Associations endorse crisis stabilization units, training

Wednesday, November 16, 2016 8:00 am

Governor included $5 million in proposed budget for three crisis units.

Various stakeholders in behavioral and mental health and criminal justice gathered for a statewide summit at the Association of Arkansas Counties in early October to further investigate options and to learn about the culmination of The Council of State Governments Justice Center's research findings.

LITTLE ROCK — Three statewide associations have passed resolutions requesting state leaders to provide “priority funding” from the state of Arkansas to address the state’s revolving door in the criminal justice system for Arkansans with mental illness.

“The voice of county government has spoken loudly. Sheriffs, county judges, and the quorum court association have all unified and made resolutions to keep the mentally ill out of jails,” said Bill Hollenbeck, Sebastian County sheriff and AAC board member.

The County Judges Association of Arkansas (CJAA), Arkansas Sheriffs’ Association (ASA) and the Quorum Court Association of Arkansas (QCAA) all passed resolutions urging the state to support adequate funding and provisions for:

• Establishment and funding for adequate in-jail behavioral health services and crisis services for the mentally ill (including support through use of telemedicine);
• Establishment and funding of regional crisis stabilization units (CSU) for the mentally ill throughout the state of Arkansas; and
• Establishment and funding for crisis intervention training (CIT) of law enforcement officers throughout the state of Arkansas.

Governor Asa Hutchinson released his proposed budget last week, and it included $5 million for three crisis stabilization centers in the state, according to the Arkansas Democrat-Gazette.

“State prisons and county jails should not be the default mental health institutions for the state,” Hollenbeck said. “We are excited to partner with Governor Hutchinson to help save jail space and use them for what they are intended for, incarcerating dangerous criminals. This will save tax dollars for our state, and it is the right thing to do.”

Unfortunately, local law enforcement officials in the state of Arkansas have few options when encountering the mentally ill on the street. Currently, Arkansas law enforcement does not have infrastructure or specialized training to divert these individuals from incarceration to treatment.

The Council of State Governments Justice Center has presented numerous times to the Criminal Justice Task Force, Behavioral Health Task Force, and State Agencies and Judiciary committees. Earlier this month, the Justice Center released its summary of findings at a statewide summit at the AAC. Those findings encompassed a multitude of options for the state in several different areas of concern in criminal justice, including crisis intervention diversion and training in efforts to better serve the mentally ill and reduce populations and the recidivism rate.

Andy Barbee, Justice Center research manager, presented “Discussion of Policy Options and Reinvestments” at the summit, and he offered policy options concerning prison and jail populations, mental health and diversion.

According to the report, the state could consider developing and funding strategies to reduce pressures on county jails, including specialized law enforcement training, screening and assessment tools and diversion for people with mental illness.

The report highlighted five main categorical policy options:

• Create a fund to reimburse Arkansas’ local law enforcement agencies for expenses associated with training officers/deputies in crisis intervention/specialized response for people with mental illness;
• Develop options for diverting people with mental illness from jails, including funding to support crisis stabilization units as well as necessary programming and treatment for successful reintegration into the community;
• Assist the AAC and ASA in the development of screening and assessment tools for use by local jails. Use of such tools by local jails will be voluntary;
• Develop a secure statewide database for maintaining information on jail intake screenings/assessments to enable this information to be readily accessible to jails in Arkansas; and
• Create county/regional councils to coordinate administration of criminal justice at local level.

Arkansas’ prison population is among the fastest growing in the nation and showed a 22 percent increase from 2004 to 2012, according to data from the Bureau of Justice Statistics (BJS).

In 2006, BJS found the majority of state, federal and local jail inmates had mental health problems and 15 percent had severe mental illness.

“We need to continue to educate decision makers and the public on the issue of mentally ill individuals being held in county jails by default due to lack of alternative treatment opportunities and the impact of this ongoing lack of treatment on public safety, county jails and the prison system,” said Sebastian County Judge David Hudson, who is also president of the CJAA. “The relationship of county jails to the state correctional system is an essential part of this discussion. Research shows that 20 to 30 percent of the average jail population is made up of mentally ill individuals who are not dangerous or violent.”

According to the National Association of Arkansas Counties (NACo), one in five adults in the U.S. experiences a mental illness, with less than half receiving treatment in the past year. One in 25 experiences a serious mental illness, with only two-thirds receiving treatment. One in ten experiences a substance abuse disorder, with only 10 percent receiving treatment in the past year. NACo has promoted for several years "Smart Justice," which emphasizes spending local tax dollars and resources smarter and more effectively by diverting the non-violent non-dangerous from jail while protecting public safety and incarcerating the dangerous and violent in jail and prison.

