County Leaders Step Up to Reduce Incarceration of Mentally Ill People

May 20, 2016

Psychiatric News

By Aaron Levin

“Data” was the word of the day at the Stepping Up Summit, held April 17 to 19 in Washington, D.C.

Teams from 50 U.S. counties gathered at the summit, the latest event held by the Stepping Up Initiative, which seeks to reduce the numbers of people with mental illness in America’s county jails. The initiative is sponsored by the Council of State Governments Justice Center, the National Association of Counties, and the American Psychiatric Association Foundation.

Quantifying data is an essential element in assessing needs for reform, prioritizing action, and measuring performance and outcomes, said many of the speakers.

“If you are not measuring the impact on prevalence rates of mental illness, the number of people with mental illness booked, lengths of stay, connections to treatment, or recidivism, then you really can’t tell how effective the programs are,” said Fred Osher, M.D., director of Health Systems and Services Policy at the Council of State Governments Justice Center.

Each county team included mental health professionals, police and sheriff’s department personnel, and local elected officials. They heard from dozens of experts and then hashed out ways to divert people with mental illnesses from the criminal justice system, to treat those who must remain in custody, and to find ways to connect them with mental health and other services in their communities after release from jail.

“Part of the value of being here was interacting with the rest of the country and picking up ideas we can take back home and see what fits and what doesn’t fit,” said John Miller, a county supervisor from Black Hawk County, Iowa, in an interview.

Demolishing professional silos and working across disciplines was a key to the success of both the Stepping Up Initiative and the summit, said APA President Renée Binder, M.D., a professor of psychiatry at the University of California, San Francisco.

“Everyone partnering together can make a difference,” said Binder, calling on the attendees to work not only on jail diversion in their localities but to inform the public and lobby Congress to pass the Comprehensive Justice and Mental Health Act of 2015.

Osher opened the conference with some grim numbers: There are 6.8 million people in the United States under correctional supervision, including 5 million on probation or parole. About 740,000 people are in jail at any one time, but 11 million churn through the jails in the course of a year. Of those, 17 percent overall have serious mental illnesses, compared with 5 percent of the general population. Within that group, 72 percent also have a co-occurring substance use disorder.

“These people are arrested more frequently, stay in jail or prison twice as long, have more limited access to health care, and have higher rates of recidivism,” said Osher.

What makes collecting data so useful?

First, because baseline data help to provide a starting point. How many people with mental illness are in the county jail? How long do they stay? How many come back? What services are offered? What changes are needed? And of course, how much does it cost?

Data can back up proposals to local elected officials for changes in procedures or hiring staff. Officeholders control the county budget and rule over county agencies, so they need to be persuaded that proposed changes in policies, practices, and funding are worth the cost. When an official says that changes will cost money, the data can reveal that not changing will cost more money.

Data also can make it easier to depict a process in a rational way and then show it can be done in a better way, said Tony Fabelo, Ph.D., M.P.A., director of research for the Council of State Governments Justice Center.

Data can inform tradeoffs, like investing in mental health treatment in the local county jail rather than sending patients to the state hospital, said Tracy Plouck, M.P.A., director of the Ohio Department of Mental Health and Addiction Services.

“Being able to measure before and after is critical when seeking funding,” said Plouck. “Perhaps there may not be much money saved from consolidating services, for instance, but the process can build goodwill and serve as a stepping stone to further cooperation with agencies.”

The response from the front lines was encouraging.

“What’s needed is cultural change,” Tianna Glenna, M.A., the Criminal Justice Collaborating Council manager in Eau Claire County, Wis., told Psychiatric News. “That hasn’t cost a lot of money—just changes in procedures and processes using staff time and brainpower. The county trusts us enough because we have collected data, and we bring all stakeholders to the table.”

Black Hawk County’s Miller was ready to move on to the next stage.

“I have a list of things to do when I get home,” said Miller. “We were the only county from Iowa invited, so I feel obliged to go back home to the other counties that voted to sign up for the Stepping up Initiative. We’ll sit down and figure out our next steps.” ■

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