July 2021 NACo Annual Conference Workshop Summary

Nearly two out of every three (63 percent) people sentenced to jail meet the criteria for drug dependence or abuse.

Annual jail admissions top 11 million per year, and nearly two out of every three (63 percent) people sentenced to jail meet the criteria for drug dependence or abuse.1 An estimated 17 percent of people in jails have a serious mental illness, and three-quarters of these individuals also meet criteria for a co-occurring substance use disorder (SUD).2 Counties are making a conscious effort to create a continuum of community-based services to meet the needs of individuals experiencing a behavioral health crisis and reduce jail populations. NACo hosted a workshop at its Annual Conference in July 2021 on Bridging the Gap: Crisis Response as Criminal Justice Diversion. This blog features key innovations discussed in the workshop. For more information, please listen to the workshop recording.

Fairfax County, Va.

Between 2016 to 2019, Fairfax County diverted over 1,700 individuals from jail through its Diversion First initiative. At an estimated cost of $300 per day to hold someone in the Adult Detention Center, the initiative helps the county avoid tangible costs associated with local detention; but, as Captain Derek Degeare of the Fairfax County Sheriff’s Office noted, the personal consequences of arrest are just as costly. By diverting qualifying individuals to community treatment, the county saves money and reduces harm.

Specifically for people with SUD, the county offers a Detoxification Diversion program where law enforcement officers can refer people experiencing a behavioral health crisis to local detox centers for services and supports. For those detained in the county jail, the Striving to Achieve Recovery (STAR) program allows people to spend quality time with their loved ones while incarcerated and offers facilitated conversations to help the person discuss their SUD and plan for recovery.

Fairfax County also provides mental health first aid training to all first responders and 911 dispatchers. The county’s community services board supports 911 dispatchers through cross-training, increased communication and guidance on the appropriate circumstances for referring calls for diversion. In addition, the county is developing a voluntary database for community members to disclose personal information related to a mental illness, SUD or developmental disability diagnosis. When these individuals reach out for assistance during a crisis, they will be connected to appropriate community-based resources.

Finally, data sharing is one of Fairfax County's main priorities. DeGeare expressed that the more information available during a crisis, the greater the probability people can be provided with the services they need. In this vein, the county is leveraging a grant from BJA’s Comprehensive Opioid, Stimulant and Substance Abuse Program (COSSAP) to create a data warehouse to store and analyze information to better understand and share outcomes. Specifically, Fairfax County’s Office of Strategic Management is developing a Secure Integrated Data approach with engagement by representatives of the Fairfax County health and human services community; public safety, education, legal, and technology representatives of the organizations involved; state prescription drug monitoring program (PDMP) representatives; and service providers to adopt and promote the information sharing efforts. The team will develop data governance structures to support the policy for data sharing and then develop a data-sharing model by using global information sharing standards to share data across various systems.

Bexar County, Texas

Bexar County has been at the forefront of law enforcement diversion and treatment for people with a SUD and/or mental illness for decades. Gilbert Gonzales, Director of the Bexar County Department of Behavioral Health, described how his department develops and monitors services that increase early identification of treatment needs and promote access to and continuity of care. The department works closely with local hospitals, health care providers, law enforcement and the sheriff’s office to offer services and diversion options for people experiencing a behavioral health crisis.

• The Crisis Restoration Center provides 24/7 substance abuse/mental health screenings, sobering, medical detox and transitional housing. The Center also offers a law enforcement drop off option in lieu of jail for people who need connections to treatment.
• The Southwest Texas Crisis Collaborative (STCC) focuses on ending ineffective utilization of services for people with SUD, mental illness and/or those experiencing homelessness by developing a comprehensive, integrated crisis system across hospitals, public safety agencies and treatment providers. STCC offers psychiatric emergency services for youth and adults, intensive care coordination, chronic crisis stabilization and acute care services with Haven for Hope.
• Bexar County opened its Justice Intake & Assessment Annex (Magistration Facility) in December 2018. Operated by the Sheriff’s Office in coordination with other criminal justice and behavioral health stakeholders, the facility is continually staffed (24/7/365) with behavioral health clinicians, public defenders, district attorneys and magistrates. Each person brought to the facility is screened for symptoms of mental illness or suicidal thoughts. Those who screen positive are assessed by a licensed clinician who may recommend diversion or release options to the magistrate.
• Lastly, the Specialized Multidisciplinary Alternate Response Team (SMART) is staffed by a licensed behavioral health professional, a peer support specialist, a CIT law enforcement officer and a paramedic. Based on the CAHOOTS Model, SMART assists people experiencing a behavioral health crisis, helps avoid unnecessary arrests and provides follow up to maintain connections to services.
• The Bexar County Commissioners Court is also using a COSSAP grant to create a strategic plan, develop a dashboard of all data related to opioid use and abuse and fund evidence-based outpatient and residential treatment.

Grand Lake Mental Health Center in Northeast Okla.

The Grand Lake Mental Health Center is a not-for-profit Certified Community Behavioral Health Clinic (CCBHC) serving adults, children and families in 12 rural counties in Northeast Oklahoma. The Center provides crisis, outpatient, inpatient, mental health, wraparound and emergency detention services. It is staffed by nurse practitioners, licensed mental health professionals and peer support specialists who have lived experience with mental illness and/or SUD. Josh Cantwell, the Center’s Chief Operating Officer, , proudly reported one of the Center’s greatest achievements was sending fewer patients to inpatient hospitalization, the most intensive form of treatment.

Mr. Cantwell attributes this success to the Center’s 24/7 technology-based program that provides iPads to every law enforcement officer in the 12-county region, serving approximately 850 police vehicles. If an officer responds to a call for service involving a person experiencing a behavioral health crisis, they can connect the person to one of the Center’s crisis care workers to help de-escalate the situation and connect the person to appropriate services. This has resulted in fewer people being arrested and positive individual outcomes. “Incarceration is about the highest level of care we can provide; [the] highest level of care equals [the] most expensive level of care.” – Josh Cantwell

Cultural diversity is also a strong component of the Center’s model, as indigenous peoples make up a large part of the local population. The Center partners with tribal law enforcement personnel to recruit staff members that are representative of the population being served. Individuals from the Modoc tribe are employed to specifically meet the cultural needs of people that are coming from a tribal background to promote cultural consideration and reduce stigma.

To further meet the needs of county residents, the Center is creating a program to reduce the number of youth removed from their homes and placed into foster care or residential treatment facilities through a brief stay in a therapeutic home. This will involve the implementation of parent-child interaction therapy, 24/7 on-site monitoring of at-risk youth and the utilization of the 24/7 technology-based program described above. The goal of this program is to reduce the number of in-patient behavioral health treatment days for youth.

More information on strategies to address the needs of people with mental illness and substance use disorders in the justice system can be found at the following resources:

• Stepping Up
• Data-Driven Justice
• Comprehensive Opioid, Stimulant and Substance Abuse Program

This blog was supported by Grant No. 2017-AR-BX-K003 awarded to the Institute for Intergovernmental Research (IIR) by the Bureau of Justice Assistance. The Bureau of Justice Assistance is a component of the Department of Justice’s Office of Justice Programs, which also includes the Bureau of Justice Statistics, the National Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention, the Office for Victims of Crime, and the SMART Office. Points of view or opinions in this document are those of the author and do not necessarily represent the official position or policies of IIR or of the U.S Department of Justice.