Arizona Mental Health Criminal Justice Coalition Goal is to reduce court involvement when possible (criminal AND civil)
Arizona Mental Health Criminal Justice Coalition 2 million seriously mentally ill individuals incarcerated in jails In 44 states jails and prison are the largest housing institutions Seriously mentally ill individuals have longer stays, greater rates of homelessness and higher recidivism Maricopa County: 5.5-6.5% of population SMI designated CY 2015bookings 5% SMI designated (JSPI); (2/9/17): 7.8% 25.6%% (2/9/17) all individuals with significant mental health needs Data reported by CHC April 2017
CURRENT ORGANIZATION -CRISIS TEAMS/POLICE/FIRE TEAMS: Time and again first contact, determines if to take to Urgent Care or Jail no ORDER initially -COUNTY: Payer for the Court-Ordered Evaluation (COE) period 72 hours period -RBHA: Pays Crisis Services & for Services during COT 1yr -MARICOPA COUNTY: PAYS RBHA FOR COEs ADHS WEBSITE This Photo by Unknown Author is licensed under CC BY-SA
BENEFITS OF UTILIZING COT Diverts BH person to Psychiatric Hospital rather then Jail County funding pays for the initial commitment and evaluation process, regardless of payer COT in AZ is widely available and used AT TIMES UNDER UTILIZED Arnold vs. Sarn lawsuit created benefits for SMI individuals Medicaid expansion supports the ongoing care needed for COT
Terminology in Petitioning Process Application May start Title 36 process for treatment & may lead to Court Intervention Emergency Application Pre-Petition Screening Report Petition completed by Psychiatrist Screening Agency Evaluation Agency Court Ordered Evaluation Court Ordered Treatment
Intercept Initial Detention & Court Hearing CRISIS EVENT FOR COURT ORDERED EVALUATION NON EMERGENT INPATIENT OR OUTPATIENT -Application -[36-520] -Provider review for Emergent Pick Up [36-521] If Determined Not-Emergent, Performs Pre-Petition Screen Report (48hrs) [36-521] & [D] OPTION-IN or OUT Patient Non Emergent Order, etc processed w/judge [36-522(C)] Complete Outpatient Eval Evaluation Date [36-522(B)] Move to COE [36-529] COT Court Hearing Inpatient or Outpatient EMERGENT APPLICATION [36-524] -Provider send Officer Pick-Up [36-525] -Assess Immediate Acute Need Inpatient -Application [36-521] -Petition [36-525 (B)] emergency is defined by the statute as a condition by which the person is either Danger to Self or Danger to Others, the time to do a non-emergent application process, there may be serious physical harm [36-524, 525, 526 and 521 (D)]
Intercept - Law Enforcement and Emergency Services Psychiatric Urgent Care Centers (AZConnections, RIAZ, CBI) Crisis Mobile Teams CIT Trained Officers valley wide Have opportunity to divert Patient(s) to Urgent Cares
CRISIS EVENT COURT ORDERED TREATMENT 72HR EVALUATION ADULTS ONLY Two Psychiatrists Assigned EXAM to Determine- 1. WILLING/ABLE TO GO VOLUNTARY- 2. RELEASE FROM COE 3. FILE COT PETITION As a result of a mental disorder, met at least one of the following four criteria: danger to him/herself danger to others persistently or acutely disabled gravely disabled HEARING FOR TREATMENT EVIDENCE PROVIDED OUTCOMES 1. ORDER COT; OR 2. DISMISSAL.
