Middlesex County Working to Solve the Question of “Divert-to-What?” Through Stakeholder Collaboration

By: Peter J. Koutoujian, Danna Mauch, PhD

Diversion Frequent Jail Users Homelessness Interagency Collaboration Mental Health Substance Abuse December 2, 2021

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.

Breaking The Cycle Of Homelessness And Jail

By: Madeline Bailey

Crime Homelessness Pretrial Services August 12, 2020

On any given night in the United States, more than 550,000 people are experiencing homelessness. Among these, 96,000 are chronically homeless, meaning they are facing long and repeated episodes of homelessness that make it increasingly difficult to return to housing. This crisis is perpetuated by a legal system that criminalizes survival behaviors associated with homelessness, fails to account for the ways in which people who are homeless face impossible odds within the legal process, and then releases them back into the community with even more obstacles than they faced before.

The time has come for local justice systems to take immediate action to halt the cycle of homelessness and jail incarceration.

This must begin with acknowledging the harms perpetuated by the current system, addressing deepening racial disparities, and enacting urgently needed changes to policies and practices.

That’s the crux of a new evidence brief issued this week by the Vera Institute of Justice—strategic allies to the Safety and Justice Challenge.

In the brief, we examine how the overenforcement and criminalization of homelessness exposes unhoused people to frequent police contact and citations for unavoidable aspects of homelessness, such as camping outside or soliciting help. For people lacking a stable income, housing, or a reliable mailing address, unpaid fines and missed court dates can quickly trigger warrants and arrests. Once caught in the system, people without housing face a higher likelihood of pretrial incarceration and increased vulnerability to conviction, leading to longer periods in jail.

After release from jail, increased obstacles and restrictions make it even harder to find safe housing, employment, and overall stability—leaving many recently released people with no realistic option for avoiding homelessness.

Confirming the cycle, researchers have found that homelessness is between 7.5 and 11.3 times more prevalent among the jail population. Because of punitive laws and enforcement practices, people who are homeless are 11 times more likely to be arrested, nationwide, than those who are housed.

Without legal and policy changes, the cycle of homelessness and jail will persist, and will deepen already existing racial disparities within the criminal legal system. Research has shown that Black people make up more than 40 percent of America’s unhoused population, despite constituting only 13 percent of the general population.

The evidence establishing the link between homelessness and jail incarceration demands further research and highlights the urgent need for alternative approaches.

The most humane way to stop the cycle of homelessness and jail is to provide safe and stable housing for all. But, as some jurisdictions are starting to recognize the urgency of stopping this cycle, local justice system stakeholders have begun implementing smaller solutions that offer people experiencing homelessness a way to avoid the devastating consequences of the criminal legal system, while also allowing communities to free up system resources for other purposes.

Our brief offers several strategies for breaking the cycle of homelessness including:

  • Eliminating harmful city ordinances that target elements of homelessness
  • Halting the issuance of warrants for quality of life offenses
  • Forgiving legal fines and fees for people experiencing homelessness
  • Reforming probation and parole procedures to support people without stable housing
  • Addressing housing and employment restrictions for justice-involved people

Especially in a year when the United States is weathering an unprecedented public health crisis, it is more important than ever to examine the systems that make communities most vulnerable and to implement alternatives that prioritize safety, health, and justice for all.

Madeline Bailey is a Program Associate with the Vera Institute of Justice


Data Analysis Homelessness Human Toll of Jail August 12, 2020

No Access to Justice: Breaking the Cycle of Homelessness and Jail

Madeline Bailey, Erica Crew, and Madz Reeve (The Vera Institute of Justice)

The time has come for local justice systems to take immediate action to halt the cycle of homelessness and jail incarceration.

