.

2. Mental Illnesses Overrepresented in Our Jails
General Population
Jail Population
5% Serious Mental Illness
72% Co-Occurring
Substance Use Disorder
17% Serious Mental Illness
National proportion of jail admissions involving mental illness:
Of the 11 million adults arrested and booked into jails annually across the country, about 2 million of them has serious mental illnesses like schizophrenia, bipolar disorder and major depression
About 5 percent of adults in the U.S. have a serious mental illness, but nationally about 17 percent of people in jails have a serious mental illness, and almost three-quarters of them has a co-occurring substance use disorder
Percentages can be even high for women in jails

3. Factors Driving the Crisis
Longer stays in jail and prison
Disproportionately higher rates of arrest
Limited access to health care
Higher recidivism rates
Individuals with MI are more likely to be arrested than people without these illnesses. Most arrested for relatively minor crimes, which tend to stem from their illness or addiction rather than intent to do harm. And the lack of law enforcement training and diversion options can lead to more arrests.
Once incarcerated, people with MI tend to stay longer in jail, because of their access to resources. They can’t post their bail or they don’t have a family to go home to. In addition, the lack of jail MH treatment options and staff training can cause individuals to exhibit poor behavior in the jail environment.
Many individuals with MI, particularly those who have had previous involvement with the criminal justice system, do not have access to quality health care to help address their MH needs.
People with MI are at a higher risk of re-incarceration, many times because of compliance issues rather than new crimes.
While many counties and states have implemented effective and evidence-based practices and programs for this population, too many have not or they are not at a scale where they are reaching everyone who needs them.
Individuals with MI tend to have more of the factors that research shows might cause a person to engage in illegal activities, such as poor family relationships, lack of employment, substance use and low levels of involvement in positive leisure activities.
It is important to note that crime—and in particular violent crime – is not necessarily caused by someone’s mental illness
Low utilization of EBPs
More criminogenic risk factors

4. Stepping Up Launched May 2015
Why it was created
Elevate the issue at the federal, state, local and national levels
Who it was created by
NACo along with Council of State Governments Justice Center and American Psychiatric Association Foundation
How it is supported
Stepping Up is possible through support from the U.S. Department of Justice’s Bureau of Justice Assistance and other private foundations and companies
Partners we work with: NSA, NAMI, NACBHDD, NIC, etc.
A number of other organizations, agencies and associations have been working on this issue for a long time and so we have partnered with a number of them to help steer and support the initiative.
This includes the National Sheriffs Association, the National Alliance on Mental Illness (NAMI), the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD), as well as state associations like the National Association of State Mental Health Program Directors, federal agencies like the National Institute of Corrections, and non-profit technical assistance providers like Policy Research Associates.
All of these organizations have resources to provide to you as you move forward with trying to reduce mental illness in your jails.

5. Why NACo is Part of this Initiative
$28 BILLION
NACo is a part of this initiative because we know that it matters to counties and that county leaders like you are at the forefront of this issue
Counties run 91 percent of local jails and spend $93 billion on justice and public safety annually
11.4 million people were admitted to county and other local jails in 2014
Counties run more than 1,500 local health departments and spend $83 billion on health and hospitals annually
According to a survey of NACo members conducted this year, mental health and substance use are two of the most pressing health issues facing counties in Almost two thirds (65 percent) of county officials reported that a shortage of mental health providers is the greatest issue affecting access to health care
County officials are positioned to be key leaders on this issue and make a difference in their communities and NACo wants to help you to be successful

6. Counties are Stepping Up
Stepping Up Resolutions Received as of October 1, 2016
Since launching in May 2015, counties have really stepped up to take on this issue
Number of resolutions passed
Number of states covered
Number of people in these counties
you can see the full list of counties on the Stepping up website
More than 160 counties have passed resolutions in support of Stepping Up. This is a map of those counties.
These counties represent more than 65 million residents across the country – more than 20 percent of the U.S. population
Counties of all sizes have signed on. The smallest is Grant County, Oklahoma with less than 5,000 residents and the largest is Cook County with more than 5 million residents. About a third of the counties that have signed on have less than 100,000 residents.
This is not a big county problem or a small county problem or an urban county problem or a rural county issue – it’s an every county problem.

7. Counties of All Sizes are Stepping Up
Percent of counties who are rural (100k), mid-size (100k,500k), large/urban (.500k)
This is not a big count problem or a small county problem. This is an every county problem and diverse counties will need diverse solutions to address it

8. Getting Started www.stepuptogether.org
You can get a resolution template on the Stepping Up website—StepUpTogether.org – and click on “What You Can Do”
After you pass the resolution send it to us so we can include you on the map and website
No deadline for joining the initiative

9. Six Steps Convene or draw on a diverse team
Collect and review prevalence numbers and assess individuals’ needs
Examine treatment and service capacity and identify state and local policy and funding barriers
Develop a plan
Implement research-based approaches
Create a process to track progress
Once you consider these questions and decide that you are ready to start an initiative, we have developed a six step process to get you started. So, six questions to ask to see if you’re ready and six steps to get started.
The six steps start with building a strong team of diverse stakeholders, then looking at your data and analyzing your system to identify barriers and gaps, them implementing research-based policies, practices and programs and finally keeping track on progress toward your goals
Everyone in this room will be at different points within these steps – some will be starting from scratch while others have been working on this a long time but are still looking for more ways to improve.
This process takes time and commitment and collaboration – it’s not going to happen overnight. But you can chip away at it piece by piece – find out what you CAN do in the short term, and what you WANT to do in the long term to get to your county’s goals. Then plan for how to get there and talk to your peers to see how they did it.

10. Four Key Measures
Outcome measures needed to evaluate impact and prioritize scare resources
1. Reduce
the number of people with mental illnesses booked into jail
2. Shorten
the length of stay for people with mental illnesses in jails
3. Increase
the percentage of people with mental illnesses connected to the right services and supports upon release 
4. Lower
rates of recidivism
One way to think about how to move forward is to break your work down into four key outcomes.
Reduce the number of people coming in
Reduce the amount of time that they’re in there
Increase connections to community-based services
Reduce the number of people coming back to the jail
If you can impact these four—or even one at a time – you will see a noticeable difference in your jail population
Using these outcome measures can help you to evaluate your impact on the system and to prioritize scarce resources

11. Self-Assessment Tools
Resources Toolkit
Webinars
Self-Assessment Tools
County Examples
Planning Exercises
Research
And we’re here to help!
On the Stepping Up website, at StepUpTogether.org/Toolkit, we have a series of tools and resources for you that are organized by those six steps. These resources include archived and upcoming webinars, the latest research, case studies, planning guides, and that Six Questions report.
We also get requests to connect people to other counties who have taken on some of the ideas that they have – and we are happy to do so! Please use us as a resource. or call us if you are looking for help.
We will also be hosting more conference calls and webinars and other technical assistance opportunities going forward for you to learn from experts and your peers, so I would encourage you and your staff to sign up for the list for updates and opportunities.

12. Stay Updated
To stay updated on the latest resources, news and opportunities related to Stepping Up, go to the Stepping Up homepage – – and click on the orange button to sign up for the list.
We send out new technical assistance resources, promote events and conferences, highlight the great work of Stepping Up counties, and share funding opportunities when they become available.
Visit stepuptogether.org and click on the Take Action Now button to receive Stepping Up updates

13. Contact Information
Nastassia Walsh, MA
Program Manager, NACo E: P:
Questions?
Thank you for allowing me to present to you today and for your interest in this important issue
My information is up on the screen and I would be happy to help your efforts in any way that we can.