Topic: Mental Health

In Multnomah County, Oregon, we are committed to addressing racial disparities in our local justice system, and to addressing the unique needs of those most directly impacted by jail incarceration.

One population that is particularly vulnerable to justice-system involvement is people with mental illness. In 2015, we conducted a study to identify ways in which we could safely divert these people away from jail and into other treatment services. Through our Mental Health Jail Diversion Feasibility Study, we discovered that African Americans who struggle with mental illness are over-represented in the local jail.

This was compounded by an additional report in 2016—released by Multnomah County in partnership with the MacArthur Foundation’s Safety and Justice Challenge—that found African Americans in the county were six times more likely than whites to be in jail, despite only representing 6 percent of the local population.

Further, data provided by the county’s Department of Community Justice in 2017 showed that women with mental illness were sanctioned to jail more frequently on probation violations than women who were not struggling with mental health concerns. And, once in jail, women with mental illness stayed longer.

Based on these findings, Multnomah County’s public safety partners realized that we needed to develop more tailored responses to women—particularly women of color—who are involved in the justice system and suffering from mental illness.

This Fall, we are excited to launch one of these strategies: the first-of-its-kind transitional housing program in the county for adult women involved in the criminal justice system. The Diane Wade House will provide gender-responsive, trauma-informed services that are also Afrocentric. This means that residents, who must be referred to the program, will have access to culturally specific mental health stabilization and support services.

In addition to dormitory-style housing, the Diane Wade House will offer a variety of daytime services, including mentoring and life-skills programs. It is intended to be a low-barrier, transitional housing program, meaning that its eligibility requirements aim to reduce barriers to entry rather than place undue burdens on those who need housing and services.

The home will serve 38 justice-involved women referred by the Multnomah County Department of Community Justice and Multnomah County Mental Health and Addiction Services. Twenty-one of those beds will be funded by the Safety and Justice Challenge, which supports efforts like ours to reduce unnecessary incarceration without compromising public safety—particularly for those struggling with mental health or addiction issues.

Diane Wade has a special connection to Multnomah County. A parole and probation officer with the county’s Department of Community Justice, she was a leader in the African American community and best known for her advocacy and passion for justice-involved women. Wade worked with adults in Multnomah County from May 1999 until she passed away in October 2010. Most of her work was with women of color as a lead parole and probation officer with the African American Program as well as the Gang Unit.

As part of community-involvement requests from both the Safety and Justice Challenge and the Multnomah County Board of Commissioners, community members are providing input and feedback for the women’s program. This includes women who are currently or previously involved in the justice system. The Department of Community Justice will also launch a Community Advisory Board, made up of justice-involved women, to help guide ongoing program development and operations. The Advisory Board will include a current resident of the Diane Wade House.

Through these efforts, Multnomah County seeks to reduce the overrepresentation of women with mental illness in the criminal justice system, and help women develop a foundation for future stability and success.

Yakima County, Washington has been actively working to improve our criminal justice system with analysis-driven, evidence-based system change. One of the significant ways in which we are doing this is by focusing on some of the most vulnerable people who are involved in the justice system: people with severe mental illness. By actively working to develop a continuum of care for people with mental illness, we hope to limit or even end their future system involvement.

Our focus on this population evolved from initial work to develop an innovative pretrial release program. Prior to our selection for a Safety and Justice Challenge Innovation Fund grant, Yakima County was one of three selected Smart Pretrial demonstration sites in the country. The Smart Pretrial initiative, funded by the Bureau of Justice Assistance, aimed to provide a pretrial system that is safe, fair, and effective, and that maximizes public safety, court attendance, and appropriate use of release, supervision, and detention.

With Smart Pretrial support, we implemented a pretrial assessment for all newly booked people, reduced the use of secured money bail, and developed a dedicated first appearance hearing on our docket. We further adopted the Arnold Foundation’s Public Safety Assessment (PSA) tool, a risk assessment tool that helps judges make accurate, efficient, and evidence-based decisions about which defendants should be detained prior to trial and which can be safely released. As a result, pretrial detention rates decreased from 47 percent to 27 percent over one year and racial disparities were reduced significantly. All of this was accomplished without sacrificing public safety or court appearance rates.

Early data from these reforms, however, indicated that individuals with serious mental health issues were experiencing challenges with the pretrial release program. To help address these challenges, we decided that developing a continuum of care was the next logical step to ensure a reduction in over-incarceration, particularly for this vulnerable group. Our work to develop this continuum of care was supported by the Innovation Fund.

We were well positioned to implement these efforts. Yakima County already had many of the required components in place, including a Mental Health Crisis Stabilization Unit, Crisis Intervention Training for Law Enforcement, a Behavioral Health Diversion Program, and a Mental Health Court. Yakima County is also one of the few sites in the country to implement a Dual Diagnosis Mental Health/Drug and Alcohol Court. While each sector had successes and innovative programs, Yakima County needed to assess the system as a whole to have effective change.

