Seminole County, Florida: Improving Services for Adults with Mental Illnesses in Contact with the Criminal Justice System

Transcription

1 Seminole County, Florida: Improving Services for Adults with Mental Illnesses in Contact with the Criminal Justice System Introduction Sequential Intercept Mapping This report summarizes the Cross-Systems Sequential Intercept Mapping workshop held in th Seminole County, March 6P P, The workshop was facilitated by the Florida Criminal Justice, Mental Health, and Substance Abuse (CJMHSA) Technical Assistance Center at Florida Mental Health Institute (FMHI), University of South Florida (USF). This report includes: A brief review of the origins and background for the workshop Information gathered at the workshop based the Sequential Intercept Model or Cross-Systems Mapping An action planning matrix as developed by the group Summary, consensus and observations by the CJMHSA Technical Assistance Center to assist Seminole County achieve its goals A cross-systems intercept map based on the perceptions of the Seminole County mapping participants Background The Honorable Judge John Woodard and Dr. Valerie Westhead, along with the full support of multiple local stakeholders and the Seminole County Mental Health Task Force requested that the CJMHSA Technical Assistance Center facilitate the Cross-Systems Sequential Intercept Model Mapping in Seminole County, Florida to provide assistance with: Creating a map of the points of interception among all relevant systems Identification of resources, gaps, and barriers in the existing systems to support recovery Development of an initial strategic action plan to promote progress in addressing the criminal justice diversion and treatment needs of the target population The participants in the workshop included 11 individuals representing multiple stakeholder systems, including leadership from mental health, substance abuse treatment, human services, corrections, law enforcement, county government, Department of Veterans Affairs (VA) and the courts. A complete list of participants is available at the end of this document. Mark Engelhardt MS, MSW, ACSW and Jessica Mitchell, M.A. from USF-FMHI facilitated the workshop session.

2 Objectives of the Cross-Systems Mapping Exercise The Cross-Systems Mapping Exercise had three primary objectives: 1. The development of a comprehensive picture of how adults with mental illness, substance abuse and co-occurring mental health and/or substance use disorders flow through the Seminole County criminal justice system along five distinct intercept points: Law Enforcement and Emergency Services (Intercept 1), Initial Detention/Initial Court Hearings (Intercept 2), Jails and Courts (Intercept 3), Community Re-entry (Intercept 4), and Community Corrections/Community Support (Intercept 5). 2. The identification of gaps, resources, and opportunities at each intercept point for individuals in the target population. 3. The development of priority areas for activities designed to improve system and service level responses for individuals in the target population. The Seminole County Cross-Systems Map created during the workshop is on the last page of this document. Resources and Opportunities There are several features of the Seminole County Systems Map that are particularly noteworthy. These include, but are not limited to the items listed below. Existing Cross-Systems Partnerships include: CJMHSA/Public Safety Planning Council and Mental Health Task Force Established Diversion Programs o Drug Court o Mental Health Court o Veteran s Court Baker Act Memorandum of Understanding (MOU) among community partners Seminole County Strengths Identified: Long history of working together in various planning committees and task forces Emphasis on diversion for people with co-occurring mental health and substance use disorders from the criminal justice system Implementation of mental health screening at the jail with the support of the Sheriff s Department Exploration of future implementation of risk assessment tool Strong working relationship between the local jail and local mental health provider, Seminole Behavioral Healthcare (SBH) SBH accepts all Baker Act assessments and admissions and does not experience overcrowding Crisis Intervention Team (CIT) training for all law enforcement officers and dispatchers in Seminole County The Mental Health Task Force is in the process of planning for establishing an assessment center in Sanford, FL for a reentry program for first-time offenders or first/second contacts in - 2 -

