Keeping mental health crises out of the criminal justice system

AUSTIN, Texas – Across the country and within Travis County, a disproportionate number of people living with mental health and substance use disorders end up in jail instead of receiving the mental health treatment and support they need.

Mental health experts in Dell Medical School at the University of Texas at Austin are joining forces with the Travis County Commissioners Court and a wide range of community partners to address this issue by rethinking, and ultimately redesigning, the local intersection of criminal, legal, and behavioral health systems. The goal of the effort, known as the Travis County Forensic Mental Health Project, is to establish solutions rooted in evidence-based, person-centered care for people stuck at this intersection or on bicycles repeatedly.

About 2 million people with serious mental illness are incarcerated annually in the US One in 5 adults in the US will experience a mental illness within any given year. In Travis County, 37% of people incarcerated as of October 2021 received mental health care in jail. By May 2022, the rate had risen to 42%.

“This planning effort brings together innovators, experts, and advocates to understand the challenges and opportunities, and to help us achieve a coordinated system of mental health care in Travis County for people who have been trapped or riding their bikes. senseless in jail,” said County Judge Andy Brown.

Based on a proven model

“To address the complexities around the intersection of the criminal, legal, and mental health systems, we need to step back and work collaboratively across both systems,” he said. steve strakowskiMD, Associate Vice President of Regional Mental Health and Professor in Dell Med’s Department of Psychiatry and Behavioral Sciences. “It will take a ‘people first’ approach to find practical solutions to this mental health crisis, with health equity as a guiding principle.

This approach is based on a proven model, Strakowski said. Since 2016, Dell Med has collaborated with the Texas Health and Human Services Commission, along with other partners, to develop an innovative model for a continuum of mental health care at Austin State Hospital (ASH). The state-funded project includes a new 240-bed hospital facility to support a new way of treating mental health problems.

Construction of the new ASH is expected to be completed by the end of 2023. Using the ASH Brain Health Redesign model of a steering committee of community stakeholders of all backgrounds and cascading expertise in a series of working groups supports a true collaboration in a complex system. By using a similar model for Travis County, it involves more people than is normally possible to support and provide input on the best solutions for Travis County residents.

“For too long, we have overlooked the most valuable perspective in designing the intersection where criminal justice engagement meets mental health care: the perspective of the people receiving services,” said Parker LaCombe, director of peer support services at Austin State Hospital. “We have seen throughout the redesign of the new ASH how valuable input from people with lived experience really is, and by using ‘people first’ as our guiding principle for both the work of the Travis County Forensic Mental Health Project as for the redesign of ASH. , we can ensure a person-centered approach rooted in the belief that recovery is possible for all people experiencing mental health or substance use issues,” LaCombe said.

The steering committee includes more than 15 experts and organizations spanning academia, law enforcement, the judicial system, health care systems, advocacy groups, substance use experts, and individuals with lived experiences and their families, among others. .

Apply a health equity perspective to find transformative solutions

The Travis County Forensic Mental Health Project will apply a health equity lens in its search for transformative solutions, striving to address and correct longstanding sociodemographic inequities, Strakowski said.

Already underway since May, the project is currently evaluating existing systems, has formed a steering committee, and will establish working groups to conduct environmental scanning and data analysis to produce actionable recommendations. By February 2023, the group plans to provide actionable and bankable recommendations to county commissioners.

“The lack of adequate mental health care for people experiencing mental health crises in the criminal justice system has forced jails to be among the largest providers of mental health care in the state,” said the county sheriff. from Travis, Sally Hernandez. “Prisons were never designed to work this way. It is a travesty that causes unnecessary suffering and severely drains resources. This is a program that is desperately needed.”

The project may result in the expansion of existing programs or the creation of new programs or services, a central building space for services, as well as other innovative and distributed components throughout the community, said Strakowski, who chairs the steering committee. Ultimately, the group hopes to form a scalable and replicable model of care for the nation’s mental health system.

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