Strengthening Partnerships between
County Jails and Community-based
Service Providers
Dan Martin
Maureen McDonnell
Dr. Fred Osher
Webinar Overview
• Background
• System Improvements:
• Medications
• Behavioral health standards
• MHFA
• Crisis interventions
• Relationship Building
• Effects of Medicaid
• Access pre- and post-jail
Fred C. Osher, M.D.
Director, Health Systems and Services Policy
Council of State Governments Justice Center
Reducing the Number of
People with Mental
Illnesses in County Jails
An Expanding Population under
Correctional Supervision
Jail Population Declining
Nationally
-3.0
-2.0
-1.0
0.0
1.0
2.0
3.0
4.0
5.0
6.0
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
00 01 02 03 04 05 06 07 08 09 10 11 12 13
YEAR
ANNUAL PERCENT CHANGE
NUMBER OF INMATES AT
MIDYEAR
Source: Bureau of Justice Statistics, “Jail Inmates at Midyear 2013—Statistical Tables,” 2014.
Inmates confined in local jails at midyear and percent change in the
jail population, 200-2013
What About Persons with Behavioral
Disorders ?
AVERAGE DAILY JAIL POPULATION (ADP)
AND
ADP WITH MENTAL HEALTH DIAGNOSIS
13,576
Total 11,94
8
Total
NEW YORK CITY
Source: Abrams & Teplin (2010)
Perc
en
t o
f P
op
ula
tio
n
8 %
Alcohol and Drug Use Disorders:
Household vs. Jail vs. State Prison
5% 95% 72% 83
%
17% 28%
GENERAL POPULATION JAIL POPULATION
SERIOUS MENTAL
ILLNESS
NO SERIOUS MENTAL
ILLNESS
SERIOUS MENTAL
ILLNESS
NO SERIOUS MENTAL
ILLNESS
CO-OCCURRING
SUBSTANCE USE
DISORDER NO CO-OCCURRING
SUBSTANCE USE
DISORDER
Prevalence of Serious Mental Illness and Co-
Occurring Disorders in Jail Populations
The Problem: Overrepresentation of
Persons with Behavioral Disorders
Arrested at disproportionately higher rates • Co-occurrence of SUD
Homelessness
Stay longer in jail and
prison
Limited access to health
care
Low utilization of EBPs
High recidivism rates
More criminogenic risk
factors
Stepping Up: A National Initiative to Reduce the Number of
People with Mental Illnesses in Jails
The Stepping Up Initiative officially launched
with a series of events in May 2015
• May 5, Washington DC
• May 5, Johnson County, KS
• May 6, Miami-Dade County, FL
• May 7, Sacramento, CA www.stepuptogether.org
Thank you!
Fred Osher, M.D.
Director of Health Systems and Services Policy,
CSG Justice Center
www.csgjusticecenter.org
The presentation was developed by members of the Council of State Governments Justice Center staff. The statements made reflect
the views of the authors, and should not be considered the official position of the Justice Center, the members of the Council of State
Governments, or the funding agency supporting the work.
Dan Martin, JD
Director of Public Policy
Mental Health Association of Maryland
Origin of MHCJP
House Bill 990 (2005) required DHMH, DPSCS and DHR to convene a workgroup of interested stakeholders to make recommendations on actions to break the cycle of rearrest and reincarceration for individuals with mental illness who become involved in the criminal justice system.
Who We Are
The HB 990 workgroup has been formalized as the Maryland Mental Health and Criminal Justice Partnership (MHCJP) and includes over 40 active members representing:
• State agencies
• Local mental health authorities
• Local law enforcement
• Correctional administrators
• Advocates
• Mental health service providers
• Members of the judiciary
Progress Report
Medication Upon Release
• Legislation enacted to ensure 30-day supply of medication upon release from state facilities and local detention centers
Professional Training/Continuing Education
• Worked with Police and Correctional Training Commissions to establish behavioral health training standards and approve curricula; more than 1,100 public safety professionals trained in MHFA
Personal Identification Cards
• Data sharing program between MVA and holding facilities; issuance of IDs upon release recognized as a priority throughout the system
Ongoing Initiatives
Data Sharing
• DataLink program developed to allow the sharing of public mental health system data across systems, promoting the continuity of care for individuals with serious mental illness that interact with law enforcement
• MHCJP DataLink Subcommittee established to advise and assist in expanding the program throughout Maryland
Crisis Intervention Teams
• Recent increased funding for and interest in CIT programs
• MHCJP CIT Subcommittee established to standardize and expand availability throughout Maryland
DataLink Overview
Key Partners
• Department of Health and Mental Hygiene
• Department of Public Safety and Correctional Services
• Administrative Services Organization
• Local Mental Health Authorities
• Local Detention Centers
Process
• DPSCS → ValueOptions → DPSCS and CSA
CIT Overview
Purpose
• Law enforcement-based intervention to assist and divert individuals in crisis
Key Partners
• Local Law Enforcement
• Local Mental Health Authorities
• Crisis Programs
• Service Providers
• Emergency Departments
Subcommittee Progress and Efforts
• Outreach to local jurisdictions – bring partners together
• Development of toolkit/materials to explain program and alleviate concerns
• Assist in implementation details and troubleshooting
• Report on progress – 8 jurisdictions and state facilities; several more nearing implementation
• Collect and review aggregate data
Subcommittee Progress and Efforts
• Development of core standards/elements document
• Development of implementation milestones grid/questionnaire
• Series of regional relationship-building forums for law enforcement and mental health professionals
• Outreach to local jurisdictions – bring partners together and assist in plan development
• Identify and overcome obstacles to implementation
• Draft legislation
For More Information
Dan Martin Director of Public Policy
Mental Health Association of Maryland
(443) 901-1550 x208
Follow me on Twitter @dan_martin1
Maureen McDonnell, MPH
Director for Business and Health Care
Strategy Development
TASC
Building Care Paths from
Jail to Community
• Medicaid Applications = Step 1
• Broad Linkages to Care = Step 2
Around the Country
• Many large jails have enrollment
projects: Chicago, LA, Louisville,
Denver…
• Building continuity of care will reduce
recidivism
• Assistance available from:
– National Institute of Corrections
– Foundations
– TASC
The Promise of Health Care
Reform Won’t solve all challenges, but... •Unique opportunity for significant change on a broad scale. • Near universal coverage for low income adults.
