In Dallas County, Texas, the main outlet of psychiatric care for those with mental illness is no longer the corrections system.
A five-year initiative aimed at bridging the gap between the legal and medical communities is successfully diverting justice-involved mentally ill individuals to effective treatment programs.
The key to the program is technology. The initiative uses software created by HarrisLogic, a Missouri-based technology and clinical services company that allows information about mentally ill individuals who fall afoul of the law to be shared among law enforcement, courts and health care providers.
Experts say such a tech-based approach could be critical to reducing overcrowding in U.S. jails.
There are now nearly ten times the number of mentally ill patients behind bars than those residing in the remaining state hospitals, according to a 2014 report by the Treatment Advocacy Center, an Arlington, Va.-based national nonprofit focused on mental illness issues.
A prime example is the Dallas County Jail, whose jurisdiction stretches from the cities of Carrollton to Mesquite, to just outside of Arlington. Dallas County’s major detention center, the Lew Sterrett Justice Center, is the second largest mental health facility in Texas, according to the County Sheriff’s Office.
In 2014, the county received a $7 million grant from the W.W. Caruth, Jr. Foundation for a “Smart Justice Initiative” to provide alternatives to jail for individuals with mental health problems who come into contact with the justice system. The county partnered with the Meadows Mental Health Policy Institute (MMHPI), a research and development organization that helps Texans connect to mental health care.
Now in its fourth year, the jail diversion program has reduced recidivism from 31 percent in 2014 to 26 percent in 2017, according to the National Association of Counties.
It’s “an impressive example of how local jurisdictions can implement data-driven innovations that enhance public safety, reduce jail costs to taxpayers, and provide effective and humane interventions for people with mental illness,” said Marc Levin, vice president of criminal justice at the Texas Public Policy Foundation.
Alternatives to Punishment
Relieving jails of the burden of providing mental health services is only a first step towards the goal of developing alternative and non-punitive options for treatment. It doesn’t address the decisions that bring mentally ill individuals into the justice system in the first place, mental health advocates say.
The Dallas County initiative uses technology to assist in the decision-making by police, courts and health providers.
Following a 911 call, if it is determined that jail is an initially appropriate response to a troubled individual, data from the standard mental health and suicide screening tests (as per Texas standards) is automatically integrated with any other data related to the individual’s medical history contained in police or emergency response records as well as hospital data.
Traditionally, such data was kept in separate silos, but the software implemented through the Jail Diversion Platform, created by Harris Logic, integrates all the personal information critical to determining a defendant’s immediate needs and subsequent care.
That includes information such as previous arrests or incarcerations, previous mental health rehabilitation, and current medication, Hudson Harris, chief engagement officer of HarrisLogic, said in an interview with The Crime Report.
This data is entered in the County Adult Information System, a “master index,” which is used to share information in a manner that allows for access by court and jail authorities, clinicians, legal professionals, and pretrial staff.
Privacy Protection
No mental health assessment is conducted without the prior permission of a defendant’s attorney—likely a public defender. Further privacy protections require that each agency using the data can only view what is authorized to them through a data usage agreement.
By involving multiple agencies, the combined knowledge and expertise allows future treatment to be tailored to an individual’s needs─better than simply checking a box during a mandatory evaluation, authorities say.
This step is arguably the most crucial. Without accurate and swift identification, issues stemming from an individual’s illness can make it more difficult for persons to follow jail rules, increasing the likelihood they will face harsh disciplinary measures, or be subjected to violence from other inmates or from guards.
The second intercept in the initiative is through pretrial release, providing an escape from being trapped in the justice system.
Mental health patients often spend more time in jail waiting for their case to be resolved than that of a mentally healthy convict, according to Alisa Roth, author of Insane: America’s Criminal Treatment of Mental Illness, in a recent article.
This may be due to the requirement in many states that inmates with serious mental illness undergo additional evaluations or be restored to competency before standing trial.
According to a survey of 40 state hospital officials by the Treatment Advocacy Center, 78 percent of the respondents were wait-listing pretrial inmates for hospital services. Often, mentally ill inmates spend more time behind bars waiting for their case to be heard than they would serve if they were convicted of the offense.
