The Center for Behavioral Health and Justice partners with community mental health agencies, local law enforcement, and jails and prisons across the state to enhance cross-disciplinary collaboration, training, and implementation of evidence-based practices. These partnerships solidify communities' desires to address the needs of those with behavioral health concerns within the criminal justice system by identifying, diverting, and treating individuals with behavioral health concerns and decreasing the burden on jails, families, and communities.
Jail Diversion Pilot Evaluation
The Michigan Mental Health Diversion Council was created in the Michigan Department of Community Health to advise and assist in the implementation of the Diversion Action Plan and provide recommendations for statutory, contractual, or procedural changes to improve the diversion of individuals with mental illness from the criminal justice system. As part of these efforts, jail diversion pilot programs were launched from 2014 – 2016 within the following communities.
- St. Joseph
The Center for Behavioral Health and Justice has served as consultants and evaluators on the pilot programs since 2015. Center staff regularly collaborate with local community mental health and law enforcement stakeholders within pilot counties to assist in the development, implementation and improvement of diversion programming across the sequential intercept model. Services include the evaluation of pilot programs, the provision of relevant and timely data findings and recommendations to support pilot counties and the Diversion Council in data-driven decision-making, identification and recommendation of best practices, and the identification of state-level policy and practice improvements.
Find out more about the Jail Diversion Pilot Programs.
Read more about the Michigan Mental Health Diversion Council.
Watch the 2020 Jail Diversion Summit
Stepping Up Technical Assistance
Stepping Up is a national initiative to reduce the number of people with mental illnesses in jails and is the result of a collaboration between the National Association of Counties, The Council of State Governments Justice Center and the American Psychiatric Association Foundation. Since 2015, over 433 counties across the country have committed to Stepping Up to reduce the number of individuals with mental illness in jails.
Within Michigan, a total of 21 counties endorsed the initiative through 2018. While local support for Stepping Up is strong, communities often lack sufficient data and technical expertise to effectively engage in the cross-system, outcome-oriented planning necessary to move forward with the initiative. Specifically, local stakeholders often struggle with insufficient data to properly identify the target population and implement the appropriate system-wide response; to select and implement appropriate evidence-based interventions; and to develop a sustainable system to track and monitor impact.
To assist Michigan counties in achieving the objectives of Stepping Up, Michigan Department of Health and Human Services is providing the services and expertise of the Center for Behavioral Health and Justice to provide technical assistance to those counties that have endorsed the Stepping Up initiative including:
Technical assistance provided is based on the needs of the individual county, but can include:
- Observation and assessment of advisory board
- Documentation of Stepping Up goals & objectives
- Review, mapping, current jail process / Assessment of system efficacy
- Review of current screening and assessment tools / Recommendation of evidence-based tools
- Data review and validation
- Development of baseline data
- Development/implementation of data collection protocol
- Data collection, cleaning, coding, merging, and analysis
- Establish prevalence of SMI in jail
- Create context by comparing county with others across the state
- Stakeholder action planning session
- Presentation of findings and recommendations to stakeholders
- Development/implementation of ongoing, sustained data collection and analysis
- Data system integration consultation and recommendations
- Identification of sustainability strategies
Get more information on the national Stepping Up initiative.
Reports and Publications:
Michigan Re-entry Project (MI-REP)
The Michigan Re-entry Project (MI-REP) was implemented in 2017 with funding from SAMHSA's State Targeted Response to the Opioid Crisis (STR) to fill a service gap for individuals in prison who have co-occurring mental health and opioid use disorders. The program is a multi-system collaboration between the Center for Behavioral Health and Justice (CBHJ), the Michigan Department of Health and Human Services (MDHHS), Michigan Department of Corrections (MDOC), County Prepaid Inpatient Health Plans (PIHPs), and University of Massachusetts Medical School (UMMS). MI-REP utilizes the MISSION (Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking) model, which is on the National Registry of Evidence-Based Practices. MISSION is based on five key components: Critical Time Intervention, Dual Recovery Therapy, Peer Support, Vocational Support, and Trauma-Informed Care.