The Yakima County Collaborative Diversion Policy team—comprising criminal justice system stakeholders and local mental health providers—conducted this assessment with an approach known as the Sequential Intercept Model (SIM). SIM involves assessing available resources, determining gaps in services, and planning for community change through the development of a map that illustrates how people with behavioral health needs flow through the criminal justice system.

Through a workshop facilitated by Policy Resource Associates (PRA), team participants identified opportunities for linkage to services and for prevention of further penetration into the criminal justice system. This workshop included stakeholders from across multiple systems, including mental health, substance abuse, law enforcement, pretrial services, courts, jails, community corrections, housing, health, and social services, as well as peers, family members, and many others.

The SIM was invaluable in providing stakeholders with a framework to assess the current system and enabling the community to identify action steps moving forward to address system change. Yakima County is currently working to address those gaps to divert these individuals from the criminal justice system into community-based treatment.

Across the country, communities are recognizing that people with mental illness are overrepresented in their local justice systems. Too often, police are called to intervene with individuals experiencing mental health crises, which leads to arrest and time in jail—an environment in which they tend to fare poorly. Fortunately, local justice systems are increasingly implementing new policies and practices to help connect these people to treatment outside of the justice system. But there are underutilized opportunities for localities to reduce incarceration rates by using legal protections found in the Americans with Disabilities Act and the Olmstead Supreme Court decision.

The Americans with Disabilities Act (ADA)—which has far-reaching requirements for public services provided by state, county, and local entities—can serve as a significant tool to achieve reductions in jail populations. The ADA is a landmark civil rights bill enacted in 1990, based on a recognition that historically, society has tended to isolate, segregate, and discriminate against individuals with disabilities. The law mandates an end to this discrimination, for the purpose of assuring people with disabilities equality of opportunity, full participation, independent living, and economic self-sufficiency.

Of the ADA’s several parts, one—Title II of the ADA— imposes legal obligations on the activities of states, counties, cities, and similar public entities. This includes the administration of law enforcement and corrections, as well as the provision of services to people with mental illness. In service of the national movement to deinstitutionalize people with disabilities, Title II prohibits unnecessary institutionalization, and includes the so-called “Integration Mandate,” which requires public entities to “administer services, programs, and activities” in non-institutional settings that “enable individuals with disabilities to interact with nondisabled persons to the fullest extent possible.” Jails and prisons can be, without question, a form of unnecessary institutionalization that affects many thousands of individuals with mental illness.

Among people with disabilities and their allies, the ADA was heralded as a game-changer. However, the requirements of the ADA have not been universally accepted by state and local governments, and the law has been repeatedly challenged in court. One such lawsuit, Olmstead v. LC, resulted in a landmark Supreme Court case that has become the platform for dramatic ADA reforms nationwide for people with mental illness. The plaintiffs were similar to many people served through public mental health systems and those who come to be incarcerated in jails. They had longstanding mental disabilities and, for many years, cycled in and out of psychiatric institutions operated by the state. The core of their complaint was that they were not being afforded appropriate public services within the community and, as a result, they were being subjected to unnecessary institutionalization in violation of the ADA.

In 1999, the Supreme Court handed down its decision in Olmstead, finding that as long as the services do not represent a fundamental alteration of public systems, people have a right to receive the community services they need to live outside of an institution. The Supreme Court was addressing unnecessary institutionalization in a hospital, but the Court’s analysis applies to unnecessarily institutionalization in jail as well.

Both the Bazelon Center and the U.S. Department of Justice have used the Olmstead decision to bring ground-breaking lawsuits that challenge the unwarranted institutionalization of people with mental illness. This has resulted in public systems being spurred to develop an array of new service alternatives within the community. For example, two important statewide lawsuits, U.S. v. Georgia and U.S. v. Delaware, stemmed from DOJ investigations that found the states were unnecessarily segregating people with mental illnesses in institutions. Both cases resulted in settlement agreements which lay out a set of community services that must be developed statewide. This included Assertive Community Treatment, supported employment,  supported housing (individuals living in their own apartment with the help of rental subsidies and supportive services), and crisis services consisting of a crisis hotline, mobile crisis services, crisis walk-in centers, crisis apartments, and crisis stabilization services providing intensive, short-term crisis interventions. This array of services is proven to be effective in keeping people out of institutions and allowing them to remain in their communities. Since the needs of people with mental illness who are served by public mental health systems and those who enter local criminal justice systems are more alike than different, providing individuals in jails or at risk of institutionalization in jail with these “Olmstead services” can produce similar success in reducing jail populations.

The ADA and the reforms it has spurred hold great promise for people with mental illness within criminal justice settings. People with serious mental illness who are justice-involved qualify for the protections of the ADA, just like the beneficiaries of the Olmstead settlements discussed above. And the systems that are responsible for their needless arrest and incarceration—the mental health system and the criminal justice system—are public systems covered by the ADA. It’s time for states to use the legal rights in the ADA and Olmstead as leverage to develop the public mental health services needed to reduce contact with the criminal justice system and the incarceration of people with mental illness in jail.