Helping citizens diagnosed with mental illness while saving taxpayers money? “Impossible!” you say. Yet that is exactly what is happening in Athens, Georgia.
Judge Brian J. Amaro, chair of the Council of Superior Court Judges Special Committee on Mental Health and Local Jails, and Judge David R. Sweat, creator of the Athens-Clarke County Justice Mental Health Collaborative.
The Justice Mental Health Collaborative in Athens is working to reduce the number of individuals in local jails who are suffering from mental illness. The goal is to divert these individuals from jails and hospitals to local mental-health-crisis stabilization units and other community-based programs.
“In a mental health crisis, people are more likely to encounter police than get medical help,” according to the National Alliance on Mental Illness (NAMI). Unfortunately, when the criminal justice system “treats” someone in a mental health crisis, the cost is tremendous. For example, housing an inmate with mental illness in jail costs $31,000 annually, while the cost of community mental health services is less than a third of that.
Athens-Clarke County Police
“The Athens-Clarke County Police Department’s Command Staff decided they wanted to do more to engage with our mentally ill population and keep them out of jail,” explains Senior Officer Robie Cochran. “So, they came to me and said, ‘Make it happen. Go help people.’” Robie, a seven-year veteran with the department, didn’t know quite what to do. As part of the Crisis Intervention Response Unit, Robie had worked with Katie McFarland, a licensed clinical social worker with Advantage Behavioral Health System (Advantage). He contacted Katie, confident she could help. After thinking about the problem for a few days, Katie came up with the answer, “We’ve got to start communicating.”
Justice Mental Health Working Group
The police were not the only ones concerned about helping individuals diagnosed with mental illness. Superior Court Judge David R. Sweat of the Western Judicial Circuit had already decided it was time for the entire system to tackle the problem. He brought together people who regularly dealt with individuals involved in the criminal justice system who may have a mental health diagnosis. Working with the University of Georgia’s Fanning Institute for Leadership Development (the Fanning Institute), Judge Sweat convened a working group of experienced individuals, including Robie and Katie, to discuss better ways to ensure the safety of the community while also ensuring the safety of these vulnerable individuals.
Everyone in the working group knew they needed to take steps to address individuals in mental health crisis, and they knew the current system was not working. They needed a more effective way to connect individuals in crisis to treatment and to creatively fill in the gaps in services. They needed a better system.
Goals for the Justice Mental Health Collaborative
The Extent of the Problem
The group first needed to understand the extent of the problem.
To start, the Fanning Institute interviewed approximately 50 stakeholders from the various systems, including representatives from the jails, law enforcement, behavioral health providers, the courts, etc. From these interviews, they developed a summary of the system’s strengths and challenges, as well as a flowchart detailing the various paths that clients with behavioral health issues used to enter and navigate the system. “Our overall goal was to identify a more efficient and productive path for clients to achieve better outcomes,” explains Julie Meehan of the Fanning Institute.
To establish a baseline, the team conducted an in-depth study to determine the true extent of the problem. Advantage’s Laura Alexander studied jail records for three months and compared those records to Advantage’s historical client records to determine how many individuals in jail had been diagnosed with a mental illness.
The result: 38-39 percent of the individuals in the Clarke County Jail have been clients at Advantage.
The information the team gathered in this study clearly shows the correlation of mental illness and jail population.
| Clarke County Jail | ||
| Ever Advantage Clients | Not Advantage Clients | |
| History of Multiple Arrests | 91% | 68% |
| Average # of Lifetime Arrests | 12.7 | 5.4 |
| Total Lifetime Arrests | 8,986 | 6,095 |
| Average Length of Stay in Jail | 21.4 days | 11.1 days |
| Return to Jail Within the Next Year | 53% | 36% |
Data from the public defender’s office shows 48 percent of their clients were Advantage clients.
Laura also looked at why their clients had been arrested. A majority of the charges were for parole and probation violations, followed by driving violations and other misdemeanors.
Chart prepared by Advantage Behavioral Health System
In addition, Robie went through every Athens-Clarke County police report from in 2017 and 2018 to find cases involving individuals with mental health issues.
