New Innovators Bernalillo County and Fulton County Prioritize Treatment

June 12, 2020

Since the Stepping Up initiative launched five years ago, a number of counties have been designated as Stepping Up Innovators. This growing cohort is made up of jurisdictions that successfully collect and use data on their jail populations with serious mental illnesses to inform policies and practices.

The latest Innovators to join are Bernalillo County, New Mexico, and Fulton County, Georgia. Despite their own unique challenges, these jurisdictions have made great progress toward connecting individuals with substance use and mental health needs to treatment and other essential services.

In addition to Stepping Up, Bernalillo and Fulton Counties both participate in the MacArthur Foundation’s Safety and Justice Challenge, a national initiative that supports communities in safely reducing their jail populations.

Can your county be a Stepping Up Innovator? Learn more.

Bernalillo County, New Mexico

Bernalillo County joined the Stepping Up initiative in May 2015 and was named an Innovator site on March 6, 2020. New Mexico’s most populous county and home of county seat Albuquerque, Bernalillo County reflects the widespread racial and ethnic diversity of the state.

According to county officials, signing the Stepping Up resolution was a milestone in their collaborative efforts to fill the most critical gaps in the county’s behavioral health continuum of care. This formalized collaboration led to a number of improvements that can reduce the prevalence of serious mental illness in the county jail.

For one, it allowed the county’s Department of Behavioral Health Services (DBHS) to establish a definition of serious mental illness that is now shared across county agencies and providers. To support the identification of people with serious mental illnesses and other needs, the Bernalillo County Metropolitan Detention Center has implemented a robust intake screening process. Among the seven validated screening tools administered is the Brief Jail Mental Health Screen, which leads to a follow-up assessment for people who receive a positive result.

The DBHS also worked with the local jail to access elements of its electronic health records system, which enables designated DBHS staff to monitor on a daily basis the number and percentage of people in the jail identified as having serious mental illnesses.

And in an effort to better serve the small number of people who frequently utilize jail, emergency, and substance use intervention services, Bernalillo County is working to identify these “high utilizers” by pulling from multiple data systems. Data elements considered include a person’s jail bookings in the preceding 18 months, their Brief Jail Mental Health Screen score, prior services received through a local detox program, and whether they received a serious mental illness diagnosis while in jail. People in jail who are identified as having serious mental illnesses and being “high utilizers” are referred to intensive pre- and post-release case management.

The activities carried out under Bernalillo County’s Stepping Up initiative are significantly financed by a one-eighth percent gross receipts tax that passed in 2014 and generates up to $22 million a year in funding for behavioral health services.

Fulton County, Georgia

The Fulton County, Georgia, Board of Commissioners unanimously adopted a Stepping Up resolution in May 2016 and was recognized as an Innovator county on April 20, 2020. Fulton County is home to Atlanta and the largest and most populous county in Georgia. The Fulton County Justice and Mental Health Task Force is a cross-systems collaborative group led by the Fulton County Superior Court, which received federal grant funding to support the planning and capacity building required to meet their Stepping Up goals.

Beyond adopting countywide definitions of serious mental Illness and serious and persistent mental illness, the task force established a thorough jail-based screening and assessment process, including a validated, gender-specific tool used to identify individuals who need further mental health assessment.

The jail’s medical provider, Naphcare, uses a system that electronically flags a person’s health record if their responses during the intake assessment indicate the need for additional mental health care. Alerts in the system prompt the clinical staff to take action as needed, such as assigning special housing. Pending a person’s release from jail, Naphcare also connects with various reentry providers to ensure a smooth transition to the community.

To build on the effectiveness of the electronic health record system, Fulton County commissioners are supporting the development and implementation of a data-sharing platform to improve reporting on the outcomes of people in jail who have serious mental illnesses.

Outside of the jail, other branches of the criminal justice system and their partners are taking measures to reduce incarceration of people with serious mental illnesses. Fulton County Pretrial Services added an in-house mental health unit in July 2019 to ensure safe pretrial supervision of individuals with mental health needs. An alternative sentencing program run by the public defender’s office has social workers that provide an array of services to individuals with substance use and mental health needs, among others. These social workers receive requests from attorneys and the court to place individuals in treatment facilities as soon as possible after arrest as an alternative to incarceration.

The task force is also designing a Community Center for Diversion and Recovery, which will serve as a 24/7 law enforcement drop-off site for arrest diversion and offer walk-in peer support and referral services for people with mental illnesses in their recovery journey.

Similar to Bernalillo County, Fulton County is analyzing every jail booking to identify “high utilizers.” Data matching is conducted among the jail’s mental health screenings, emergency room admissions, and homeless services. Identified individuals are then triaged and connected to various service providers depending on their most critical needs.

Photo by Marcelo Leal on Unsplash

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