The Stepping Up Initiative

When I first became a judge, I discov ered something that my legal and judicial training had not prepared me for. It was something all too familiar to anyone who worked in the criminal justice system, but was seldom discussed. Day after day, defendants would stand before me, often appear ing disheveled and distraught.

Most were charged with relatively minor offenses such as loitering or panhandling. Some exhibited impulsive behaviors, speaking in pressured, incoherent sen tences. Others were guarded and withdrawn, appearing to have little understanding of the cir cumstances in which they found themselves.

Before being arrested, many were living on the streets, strug gling with addiction and histories of trauma. However, homeless ness, substance abuse, and trauma were not typically the root causes of their difficulties.

Rather, these were merely symptoms of a larger set of personal and social factors contributing to unfortunate and often repeated involvement in the criminal justice system of people from many different backgrounds who all shared one thing in common: serious mental illnesses.

Upon release, many are unable to secure the types of supports necessary to facilitate adap tive re-entry and reintegration because services in the commu nity tend to be poorly coordi nated and difficult to access. Even when services are available, they tend to be severely under-resourced: between 2009 and 2012, states slashed spending on public mental health services by $4.35 billion. The result is high rates of recidivism to the justice system, compromised public health and safety, chronic home lessness, and disproportionate use of high cost and inefficient acute care services.

If we treated people with primary health care needs the way we treat people with mental illnesses, there would be rampant lawsuits and criminal indictments.

For example, a person who needs a knee replacement undergoes surgery, remains hospitalized until they are medi cally cleared, and then is sent to a rehabilitation center until they are ready to resume their life activities; all paid with insurance, Medicaid, or Medicare.

On the other hand, a person in a psychiatric crisis without finan cial means who is admitted to a hospital or crisis unit receives treatment only as long as they are considered dangerous to themselves or others frequent ly within hours or a few days. The person is then discharged, often to homelessness, and eventually finds their way into the criminal justice system, again and again and again.

Fortunately, there are promis ing solutions being developed as the result of innovative relation ships and collaborations being formed at the interface of the criminal justice and mental health arenas.

Examples of effective problem-solving initiatives include crisis intervention teams that teach law enforcement officers to better recognize and respond to psychi atric emergencies in the commu nity; jail diversion programs and mental health courts that utilize specialized dockets and provide judicial monitoring of treatment linkages and engagement; reen try programs that assist with link ages to treatment and support services upon completion of jail or prison sentences, and com munity corrections programs.

If we are to craft a more sen sible, equitable and sustainable system of care that benefits people with mental illnesses and taxpayers alike, it is impera tive that we work deliberately to examine and fix the system as a whole, and not just react as crisis situations arise.

This is a community problem requiring a community solution. None of us created this crisis alone and none of us will solve it alone. By leveraging resources and working collaboratively across the justice system and the community, stakeholders can develop effective partner ships. In doing so, we can craft more equitable and sustainable policies and legislation that will help to minimize incarceration, reduce recidivism, improve pub lic safety, and promote stronger, healthier communities.

Stepping Up Toolkit, Website will get you on your way The Stepping Up initiative's online toolkit gives counties the resources and tools they need to successfully implement an initiative to reduce the number of individuals with mental illnesses in their jails through the Six Actions for Implementing an Effective Initiative to Reduce the Number of People with Mental Illnesses in Jails (Six Actions). GETTING STARTED

• Tell Your Constituents. Send out a press release; hold a press conference or town hall; post to social media.
• Register for the Getting Started webinar. The webinar will take place at 2 p.m. EDT on Thursday, May 14.
• Help Pass a County Resolution or Proclamation. County governments must pass a resolution to be formally recognized as signing on to the Call to Action on the Stepping Up website. There is no deadline for passing a resolution or proclamation, but counties a re encouraged to join their colleagues by passing a resolution or proclamation by July 1, 2015 in order to be highlighted at NACo's Annual Conference and Exposition.
• Review the modules to familiarize yourself with the tools and resources available to start your initiative (see sidebar). Each module includes a webinar highlighting strategies for that action, an exercise from the Stepping Up Planning Guide and key resources and examples aligned with that module
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• Visit the Resource Library. The Resource Library is a clearinghouse of publications, webinars, best practices, and examples of relevant legislation and resolutions that have been shared by various organizations, associations, academic institutions, government agencies and others to assist counties in their initiative efforts. Have something you want to share? Email it to info@stepuptogether.org

Register and save the dates for the next five webinars.

