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Crisis Care Services for Countries: Preventing Individuals with Mental Illnesses form Entering Local Corrections Systems

Meaghan Gilmore and Mary-Kathleen Guerra (2010).  Washington, DC: National Association of Counties.

The National Association of Counties (NaCO) has a venerable history of concern about the overuse of jails for persons with mental illness. Dating at least as far back as the early 1980s, when NaCO was a critically important member of the short-lived National Coalition for Jail Reform, Don Murray and other staff members, who have come and gone over the years, have done an excellent job of keeping focus on issues related to persons with mental illness in the criminal justice system.

 In this most recent NaCO report, Meaghan Gilmore and Mary-Kathleen Guerra observe that detrimental consequences result from jailing young people, as well as adults, in juvenile and criminal justice systems across the country. In this report they argue that a more productive way "to facilitate reaching individuals with mental illness locally is through implementation and effective use of crisis care services." Such services, they note, can address "psychiatric emergencies" in the community.

 According to Gilmore and Guerra, "A psychiatric emergency (crisis) is a sudden serious psychological disturbance or change that affects behavior or functioning. If not responded to, it may result in life-threatening and unsafe consequences. Characteristics include: a sense of urgency; sense of being overwhelmed; lack of coping abilities; and the recognition of need for assistance from others to manage and alleviate distress. It often includes life threatening, life disrupting and life-impairing behaviors."

Gilmore and Guerra note that "crisis care services" for such circumstances take numerous forms, including mobile crisis units, crisis hotlines, crisis stabilization units, and crisis care centers. All of these services have the same objective, they say, which is "to provide crisis assessment, intervention, and linkages to community resources for stability." They note further, "Counties need to assess their population resources and geographic needs. Coordination and collaboration with many different organizations and agencies is essential for the development, success, and sustainability of crisis care services." Such services provide necessary care and offer a method of reducing county costs.

In this report, crisis care services are described for five individual counties, including Bexar County, Texas; Buncombe County, North Carolina; Yellowstone County, Montana;  Hennepin County, Minnesota; and  King County, Washington. The report also reports on services in a six-county partnership in Minnesota.  These descriptions highlight particular characteristics of each jurisdiction's work: collaborating with law enforcement to reduce arrests and the unnecessary use of emergency services, the use of innovative (and underfunded) Crisis Intervention Teams; serving both juveniles and adults; and coordinating timely rural services over a large catchment area.

Gilmore and Guerra stress the key roles that law enforcement and county officials can play in supporting and implementing these services.  The short county case studies in this report describe the organization and funding of these services, the range of actual services provided in each locality, the advantages of the services offered, statistics on the services used, and lessons to date on the implementation of these services.   In Bexar County, for example, crisis care services benefitted from political will, dedicated funding, and "a forward-thinking sheriff." 

Overall, these case studies highlight, among other things, the utility of comprehensive services, electronic recordkeeping, local partnerships, follow-up care, drop-off options, and training.

Gilmore and Guerra conclude, "Crisis care services act as an alternative to arrest for law enforcement, allowing officers to link individuals with mental illness to much needed services and focus on more urgent public safety matters. Law enforcement partnerships are imperative for enhancing crisis services as alternatives to arrest. Their partnership can help reduce the revolving door effect of individuals with mental health issues in local correctional systems. This is not only good for individuals with mental illness and families, but potentially helps with jail population management issues. Crisis care services also facilitate diverting individuals with mental illness from unnecessary emergency department visits. Ensuring county residents have access to the crisis care services they need before moving into more costly systems is the right thing to do both for individuals with mental illness and counties."

 An appendix provides a Buncombe County "Behavioral Health Crisis Continuum" guide for law enforcement officers. The guide raises certain questions (about service providers, homelessness, detoxification needs, etc.), identifies the availability of specific service providers, provides contact and location information, and reviews relevant crisis care-related issues.

Posted Fri, Mar 11 2011 4:36 PM by Tracey Vessels


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