PECAN VALLEY MHMR REGION Jail and Detention Diversion Strategies for Adults and Juveniles Diversion Action Plan FY09 Pecan Valley MHMR (PVMHMR) serves six rural counties in North Central Texas, and is responsible for the public sector portion of the mentally ill for those counties. Over 300,000 citizens reside in the service area. In those six counties, approximately 2100 adults and 200 children and adolescents receive appropriate mental health services in accordance with Resiliency and Disease Management (RD&M) guidelines. PVMHMR has developed an ongoing relationship with the judicial and law enforcement system of the six counties. Each county operates a single county jail. There are no city jails, nor youth detention centers within the service area. Goals of Jail Diversion Action Plan: To develop a process for early and ongoing identification of individuals with serious mental illness in the criminal justice system; To establish a protocol for providing crisis screening and assessment for inpatient hospitalization for juveniles in detention, boot camps, and intermediate sanction facilities. The Plan addresses the transportation of juveniles needing face-to-face assessment, if indicated; To identify high risk Consumers; To match jail and detention records with CARE; To establish procedures for receiving law enforcement, juvenile probation and TYC referrals; To identify pre and post booking diversion strategies. The focus is on diverting consumers before arrest. While in jail or juvenile detention, advocacy efforts continue to occur cognizant of community treatment alternatives. Services after release are to assure continued mental health services and supports. To integrate community resources including use of any state appropriated funds; To establish a process for ongoing collaboration and coordination among stakeholders; To develop and complete specific action steps, timelines for plan implementation, and identify responsible parties; and To provide training to local law enforcement regarding early identification, intervention and how to access the local mental health system. 1
I. Formation of Jail Diversion Task Force A Jail Diversion Task Force will be established. Representatives from the following agencies will be sought out for this task force: Hood County Judge Hood County Adult Probation Parker County Juvenile Probation STAR Council on Substance Abuse Erath and Palo Pinto County Department of Family and Protective Services (CPS) Mental Health Consumer Parker County Jail Administrator Stephenville Police Department Johnson County Sheriff Department Texas State Board of Parole Pecan Valley MHMR Mental Health Director Pecan Valley MHMR Area Managers II. Diversion Action Plan 1. The Process for early and ongoing identification of individuals with serious mental illness involved with the criminal justice system. PVMHMR has provided training to the local law enforcement officials in how to access mental health assessment services both for emergencies and non-emergency situations for both adults and juveniles coming through the criminal justice system. This includes adult and juvenile individuals coming through probation and parole services as well as the county jails. Those individuals coming through the county jail system often have not been identified as high risk in the community. The county jail staff have been trained in the use of the Mental Disability/Suicide Intake Screening form to help identify high risk individuals booked into the jail or in a pre-booking phase. PVMHMR does not have any juvenile detention facilities in its six county region. But, we often get contacts from the county juvenile probation officers when a high-risk youth has been identified. In both adult and juvenile cases, PVMHMR staff do face-to-face assessments on these identified individuals in the most appropriate setting available. Jail officials contact PVMHMR when an individual is identified as a high risk, through the use of this screening tool. PVMHMR sends a QMHP-CS staff member, trained in crisis assessments, to the jails upon request from the jail. 2
