Behavioral Health Deflection: One City’s SolutionOver the last year, I have been actively involved as a researcher for a project called Safety and Justice Challenge funded by the John D. and Catherine T. MacArthur Foundation. The Safety and Justice Challenge (SJC) is an initiative to reduce over-incarceration by changing the way America thinks about and uses jails.
Case Study: Charleston, SC
An area that has received a lot of attention is the misuse of jails as the de-facto mental health commitment center. Research shows that jails across the country are crowded with the mental health patients who aren’t getting treatment elsewhere. (Torrey E.F. 2016). One of the most comprehensive behavioral health deflection efforts is under way in Charleston, SC, in conjunction with the reopening of a long-shuttered crisis response center in downtown Charleston. The Tri-county Crisis Stabilization Center, which began operations on June 1, 2017, is itself a product of impressive local collaboration: a facility of the South Carolina Department of Mental Health, it is funded and staffed in part by two regional hospitals that expect to save big on reduced emergency room visits. Charleston County Sheriff’s deputies provides 24/7 security. And Charleston County’s addiction services agency, in addition to housing the center, will open a new Sobering Center to provide detox and sobering services alongside it.
For these new assets to work to keep people with behavioral health needs out of the criminal justice system, of course, local law enforcement agencies will have to use them. The Charleston SJC team is not leaving that to chance. First, to guide officer discretion and minimize inappropriate arrests—particularly for the kind of low-level offenses (disorderly conduct, trespassing, open container, etc.) often linked with untreated mental illness, co-occurring substance abuse, and associated homelessness—they’re launching a new risk-based decision tool for use on the street. Based on the Proxy instrument developed for the state of Hawaii, the tool is intended to frame jail as a last resort, rather than an automatic response. Significantly, it will provide a “referral for service” check-box option and a “triage service” phone number, connecting officers on the street with a master’s level social worker based full-time at the Crisis Stabilization Center. When officers call the triage service, they’ll get a live person, with quick information, expertise, and options—a short-term psychiatric treatment bed at the center, detox or sobering services, back-up from a mobile crisis team, etc.
This new work is exciting and will provide data and best practices to better serve communities small and large across our country in an effort to develop deflection protocols and alternatives that will reduce custodial arrests of low-risk, high-need individuals.
Written by Dr. James Castleberry, Lead Faculty
Torrey, E.F. (2016). A Dearth of Psychiatric Beds. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/psychiatric-emergencies/dearth-psychiatric-beds