Robie reviewed all reports, not just arrest reports. Sometimes, the police are called to the scene of an incident involving an individual with a mental illness who is the victim of a crime. In other instances, they receive odd calls requesting assistance from an individual. The highly trained Athens-Clarke County police see those calls as an opportunity to intervene before an individual goes into crisis. In these instances, just as in potential arrest situations, the responding officer can call Robie or Katie to discuss possible options.
Top 10 Types of Reports for Individuals with Mental Health Issues:
– Barring from a particular location
– Informational call requesting police assistance
– Theft by taking
– Battery and simple battery
– Assault and simple assault
Co-Responder Model
Having clear data about the problem of individuals with mental illness in the criminal justice system, the team began to look at how other jurisdictions have addressed the issue. After reviewing the effectiveness of various methods, and traveling to Johnson County, Kansas to study that community’s innovative initiatives, the team decided to employ the Co-Responder Model.
The Co-Responder Model is a proactive approach. The team, one person from law enforcement and one person from a mental health provider, try to make early contact with the person in crisis.
The team realized from the start the only way the Co-Responder Model was going to work was if the agencies communicated. Law enforcement and mental health providers need to have access to information and need to share that information. That level of cooperation requires hard work, trust, and understanding.
Day-to-Day Operation
Every day, Robie goes through every police report looking for indications of people with mental health issues. When he finds an individual who might need help, he gives the name to Katie to determine if that person is an Advantage client. If so, Katie reaches out to the providers and case managers to determine what is going on with that person, so they can intervene as necessary.
Robie and Katie also co-respond when officers need them. The police officers on the street can contact the team when they encounter someone who appears to have a mental health issue. Sometimes, the officer just needs a consultation, but other times Robie and Katie may go to the scene and try to help the first responders find the right solution for the person in crisis. While on the scene, Katie is able to perform an assessment and direct the individual to treatment. “Without the partnership, that person would have ended up in jail,” Robie explains.
Often, law enforcement sees someone going into crisis. Possibly a person calls the police to report the meat in their refrigerator is poisoned. Being able to call a treatment person to the scene allows the police to determine an effective intervention. In addition, a good working relationship with law enforcement allows treatment providers to request welfare checks to intervene before a crisis.
CASE EXAMPLE: The police received a call about a woman behaving strangely. The woman was using a knife to dig into her ear. The woman was refusing to go to the hospital. The police contacted the co-responder team. Robie spoke with her, calming her down. He learned she had two children who would be getting off the bus soon. Understanding this, Robie was able to talk the woman into going to Advantage for a walk-in appointment so she could meet her children at the bus. Katie was able to do an evaluation and get her treatment.
Through co-responding and report reviews, Robie knows most of the individuals with a mental illness that the police regularly encounter. Because he has gotten to know these individuals and they have grown to trust him, they listen to him and are cooperative when he arranges help for them.
In most jurisdictions, the police have two choices of where to take an individual who may be in mental health crisis—the jail or the hospital. These are both expensive options. The Crisis Intervention Response Unit intervenes to find a place to take individuals where they can get specialized help.
With the support of the Department of Behavioral Health and Developmental Disabilities (DBHDD), Advantage recently opened a Behavioral Health Crisis Center where law enforcement can take a person who is in crisis for treatment. The center is open 24 hours a day and has a walk-in center, 8 temporary observation units, and 30 beds (recently expanded from 14).
Robie Cochran, Katie McFarland, and Judge David Sweat
Training
Everyone in the criminal justice system requires training to effectively assist individuals in a mental health crisis.
Officers with the Athens-Clarke County Police receive a 40-hour course of Crisis Intervention Training (CIT). This training includes information about mental health disorders and how to interact with a person in crisis. They also teach de-escalation tactics. Not all police departments have that level of commitment to mental health training for officers.
But that training was not enough; the officers wanted more. Robie and Katie, who both sit on Georgia’s CIT Advisory Board, polled the officers to determine what they wanted to learn. They used that information to design a 24-hour advanced behavioral crisis training. this class includes information on trauma-informed care, officer self-care, autism, and suicide assessment.