To remedy this delay, the comprehensive technology utilized in the Smart Justice program increases the likelihood of a pretrial release by allowing officials to determine if the person is a flight risk, or a danger to the public.
Using this complete data, a judge is more likely to issue a pretrial release, but with conditions for connection to treatment.
An evaluation of the Smart Justice Initiative from April 2017 to January 2018 showed that of the individuals presented before the magistrate for a release decision, 89 percent were successful in being granted a pretrial release bond. Of those granted bond, 100 percent were “released, connected to treatment, and supervised on bond with monitored treatment for the Court,” reports Dallas County.
Need for Coordinated Care
So why are mentally ill offenders more prone to getting re-arrested and re-booked than the general population, even with increased treatment availability?
The main reason, explains Hudson Harris, is the lack of coordinated care. This refers to the absence of follow-up treatment or supervision of mentally ill persons after they have been released from jail, typically back to the same environment that caused them to get arrested in the first place.
It’s here that the third intercept comes into play.
The software directly assigns an individual to a treatment program based on the data provided. Normally it takes weeks to find a person eligible for mental health care programs, but with this technology it takes an estimated 15 minutes or less.
Inadequate coordination is not only a problem within the jail system, but also in an individual’s contact with hospitals.
When dealing with an individual with a mental health illness, a hospital’s main goal is only to focus on the individuals’ current state of health─stabilize them, get them locked down, and then out the door as quickly as possible—with little to no coordination of care, says Harris.
There is no link between simply going to the hospital and getting better when you have a psychiatric condition.
In fact, a 2018 study from the American Psychological Association found that hospitalization has an iatrogenic effect on mental health, meaning the treatment causes a worsening of the condition.
Follow-up Care Crucial
Connecting mentally ill persons with the care and follow-up that they require will ensure they are less likely to become involved in the justice system, said Levin.
“The initiative has resulted in rapid screening and diversion to appropriate treatment programs for thousands of individuals arrested for conducted related to a serious mental illness,” he said.
Providing access to treatment and follow-up care can also help authorities save money on their corrections budgets.
When mentally ill inmates do not receive consistent treatment, they frequently cycle in and out of the jails, forcing the facility (and taxpayers) to spend additional money on health professional staff, medication needed for certain mental illnesses, and simply housing them behind bars for longer periods of time.
A 2003 study reports that in Texas prisons, “the average prisoner costs the state about $22,000 a year compared to the cost of prisoners with mental illness, which ranges from $30,000 to $50,000 a year.”
Also at a state level, Texas spends $1.4 billion in emergency room costs and $650 million in local justice system costs annually to address mental illness and substance use disorders that are not otherwise being adequately treated, according to MMHPI.
The operation of increased treatment may seem like a burden to the jail’s budget, but simply by providing individuals with the appropriate care that they need, the cost of doing so declines; breaking the high-utilizer cycle and reducing contact of the mentally ill with the corrections system.
According to HarrisLogic, the Smart Justice Initiative will be able to trim over $30 million in these expenses over the five-year implementation period.
While the initiative has resulted in significant savings to Dallas County on jail costs and indigent defense costs, and helped reduce overcrowding in the courts system, Levin notes the challenge is to replicate it in other jurisdictions.
While Dallas received a large grant, other jurisdictions would have to provide upfront funding or use a pay-for-performance model in order to get similar initiatives off the ground, which may prove difficult for less-fortunate counties, he said.
However, the prospects for similar programs elsewhere have brightened thanks to the increased interest of private funders, and a call to action by the Stepping Up Initiative, a national effort to divert people with mental illness from jails by asking state and local officials to pass mental health legislation.
Noting that 451 counties across the nation have already passed motions calling for reforms to the justice system’s treatment of mentally ill, the initiative organizers said a nationwide consensus for change was crucial.
“Without change, large numbers of people with mental illnesses will continue to cycle through the criminal justice system,” the organization declared on its website, “often resulting in tragic outcomes for these individuals and their families, missed opportunities for connections to treatment, inefficient use of funding, and a failure to improve public safety.”