Coordinate Activities between CJ and MH

o Improve Communication Channels

o Clear Linkages between CJ and MH

o Provide Resources to Promote System

X X X

Standardized Screening and Specific Criteria to Identify those Eligible for Diversion - There should be a standardized process used to identify individuals who are eligible for screening. In most programs the eligibility criteria focus initially on the alleged offense and where the offender resides. Typically, only minor misdemeanor offenses are eligible.

Example: The Mental Health Diversion Program in Albany, NY targets adults with mental illness and substance abuse disorders who reside in the County and have been arrested for a misdemeanor or a non-violent low-level felony.

Based on discussions with administrators, Orange County practices are somewhat

standardized, but not in the way that best practices would suggest. Each person booked into the jail is screened initially with the same instrument (standardization) but the process seems to be done more for identifying anyone with mental health issues for proper placement within the facility and for further evaluation. It is not clear that there are strict criteria and client finding procedures for the diversion program.

Within the First 8 hours (Typically at Booking) - Best practice (BP) post-booking diversion programs do the initial screening as a person is being booked or admitted to the jail (or shortly thereafter; less than 8 hours) because many detainees may be released quickly, without obtaining any services (Steadman et. al., 1995; Peters and Hills, 1997).

Orange County attempts to conduct this initial screening while the person is being booked. Orange County administrators indicate that the initial screening does occur within the first four to eight hours.

Screener has Minimal Training in Medical/Mental Health - The person responsible for the initial screening should have some minimal training in medical/mental health areas. This can be a trained correctional officer, but the person should know the basics about identifying someone who has a mental illness or substance abuse problem (Borum, 1999; Peters and Hills, 1997).

In Orange County the initial evaluation is done by staff with training in the medical/mental health area.

Detailed Evaluation

If a detainee is identified in the initial screening as one with possible mental health or substance abuse concerns, then they should be further evaluated by a licensed mental health professional. Orange County meets this criterion.

Prior to Initial Appearance before Judge - Best practice (BP) diversion programs conduct a detailed evaluation within a short amount of time for accurate placement within the jail and so that if a person appears before a judge (usually within 24-48 hours) the judge will be fully informed of their mental health status.

Orange County administrators state that they try to complete the evaluation before arraignment, but they also admit that this is frequently not done in time.

Negotiation

Best practices (BP) indicate a need for an open line of communication between jail diversion personnel, the judge and prosecutor, defense counsel, and mental health providers in the community.

Team Approach where all Parties Agree on Diversion Program with Judges Approval and the Diversion occurs in Lieu of Prosecution or as a Condition of Release or Charge Reduction - The mental health inmate will need an advocate that will contact agencies in the community for mental health resources, the prosecutor, and the judge in order to work out a possible diversion program. All must agree on the program in order for the person to be diverted. The diversion from jail should occur either in lieu of prosecution or as condition of reduction in charges or community supervision. Diverting a person “until they go to trial” is not a true diversion program. The diversion program should be agreed upon by the judge, prosecutor, and diversion coordinator as part of the case disposition. Typically, best practices (BP) post-booking diversion programs allow the judge to make the final decision about the diversion of a detainee – but agencies should come together and first agree upon who will make this important decision (usually a judge’s decision is based on input from the prosecutor and the diversion coordinator and/or defense attorney) (Steadman et. al., 1995).

Current Orange County practice does not meet this criterion. All of the system partners do not meet and discuss diversion options and agree on treatment plans. Typically if a client is placed into a program it is not because all parties agree on the diversion program, often a detainee is diverted because someone (the judge, court officer, counsel) suggests that they may be a good candidate for pre trial diversion. One of the elements most in need of remedy in order for the Orange County program to be a “diversion” program has to do with the current practice of still having clients face trial and answer for their charges. This practice makes the Orange County program temporary – where diversion is only a ‘short term diversion’ from jail. Because individuals can get mental health treatment while in jail, this seems to make the purpose of the temporary diversion to be more of an attempt to reduce the jail population than an effort to divert individuals from jail.

Liaison, Boundary Spanner, to Manage Interactions - For negotiation to occur there must be an integration of services. Many best practice programs have a liaison (or boundary spanner) to directly manage interactions between different agencies. To be most successful, a boundary spanner should have experience and knowledge of all of the agencies. Some diversion programs report having created a staff position to create a linkage between the criminal justice system and the mental health system (Steadman et. al., 1995; Borum, 1999).