The advanced crisis training also informs officers about the Mental Health Accountability Court. “After the training, the officers have a more positive attitude toward the Accountability Court,” Robie explains. “They realize participants aren’t just getting out of jail free—the program is a lot of work.”
Mental health professionals also need training, particularly on how to work with law enforcement. “I didn’t know cops well,” explains Katie. “They are not touchy-feely and I am. I needed to learn how to talk with officers. I also let them know I am available to help them with their own issues. That helped build trust.”
Katie and Robie also train members of the community who come into regular contact with individuals who might be in crisis. They regularly conduct Mental Health First Aid and other community trainings. Understanding the issues and knowing there is assistance available helps the community become part of the solution.
Grant Funding
When the Collaborative started, it didn’t have any dedicated funding. It had dedicated people, and the agencies involved believed in the project and directed resources to solve the funding issue.
The team sought grant funding for the project and received a $150,000 Planning Grant from the Department of Justice’s Bureau of Justice Assistance. The planning process took approximately two years, during which the team collected and analyzed the data above. The Collaborative then received a two-year, $340,000 Implementation Grant to implement the Co-Responder Model and expand training around mental health in the community.
Success
The Justice and Mental Health Collaborative is a work in progress, but it has made significant strides.
Why has it been so successful? Everyone agrees the key to its success is finding the right people. The Athens-Clarke County project has the commitment of the partners at the highest level, from the chief of police to the CEO of Advantage. And the people on the ground, on the day-to-day level, are committed and creative. “This is an amazing project because we’ve got a really good collaboration,” Julie Meehan of the Fanning Institute explains. “There are no egos in it. We have a team that wants to initiate change to make the system better. And we are. We are coming up with the best product for individuals, communities, and institutions.”
The community at large is also seeing the benefit of this work. The Collaborative is supported by the mayor of Athens and the Athens-Clarke County Commission. In April 2017, Athens-Clarke County passed a resolution to join the Stepping Up Initiative, a national initiative to reduce the number of people with mental illness in jails.
The Future
What does the future hold? The team members are striving to find the best way to share information between the hospitals, mental health service providers, jails, law enforcement and the courts. In addition, staffing is critical. The project not only hopes to sustain staffing, but also to hire a dedicated administrator and a second co-responder team.
Other Jurisdictions Can Do This Too
Several other areas in Georgia are developing similar programs. The Athens-Clarke County team is helping other jurisdictions and stands ready to help your county.
Role of the Judge (in praise of Judge Sweat)
“It all starts with communications between agencies,” notes Julie Meehan of the Fanning Institute. She believes the first critical step to opening communication is to have local judges actively involved. “When judges are involved, they lend credibility and impetus for others to get involved. Judge Sweat is one of the few individuals who could have brought all the partners in Athens together.”
Laura Alexander and Evan Mills of Advantage add, “Having Judge Sweat at the helm is essential. Judges are needed to get things rolling and to inspire people to keep working.”
Judge Sweat understands the importance of his role. “We (judges) need to be the conveners for the people who can do this. We need to get the people who can make this happen in the same place at the same time, so we can collaborate.”
Other Recommendations
The team has some recommendations for groups interested in reducing the number of people in jails and prisons with mental illness.
- Connect your local mental health provider with law enforcement
- Train law enforcement officers in crisis intervention
- Be open to doing things differently
- COMMUNICATE
There is one final recommendation. This can be distressing work. Katie and Robie preach self-care, both at CIT trainings and for their team. Katie practices yoga, and Robie chases his six year old around. Just like on an airplane, take care of yourself first so you can help others.
ABOUT THE AUTHOR
Aimee Maxwell works at the Judicial Council of Georgia’s Administrative Office of the Courts (AOC) as the assistant division director of the Communications, Children, Family and the Courts Division. Before joining the AOC, she practiced criminal defense and labor law. She is the founding executive director of the Georgia Innocence Project.
