Title
a. Receive a presentation on the Stepping Up Initiative adopted by the Board of Supervisors on April 30, 2019, per Resolution No. 19-124, to reduce the number of people with mental illnesses in our county jail; and
b. Provide direction as appropriate.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive a presentation on the Stepping Up Initiative adopted by the Board of Supervisors on April 30, 2019, per Resolution No. 19-124, to reduce the number of people with mental illnesses in our county jail; and
b. Provide direction as appropriate.
SUMMARY/DISCUSSION:
The Stepping Up Initiative is a national effort launched in May 2015 by the National Association of Counties (NACo), the Council of State Governments (CSG) Justice Center, and the American Psychiatric Association Foundation (APAF). Its goal is to reduce the number of people with mental health and substance use disorders in jails by helping counties develop data-driven, locally tailored strategies to address the intersection of behavioral health and the criminal justice system. In particular, Stepping Up calls for efforts to achieve four broad goals for the target population:
1) reduce jail bookings;
2) reduce the average length of stay in jail;
3) increase connections to care and treatment; and
4) reduce recidivism.
In April 2019, the Board adopted a resolution proposed by the Monterey County Sheriff’s Office (MCSO) to become a Stepping Up county. Monterey County Behavioral Health (MCBH) subsequently contracted with The Council of State Governments (CSG) Justice Center to work with stakeholders in the county to map current policies, processes, and resources for people with behavioral health needs who enter the criminal justice system. This effort was co-led by MCBH, MCSO, and the Monterey County Probation Department (Probation). The Stepping Up Monterey County System Mapping project kicked off in February 2020 however was temporarily delayed due to the Covid pandemic and re-launched in January 2021. Focus groups, interviews and document reviews were conducted to identify opportunities and obstacles at various “process points” in the County’s crisis response and criminal justice system.
The Stepping Up Monterey County System Mapping Report (Report) prepared by CSG that resulted from this exercise included a system mapping diagram and a set of recommendations to help local stakeholders scale up their efforts so that more people can be in needed care and housing, rather than cycling through the criminal justice system.
The findings in the report dated June 2021 concluded:
Cross-system coordination is ad-hoc and occurs primarily on a case-by-case basis; individuals often “fall through the cracks” during transitions, such as following emergency room discharge and release from jail.
People with firsthand experience of the criminal justice and behavioral health systems and their families often find current policies, processes, and eligibility criteria difficult to understand and navigate.
Some focus group members expressed concern about whether community-based treatment and supports are available on an equitable basis-in particular, whether people of color are more likely to be taken to secure settings (such as the jail) than White people.
The recommendations in the report dated June 2021 included:
Improve cross-system collaboration and recommended establishing a regular forum for interagency information sharing and development of new initiatives across justice, health, and housing/homelessness services; reinstituting a forum for contracted providers to meet regularly to share information; developing and providing training on mental illness, substance use disorders, and co-occurring disorders for various justice partners; and analyzing data to inform cross-system decision-making.
Reduce jail bookings for people with behavioral health needs and recommended restoring the Mobile Crisis Team; providing additional training to law enforcement on interacting with people who have behavioral health needs; developing recommended pathways that make it easier to get people into treatment instead of jail; increasing capacity of social workers and peer specialists; and expanding non-emergency room options for crisis response and stabilization.
Reduce average length of stay in jail and recommended developing strategies to share mental health information with defense counsel to facilitate earlier identification for potential diversion or other programming; consolidating behavioral health matters in court calendars; and analyzing the current medications and charges for people in custody.
Increase connections to treatment and reduce recidivism and recommended establishing a strategy for proactive community outreach to raise the visibility of and improve access to existing services; increasing available treatment and programming for people with behavioral health needs in custody; developing or formalizing a transition planning process that includes Medi-Cal reactivation and warm hand-offs to treatment and services, potentially with peer navigators; expanding the use of Coordinated Entry by justice partners and local hospitals; expanding the use of peer navigators for care coordination in the community.
In addition to recommendations specific to the four Stepping Up goals, the Stepping Up Project Report identified a need to improve cross-system collaboration and recommended establishment of a regular forum for interagency information sharing and development of new initiatives across justice, health, and housing/homelessness services. The Stepping Up Steering Committee (Committee) launched in March 2022 with Health, MCBH, MCSO, Probation, District Attorney, Public Defender, and Court representation in attendance. The Committee agreed to meet monthly and met seven times in calendar year 2022. In February 2023, the Committee met and transitioned coordination of the Committee moving forward from under the Health Department’s Behavioral Health Bureau to the under the Homeless Services Director and the Homelessness Strategies and Initiatives Division of the CAO’s office.
In Spring 2023, the County was awarded a 5-year, $500,000 planning grant from the Department of State Hospitals (DSH) to develop strategies to achieve goals similar to the Stepping Up goals. Specifically, the funds were awarded to facilitate a collaborative community stakeholder workgroup focused on developing and implementing local solutions that target:
1. the reduction of the number of individuals with serious mental illness arrested and incarcerated for behavior connected to their illness, and
2. the reduction of Felony Incompetent to Stand Trial (FIST) commitments overall within the county.
It should be noted that some of the findings and recommendations in the report resolved themselves as the County came out of the Covid pandemic. Other areas of programming and coordination have been resolved or are currently works in progress given more recent legislative changes at the state level and with the CalAIM Justice Involved Reentry Initiative. In 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and eligible adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. The Department of Health Care Services (DHCS) implemented a phased approach for the state prison system and county correctional facilities (inclusive of county jails and youth correctional facilities) to go live in several readiness-based cohorts over a two-year period (October 1, 2024 - September 30, 2026). MCBH went live with the Behavioral Health Linkages requirement October 1, 2024. Multiple agencies continue to work collaboratively in the lead up to go-live for our local youth and adult correctional facilities.
OTHER AGENCY INVOLVEMENT:
The Department of State Hospital grant currently supporting the initiative requires the participation, at a minimum, of representatives from the Sheriff’s Office, Probation, Behavioral Health, Superior Court, District Attorney’s Office and Public Defender’s Office. Currently, the Workgroup has a total of 24 members, including representatives from Health and Military & Veterans Affairs in addition to the six departments mentioned and the Homelessness Strategies and Initiatives Division. The DSH grant funding is supporting a Management Analyst position in the Homelessness Strategies and Initiative Division responsible for organizing monthly meetings of the Stepping Up Workgroup, billing and reporting to DSH, and supporting a Strategic Planning process to encourage uptake of CalAIM-enabled services that contribute to achievement of the Stepping Up Initiative goals.
FINANCING:
The sole source of financing for this initiative is the DSH grant currently managed by Homelessness Strategies and Initiatives. There are no impacts on the General Fund.
Mark a check to the related Board of Supervisors Strategic Initiatives
___ Economic Development
___ Administration
_X_ Health & Human Services
___ Infrastructure
___ Public Safety
Prepared by: Cindy Joerger, Management Analyst II, CAO-HSI Division, ext 5163
Reviewed by: Roxanne Wilson, Director, CAO-HSI Division, ext 5445
Melanie Rhodes, Bureau Chief, Behavioral Health, 831-796-1742
Approved by: Deborah Paolinelli, Assistant County Administrative Officer, ext 5309
Attachments: Presentation