Case Study

Stepping Up Six Questions Case Studies

Stepping Up is a national initiative to reduce the number of people with mental illnesses in jails. In January 2017, the Stepping Up partners released Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need to Ask (Six Questions), a report outlining a framework for counties to assess their existing efforts to reduce the number of people with mental illnesses in jails. With the release of the report, the initiative hosted a series of webinars and network calls to outline some of the key strategies within the report and feature counties that have been working through the Six Questions process. The Stepping Up Six Questions Case Studies serve as a quick reference to the counties highlighted in this series. More information on the Six Questions and the webinar recording featuring this county are available on the Stepping Up Resources Toolkit.

More case studies on the subjects of mental health and criminal justice are available here.

Question 1: Is Our Leadership Committed?

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Reducing the number of adults with mental illnesses in jails requires a cross-systems, collaborative approach involving a system-wide planning team. Planning teams may already exist in the form of a criminal justice coordinating council or mental health task force, or your county may decide to create a new planning team. Planning teams should include, at a minimum, county elected officials such as commissioners or supervisors, criminal justice and behavioral health leaders, representatives from the courts, people with mental illnesses or their family members and other relevant community stakeholders. Designating a person to coordinate the planning team’s meetings and activities and to manage details will push the initiative plans forward. In addition, an elected official should be designated as the planning team chairperson, as strong leadership from elected officials is essential to rally county agencies in these efforts.

This case study features Pitt County, N.C., and Tarrant County, Texas. The associated webinar is available here.

Question 2: Do We Conduct Timely Screening and Assessments?

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Counties should have a clear and accurate process for identifying people with mental illnesses coming into the jail. This requires conducting a screening for symptoms of mental illness on every person booked into jail, as well as for other behavioral health needs such as substance use disorders. Jails should also screen individuals for pretrial and criminogenic risks to help determine release and supervision strategies. People who screen positive for symptoms of mental illness should be referred to a follow-up clinical assessment by a licensed mental health professional. Ideally, these clinical assessment results will be recorded in a database or spreadsheet that can be queried. Having accurate information on individuals’ risk and needs will assist with referrals to mental health treatment while they are in the jail and connections to services when they are released. Having the ability to store and query this information using system-wide definitions of mental illness and serious mental illness will assist with county planning efforts.

This case study features Champaign County, Ill. The associated webinar is available here.

Question 3: Do We Have Baseline Data?

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Baseline data highlight where some of the best opportunities exist to reduce the number of people with mental illnesses in the jail and provide benchmarks against which progress can be measured. The following four key measures are important indicators for counties to track and can help structure county efforts to address these challenges.

  • The number of people with mental illnesses booked into jail
  • Their average length of stay
  • The percentage of people with mental illnesses connected to treatment; and
  • Their recidivism rates.

Counties may consider comparing these four key measures to those of the general population in the jail to identify disparities. These comparisons can be especially useful when data on both populations are disaggregated further by charge type, criminogenic risk level, race, gender or other demographic factors.

This case study features Wake County, N.C., and Athens-Clarke County, Ga. The associated webinar is available here.

Question 4: Have We Conducted a Comprehensive Process Analysis and Inventory of Services?

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An opportunity exists at every step along the criminal justice continuum to improve responses to a person’s mental health needs. Completing a comprehensive process analysis helps county leaders determine where improvements can be made to better identify needs and share information. Some counties choose to conduct an initial analysis through a system mapping exercise. It is important that an inventory of community-based services and supports also be conducted as part of this process, and data to support this analysis should be included at all possible points. For example, knowing the current number of people who have mental illness who are booked into jail helps county leaders determine the scale of the problem they are working to address and can be used to the compare arrest rates of people who have mental illness to people who do not.

This case study features Chester County, Pa., and Franklin County, Ohio. The associated webinar is available here.

Question 5: Have We Prioritized Policy, Practice and Funding Improvements?

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Counties should prioritize policies and processes that will impact one or more of the four key measures: reducing jail bookings, shortening length of stay, increasing connections to treatment and reducing recidivism. County leaders should provide guidance to the planning team on how to make policy recommendations and budget requests that are practical, concrete and aligned with the fiscal realities and budget process of the county. Any budget proposal should identify external funding streams including federal programs such as Medicaid, federal grant opportunities and state block grant dollars as the first source for funding, with any potential county dollars filling final gaps in needed funding. Routine communication with the planning team on its ongoing efforts will help county leaders stay up to speed on the latest developments.

This case study features Pacific County, Wash. The associated webinar is available here.

Question 6: Do We Track Progress?

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Once planning is completed and the prioritized strategies are being implemented, tracking progress and ongoing evaluation begins. Planning teams should monitor the completion of short-term, intermediate and long-term goals, as it may take years to demonstrate measurable reductions in jail populations and the prevalence of people with mental illnesses in jail. Showing evidence of more immediate accomplishments, such as the implementation of new procedures, policies and evidence-based practices, contributes to the momentum and commitment necessary to ensure this is a permanent initiative. Tracking data within the four key measures may also provide the justification necessary to secure continuation funding and/or additional implementation funding.

This case study features Maricopa County, Ariz. The associated webinar is available here.

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