Keeping the mentally ill out of jail

From the Chinook Observer, July 25, 2014

Law enforcement officers see them every day: people in the grip of serious mental illness.

Officers encounter them on the streets, some strung out, some committing crimes while glimpsing life through a faulty filter. Options for police are limited. Mentally ill inmates clog the state’s jails and prisons, which have fast become de facto mental health institutions. The most severe cases go to the Oregon State Hospital.

And there’s not many options in between.

Instead of spending $25,000 per month at the state hospital to care for someone who has slid deep into crisis, it could be cheaper and more effective to intervene earlier back in the home community.

That was one of the messages at this week’s Association of Oregon Counties’ public safety summit at the Umatilla County Justice Center.

“How do we divert people earlier rather than later from a criminal justice system where things get very expensive?” asked Rob Bovett, legal counsel for the Association of Oregon Counties.

“There is tremendous savings to the state if we can divert these folks away from the state hospital.”

Bovett spoke to room packed with county sheriffs, district attorneys, county corrections staff and mental health professionals.

Bovett wrote draft legislation – dubbed the Mental Health Justice Reinvestment Program – that would infuse money into Oregon’s counties to establish services and programs designed to prevent individuals with mental illnesses from entering or reentering the criminal justice system. Ideally, it would also reduce referrals to the Oregon State Hospital.

Interventions could include mental health courts, mobile crisis response units, respite and crisis centers, peer mentors, crisis intervention training for officers, transitional housing and others.

“Our system right now drives people to the highest level of cost,” Bovett said. “People rot in our jail or we send them off to the State Hospital.”

That’s like zooming from zero miles-per-hour to 100, he said.

“We’ve got nothing in between,” Bovett said. “We can save the state a ton of money.”

Some counties are already experiencing impressive results with local intervention, said Cheryl Ramirez, executive director of the Association of Community Mental Health Programs. A county in Texas documented cost savings of $50 million over five years, diverting people from jail with crisis intervention, drop-off centers, respite care and other approaches. Salt Lake County in Utah focused on the area’s 10 highest-cost inmates. A team of judiciary, mental health and corrections officials met regularly to discuss and plan interventions. The number of incarcerations declined dramatically.

“This is where we’re going nationwide,” Ramirez said. “It’s been shown to deliver.”

Kevin Campbell, CEO of Greater Oregon Behavioral Health, Inc., is also singing this song – and he’s singing it loudly. He likes to say, “Why doesn’t the state tell us what the hell they want, give us 90 percent of the money, get out of our way and we’ll shock ’em with the outcomes?”

Campbell is also CEO of the Eastern Oregon Coordinated Care Organization – one of 16 organizations around the state charged with providing health care to Oregon’s poorest residents. He said he has witnessed this type of prevention and intervention approach work with children when schools, child welfare, law enforcement and education service districts partner together.

“This is an opportunity to do the same for adults who are costing us the most money and present the greatest threat to public safety,” Campbell said.

During a question-and-answer period, Morrow County District Attorney Justin Nelson told Campbell he has reservations about treating locally instead sending folks to the state hospital. Of special concern are unstable individuals who are unable to aid and assist attorneys in their own defense.

“They are in custody because they are a public safety concern,” he said. “It’s a security issue. Sometimes people with mental health issues have decompensated quite a bit.”

Campbell called Nelson’s concern valid, but suggested that a number of regional secured facilities could house those who are a danger to themselves or others.

“Certain people do need to be locked up in a secured facility, but does that have to be in Salem or Junction City?” Campbell said, referring to the main state hospital and another being built about 60 miles south. “There has to be a balance between community safety and mental health.”

After conferring with sheriffs, DAs and others involved in law enforcement, Bovett will craft a final draft of proposed legislation in time for the start of the next session of the Oregon Legislature.