Partnership with the Mental Health Diversion Council
In February of 2013, Governor Rick Snyder elevated the Diversion Strategies workgroup by forming the Mental Health Diversion Council through Executive Order 2013-7 in 2013. The council is charged with "…reducing the number of people with mental illness or intellectual or developmental disabilities (including comorbid substance addiction) from entering the corrections system, while maintaining public safety." In March of 2014, Governor Snyder expanded the scope of the Diversion Council to incorporate the issue of juvenile justice through Executive Order 2014-7. The Council's membership was expanded from 14 to 18 members to include juvenile justice experts, and since an action plan specific to the juvenile justice population has been adopted.
Since 2015, the Center for Behavioral Health and Justice (CBHJ) has served as consultants and evaluators for the Mental Health Diversion Council. The partnership has produced a number of robust projects that have engaged criminal/legal and behavioral/physical health agencies in 29 counties across the state, providing, evaluation, training, and technical assistance to optimize diversion of individuals from involvement in the criminal/legal system. Thanks to the generosity of the Diversion Council, these services come at no cost to the counties.
Jail diversion and Stepping Up technical assistance
Diversion and Stepping Up TA research products
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.
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 partners 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.
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 collaborators 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.
Assisted outpatient treatment toolkit
Assisted outpatient treatment (AOT) is a legal mechanism for providing outpatient treatment to individuals living with serious mental illness (SMI) whose non-adherence places them at risk for negative outcomes. It is an evidence-based tool that promotes recovery, reduces harmful behavior, hospitalization and emergency room use as well as reducing costs. AOT works by compelling the recipient to receive specific treatment that will prevent their condition from worsening and by committing the mental health system to provide treatment.
The Assisted Outpatient Treatment (AOT) toolkit is an evidence-based tool that promotes recovery and reduces harmful behavior, hospitalization, emergency room use, and costs. The toolkit strives to improve the practice of providing outpatient treatment under civil court order to individuals with SMI who have demonstrated difficulty engaging with treatment on a voluntary basis. When systematically implemented and adequately resourced, AOT can dramatically reduce hospitalization, criminalization and other adverse outcomes for its target population. The toolkit aims to provide general information about the process of AOT and more specific guidance for key components of the system: courts, mental health providers, hospitals (including emergency rooms and inpatient psychiatric care), individuals under AOT orders, families and advocates, and law enforcement.
Michigan has some of the best laws in the nation for assisted outpatient treatment (AOT). Effective AOT programs and systems will help ensure individuals receive high-quality services in the community and work toward transitioning back to voluntary care. Every part of the system of care plays a uniquely important role in an effective AOT program, including courts, mental health providers, hospitals, families and advocates, individuals, and law enforcement.
Crisis response
Crisis response research products
Informed by SAMHSA guidelines, the CBHJ seeks to understand crisis services across the state and help local communities work toward a comprehensive crisis continuum for those in crisis to have someone to talk to, someone to respond, and a place to go. A three-phase data collection project explored the current state of crisis response and investigated short-term outcomes for common program models. Now, data analysis seeks to assess long-term impact of crisis response, system engagement for individuals in crisis, and cost effectiveness.
The CBHJ uses technical assistance and evaluation to push crisis systems toward SAMHSA best practices. Crisis services are primarily local-level systems, each facing unique challenges, often working independently through different funding sources. We foster relationships with county-level partners to explore crisis system nuances on behalf of the state. To assess crisis systems and tailor appropriate interventions, we developed a scorecard based on SAMHSA's minimum expectations and best practices for "someone to talk to, someone to respond, and a place to go". Examining systems in an interdisciplinary partnership demonstrates crisis system needs, outlines collaborative goals, and inspires local-level change. There is plenty of work to do!