• Example: The Nathaniel Project, Center for Alternative Sentencing and Employment Services (CASES), New York City, NY. This project is a two year intensive case management and community supervision alternative to

incarceration program for defendants with serious mental illness. The program targets individuals who have been indicted on a felony, including violent offenses, most of whom are homeless and suffer from co-occurring substance abuse disorders. Forensic Clinical Coordinators, who are Masters level mental health professionals and have expertise in negotiating the criminal justice system create a comprehensive plan for community

treatment. They also work with participants prior to their release to create a transition to community care – participants are required to attend periodic court progress dates. Charges are dismissed upon successful completion of the program (Criminal Justice Mental Health Consensus Project, 2002). Orange County does not have a boundary spanner to manage interagency communications, however some jail staff do, when time allows, try and communicate with other agencies to reach an agreement about a particular client.

Aftercare/Case Management

A successful diversion program should not only match up clients with an appropriate program but should also monitor client success over time. Case managers perform many functions within these programs, including identification and outreach, evaluation of client needs, development of a treatment plan, linking the client to services, monitoring client progress and service delivery. Because of the complexity of the role, case managers should have experience in both criminal justice and mental health systems. (Steadman et. al., 1995)

(BP).

Case Managers to Monitor Clients While in Program - Successful programs often have case managers that are intensely involved with clients while they are in the program. They help to identify the most appropriate services for clients and they monitor client success over time.

Orange County does have case managers who closely monitor their clients while they are in the program.

Long Term Commitment - The key is not to refer clients for service and then never monitor their progress or check to see how those services are meeting their needs. This commitment must extend beyond the next court date. One can only assume that without this component one will be more likely to see clients re-cycling back into the system (Peters and Hills, 1997)

Success in Orange County’s Mental Health PTR means that a client who was diverted made it to the court appearance without having any further problems. Once they answer for their charges the County no longer follows up on their mental health status.

Regular Meetings With Partners, Service Providers, Stakeholders

The most effective diversion programs hold regular meetings with the key partners and stakeholders. Two levels of meetings were noted to occur (many met each week or every two weeks) (Steadman et. al., 1995).

Regular Administrative Meetings – The best practicing programs reported they had meetings of interagency administrative staff (judges, jail administrators, public defenders, district attorneys) to discuss funding and staffing concerns once every week to two weeks.

Regular Meetings among Service Providers - Meetings of direct service providers to discuss individual treatment plans and any day to day issues that may arise.

Orange County does not meet regularly with all of the key partners and stakeholders.

However they do meet regularly with one provider (the one most frequently used); Lakeside Alternatives.

Strong Leadership

Another key factor noted in effective diversion programs is strong leadership. Someone with authority to make decisions and take action and who has a true understanding of all system components (including the informal channels) is needed in the leadership role. This should not be simply a person to whom a committee reports but someone that will actively participate in meetings and take action when necessary (see Steadman et al., 1995). Some Orange County Jail administrators have indicated that they need someone in a leadership role that can meet with the staff and service providers, assess the program, and have the authority to make changes. The need for a ‘working committee’ came up a couple of times in interviews.

Coordination of Activities Between Criminal Justice and Mental Health

The two systems must coordinate activities; even if their goals are not identical. There is a need for high levels of cooperation at the community level with corrections, mental health, judiciary, prosecutor, and the social service system.

Suggestions for closing the gaps between these systems include:

The improvement of communication channels – This might be accomplished with help from boundary spanners and regular meetings.

Clear Linkages between Criminal Justice and Mental Health - Creation of linkages between systems where agencies work out their availability of services to one another.

Agencies must agree to focus on common goals and offer services and flexibility in working out the logistics.

Increasing resources allocated specifically to promote system interactions - Steadman and colleagues point to programs that have created staff positions where key personnel are responsible for promoting interactions and creating linkages between criminal justice and mental health.

SECTION SUMMARY

There is some evidence to suggest that many jail administrators report that they have some kind of diversion program for mentally ill and substance abuse disorder offenders – but when asked more detailed questions about the nature of the diversion it becomes clear that the program does not operate as a true diversion program. Programs not meeting the criteria tend to fail on the negotiationelement – many programs claim to be jail diversion programs

when in fact they do not divert mentally ill inmates to some mental health services “in lieu of prosecution” or as a condition of charge reduction. Simply diverting someone out of jail (or diverting until a trial date) is not a jail diversion program, clients must be provided some adequate mental health services (Borum, 1999).

The Orange County program seems to break down on the negotiation element. The team approach where all parties agree on diversion as a condition of release or in lieu of

prosecution is nonexistent. Further, without adequate leadership and integration of mental health and criminal justice it will be difficult to reform the current program. While jail personnel are working hard to meet the needs of mentally ill detainees they can only do so much without these essential components (leadership and integration).