Topic: Frequent Jail Users

For years we have witnessed an increase in the number law enforcement interactions with individuals in the community with unaddressed behavioral health challenges. Conversely, there remain far too few alternatives to unnecessary arrest or transport to the emergency department.

Middlesex County, in Eastern Massachusetts, is New England’s most populous county. Our criminal justice and behavioral health leaders recognized the need improve capacity and access to behavioral healthcare in the community. In 2018, the Massachusetts legislature created the Middlesex County Restoration Center Commission to develop a pilot that would help solve the “divert-to-what?” question. In Middlesex County, the sheriff’s office offers evidence-based programing and treatment for incarcerated individuals, but individuals should not have to go to jail to receive the services they need.

We are grateful to have recently been invited to join the Safety and Justice Challenge’s new IMPACT behavioral health cohort, to share some of the lessons we have learned, and learn from our partner jurisdictions in this impressive network. The Commission has just entered its fourth year of work, and our path forward will be made easier through this tremendous peer exchange opportunity.

One of the biggest lessons we have learned, and hope to pass along to our partner jurisdictions, is the importance of improving collaboration and communication across siloed fields like public safety and behavioral health. All too often, addressing behavioral health needs of the community remains in traditional agency siloes. From the sheriff’s office to mental health service providers and police departments to peer and advocacy organizations, it is only this kind of collaboration that is able to stop people from falling through the cracks.

Middlesex County has 1.6 million people with 54 different police departments spread across urban, suburban, and rural areas. We are fortunate to have the progressive leadership of our police chiefs focused on diverting individuals away from the criminal justice system and into treatment. Similarly, we are fortunate to have a health and human services community poised to step up to increase outreach and engagement, to partner with public safety, and to provide appropriate assessment, treatment, stabilization, and support services to affected individuals.

In an effort to shift the responsibility back to the behavioral health community, we knew it was necessary to develop a model that knit together services in a way that made them easily accessible to both the public and local law enforcement. We wanted to move away from the traditional model of stabilization and release from the emergency department. The Restoration Center will offer both stabilization as well as a comprehensive assessment to inform referral to treatment so the needs of individuals can be appropriately met. Our goal is not only to stop the cycle of unnecessary incarceration but also to help individuals stay healthy enough that they do not have to return to the center.

After years of planning and implementation our goal is to launch a pilot Restoration Center in 2022. We believe we are well positioned to launch the model we have developed in large part due to our commitment to the cross-sector planning process which started with identifying gaps in the delivery of behavioral healthcare, a cost-benefit analysis, and interviews with individuals with lived experience. Through our state legislature, we were successful in securing initial funding as well as a trust fund that will allow the Commission to accept third-party funding.

Now that the Commission’s 2022 budget includes $1 million in funding for the pilot – endorsed by a recent editorial in the Boston Globe, we can begin our work of identifying a provider. We continue to pursue additional funding to ensure that we can implement a full range of services identified as critical to the success of individuals who might otherwise be arrested or hospitalized.

The center will provide behavioral health services to individuals in mental health or substance use crisis. These services will help support ongoing law enforcement efforts across the county to divert individuals with behavioral health conditions from arrest or unnecessary hospitalization.

Local law enforcement and corrections have shouldered this burden for far too long, with over 70 percent of people in our Middlesex Jail & House of Correction having an open mental health case and 80 percent have a history of substance use.  Each and every one of these individuals receives treatment while incarcerated, but these are services that people should be able to access in the community. Our hope is that the Restoration Center will help stop the cycle of unnecessary incarceration.

We attribute a lot of the success of the Middlesex County Restoration Center Commission to the commitment of our diverse stakeholder group. It is not common to have a sheriff co-chair a legislative commission with the president of a mental health advocacy group. It is also unusual to get representatives of the 80 largest behavioral health providers at the county, police chiefs, the chief administrative justice of the trial court, and key state legislators at that table. And sustaining the focus on a challenging goal for over three years is the rarest thing of all. But that is what it takes.

Unfortunately, political will is often the hardest thing to secure. But we owe it to the people falling through the cracks to get it right.

When it comes to predictions—for example, the weather or national elections—experts are not always right. One safe bet, however, is when we try and predict who will continue to be arrested and booked into jail for minor criminal matters. In those cases, past behavior, uninterrupted by interventions, may well be the best predictor of future arrests.

In King County, Washington (Seattle), we have begun to predict who will be coming to our county jails based on the frequency of their past bookings. What we have learned has inspired us to consider a new approach. The King County Department of Community and Human Services (DCHS) took a look at individuals who have been booked four or more times in any 12-month period over the past three years and found that at any given time, there are about 2,000 people in our jail system who meet this criteria.

County taxpayers spent about $35 million a year on this group—an average of about $28,000 for each of the frequent visitors to our jail. Of this money, 87% was spent on due processes—criminal justice or crisis response programs—which primarily deal with the negative results of behavioral health disorders. Only 13% was devoted to programs like housing, treatment, or health care that can prevent frequent utilization of jails and other emergency services.

The Familiar Faces Initiative was created collaboratively within King County agencies with the goal to proactively assist people with the highest risk of arrest and incarceration for minor crimes. “When you look at this challenge through a behavioral health lens there is a real opportunity to help people find stability in their lives to avoid the patterns of conduct that lead so regularly to jail,”  said Adrienne Quinn, Director of DCHS. “We know that there is a better use of County resources than repeatedly processing the same people through the court system for minor matters,” she said.

The first step has been to identify a small cohort of 60 people meeting the definition of a “Familiar Face.” Care managers are reaching out to these individuals before they come back to jail with an offer of services and support. The program is in its inception, so there is little data yet, but we are encouraged by individual stories of success—like the man who was homeless for 17 years and is now in supportive housing through the efforts of the Familiar Faces team.

There is even a role for a deputy prosecuting attorney in Familiar Faces, which is modeled after the prosecutor’s role in Seattle’s Law Enforcement Assisted Diversion (LEAD) program, an arrest diversion model that has been replicated nationally. The prosecutor monitors all Familiar Faces participants for any new criminal activity as well as any pre-existing legal entanglements, and provides information to the care team regarding outstanding warrants and pending cases. The deputy prosecuting attorney utilizes prosecutorial discretion to divert cases, or works closely with law enforcement, the intensive care management team, defense attorneys, and community members collaboratively to resolve participants’ criminal entanglements so that they can access treatment and other services.

This preventative approach depends on new partnerships between social service providers and the criminal justice system. We all share the same goals of increased public safety and improved health for those stuck in the downward spiral of the criminal justice system. Familiar Faces is one example of what I call “Community Justice”: doing justice together with the community, and defining accountability through an outcome that is focused on reducing the harm that people do to themselves and their neighborhood.

For more information about Familiar Faces, please contact Jesse Benet, King County Behavioral Health and Recovery Division, Diversion and Reentry Services, at jesse.benet@kingcounty.gov.