Stepping Up Strategy Lab Showcases Proven and Promising Practices to Help Reduce the Number of People with Serious Mental Illnesses in Jail

May 22, 2019

By The Council of State Governments Justice Center Staff

Fulton County, Georgia, has a proven record of working to reduce the number of people with serious mental illnesses (SMI) in its jail. The county, which includes Atlanta, was one of the first to join the Stepping Up initiative—a national campaign that aims to combat that very issue—when it launched in May 2015. Not long after that, with support from a grant from the U.S. Department of Justice’s Bureau of Justice Assistance, it convened a Justice and Mental Health Task Force to address this crisis.

Photo of The Fulton County Justice and Mental Health Task Force MeetingIt was at the inaugural meeting of this the task force (pictured right)—which comprised law enforcement, behavioral health, corrections, the courts, and advocates—that its members came to a stark conclusion: While this challenge was impacting many of the county’s departments, the obstacles were even harder to overcome because each group was working in isolation. No one knew what anyone else was working on.

“The right hand didn’t know what the left was doing,” said Tiffany Russell, planning and development director of the Superior Court of Fulton County. “Once everyone realized that each of us was addressing this crisis in their own way, we begin to discuss ways we could work together. It was a lively discussion, but in a good way.”

Since that initial gathering of 60 people, the monthly task force has grown to a 225-member planning team, which includes representatives from key organizations from the county. This representative planning team has developed a roadmap for addressing the crisis of people with SMI in the county’s jail, and on January 23, 2019, Fulton County authorized $1.3 million to help the planning team implement its priorities. These priorities include a validated mental health screening in the jail, a data sharing system for care coordination, mental health training for officers, and a mental health diversion center. While these steps are promising, getting to this point was not without difficulty.

“We would have been able to avoid some of the initial hurdles that our planning group faced if we had a resource to turn to that contained solid examples of strategies that other planning groups were using to reduce the number of people with mental illnesses in jail, but there wasn’t a lot of information out there, so we had to learn as we went along,” Russell said.

Jurisdictions looking for these strategies will no longer face this issue. The methods used by the Fulton County task force, along with many more, are now highlighted in the new Stepping Up Strategy Lab, an interactive repository of some of the best programs, policies, and practices that jurisdictions—ranging from big to small, both rural and urban—have implemented in recent decades to reduce the prevalence of people with SMI in their jails.

The Strategy Lab, which features over a hundred examples, was created for Stepping Up project coordinators as well as state and local government officials, policymakers, and researchers, among others, to guide the creation of cross-systems, data-informed strategies along four key measures. These measures are: (1) reduce bookings into jail, (2) reduce length of stay, (3) increase connection to treatment, and (4) reduce recidivism. Users can access the Strategy Lab to search through interventions by: their relevance to each of the four key measures; whether the intervention is a program, policy, or practice; by categories such as behavioral health, courts, crisis services, housing, jail, law enforcement, pretrial, project coordination, and reentry; or by a combination of all three. The database will be updated every six months to reflect new programs, progress, and changes in the field.

Fulton County is only one of many counties that are featured in the Strategy Lab.

Hancock County, Ohio, is also highlighted in the Stepping Up Strategy Lab, for its work establishing cognitive behavioral therapy (CBT) in its jail based on risk and need assessment results.

“The overall goal was to link people to CBT while they were in jail and then be able to refer them to community-based treatment,” said Cayla Fortman, the Stepping Up project coordinator for Hancock County. “Introducing treatment while incarcerated has been proven to be a positive link to continuing treatment in the community.”

To achieve this, the county’s mental health agency, Century Health, has a case manager employed in the jail along with another case manager based in the community and two peer supports. Overall, Fortman says, the county found lower rates of recidivism and increased connection to community-based treatment if the individual partook in the CBT groups and received one-on-one assistance from the jail-based case manager. This promising practice is just one of many related to behavioral health that counties can learn from by searching through the Strategy Lab.

Another county featured for its exemplary work is Lubbock County, Texas. Also one of 11 Stepping Up Innovator Counties recognized for its efforts in reducing the number of people with SMI in their jail, the county is featured in the Strategy Lab for its work implementing individual and group counseling in its detention center and collaborating with peer support specialists.

Some of the biggest challenges Lubbock County overcame involved establishing training for security staff and finding ways to implement counseling in a therapeutic environment, which requires a degree of privacy often lacking in detention centers. But finding solutions paid off.

“The policies and practices we enacted have increased staff awareness about this issue and have assisted in making the agency more accepting of a therapeutic environment. It’s also given those who are incarcerated a sense of ownership in their treatment and rehabilitation,” said Captain Ryan Braus of the Lubbock County Sheriff’s Department.

Back in Fulton County, Russell said that implementing the planning group highlighted in the Strategy Lab was not an easy endeavor but was well worth the effort. That’s why she believes that the Strategy Lab will be a powerful tool that counties can turn to as they begin to create their own plans to tackle this crisis.

“Changing business as usual takes getting used to,” Russell said. “It’s difficult, but once you have everyone on board and working toward a common goal, that’s when the real successes happen, and you begin to improve lives.”

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