2. Protocol for providing crisis screening and assessment for inpatient hospitalization. PVMHMR maintains a two layer on call system to provide support for adults and juveniles suffering a mental health crisis across its six counties. The first layer is having trained QMHP-CS available 24/7 to do face-to-face assessments in the jails, hospitals, clinics. The second layer is having an Administrator on Call 24/7 to assure policy and procedure adherence and for technical support to the QMHP-CS. Local law enforcement has the 24-hour crisis hot-line number. When a call comes in, the QMHP responds by providing a face-to-face screening assessment during business hours, afterhours and on weekends and holidays. The QMHP-CS staff have 24/7 access to a physician for clinical consultation. PVMHMR does not have a Pre-Adjudication and Post-Adjudication Secure Facility in any of its six counties. If mental health screening or assessment services to determine the need for inpatient hospitalization, is necessary, then the Mental Health Authority that presides over that county would be responsible for performing the appropriate assessment and complying with Title 37 TAC, Chapter 343, Subchapter B, Pre-Adjudication and Post- Adjudication Secure Facility Standards, 343.10. 3. Identification of high-risk consumers. PVMHMR contracts with the Texas Commission on Offenders with Mental and Medical Impairments (TCOOMMI) through the Texas Department of Criminal Justice (TDCJ). High-risk individuals are both adults and juveniles that have a diagnosis of mental illness and criminal justice involvement. These high-risk individuals are identified to PVMHMR through regional liaison staff to PVMHMR liaison staff. This PVMHMR liaison staff person is funded through the contract PVMHMR has with TCOOMMI. Once high-risk individuals have been identified, PVMHMR liaison staff contact that individual and engage them into PVMHMR services. Referrals come to our liaison staff, via TCOOMMI, include both adults and juveniles. PVMHMR receives referrals on both adult and juveniles from the Texas Youth Commission (TYC), or State Jails, or prisons. There is also a limited ability to deem an individual in the local criminal justice system as eligible for TCOOMMI funds. The PVMHMR TCOOMMI liaison provides and coordinates face-to-face screening to all referrals of mentally ill individuals returning to the region from TYC or State Jails or prisons. PVMHMR compiles monthly reports for TCOOMMI. PVMHMR also tracks the 46.B individuals and provides continuity services between the State Mental Health Facility and the Jails. PVMHMR contracts with the Department of State Health Services (DSHS) for funds to serve individuals that are diagnosed with both mental illness and substance use. The program is the Co-occurring Psychiatric Substance Use 3
Program (COPSD). This funding provides for PVMHMR to staff two QMHP-CS staff with experience in substance abuse issues. Individuals with both substance use issues and mental illness are screened at intake. These are considered high-risk individuals for criminal justice involvement. The COPSD staff engages these individuals at the beginning of the enrollment process into PVMHMR services. Specialized Case Management Services is provided in the effort to help the individual maintain stability in the community and avoid arrest. 4. Matching of jail and detention records with CARE. Pecan Valley MHMR Region is in compliance with DSHS requirements for jail batching. As previously stated, PVMHMR does not have any detention facilities in its six county area. However, each county does have a jail facility. CARE checks are run daily by PVMHMR staff from the jail s daily jail admission logs. Formerly served consumers and current MHMR consumers are identified by entering the names from the jail admission logs into the PVMHMR CARE batching system. This information is then shared daily with the Jail staff. A face-to-face screening is provided by PVMHMR QMHP-CS staff as appropriate. PVMHMR has identified a specific contact person to each jail as a person to contact when questions arise. 5. Procedures for receiving law enforcement, juvenile probation and TYC referrals. PVMHMR liaison staff are in place to receive referrals from TCOOMMI as well as local county law enforcement, city law enforcement, juvenile probation and parole officials, and adult probation and parole officials. These include TYC referrals, state prison referrals and State Jail referrals. Local county Community Resource Coordination Groups (CRCG) staff high-risk juveniles and adults and make referrals to the local PVMHMR outpatient clinical Intake Coordinators. PVMHMR Intake Coordinators and PVMHMR TCOOMMI liaison staff receive referrals from local jails or law enforcement officers if an inmate or detainee is exhibiting symptoms of mental health problems. These adults may be seen at the jails or may also be transported to the local emergency rooms or to the PVMHMR outpatient clinics for an assessment of needs. Juveniles are transported, to a PVMHMR outpatient clinic or another acceptable location, for a mental health assessment by their legally authorized representative. Assessment staff and Intake Coordinators make referrals of high-risk individuals to PVMHMR COPSD staff as appropriate. 6. Pre-Booking and Post-Booking Engagement Strategies. 4
