Transforming Services for Persons with Mental Illness in Contact with the Criminal Justice System (PDF – 200+ pages)

Final Report Multnomah County, Oregon Sequential Intercept Mapping and Taking Action for Change April 13 and 14, 2010

Executive Summary The Mental Health/Public Safety Subcommittee of the Local Public Safety Coordinating Council (LPSCC) and multiple other stakeholders in Multnomah County requested the Sequential Intercept Mapping and Taking Action for Change workshops to provide assistance with:  Creation of a map indicating points of interface among all relevant Multnomah systems  Identification of resources, gaps, and barriers in the existing systems  Development of a strategic action plan to promote progress in addressing the criminal justice diversion and treatment needs of adults with mental illness in contact with the criminal justice system The participants in the workshops included forty-two individuals representing multiple stakeholder systems including mental health, substance abuse treatment, human services, corrections, advocates, family members, consumers, law enforcement, and the courts. Dan Abreu, MS CRC LMHC and Patty Griffin, PhD from Policy Research Associates, facilitated the workshop sessions. This report includes:  A brief review of the origins and background for the workshop  A summary of the information gathered at the workshop  A sequential intercept map as developed by the group during the workshop  An action planning matrix as developed by the group  Observations, comments, and recommendations to help Multnomah County achieve its goals Top Priorities:  Address communication/information sharing issues Non-crisis Release of Information forms that are proactive Better linkage between mental health and the jail Identify boundary spanners for each represented entity that can carry this work forward o Can act as cross-system trainers  Develop a true diversion from jail or before jail Develop the possibility of a different response to the low level criminal charges typically found with this population Address prevention Secondary Priorities:  Develop more flexible housing options  Expand capacity of MH Court by broadening the door  Develop Crisis Assessment and Triage Center for police to drop people off Healing environment Staff willing to accept broad range of behaviors  Include Forensic Peer Support  Address female offenders with specialized services/treatment  Prioritize new Intensive Case Management for this population  Develop a community involvement group that takes advantage of citizen interest and energy  Expand CIT training to other partners such as 911, jail staff, etc.  Develop cross system training Multnomah County, Oregon Final Report, April 2010 Sequential Intercept Mapping & Taking Action for Change – 7 –  Develop active understanding and engagement from County Commissioners Recommendations: Recommendations contained in this report are based on information received prior to or during the workshops. Additional information is provided that may be relevant to future action planning. Multnomah County is currently doing excellent work to enhance collaboration, improve services, and increase community alternatives for people with mental illness involved in the criminal justice system. The recommendations offered below can be used to build on recent accomplishments to enhance cross-system collaboration and the current service delivery system. Cross-Intercepts:  At all stages of the Sequential Intercept Model, data should be developed to document the involvement of people with severe mental illness and often co-occurring substance use disorders involved in the Multnomah County criminal justice system.  Expand forensic peer counseling, support, and specialists to promote recovery.  Continue interaction with family members who have shown interest in collaborating to improve the continuum of criminal justice/behavioral health services.  Review screening and assessment procedures for mental illness, substance abuse, and cooccurring disorders across the intercepts.  Address fragmentation and breaks in continuity of care; focus on improving current linkages and continuity of care to break the cycle of repeated admissions and high use of crisis/emergency services.  Identify frequent users, a group that tends to cycle repeatedly through the mental health, substance abuse, and criminal justice systems without long-term improvement.  Increase information sharing to enhance rapid identification of current mental illness and history of services so diversion can be immediately initiated.  Establish formal collaboration with the Department of Veterans Affairs by including a VA representative in local planning groups. Intercept I: Law Enforcement and Emergency Services  Improve coordination with law enforcement and develop crisis stabilization bed capacity. Intercept 2: Initial Detention and Initial Hearings  Develop Intercept II diversion options. Intercept 4: Re-entry  Carefully coordinate the resources offered by the jail‟s mental health staff, MCSO, community providers, probation, and others.  Explore ways to enhance the “bridge medication” when a person reenters the community from the jail so there is not a lapse in treatment.  Build on current work to systematically develop “in-reach” efforts into the jail to identify those with severe mental illness and often co-occurring disorders in order to facilitate continuity of care and alternatives to incarceration.  Systemically expedite access to Medical Assistance, Social Security, and other benefits to facilitate successful reentry to the community.  Explore methods to help people obtain birth certificates or other needed identification. Multnomah County, Oregon Final Report, April 2010 Sequential Intercept Mapping & Taking Action for Change – 8 – Intercept 5: Community Corrections and Community Support  Carefully coordinate the resources offered by the jail‟s mental health staff, MCSO, community providers, probation, and others.  Explore ways to enhance the “bridge medication” when a person reenters the community from the jail so there is not a lapse in treatment.  Build on current work to systematically develop “in-reach” efforts into the jail to identify those with severe mental illness and often co-occurring disorders in order to facilitate continuity of care and alternatives to incarceration.  Systemically expedite access to Medical Assistance, Social Security, and other benefits to facilitate successful reentry to the community.  Explore methods to help people obtain birth certificates or other needed identification. The details of these recommendations can be reviewed in PRA‟s technical report.