Breaking the Cycle of Incarceration and Homelessness

By: Bert Winkler

Courts Homelessness Interagency Collaboration March 2, 2018

Palm Beach County, like many jurisdictions across the country, faces numerous challenges as it seeks to safely reduce its jail population. One of these challenges is addressing the “frequent users” of our system—people who cycle in and out of our county’s jail, hospital, and behavioral health systems. Many of these people are experiencing their own challenges, including housing instability and mental health problems. County leaders recognize that without addressing these issues—poverty, instability, and untreated mental health conditions—we will never address overuse of our local jail.

Palm Beach County also has a long history of collaboration in addressing challenges within the criminal justice system. Our Criminal Justice Commission was created in 1988 and has regularly gathered key system players around the table to bring meaningful improvement and reform to areas such as pretrial services, pretrial diversion, and reentry, among others. We were able to draw upon this history of collaboration as we worked together to develop responses to our county’s frequent system users. Through this process, we created the Palm Beach County FUSE Project (PBC FUSE), which we plan to implement this year.

FUSE is an acronym for Frequent Users System Engagement, a model for addressing homelessness among our most vulnerable individuals. It was developed by the Corporation for Supportive Housing (CSH), a national organization based in New York City, and has now been adopted by more than 20 jurisdictions around the country, including Mecklenburg County, North Carolina and Harris County, Texas, which are also part of the Challenge Network. The goal of FUSE is to break the cycle of incarceration and homelessness by providing stable housing to people who are identified as the most frequent users of jails, homeless shelters, behavioral health crisis services, and hospitals in Palm Beach County.

Implementation of PBC FUSE will reduce our local jail population by decreasing recidivism among program participants. Concurrently, it will lead to an increase in housing stability and a decrease in reliance on multiple crisis services. Permanent supportive housing is a key factor in decreasing a person’s  involvement with the criminal justice system. Nothing stabilizes a person in crisis more than having a home—particularly when necessary services are provided as well.

FUSE participants are identified through data matching. The PBC FUSE Policy Team will develop a list of individuals who were arrested three or more times in the past year. We will then match that list with our homeless and behavioral health crisis centers’ patient lists. (Hospital data will be added later.) After an initial list is developed, these people will be located through a process of “inreach” (homeless shelters, jails, and hospitals) and outreach (streets and parks). Case managers will enlist and engage participants and place them in permanent supportive housing. The managers will then coordinate the procurement of any necessary services. This may include physical and behavioral healthcare (including therapy and treatment), transportation, job training, obtaining identification documents, and accessing benefits.

There has been strong support for PBC FUSE throughout the community from the beginning. Participating organizations are enthusiastic about the project and committed to its success. These include the Criminal Justice Commission, PBC Human Services Department, City of West Palm Beach, Public Defender, State Attorney, Southeast Florida Behavioral Health Network, individual behavioral healthcare providers, agencies that provide housing and services for the homeless, and two of our local hospitals. In addition to the generous funding we’ve received from the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge, we are working with a local foundation which is supportive of the project. We have also been the recipient of local and federal government dollars. The Lord’s Place, a leading agency working with the homeless in our county, recently received a major HUD grant providing for fifteen individual housing units which will be prioritized for our FUSE participants. We will have an initial pilot project serving 25 individuals in 2018 with plans to expand to 100 individuals within two years.

All our stakeholders are working together to identify PBC FUSE participants and help them stabilize and improve their health and their lives. The unique nature of the FUSE project is a key factor in enabling us to maintain collaboration, enthusiasm, and commitment. FUSE cuts across four major crisis systems: criminal justice, homelessness, behavioral health, and physical health. A successful FUSE project can help numerous individuals reclaim their lives. But there is an additional benefit which makes FUSE attractive to stakeholders. It can produce tremendous cost savings. If participants are able to be housed and stabilized, then jails, hospitals, behavioral health crisis centers, and homeless agencies can save a great deal of money as these individuals will no longer be cycling through their doors.

After months of planning, PBC FUSE is nearing the implementation phase. We are optimistic that our efforts will lead to success for both individuals and the community at large.