3 criminal justice system with mental health and/or substance use problems that links these individuals to services Seminole County Cross-Systems Map Narrative The following information reflects the information gleaned during the Cross-Systems Mapping Exercise. These participant notes include a description of potential interventions at each intercept point in the Criminal Justice and Behavioral Health System as perceived by the participants during the mapping process. Gaps in service delivery and resource opportunities are identified at each intercept point. These notes may be used as a reference in reviewing the Seminole County Cross-Systems Map and as a tool in developing a formal strategic action plan and/or future Memorandum of Understanding (MOU) among community stakeholders and local planning entities. Intercept I: Initial Contact w/ Law Enforcement, Prevention Programs, or Emergency Services UIdentified Gaps Law Enforcement / Emergency Services (Intercept 1) Need for a secure Marchman Act receiving facility in Seminole county Limited data collected on the number of diversions and services by CIT Data needed on numbers served Feasibility of a Baker Act/Marchman Act task force to meet on a quarterly basis to review systems issues 100% of Baker Act transportation is by law enforcement (may not be a friendly environment) UIdentified Strengths Strong relationships between county entities The Baker Act system is well organized Advanced CIT all law enforcement officers and dispatchers are trained The local MOU is active among all partners Baker Act Transportation is 100% law enforcement Good relationship with hospital emergency departments Intercept II: Initial Detention / Initial Detention and Court Appearance UIdentified Gaps Initial Detention and Court Appearance (Intercept 2) Better identification of mental health conditions for the judges at first appearance ( Veterans Court has key information available) SBH not always contacted about clients sent by Judge or attorney UIdentified Strengths Community partnerships are strong - 3 -

4 Examining tools for risk assessment to be implemented in the jail are underway Intercept III: Jails / Courts UIdentified Gaps Jails/Courts (Intercept 3) Develop a dedicated team from SBH for mental health court (I.e. Forensic Intensive Case Management Team - FICM or Modified Assertive Community Treatment Team - ACT team) UIdentified Strengths Mental Health Court takes violation of probations (VOPs), felonies, and misdemeanors (up to persons, but typically around 30-45) 3 FTEs from SBH provide case management for mental health court, but not a dedicated mental health court caseload, and 1 probation officer tracks all behavioral clients on a weekly basis Drug Court several tiers, felony only (40-50) different judges Veteran s Court currently at 19, small, manageable caseload with strong communication and service availability by the VA Intercept IV: Re-Entry UIdentified Gaps Re-entry (Intercept 4) SBH needs more of a presence in jail for identification and screening UIdentified Strengths Focus on individuals with chronic illness in jails (complex health conditions) Chief Medical Director is allowed to prescribe appropriate psychiatric medications Reentry task force used to identify and link individuals to services in the community Intercept V: Home and Community Supervision and Support UIdentified Gaps - Community Corrections / Community Support (Intercept 5) Limited transitional and permanent supportive housing No supported employment programs for people with mental illnesses Poor transportation system UIdentified Strengths Strong faith-based programs available Strong VA services available - 4 -

5 The Seminole County Action Plan Subsequent to the completion of the Systems Mapping exercise, the assembled stakeholders began to define specific steps that could be taken to address the gaps identified in the group discussion about the systems map. Four priority areas were identified, including opportunities for tactical interventions to promote early, quick victories and more strategic interventions to stimulate longer-term systems changes. These priority areas are outlined on the following pages. The Seminole County Mental Health Task Force will need to refine the persons responsible for implementation, action items, and longer term timetable

6 Priority Area: Secure Marchman Act Services [Intercept 1] Objective Action Step Who When Develop a Secure Marchman Act Unit Examine feasibility: Use of existing facilities and costs to operate Seminole Behavioral Healthcare (board level) Initiate within 6 months Priority Area: Data Collection [Intercept 1] Objective Action Step Who When Establish and improve data collection on individuals and services (including CIT) Establish data collection process Mental Health Task Force Initiate at task force meeting - 6 -

7 Priority Area: Forensic Substance Abuse/Mental Health Team [Intercept 3] Objective Action Step Who When Interagency collaboration Develop an integrated team: Hire coordinator, employment specialist, housing specialist, and peer support Seminole Behavioral Healthcare (Charlotte Giuliani) and Mental Health Task Force Initiate planning at task force meeting Priority Area: Discharge Planning [Intercept 4] Objective Action Step Who When Establish a discharge planning program Hire a part time or full time FTE to provide discharge planning with inmates with mental health/substance use issues Mental Health Task Force and Seminole County Sheriff s Office Initiate at task force meeting - 7 -

