News Stepping Up: Alternatives to Incarceration Newsletter

Welcome to the third Stepping Up-Alternatives to Incarceration Quarterly Newsletter from Southwest Iowa Mental Health and Disability Services Region (Region). The purpose of the newsletter is to keep key stakeholders in the Region informed of the status of the Stepping Up-Alternatives to Incarceration Initiative in Southwest Iowa.

IN THIS ISSUE

In this issue, we revisit the Sequential Intercept Model (SIM) that serves as the organizing framework for the Stepping Up-Alternatives to Incarceration Initiative. Our attention then turns to a review of services provided by the Mental Health Crisis Response Team. Next, we take a closer look at one specific service offered by the Mental Health Crisis Response Team. Finally, we share the success story of an individual served by the Mobile Crisis Response Team initiated by a local county jail.

WHAT IS THE SEQUENTIAL INTERCEPT MODEL?

In our last issue, we introduced you to the SIM, first published by Policy Research Associates, Inc. in 2005. The SIM provides a framework for understanding the flow of individuals with mental illness through the stages of the criminal justice system, identifying existing resources and service gaps at each stage, and prioritizing implementation of community-based services. The intercepts, ranging from Intercept 0 through intercept 5, encompass the decision-making stages of the justice system. In future issues, we will continue to include the visualization of the SIM to serve as a point of reference as we discuss specific services offered throughout the Region.

WHAT IS THE MENTAL HEALTH CRISIS RESPONSE TEAM (MHCRT)?

MHCRT, a service provided by Heartland Family Services, provides immediate therapeutic intervention for mental illness and substance abuse crises. MHCRT crisis assessments are requested from five sources. Mobile Crisis Response assessments result from requests made by law enforcement officers who come in contact with individuals or respond to calls involving individuals in crisis. Jail-Based Crisis Response is requested by county jails as an intervention for inmates who experience mental health crisis. Pre-committal assessments occur when citizens who are considering filing civil commitment paperwork contact the MHCRT for assistance in determining the appropriate level of care for a family member in crisis. Court-ordered assessments occur when a judge is concerned that a civil commitment may not be the appropriate course of action in cases brought before them. Hospital-Based assessments are requested by emergency department staff to determine the appropriate level of care for individuals who present in the emergency department in non-medical mental health crisis.

The origins of MHCRT in Southwest Iowa date back to December 2010 with the implementation of Mobile Crisis Response and Jail-Based Crisis Response in Pottawattamie County. Pre-Committal Assessments (2012) and Court Ordered Assessments (2015) were also first implemented in Pottawattamie County. By the second half of 2016, MHCRT services were made available to all counties in the Region.  In spring 2018, the Region launched a Hospital-based pilot program for critical access hospitals in rural communities. The current expansion status of all MHCRT services throughout the Region appear in the table below.

A CLOSER LOOK AT JAIL-INITIATED MOBILE CRISIS RESPONSE

Jail-Initiated Mobile Crisis Response is activated by calls from local county jail staff. After receiving a call from the jail, therapists provide on-site, face-to-face or technology assisted risk assessments to prevent unnecessary hospitalization, protective custody, and/or incarceration. The MHCRT follows up with all individuals assessed to make sure they have the information they need to successfully seek services. Therapists also follow up with individuals to provide necessary referrals in order to prevent future crises.

Mobile Crisis Response is available to every jail in the 9-county region. Currently, six county jails utilize the service. Feedback from the jails that have implemented Mobile Crisis Response has been positive. They find it not only saves them time, it also provides a quality service to individuals.

The data below represent Jail-Initiated Mobile Crisis Response assessments completed through March 2020 of the Region's FY2020 (July 1, 2019-June 30, 2020). The data indicates that eighty-eight percent of Jail-Initiated Mobile Crisis Response assessments conducted determined that the individual does not meet criteria for involuntary committal. When this occurs, MHCRT develops a safety plan with the individual to help them remain safe while in the jail, and once back in the community the MHCRT team conducts follow-up with the client to make sure they are seeking or attending mental health/substance abuse treatment at local mental health centers. The Region would like to encourage more counties to utilize MHCRT services. For more information, please contact Suzanne Watson, Region CEO at swatson@swiamhds.org.

JAIL-INITIATED MOBILE CRISIS RESPONSE ASSESSMENTS YEAR-TO-DATE (JULY 2019-MARCH 2020)

Success Story

The following story highlights the impact of Mobile Crisis Response (Intercept 3) on the life of an individual living in our Region. Jenny Stewart (LMHC), the Director of Crisis Response from Heartland Family Service, provided information about the program and a local jail administrator from the northern part of our Region recently reported on a case in their jail.

In this case, the local jail administrator was concerned about an inmate that had come into the jail intoxicated and was making remarks that they thought could be suicidal.  The inmate was scheduled to be released the next day so the jail decided that they wanted a professional opinion on the inmate's mental health status.  The jail administrator called the number provided by MHCRT, a licensed Mental Health therapist answered the call and took the report from the jail administrator regarding the background of the case. The therapist received verbal consent from the inmate to perform a brief (30-40 min) mental health/substance abuse telehealth assessment through a secure program on the jail's laptop. Through the professional assessment, the therapist determined that the individual had been making suicidal remarks but was not in immediate danger. They developed a safety plan and upon release the next day the inmate was willing to seek mental health/substance treatment from a local mental health provider.  The inmate also had a positive family support system at home and the inmate stated that he would follow through with treatment. The MHCRT therapist then gave this verbal report to the jail administrator involved and they both agreed this was an appropriate plan and the inmate was safe to be released from jail the following day with this safety plan. The MHCRT therapist also contacted the local mental health provider to help set up the appointment as well as followed up with the mental health center to ensure that the individual attended the mental health appointment.  With written consent from the individual/client, the MHCRT therapist provided both the jail and the mental health center a copy of their written assessment to provide continuity of care. It is standard protocol for the MHCRT therapist to follow up with the individual/client within 24 hours after an assessment and then again in 30 days. The jail administrator was happy to report that the individual involved continues to do well in the community with no further incidents involving the police or sheriff's office.

This is just one example of how early intervention can assist an individual in need and prevent unnecessary involuntary mental health commitment when they are deemed not appropriate by a mental health professional. Thanks to the hard work and dedication by this local county jail and the  MHCRT therapist, this individual was able to get the support they needed to make positive changes in their life.

*Mobile Crisis Response assessments can be performed wherever the individual (child or adult) is currently located and is not always performed at the jail. Jenny Stewart reported that she and her staff have conducted assessments under bridges, in the individual's home, and in schools just to name a few examples.

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