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

dmartin@mhamd.org

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

mmcdonnell@tasc.org

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