The state alone now spends more than $500 million on corrections, a 68 percent increase from 2004. Without interruption to the status quo, from 2018 to 2023, the Justice Center projects the state will spend $650 million more.

“Treatment of the mentally ill in county jail is not appropriate and re-arrest is likely, creating a cost of incarceration higher than for other inmates,” Hudson said. “Crisis intervention training for law enforcement officers coupled with diversion to a crisis treatment facility is a smarter and more cost effective manner in which to address these individuals.”

The Justice Center previously reported that Arkansas’ recidivism rate is about 48 percent.

The growing trend in populations is not expected to plateau. The Justice Center also reported Arkansas’ prison population is projected to increase 19 percent by the end of 2023.

“Crisis intervention and training to divert mentally ill away from the criminal justice system is a win-win from the Quorum Court Association’s viewpoint,” said David Thompson, Boone County justice of the peace and Quorum Court Association president. “This concept utilizes funds in a better manner and it helps people who need it. So, we consider crisis intervention training and units to be smart economically, and it will display a better way to care for people.”

It is estimated that 8.5 million adults have both a mental health and substance abuse disorder, according to NACo.

Last fall, the ASA, AAC and the Mental Health Council conducted regional meetings with local law enforcement and state legislators that focused on education about the positive impacts of diversion programs and crisis intervention units.

“These individuals need to be diverted for treatment, including possible medication, to stabilize and return to the community,” Hudson said. “Setting up regional treatment facilities for the mentally ill is needed in Arkansas to keep the backlog of individuals in county jails from waiting for a bed in the only treatment facility in Little Rock.”

Forty-five states have crisis stabilization units, crisis intervention training and diversion programs of some nature, including Arkansas’ surrounding states. Many stakeholders, including state legislative leadership, toured crisis intervention units in Texas and elsewhere earlier this year.

In San Antonio (Bexar County), officers who encounter people with mental-health and substance-abuse issues who are engaging in activity that could lead to a low-level misdemeanor arrest are trained to take those people to a facility known as a crisis stabilization unit for treatment instead of to jail.

According to local officials, that program has diverted more than 17,000 people statewide from jails and emergency rooms, has provided training in crisis intervention to more than 2,600 law enforcement officers and more than 250 school police officers and administrators, and has saved taxpayers more than $50 million over about 12 years. The Bexar County jail now has empty beds instead of overcrowding.

The Justice Center identified that multiple funding streams are best to leverage federal funds where possible and reduce financial barriers and/or complications to crisis admissions (so ideally no one in crisis is excluded for services for funding reasons). Common sources:

Medicaid

• Rehabilitation Option
• Clinic Option
• Waivers [1115; 1915(b)]

Mental Health and Substance Abuse Block Grants

Private insurance

Local government funds

Self pay? and state general funds

Other grant funding

The Justice Center also offered two policy options to increase the availability of effective community-based substance abuse treatment and services:

• Expand community-based substance use programming and treatment for medium- and high-risk populations on supervision; and
• Leverage Medicaid to cover the cost of substance use treatment and services for medium- and high-risk people on supervision.

“Implementation of Mental Health Courts in Arkansas is also recommended to connect offenders that suffer from mental illness to court accountability and supervised treatment,” Hudson said. “Each of the components of this initiative, from CIT law enforcement training, CIT treatment facilities and implementation of mental health courts, work together to improve outcomes in the criminal justice system.”

The Council of State Governments is a national non-profit, non-partisan membership association of state government officials that engages members of all three branches of state government. The Justice Center provides practical, nonpartisan advice informed by the best available evidence, and justice reinvestment is a data-driven approach to reduce corrections spending and reinvest savings in strategies that can decrease recidivism and increase public safety. The U.S. Department of Justice’s Bureau of Justice Assistance and The Pew Charitable Trusts provide funding support for the Justice Reinvestment Initiative.

What is a crisis stabilzation unit?
A crisis unit would be a 16-bed unit, serving as a diversion site for individuals with mental illness who might otherwise be incarcerated and could also be designed for Arkansas’ needs. These units would provide immediate access to assessment, mental health treatment, stabilization, and aftercare follow-up. Staff for these units would include psychiatrists, and/or psychiatric nurse practitioners, licensed mental health professionals, registered nurses, licensed practical nurses, and caseworkers. These units would admit individuals on a voluntary or involuntary basis, and would be structured to serve the majority of individuals who would present for admission.