• Address gaps in services. • Eliminate long waiting lists.
o Developing unified systems with single point of access to care – improve outcomes, increase competitive position.
• Ending piecemeal approach to public funding.
Cook County Justice & Health Initiative
• August 2012 – Planning process convened by the Honorable
Paul P. Biebel, Jr., Presiding Judge of the Criminal Division
• The Justice and Health Initiative (JHI) Steering Committee
includes leadership from: – Cook County Sheriff’s Office and justice agencies
– Cook County Health and Hospitals System
– Community substance abuse and mental health providers
– Community foundations
• Builds on Cook County’s early expansion of Medicaid
(2012).
• JHI was developed and led by TASC with Chicago
Community Trust funding; other foundations joined.
Justice & Health Initiative Goals:
1. Determine how to facilitate applications for all eligible persons entering the justice system.
2. Develop infrastructure and processes that support universal linkage to medical, mental health, and substance abuse treatment.
3. Support expansion of care in the community that meets the needs of people under supervision.
4. Expand diversion from jail and prison to care in the community under appropriate supervision.
Jail Intake Application
Assistance Process Partnership between Cook County Health & Hospitals System, Cook County Sheriff’s Office and TASC
Operational Goals: Maximize Applications & Use of Care
• Complete full application during intake: • Fingerprint-based identifying information used to verify inmate identity. • Applications are completed online using state Medicaid application websites and
jail management system records.
• Process must fit in fast-paced secure environment: • 200-300 new detainees/day. • Cannot impede security or medical flow. • Each application takes approximately ten minutes.
• Encourage applicants to use care after release.
Results: Over 20,000 Medicaid applications have been initiated to date (April 2013 – March 2015).
Jail to Community Continuity
of Care
• Planning Process: How to establish processes that link people with
serious mental illness, severe substance use disorders and chronic
medical conditions to needed care in the community, given jail
release timeframes?
• Demonstration Project: Link 30 people /day with serious mental
illness released to care in the community (local foundation funding).
• Expanded to Full Care Coordination Project through Cook
County Health System contract.
• Partnership between Sheriff’s Office, Cook County Health and
Hospitals System, Cermak Mental Health Services/CCHHS and
TASC
• NEW: Provider Learning Collaborative – Build solid connections between jail release and community care
– Integrate transitional housing, mental health care , other needed supports
– Test projects for future investments
– Funded by Polk Bros. Foundation
Jail Diversion
• Bridgeport CT
• Corrections/courts/treatment provider
working together
• Early results
• 14 people diverted from jail in first 6 weeks
• Funded by Public Welfare Foundation
• PWF looking for additional sites; TASC
provides TA
Contact Information
Maureen McDonnell
Director for Business and
Health Care Strategy Development
312.573.8222
SAMHSA Resources
• SAMHSA’s GAINS Center • Provides technical assistance to
the field and grantees.
• Supports the following grant
programs: • Behavioral Health Treatment
Court Collaborative
• Mental Health Transformation
Grant
• Early Diversion
• Adult Treatment Court
Collaboratives
• Jail Diversion Trauma Recovery
http://gainscenter.samhsa.gov/
• Behavioral Health and Justice Involved
Populations
• Discusses the impact of behavioral health on
the criminal justice system (e.g. changes in
the field, impacts of health reform, the
challenges related to trauma, etc.).
• SAMHSA’s Efforts on Criminal and
Juvenile Justice Issues
• Reviews SAMHSA’s five areas of focus for
justice-involve populations.
SAMHSA Resources
Questions