This agenda item requests that the Board approve a Resolution to Participate in the National Association of Counties' Stepping Up Program to Reduce the Number of People with Mental Illness in Jail, which is a stepping stone for further participation in the Program.  Information about the Stepping Up Program is below.

The effort to participate in the Stepping Up Program is being led by Public Defender Mark Suagee, Chief Deputy Probation Officer Patty Demeroto, and Britt Hanson and Kathy Aguilar of the County Attorney's Office.  However, the Resolution, and participation in the Program, is supported by the Sheriff, including Jail Commander Kenny Bradshaw, the Courts and Health Department Director Mary Gomez.  It is also supported by other local organizations and agencies that have an interest in treating people with mental illness, such as NAMI and Wellness Connections.  The expectation is that more of these offices, agencies and organizations will be brought into fuller participation in 2016.

Mr. Suagee, Ms. Demeroto, Ms. Aguilar and Mr. Hanson are preparing an application to NACO to request that it sponsor (and pay for) a workshop on Sequential Intercept Mapping (SIMS).  The purpose of the SIMS workshop will be to help the County design a system for collaboratively "intercepting" people with mental illness at various points in the criminal justice system--from first contact with law enforcement to sentencing--with the goal of steering them into appropriate treatment and reduced recidivism. If the application is granted, the workshop will be conducted in the Spring of 2016, and will include up to 40 participants.  A draft of the SIMS application is attached to this agenda item.  The Resolution that is the focus of this agenda item will be included in the application.

Stepping Up Background

There was a time when news of jails serving more people with mental illnesses than in-patient treatment facilities was shocking. Now, it is not surprising to hear that jails across the nation serve an estimated 2 million people with serious mental illnesses each year—almost three-quarters of whom also have substance use disorders—or that the prevalence of people with serious mental illnesses in jails is three to six times higher than for the general population. Once incarcerated, they tend to stay longer in jail and upon release are at a higher risk of returning than individuals without these disorders.

The human toll—and its cost to taxpayers—is staggering. Jails spend two to three times more on adults with mental illnesses that require intervention than on people without those needs, yet often do not see improvements in recidivism or recovery. Despite counties’ tremendous efforts to address this problem, they are often thwarted by significant obstacles, such as coordinating multiple systems and operating with minimal resources. Without change, large numbers of people with mental illnesses will continue to cycle through the criminal justice system, often resulting in missed opportunities to link them to treatment, tragic outcomes, inefficient use of funding, and failure to improve public safety.

The National Initiative

Recognizing the critical role local and state officials play in supporting change, the National Association of Counties (NACo), the Council of State Governments (CSG) Justice Center, and the American Psychiatric Foundation (APF) have come together to lead a national initiative to help advance counties’ efforts to reduce the number of adults with mental and co-occurring substance use disorders in jails. With support from the U.S. Justice Department’s Bureau of Justice Assistance, the initiative will build on the many innovative and proven practices being implemented across the country. The initiative engages a diverse group of organizations with expertise on these issues, including those representing sheriffs, jail administrators, judges, community corrections professionals, treatment providers, people with mental illnesses and their families, mental health and substance use program directors, and other stakeholders.

The initiative is about creating a long-term, national movement—not a moment in time—to raise awareness of the factors contributing to the over-representation of people with mental illnesses in jails, and then using practices and strategies that work to drive those numbers down. The initiative has two key components:

1. A CALL TO ACTION demonstrating strong county and state leadership and a shared commitment to a multi-step planning process that can achieve concrete results for jails in counties of all sizes.

The Call to Action is more than a vague promise for reform; it focuses on developing an actionable plan that can be used to achieve county and state system changes. As part of this Call to Action, county elected officials are being asked to pass a resolution and work with other leaders (e.g., the sheriff, district attorney, treatment providers, and state policymakers), people with mental illnesses and their advocates, and other stakeholders on the following six actions:

1. Convene or draw on a diverse team of leaders and decision makers from multiple agencies committed to safely reducing the number of people with mental illnesses in jails.
2. Collect and review prevalence numbers and assess individuals’ needs to better identify adults entering jails with mental illnesses and their recidivism risk, and use that baseline information to guide decision making at the system, program, and case levels.
3. Examine treatment and service capacity to determine which programs and services are available in the county for people with mental illnesses and co-occurring substance use disorders, and identify state and local policy and funding barriers to minimizing contact with the justice system and providing treatment and supports in the community.
4. Develop a plan with measurable outcomes that draws on the jail assessment and prevalence data and the examination of available treatment and service capacity, while considering identified barriers.
5. Implement research-based approaches that advance the plan.
6. Create a process to track progress using data and information systems, and to report on successes.

In addition to county leaders, national and state associations, criminal justice and behavioral health professionals, state and local policymakers, others with jail authority, and individuals committed to reducing the number of people with mental illnesses in jails should sign on to the Call to Action. Stepping Up participants will receive an online toolkit keyed to the six actions, with a series of exercises and related distance-learning opportunities, peer-to-peer exchanges, and key resources from initiative partners. The online toolkit will include self-assessment checklists and information to assist participants working in counties in identifying how much progress they have already made and a planning template to help county teams develop data-driven strategies that are tailored to local needs.

1. A NATIONAL SUMMIT to advance county-led plans to reduce the number of people with mental illnesses in jails.

Supported by the American Psychiatric Foundation, a summit will be convened in the spring of 2016 in Washington, DC, that includes counties that have signed on to the Call to Action, as well as state officials and community stakeholders such as criminal justice professionals, treatment providers, people with mental illnesses and their advocates, and other subject-matter experts. The summit will help counties advance their plans and measure progress, and identify a core group of counties that are poised to lead others in their regions. Follow-up assistance will be provided to participants to help refine strategies that can be used in counties across the nation. After the 2016 summit, participants will be notified of potential opportunities for sites to be selected for more intensive assistance through federal and private grant programs.

Although much of the initiative focuses on county efforts, states will be engaged at every step to ensure that their legislative mandates, policies, and resource-allocation decisions do not create barriers to plan implementation.

To learn more about the initiative or to join the Call to Action, go to StepUpTogether.org.