8 Summary A process such as the Cross-Systems Mapping workshop can result in the acknowledgment of a challenging list of service gaps. In this respect, Seminole County is much like most Florida counties and indeed like many jurisdictions in the United States. At the same time, Seminole County is very unique and has important strengths. First, the individuals who participated in this workshop represented most of the major stakeholders necessary to accomplish change in this area. Missing participants included NAMI (National Alliance for Mental Illness), consumers, emergency services/local hospitals, jail staff, and local homeless/housing coalition. Second, participants were enthusiastic and frank in their comments and observations. This spirit of collegiality and willingness to discuss limitations as well as strengths is an important part of being able to work across systems, as is necessary in improving the lives of adults with mental illnesses/substance abuse disorders in or at risk for entering the criminal justice system. As Seminole County moves forward with its strategic planning process, there are several issues that may be of particular importance. The planning process over time needs to identify the specific points in the process where intervention is possible and might have the biggest impact. It is difficult within existing resources to resolve every problem identified in a planning process, but it is possible to identify the potential points where an intervention might make the most difference. There seems to be consensus that the establishment of a secure Marchman Act receiving facility (detoxification) may have the greatest immediate impact on keeping adults with co-occurring disorders in the community and offer an alternative for incarceration. A local Marchman Act unit would also reduce the number of transportations to Orange County, reduce law enforcement time in transport and serve people closer to home and outpatient services. There was a significant discussion concerning enhancing community services available at discharge and discharge planning, which appeared to be a combination of increased communication processes, potential for grant development, and expansion of available services or resources. The development of an integrated forensic team composed of intensive case management, supportive housing, employment, psychiatry and other community based services is a small step towards a larger vision for the county in pursuing financial resources to support evidenced-based teams rather than individual FTE s to meet future demand in services. Communication between jails, SBH, and the mental health court judge was also cited as a priority to improve identification of specific individuals and increase participation in mental health services. Observation: It would be very helpful to utilize the data collected by varying entities in Seminole County to better understand the scope of the problem in regards to those who are in need of continuing mental health and substance abuse services within the community

9 Utilization of this readily available data may also assist in strengthening future grant applications to assist in sustainability of current programs and specialty courts. It is critical that the planning process not lose the momentum created to date. Planning meetings involving all relevant stakeholders should be conducted on a regular basis and assigned priority by stakeholders. As agreed, this effort needs to be focused on the target population and the action plan needs to be refined with concrete assignments and timetables. In addition, there are a number of potential resources available to Seminole County to accomplish some of the tasks identified during the workshop as next steps. Leadership It is incumbent upon the Seminole County Mental Health Task Force to continue to provide the leadership needed to keep decision makers at the table. In closing, we would like to thank the Seminole County Mental Health Task Force and its partners for allowing the CJMHSA Technical Assistance Center to facilitate this workshop. In particular, we would like to thank Dr. Valerie Westhead and Charlotte Giuliani for their organizing and leadership efforts. Finally, we would like to express gratitude to all the local stakeholders who took the time to share their experiences throughout the workshop. We look forward to continuing to work with Seminole County. Please contact 20TUmengelhardt@usf.eduU20T for any clarification or questions regarding this report or call

10 Resources Website Resources and Partners Criminal Justice Mental Health and Substance Abuse Technical Assistance Center Louis de la Parte Florida Mental Health Institute Department of Mental Health Law and Policy Florida Partners in Crisis Justice Center Policy Research Associates National GAINS Center Florida Department of Children and Families (DCF) Mental Health and Substance Use gainscenter.samhsa.gov Other Web Resources Center for Mental Health Services Center for Substance Abuse Prevention Center for Substance Abuse Treatment Council of State Governments National Alliance for the Mentally Ill National Center on Cultural Competence National Clearinghouse for Alcohol and Drug Information www11.georgetown.edu/research/gucchd/nccc/ National Criminal Justice Reference Service National Institute of Corrections National Institute on Drug Abuse Office of Justice Programs Partners for Recovery Substance Abuse and Mental Health Services Administration