With STR funding, MI-REP is currently being offered in two MDOC facilities – Women's Huron Valley and the Detroit Re-entry Center – for individuals being released to Macomb, Oakland, or Wayne County. MI-REP teams, comprised of a Community Mental Health case manager and peer support specialist, provide intensive wraparound supports with three months of in-reach and six months of post-release services. MI-REP participants may also opt to receive Vivitrol or other prescribed Medication Assisted Treatment.
The CBHJ team has a dual role as systems broker and program evaluator. As the systems broker, the CBHJ team facilitates linkages, discussions, and problem-solving among stakeholders. As the program evaluator, the team is using a mixed methods approach for a comprehensive understanding of the implementation process as well as participant outcomes. The team is collecting data through focus groups, interactive meetings, and standardized screens, all of which are analyzed on an ongoing basis. Findings and recommendations are then shared with stakeholders regularly to implement practice and policy changes as needed. This feedback loop is part of the team's Plan-Do-Study-Act approach to support continuous process improvement.
Read more on the MISSION model.
During these unprecedented times, MIREP staff have gone the extra mile in ensuring that participants are engaged in services and in supporting their recovery and well-being. Learn more about the creative work and commitment that MIREP staff have shown during the COVID-19 pandemic.
MIREP Reports, Publications and Resources
Opioid Treatment Ecosystem Initiative:
The Center for Behavioral Health and Justice Opioid Treatment Ecosystem (OTE) initiative started in 2019 with funding from the Michigan Opioid Partnership, a public-private collaborative that includes the state and key non-profits. The goal of the initiative is to foster sustainable community-based alliances aimed at changing the cultural landscape around substance use disorder and decreasing overdose deaths through prevention, treatment, harm reduction and sustained recovery.
In developing these OTEs, much of our initial efforts have focused on the delivery of evidence-based treatments to those involved in criminal/legal systems because of the high risk of death from overdose among this population. Thus, we aim to implement the delivery of medications for opioid use disorder (MOUD), the gold standard treatment for opioid use disorder, within county jails but also strengthen the ecosystem by implementing first responder interventions prior to incarceration and a continuum-of-care plan following release from incarceration.
The Center for Behavioral Health and Justice is currently working with six counties to implement and evaluate opioid use disorder treatment in the county jail (Jackson, Kent, Monroe, Muskegon, Washtenaw, and Wayne) along with additional first responder and community reentry initiatives in select counties (Kent and Monroe).
Through these efforts, we will also work to reduce stigma and educate the community stakeholders in these counties by providing technical assistance for implementation and evaluation, and by facilitating Communities of Practice (CoPs) around addiction, treatment, and recovery. Technical assistance includes the provision of relevant and timely data findings and recommendations to support data-driven decision-making and state-level policy and practice improvements. CoPs are intended to foster alliances between first responders, correctional supervision, criminal/legal systems, and community-treatment providers to address barriers in implementing and sustaining treatment of substance use disorders but are also aimed at improving knowledge and attitudes around these practices.
OTE Reports and Resources:
- Community of Practice Summit: September 20, 2020
- Community of Practice Summit: May 5, 2020
- Review the February 2020 Update
- Medications for Opioid Use Disorder (MOUD) Infographic
- Opioid Treatment Ecosystem - Developing Pathways to Treatment
Read the press release announcing the project.
Learn more about the Michigan Opioid Partnership.
The Center for Behavioral Health and Justice (CBHJ) engages in a number of harm reduction initiatives aimed at improving public health and decreasing mortality, particularly among vulnerable groups.
Syringe exchange programs aim to reduce the harm associated with injection drug use by providing unused needles and collecting and disposing of used needles, providing HIV and hepatitis testing services, providing other hygienic supplies, and offering connection with treatment services. We are working with the Safe Syringe Access and Support Program in Marion County, Indiana to examine and address law enforcement barriers to these services.
