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By Paul Neitman, LMSW, MSW

A couple weeks ago, news in Pennsylvania caught my eye – Pennsylvania is joining the Stepping Up Initiative (SUI) to reduce the number of people with mental illnesses in county jails. My colleague Monica E. Oss covered that development in, ‘Stepping Up’ To The Problem Of Mental Illness In Corrections Facilities.

If you are unfamiliar with it, the Stepping Up Initiative is a national effort to divert consumers with behavioral health issues (including those with co-occurring substance use disorders, as well as serious mental illness or serious and persistent mental illness) from jails and into treatment (see Pennsylvania Jails To Launch Stepping Up Initiative To Reduce Number Of Inmates With Mental Illness). As part of the program, SUI provides strategic planning and service implementation assistance to provider organizations with a heavy focus on metrics-based management (see Reducing the Number of People with Mental Illnesses in Jail: Six Questions County Leaders Need to Ask).

As part of this planning and implementation assistance, the SUI program asks six questions that county leadership can use to craft a local plan: Is our leadership committed?; Do we conduct timely screening and assessments?; Do we have baseline data?; Have we conducted a comprehensive process analysis and inventory of services?; Have we prioritized policy, practice, and funding improvements?; Do we track progress?

I think any initiative to reduce the inappropriate incarceration of people with mental illnesses is a good idea. But, based on my experience, I wonder whether counties really have the capacity to take this on and what the challenges are to getting voluntary collaborative agreements like this up and running – and sustaining them long-term. In my work with these systems, I have found there are a few key issues to keep in mind:

  1. Counties are often challenged by limited budgets and resources that restrict action beyond their basic statutory responsibilities
  2. County Sheriff’s often face significant budget issues that challenge the sheriffs’ ability to juggle needed corrections officers, road patrol personnel, and administrative supports
  3. Corrections personnel are continually challenged by the dual goals of keeping tight internal controls and meeting the basic needs of inmates. Trying to expand or bring in resources may raise concerns about controlling the jail environment and subsequent threats to safety and security
  4. While training jail staff may help them to more appropriately work with mental health inmates, some form of professional staff will be needed to support their efforts

All the above being said, counties and jails should have an incentive to participate in efforts to address the mental health needs of inmates due to increases in “critical incidents” involving mental health inmates and subsequent lawsuits for harm to inmates including deaths. We’ve covered a number of these lawsuits and court actions in recent months:

  1. Judge Grants Class Action Status To Inmate Lawsuit Against Shasta County Jail
  2. Inmate Lawsuit Alleges Tennessee Private Prison Understaffing Led To Inadequate Diabetic Care
  3. Trial Begins For Mental Health Class Action Suit Against Alabama Corrections
  4. Delaware Prison Officials Settle Class Action Lawsuit Over Solitary Confinement Of Offenders With Mental Illness
  5. Alabama Corrections Agrees To Improve Conditions For Inmates With Disabilities

Programs such as crisis intervention teams and mental health courts are examples of programs likely to help reduce the number of individuals (or at least the number of days) in jail. Many communities are working in partnership with local law enforcement to address the issue this way.

What are the keys to developing functional relationships between law enforcement/corrections officers and behavioral health provider organizations? I have four suggestions:

  1. Create formal and informal opportunities for both groups of professionals to talk and get to know one another on a personal level
  2. Create opportunities for behavioral health professionals to hear the circumstances and issues that law enforcement faces in dealing with inmates with mental health needs
  3. Create opportunities for law enforcement to hear and learn more about some of the clinical profiles they are seeing on the streets and in jails, and how their attitudes and behaviors can either escalate or mitigate disruptive/dangerous behaviors
  4. Develop opportunities for law enforcement/corrections officers and behavioral health professionals to discuss the common values and beliefs around dealing with mental health issues in law enforcement – examples include increasing the safety of the community and the mental health consumer; increasing the safety of law enforcement/corrections personnel; preventing “critical incidents” related to harm in law enforcement situations and during whatever jail time occurs; and preventing legal action that might arise out of critical incidents

Once these foundational relationships have developed, then the greater the chance of meaningful planning and ongoing collaborative relationships.

This initiative is focused specifically on diverting consumers with mental illness away from jail – but the overall lesson is one that I think is quintessential for the overall health and human services market space. Metrics and data sharing between social services, behavioral health provider organizations, and a funding source – and a commitment to innovate and monitor performance based on that data – is the path forward for coordinated care management and utilization. This is a lesson that applies to all those institutions that come into contact with individuals suffering significant health and mental health disorders, including our law enforcement and criminal justice systems.

For more on the scenarios you can apply this approach to, join me on August 16 for my colleague Joseph P. Naughton-Travers’ session, “Preparing For An Uncertain Future In Health & Human Services: A Guide To Scenario-Based Strategy Development,” at The 2017 OPEN MINDS Management Best Practices Institute, in Long Beach, California.


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