Virginia county’s collaboration tackles mental health in jails

A collaboration with service providers  in Fairfax County, Va. is providing behavioral health services to individuals who become involved in the criminal justice system and are living with a mental illness.

The Fairfax County Adult Detention Center’s average population in fiscal year 2019 was 964. Around 20 percent of the jail’s inmates have been diagnosed with a serious mental illness.

The Fairfax-Falls Church Community Services Board (CSB), which includes Fairfax County, the City of Fairfax and the City of Falls Church, operates as part of the Health and Human Services System in Fairfax County. The board provides services for individuals of all ages in the community who experience a mental illness, substance use disorders or developmental disabilities.

The CSB oversees mental health and substance use services and established a staff on site at the Fairfax County Adult Detention Center to address the needs of incarcerated individuals living with mental illnesses, said Marissa Farina-Morse, a CSB mental health counselor who oversees mental health and substance use services at the detention center. The board provides behavioral health services including crisis response, assessment and referrals.

“We have a really unique situation here with the Community Services Board in that we are the provider of mental health and substance use and developmental disabilities services in the community, and then we’re also here in the jail,” Farina-Morse said.

CSB staff includes therapists, psychiatrists, nurse practitioners and nurses who work inside the Fairfax County Adult Detention Center.

With the CSB working both inside the detention center and outside in the community, CSB staff are able to easily partner with outside providers to meet an individual’s needs, allowing inmates in the jail access to a variety of services, Farina-Morse said.

“When someone comes in here [the jail], their mental health services are a continuation of what they have been getting in the community,” she said.

The CSB staff does not do it alone. The board partners with the Fairfax County Sheriff’s Office to provide emergency mental health needs and case management services.

Fairfax County Sheriff Stacey Kincaid has made mental health a key priority in the county, explained Laura Yager, director of Correctional Health and Human Services for the Fairfax County Sheriff’s Office. Kincaid ensured the entire workforce, including both civilian and uniform, were trained in mental health first aid in partnership with the CSB.

“We’ve undergone major workforce development in understanding mental illness and addiction issues across our system and we’ve seen a huge change in how we interact with people,” Yager said.

As of 2018, Fairfax County saw nearly 735 graduates who completed Crisis Intervention Training.

“I think it’s pretty amazing that from the food service to the custodial staff to anyone who interacts with an inmate — all are trained to identify mental illness,” Yager said.

 “The position I’m in didn’t exist a year ago,” Yager added. “It’s a position that she [Kincaid] created to really assure that we’re co-treating people, that our partnership between the sheriff’s office and CSB exists.”

When a person enters the detention center and goes through the booking process, a nurse asks questions during a complete mental health screening to determine one’s potential to have a serious mental illness or substance use disorder. If someone screens positive, they are referred to the CSB team within the Adult Detention Center, Farina-Morse said.

The Fairfax County Adult Detention Center’s Behavioral Health Unit serves as a special housing unit for inmates with serious mental illness. The unit is in close proximity to CSB staff and offers jail, trauma and treatment groups and recovery-oriented group programming. Individuals in the unit participate in recreational groups where they have opportunities to work on social skills and interact with others.

“Our goal is to not house people indefinitely or for the duration of their stay in the Behavioral Health Unit, but it is a place for some of the most vulnerable individuals where we can have them be in one place,” Farina-Morse said.

Individuals in the unit have more spacious single cells where they can turn the lights on and off themselves, have windows with natural light and may have the option to leave their cells during the day and participate in recreational activities.

Deputies who have crisis intervention and mental health training can make the determination if an individual should move to the Behavioral Health Unit.

“They become a part of the treatment team,” Farina-Morse said. “We want to hear from the deputy — what they are observing — and the deputies are also working and helping build rapport and they are part of the treatment.”

Some individuals with mental illnesses who commit low-level offenses may not even find themselves booked into the detention center. Diversion First, a county initiative, provides alternatives to incarceration for individuals with mental illness, substance use disorders or developmental disabilities who have become involved in the criminal justice system with low-level offenses.

The Merriweather Crisis Response Center, which opened in 2015, allows law enforcement officers to divert an individual with a low-level offense to treatment in lieu of arrest, Farina-Morse said. At the center, individuals are evaluated by a mental health professional. Those who are diverted from jail are not arrested or charged.

“That’s been an amazing and a real partnership with not just the sheriff’s office, but Fairfax County police, who also provide staffing because law enforcement has to be on site there 24 hours per day,” Farina-Morse said.

In 2018, 530 people were diverted from potential arrest and brought to the Merrifield Crisis Response Center. The center had over 6,660 total service encounters that year.

“It’s an opportunity to intercept someone with a mental illness or behavioral health issue and get them to treatment,” Yager said. “The whole idea is to identify and refer appropriately. Nobody is going to get well getting arrested who has a behavioral health issue.”

Both Farina-Morse and Yager emphasized the collaborative partnerships to address behavioral health needs among various organizations within the county including medical services, behavioral health services, the CSB and the Sheriff’s Office.

“I think the common ripple of everything we’re talking about is this collaborative relationship because we need each other to do the jobs we both have to do,” Yager said.