Persons with lived experience in addiction who support engagement in treatment for people experiencing a substance use disorder are increasingly used to reduce the risk of overdose. We examine the integration of peer supports in emergency medical settings (EMS and emergency department) as well as criminal legal systems (prior to a police encounter and following incarceration). Moreover, we facilitate harm reduction training for peers.
The CBHJ Harm Reduction Initiative team studies the distribution and impact of the overdose-reversal antidote, naloxone. This has included community training, as well specialized law enforcement training, and the identification of barriers to naloxone use.
Drug testing technologies:
Drug testing technologies can help persons who use drugs make decisions about whether to and how much to consume given test results. As part of interdisciplinary collaboration with chemical researcher we aim to validate and advance these technologies as a harm reduction strategy.
Co-Response or Mobile Crisis Teams:
These programs aim to divert persons with a mental or behavioral health issue and/or substance use issue from the criminal legal system. Teams respond to mental health or substance use related crises or provide follow-up services to meet people where they are and engage them with treatment. The CBHJ has studied co-response team implementation and patient outcomes.
- Barriers and facilitators to implementing an urban co-responding police-mental health team
- Lay responder naloxone access and Good Samaritan law compliance: postcard survey results from 20 Indiana counties
- EMS naloxone administration as non‐fatal opioid overdose surveillance: 6‐year outcomes in Marion County, Indiana
- Emergency department-based peer support for opioid use disorder: Emergent functions and forms
- Police officer attitudes towards syringe services programming
Crisis response and stabilization
With communities calling out for new and improved ways to respond to behavioral health crises, the Center for Behavioral Health and Justice uses evaluation, technical assistance, and change team implementation techniques to advance crisis response systems. Several strategies are emerging to improve public response to mental health crises, suicidal calls, overdoses, delusions, and general public welfare. Program implementation can seem daunting to first responder and community mental health agencies, who are busy enough addressing the crises at hand. The CBHJ can demystify new models by bringing stakeholder groups together in communities of practice to share lessons from project implementation across the state. As a leading research institution in crisis response interventions, the CBHJ’s data-driven techniques can help counties lay the groundwork for rigorous evaluation of their new and innovative programming.
Behavioral health trainings prepare law enforcement and other first responders for crisis incidents. About a quarter of all U.S. police shootings involve a person with mental illness. Popular training models include Crisis Intervention Team (CIT), Michigan Crisis Intervention System, Managing Mental Health Crisis, Mental Health First Aid, Safety & Health Integration in the Enforcement of Laws on Drugs (SHIELD), and others. While some models have undergone thorough evaluation, both on attitudinal and behavioral changes among trained professionals, many have not. The CBHJ provides pre/post evaluations on improved knowledge, de-escalation skills, arrest frequency, officer and citizen safety, use of force, and successful referrals to treatment. Empirically driven outcomes can be used to justify program sustainability and expansion.
Alternative response units have begun to proliferate among Michigan law enforcement agencies, bringing trained mental health clinicians directly to crisis incidents. Model variations abound, from paired law enforcement officers with mental health clinicians, telehealth-based clinician visitation via tablet, and mobile mental health crisis teams. Much like other innovative programs, the empirical basis supporting each model is nascent and needs development. Moreover, communities need models that fit their particular institutional, fiscal, personnel, and clientele environment. Researchers at the CBHJ are conducting the first ever randomized control model of a co-response team in Indianapolis. The CBHJ can assist with action planning, evaluation, and technical assistance in the development of new response models.
Post-incident response for both mental health and overdose incidents can strengthen the linkage between crisis and ongoing care. People who overdose once are 15 to 24 times more likely to die in the following year. Without notification from first responders, treatment agencies often do not hear about critical events. Some communities have developed referral protocols from law enforcement to community mental health agencies, who can follow-up after incidents to provide additional resources. In the Proactive Response to Overdose and Appropriate Connections to Treatment (PROACT) model, Emergency Medical Service agencies forward overdose patient information to substance use disorder and harm reduction agencies to provide additional support. The CBHJ can help navigate sticky legal territory between first responder and treatment agencies to facilitate potential life-saving follow-up care.