• Collecting and Reviewing Prevalence Numbers and Assessing Needs of People with Mental Illness in Jails and Co-Occurring Substance Use Disorders June 11, 2 p.m. EDT.
• Examining Treatment and Service Capacity to Serve People with Mental Illness July 23, 2 p.m. EDT.
• Developing a Plan to Reduce the Number of People with Mental Illness in Jails Aug. 13, 2 p.m. EDT.
• Implementing Research-Based Approaches to Reducing the Number of People with Mental Illness in Jails Sept. 10, 2 p.m. EDT.
• Creating Processes to Track Progress Oct. 8 2 p.m. EDT.

Check your email. As active members of Stepping Up, counties will continue to receive information about upcoming events and resources via email and on this website. Ask questions. Have additional questions or need help? Email us at info@stepuptogether.org. Stepping Up Initiative Sample Resolution

Stepping Up Initiative to Reduce the Number of People with Mental Illnesses in Jails Date

WHEREAS, counties routinely provide treatment services to the estimated 2 million people with serious mental illnesses booked into jail each year; and

WHEREAS, prevalence rates of serious mental illnesses in jails are three to six times higher than for the general population; and

WHEREAS, almost three-quarters of adults with serious mental illnesses in jails have co-occurring substance use disorders; and

WHEREAS, adults with mental illnesses tend to stay longer in jail and upon release are at a higher risk of recidivism than people without these

disorders; and

WHEREAS, county jails spend two to three times more on adults with mental illnesses that require interventions compared to those without these

treatment needs; and

WHEREAS, without the appropriate treatment and services, people with mental illnesses continue to cycle through the criminal justice system,

often resulting in tragic outcomes for these individuals and their families; and

WHEREAS, [INSERT YOUR COUNTY'S NAME] and all counties take pride in their responsibility to protect and enhance the health, welfare and safety

of its residents in efficient and cost-effective ways; and

WHEREAS, [INSERT COUNTY SPECIFIC INFO/DATA TO HIGHLIGHT e.g. Bexar County has developed its Restoration Center which helps people

stay out of jail by offering mental health and substance use disorder treatment]; and

WHEREAS, through the Stepping Up initiative, the National Association of Counties, the Council of State Governments Justice Center and the American

Psychiatric Foundation are encouraging public, private and nonprofit partners to reduce the number of people with mental illnesses in jails;

NOW THEREFORE LET IT BE RESOLVED, THAT I [NAME, TITLE OF CHIEF ELECTED OFFICIAL], do hereby sign on to the Call to Action to reduce the

number of people with mental illnesses in our county jail, commit to sharing lessons learned with other counties in my state and across the country

to support a national initiative and encourage all county officials, employees and residents to participate in Stepping Up. We resolve to utilize the

comprehensive resources available through Stepping Up to:

Convene or draw on a diverse team of leaders and decision makers from multiple agencies committed to safely reducing the

number of people with mental illnesses in jails

Collect and review prevalence numbers and assess individuals' needs to better identify adults entering jails with mental illnesses

and their recidivism risk, and use that baseline information to guide decision making

Examine treatment and service capacity to determine which programs and services are available in the county for people

with mental illnesses and co-occurring substance use disorders, and identify state and local policy and funding barriers to

minimizing contact with the justice system and providing treatment and supports in the community

Develop a plan with measurable outcomes that draws on the needs and prevalence assessment data and examination of

available treatment and service capacity, while considering identified barriers

Implement research-based approaches that advance the plan

Create a process to track progress using data and information systems, and to report

PASSED AND APPROVED in this ______ day of____________ , 2015.