CASE EVOLUTION Order to Admit & Evaluate Court Notifies Stakeholders Clinical Team Assigned to Evaluate & Investigate Allegations Research Hx, SMI Eligibility, Guardianship Possibilities Petition for Tx w/supporting Affidavits In/Outpatient Tx Planning Reinstituted Stabilization Occurs on an Amended Order for Tx Inpatient Stabilization or Outpatient Placement Tx Hearing Guardianship Investigation Requested Info to Family
Patient sent for Court Order Evaluzation from Criminal Order or PAD Jail Petition Identified in CR Court as Possible Mental Illness/Previous Illness/Current Court OrderDisorder Order for direct Admit & Evaluation Pursuant to Title 36 Court notifies -Hospital/Correctional Health/Sheriff's Office/Court Liaison Hospital works within protocol to ensure proper documentation for evaluation is sent with inmate/patient Doctor & Social Worker are assigned for evaluation Research history/smi Eligibility Community Resources communication with jail, probation services,police and all other relevent agencies Court Order Treatment Petition Filed Inpatient/Outpatient Treatment Plan Filed with Court COT Hearing in MH Court at Hospital If appropriate COT Order Request Title 14 Guardianship investigation if appropriate If appropriate provide family or interested Title 14 guardianship information Outpatient Placement May return to jail after stabalization Probation may interject and pick up Placement in community Reoccuring stabilization occurs on Amended Orders or Order of CMHC
PETITIONS PROCESSED BY MIHS AT VARIOUS STARTING P0INTS COE Petition Emergent PSYCHIATRIC URGENT CARES Non Emergent CINICS, URGENT CARE, COMMUNITY TEAMS, POLICE Special Court Order PSRB BOARD ADOC AGs Office Conditional Releases CHC Rule XI FROM COUNTY ATTORNEY CITY ATTORNEY COT PETITION & HEARING COT ORDER OR DISMISSAL
MARICOPA COUNTY Average Time Application for Emergency * Admission Received from a Hospital/ED to Decision (Accept/Decline) Rendered Data from Mercy Maricopa Integrated Care
MARICOPA COUNTY APPLICATIONs FOR 24hr EMERGENCY EVALUATION -12/17 (TOTAL # OF APPLICATIONS FOR EMERGENCY ADMISSION SUBMITTED/TOTAL # ACCEPTED) Data from Mercy Maricopa Integrated Care
MARICOPA COUNTY PETITION FILINGS 2005 2,107 COURT ORDERED EVALUATIONS 1,372 COURT ORDERED TREATMENTS 2008 2,887 COURT ORDERED EVALUATIONS 1,858 COURT ORDERED TREATMENT 2017 7,052 COURT ORDERED EVALUATIONS 1,908 COURT ORDERED TREATMENT 500 RENEWALS OF COTS 2018 2905 COURT ORDERED EVALUATIONS AS OF MAY 8000 7000 6000 5000 4000 3000 2000 1000 0 2005 2008 2017 2018
MARICOPA COUNTY 2768+/- PATIENTS BROUGHT INPATIENT COE 284 10% (.0987) PRIOR TO HEARING 297 10% (.1029) DISMISSED BY COURT - 278 10% (.0963)
3000 MARICOPA COUNTY TITLE 36 COMBINED IN/OUT-PATIENT COT POPULATION - 5/2017 1/2018 (Does not include Long Term Care or Dual Eligible Populations) 2500 2166 2348 2393 2419 2442 2443 2215 2234 2255 2255 2191 2377 2456 2454 2476 2274 2273 2287 2000 1500 SMI 1000 GMH/SA 500 Total 182 178 185 187 188 186 182 181 189 0 May June July Aug Sept Oct Nov Dec Jan Data from Mercy Maricopa Integrated Care
MARICOPA COUNTY 2017 BREAK DOWN COEs 7052 COTs 1908 27.06% *COT RENEWALs 500 DISMISSED/RELEASED 5144 72.94%
UTILIZAING TECHNOLOGY AT COURT HEARING Title 36 Personal Recommendations COURT ORDERED EVALUATION/TREATMENT TELEMEDICINE PSYCHIATRIST TELE TESTIMONY PROFESSIONALS Allow for professionals to testify VIA Telephone or Skype Utilization of Technology Other Options Open Discussion
COLLABORATION & EDUCATION