Mental Health and the Justice System, Part 1
By Carol Olson, MD, DFAPA, Chair, Psychiatry Department, Valleywise Health System
Digital - September 2022
Over 25% of incarcerated people have a recent history of a mental health condition.
70% of youth involved in the juvenile justice system have a mental health condition; 20% have a severe mental illness.
Arizona ranks 48th in state psychiatric hospital beds per capita.
Closure of longer-term psychiatric treatment beds and lack of community mental health resources have contributed to large numbers of mentally ill people getting care in jails and prisons. In addition, those charged with a crime who have a serious mental illness are more likely to be detained in jail prior to their trial, and to spend overall more time being detained than others charged with similar offenses. The mental health of justice-involved individuals has tremendous impact on public safety, community health, and justice system costs.
The Arizona Supreme Court convened a Committee on Mental Health and the Justice System to provide recommendations, in view of the fact that often the justice system is the last stop for a person who has failed to get the help they need before being charged with a crime. Our court system has adopted the Sequential Intercept Model (SIM) as a goal, with the intention of intervening as early as possible to intercept those with a mental health condition, minimize their encounters with law enforcement and entanglement in the criminal justice system, and get them to the appropriate level of care.
The following are examples of what SIM includes:
Mobile crisis outreach teams - Emergency help from teams with special training in behavioral health intervention, so family or bystanders have someone to call besides the police when a person is experiencing acute psychiatric symptoms and needs immediate help.
Education of the public and healthcare providers - On resources for mental health care, advanced mental health care directives (such as Powers of Attorney for Mental Health Care), and indications for and process of referral for involuntary psychiatric evaluation.
Emergency department diversion - Maricopa County now has four psychiatric urgent care centers which are open 24 hours per day and can take walk-in patients, transfers from EDs, and involuntary patients.
Police-behavioral health system collaboration - e.g., having specialized police units intended to interface with the behavioral health system when a person with psychiatric symptoms is repeatedly encountering police. Having mobile crisis teams co-respond with police units in appropriate situations.
Police/911 dispatcher training - Ensuring dispatchers are trained to evaluate the situation and arrange an appropriate response (e.g., mobile crisis team vs. police).
The Sequential Intercept Model also includes:
Specialized police response to emergencies involving an individual with acute psychiatric symptoms - if police response is needed, having available officers with CIT (Crisis Intervention Training) to assess the situation and de-escalate.
Intervention with frequent 911/ED users - Addressing those who appear to be having a psychiatric condition causing or contributing to their frequent use of the emergency system, including prompt follow-up after crisis intervention to ensure a longer-term plan is in place and acted upon to get the condition treated.
Generalized screening in EDs and jails - Ensuring individuals are screened for mental health and substance use disorders, and provision of effective treatment for both (e.g., buprenorphine first dose in ED for opioid use disorder patients; immediate availability of a substance abuse treatment program, including residential treatment, for those who need that level of care).
Data-sharing between jails and community behavioral health centers - For example, ensuring that those with mental illness who are arrested can continue on their medication while in jail.
Specialized treatment courts - Courts in which the judge and others have additional training and lower caseloads so that they can better supervise and coordinate treatment needs of defendants (e.g., mental health court, veterans court).
Effective treatment planning from jail - Ensuring that inmates get ongoing treatment in the jail setting for their psychiatric condition and that there is close coordination with outpatient providers prior to release, and ensuring access to prescribed medication continues upon release.
Probation/parole officers with specialized knowledge - These officers would have in-depth knowledge of the behavioral health system and lower caseloads, to provide better community supervision for those on probation or parole who have a serious psychiatric condition.
Adequate access to resources which support recovery - Access across Arizona, in both urban and rural areas, o supports, housing and employment to promote stability and recovery of those with serious mental illness.
Effective community adoption of these interventions will save lives and make our entire health care system function better.
For a behavioral health crisis, call 988.
For non-emergency behavioral health service referrals, call 211 or go to 211arizona.org.
Reference: Munetz MR & Griffin, PA (2006). Use of the sequential intercept model as an approach to decriminalization of people with serious mental illness. Psychiatric Services, 57,544-549.
More About the Author:
Carol Kline Olson, MD, DFAPA, was born and raised in Phoenix, Arizona. She received an AB degree from Bryn Mawr College in Pennsylvania and completed medical school at Stanford University. Her psychiatry residency training was at the University of California, San Diego and Maricopa Medical Center in Phoenix. Dr. Olson has since spent her career practicing psychiatry at Valleywise Health (formerly Maricopa Integrated Health System), and since 2004 she has held the position of District Medical Group Chair of Psychiatry at Valleywise Health. Dr. Olson is board certified in general psychiatry as well as forensic psychiatry. Her interests include treatment of serious mental illness and the intersection between mental health and the criminal justice system. Dr. Olson lives in Scottsdale with her husband and college-age son. Her interests outside work include gardening, cooking, public affairs, travel, and playing a mean game of Trivial Pursuit. Contact Dr. Olson through the District Medical Group.