11 List of Workshop Participants Name Organization Title Phone # Meg Johnson Probation Probation Officer Tmjohnson@seminolecountyFL.gov20T Charlotte Giuliani Seminole Behavioral Health (SBH) Director of Acute Care Tcgiuliani@seminolecares.org20T Elizabeth Seminole County Sheriff Manager Grants Tevergara@seminolesheriff.org20T Vergara Office Admin Sue Pierce State Attorney s Office Assistant State Tspierce@sa18.org20T Attorney 6411 Angela Seminole County Financial Tasingleton@seminolecountyFL.gov20T Singleton Administrator 7168 Karen Harmon SBH Coordinator of Tkharmon@seminolecares.org20T Housing 3170 Julio Peres Seminole County Accounting Tjperesvesa@seminolecountyFL.gov20T 7161 Kelly Anderson Veteran s Affairs Veteran Justice TKelly.anderson6@va.gov20T Outreach Specialist 6254 Valerie Westhead, SBH MD TVwestheadtonner@seminolecares.org20T M.D. Tiy McIntosh Seminole County Public Social Work Intern Tsanfordintern@pd18.net20T Defender s Office UCF 4645 John Woodard Seminole County County Judge TJohn.woodard@flcourts18.org20T

12 Community (Limited Array of Services) Seminole County Mapping 3/6/14 Intercept 1: Law Enforcement Intercept 2: Initial Detention and Court Appearance Intercept 3: Jails and Courts Intercept 4: Re-Entry Intercept 5: Community Supervision Initial Contact All LEO CIT Trained Emergency Services 911 Emergency Line First call for help (Dispatchers CIT Trained and Referrals Given to Local Resources) Marchman Act Baker Act Law Enforcement - SCSO - FHP - Altamonte Springs PD - Casselberry PD - Lake Mary PD - Longwood PD - Oviedo PD - Sanford PD - Winter Springs PD Released Law Enforcement MH and SA Facilities - Seminole Behavioral Health (CSU) Accepts all LEO Baker Acts (30 Beds with avg. length of stay 3 days) - Orange County for All Marchman Acts or Overflow sent to detox in Seminole Jail (24 hrs. and then released) Hospitals - South Seminole ER (Baker Act Receiving Facility) Arrest Assessment by Booking Staff / Nurse (w/in first 24 hours) - Completes Health Assessment Form (Medical/MH/SA Screening) by Jail Staff (RN) Initial Court Appearance If arrested by 3am, will see Judge by 1:30pm 10% will bond out before initial appearance Set Bond Conditions If unable to pay, returns to jail to await trial / sentencing (often true for MI population) ROR (May request ROR so can be BA upon release) May Plead out Seminole County Jail (xxx annually w/xx misdemeanors and xx% on pychotropics daily) Booking & Initial Detention Initial Court Appearance Pre-Adjudication Jail Dunnellen ll b - 1 -CSU Circuit Court (felony) County Court (misdemeanors) Drug Court (40-50 clients Felony only) Mental Health Court (45-50 clients All types) Veterans Court (19 current clients) Judicial Disposition In-Jail Services - SBH conducts assessments in jail and links clients to services for special needs upon release In-Jail Placement - Area for Suicide Precaution - MH section (80 beds; counselor, psychiatrist monthly, 24% on meds) - Chronic/special treatment 24 beds - Post-Adjudication Jail State Prison (DOC) Upon Release - 3 day supply of meds from pharmacy - Appt. SBH set and service information provided - No list of other resources - No transportation; often released in evening - If suicidal, can be Baker Acted - Discharge planning for Vets Conditional Release State Probation County Probation (High Caseloads) Community Services - Drop in center - Limited housing - Strong veterans services - Limited employment opportunities Discharged to Community