a. Pre-booking A 24-hour crisis mental health screening at the pre-booking site, the county jail, is available and provided by PVMHMR QMHP-CS staff for those situations where the individual can not be taken to a PVMHMR triage location for assessment. In addition, the agency s newly created Mobile Crisis Outreach Team (MCOT) will also be available 56 hours per week to respond to crisis calls and to conduct mental health screenings at pre-booking sites. The typical triage location is either a local emergency room or a PVMHMR outpatient clinic. The intent of the screening will be to redirect the individual to appropriate mental health services instead of going to jail. b. Services in jail None of the county jails in the PVMHMR area has a psychiatric unit or a medical doctor on site which facilitates mental health services to inmates. However, the jails notify PVMHMR staff when an inmate is exhibiting symptoms of mental illness; and in Cleburne, a PVMHMR physician spends 4 hours a week at the jail to visit with PVMHMR clients and assess potentially new clients. Designated PVMHMR QMHP-CS staff also go to the jail and do an assessment on those inmates identified. If the inmate is identified as an actively enrolled consumer of PVMHMR then PVMHMR will continue to provide medication evaluations. If the individual is identified as a person that is mentally ill but not a actively enrolled consumer of PVMHMR then medication evaluations will be provided by PVMHMR but the prescriptions will be given to the jail staff to fill at the counties/jail s expense. Individuals identified as PVMHMR consumers, will not be discharged from PVMHMR services upon arrest or booking into the jail. They will be reassessed into the appropriate service package for services and remain enrolled. c. Services after release The PVMHMR jail liaison will coordinate intake appointments for identified mentally ill inmates upon their release. Care will be taken to continue treatment that was occurring in the jail whether the inmate was an active consumer of PVMHMR or not. Proper assessments will be done by the PVMHMR Intake Coordinator upon release of the inmate back into the community. If deemed eligible, according to R&DM admission guidelines, the individual will continue to receive services. If not eligible according to R&DM admission guidelines, proper referrals will be made by the Intake Coordinator. Individuals identified as mentally ill in the jail will be followed upon release back into the community to avoid returning to jail. Either PVMHMR TCOOMMI staff or PVMHMR COPSD staff or Intake Coordinator staff will assure inmates released back into the community follow up with PVMHMR outpatient services. 5
7. Integration of community resources including use of any state appropriated funds. PVMHMR utilizes funds through contracts with TCOOMMI, and the COPSD Program. General Revenue funding from the DSHS is also utilized for those individuals that are in jail. For those released, all those eligible for Medicaid or other benefits will be assessed and applications facilitated by PVMHMR Eligibility Staff. Other community resources are given to inmates upon release to help them remain in the community. 8. Action Steps, Timelines for Implementation, and resources to support the plan and responsible parties. a. Action Steps Development of a Mental Health Resource Guide Establish Task Force Seek funding opportunities to expand services Seek training from Law Enforcement Officials regarding jails for PVMHMR staff Schedule ongoing mental health screening training for law enforcement b. Timelines for Implementation Establish Task Force by May 1, 2007 Task Force will meet by June 15, 2007 for planning meeting Development of Mental Health Resource Guide by August 1, 2007 Schedule training from law enforcement officials for PVMHMR staff by August 1, 2007 Schedule mental health screening training for law enforcement by August 1, 2007 c. Resources to support the plan PVMHMR staff are being asked to implement this plan along with their other regular assigned duties with limited resources. PVMHMR recently received new Crisis Redesign dollars that will be utilized to support this plan. d. Responsible Parties Jail Diversion Task Force PVMHMR Mental Health Director 6
PVMHMR Continuity of Care Coordinator 9. Training to Local Law Enforcement: PVMHMR will schedule annual Refresher Training to local law enforcement officials on how to access the mental health system for both adults and juveniles. Sheriffs, Judges, Police Chiefs, Jail Administrators, PVMHMR Intake Coordinators, PVMHMR Clinic Managers, and the Jail Diversion Task Force members will be invited to the training. This year, PVMHMR is conducting MH Deputy Training that is certified by TCLEOSE. The training will certify the peace officers as Mental Health Peace Officers in the State of Texas. 7