Behavioral Health Resource Hub


In order to address mental health needs in your community, certain court and community responses must be developed early on. The best practices recommended on this website build the foundation for improving the court and community responses to mental health and co-occurring disorders.

The most effective approach is to design responses that are regularly engaged in by community collaborators. The resources on this webpage build on the Sequential Intercept Model (SIM), which identifies appropriate responses at particular intercepts that can keep an individual from continuing to penetrate the criminal justice system. Additionally, effective court and community responses require interventions prior to engagement in the criminal justice system.

This website highlights several additional areas of focus that, if engaged in proactively, can create necessary support structures and prevent justice system involvement for those with mental health disorders. These additional practices address physical and behavioral health needs, pre-crisis community resources, family and public outreach, civil justice needs, and data and information sharing.

Finally, meaningful system change requires leadership. Courts, and judges in particular, are in a unique position to convene stakeholders and to lead such a group to consensus and action. This website begins with leading change resources specifically designed for judges.

Every community will be at a different place with each of these practices. As you look through the various recommendations, consider your own community and the best way to use these tools to build a structure of support for mental health issues within it. Your community may require additional practices or approaches not listed below.

← Court Leaders →
← Physical & Behavioral Health →
← Pre-Crisis Community Resources →
← Family & Public Outreach →
← Civil Justice →
← Data & Information Sharing →
← New Uses of Technology Across the Intercepts →
Intercept 0
Community Services
Intercept 1
Law Enforcement
Intercept 2
Initial Detention / Initial Court Hearings
Intercept 3
Jails / Courts
Intercept 4
Reentry
Intercept 5
Community Corrections
View the full Sequential Intercept Model

Find out more about PRA's Sequential Intercept Model →

Court Leaders

 
Leading Change
Resources for Rural Leaders
Best Practices and Resources Across the Intercepts
Leading Change

The Leading Change Guide describes the important steps of convening stakeholders, assessing the mental health landscape in your community, and implementing court and community responses and strategies.

Learn more about leading change

Courts and Judges:

Other Partners:
Resources for Rural Leaders

Rural jurisdictions face some challenges that are different than those confronting suburban and urban sites. Increased use of technology is one promising solution, and other resources have been developed specifically for rural jurisdictions.

Resources for Rural Communities:
Best Practices and Resources Across the Intercepts

As the Sequential Intercept Model gains in acceptance and usage, researchers and resource providers are increasingly using the SIM as a cohesive framework for that research and for those resources. These across-the-intercept resources touch on aspects of best practices that span the SIM, so they are listed separately from the specific categories and intercepts.


Additional PRA Best Practice Principles Across the Intercepts:

Cross-systems collaboration and coordination of initiatives. Coordinating bodies improve outcomes through the development of community buy-in, identification of priorities and funding streams, and as an accountability mechanism.

Routine identification of people with mental and substance use disorders. Individuals with mental and substance use disorders should be identified through routine administration of validated, brief screening instruments and follow-up assessment as warranted.

Access to treatment for mental and substance use disorders. Justice- involved people with mental and substance use disorders should have access to individualized behavioral health services, including integrated treatment for co-occurring disorders and cognitive behavioral therapies addressing criminogenic risk factors.

Linkage to benefits to support treatment success, including Medicaid and Social Security. People in the justice system routinely lack access to health care coverage. Practices such as jail Medicaid suspension vs. termination and benefits specialists can reduce treatment gaps. People with disabilities may qualify for limited income support from Social Security.

Information-sharing and performance measurement among behavioral health, criminal justice, and housing / homelessness providers. Information- sharing practices can assist communities in identifying super- utilizers, provide an understanding of the population and its specific needs, and identify gaps in the system.

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Physical & Behavioral Health

 
Behavioral Health Care
Continuity of Care
Physical Health Care
Screening & Assessment
Behavioral Health Care

Treatment for mental health and substance use disorders has been demonstrated to be extremely effective. Factors that lead to better treatment outcomes include early identification and intervention, accurate assessment, availability of a full continuum of treatment options, and the use of evidence-based treatment programs, a sample of which are linked below.

Learn more about evidence-based behavioral health care resources:

These treatment modalities reflect an understanding that effective treatment for people in the criminal justice system requires a blend of traditional behavioral health treatment services and services tailored to the relevant criminogenic risks and needs of the individual. They will typically have a diverse range of behavioral health, criminogenic, case management, and social support needs that require different screening and assessment, more coordination among service providers, and a broader range of complimentary services. The accepted model for conceptualizing theis constellation of needs and services is the risk need responsivity (RNR) model. An excellent summary of the basics of these principles is this PRA publication:

RNR has a strong foothold in the substance use disorder context, but receives less consideration relative to treating people with mental illness in the criminal justice system. Yet recent research makes clear that the RNR principles apply with equal force in addressing mental illness:

SAMHSA’s Principles of Community-based Behavioral Health Services for Justice-involved Individuals provides a useful summary of how it all fits together, and the appropriate services described can then be found, locally, at the SAMHSA findtreatment.gov site.

While traditionally behavioral health treatment has been delivered in one on one settings or in small groups, evidence-based remote or online treatment has been found to be as effective as in-person treatment. Examples of these on-line programs include:

Continuity of Care

Treatment continuity is integral to addressing behavioral health issues. Communities should take steps to ensure that mental health, substance abuse disorder, and physical health treatment is available to those who need it throughout their interaction with the justice and behavioral health systems.

Once detained or in custody, individuals must receive appropriate mental health, substance use disorder, and physical health services. One component of this is prescription continuity. Prescription continuity ensures that individuals can continue their treatment plans and avoid adverse outcomes from lapsed medication treatment. Medications may be necessary to maintain stability and/or competency. Prescription continuity also eases re-entry hurdles and disruption.

Intake officials should screen individuals and coordinate with local behavioral health authorities to identify and coordinate existing prescriptions and treatment plans upon entry into detention. Medication continuity should be a priority along with suspended rather than discontinued enrollment in Medicaid.

Physical Health Care

Access to physical health care is integral to help individuals with the physical health issues that often occur alongside mental health issues. Individuals in the midst of a mental health crisis may neglect their physical health which can lead to long-term health concerns. Affordable and accessible medical treatment, including dental care, can help ensure better long-term outcomes. In addition, early identification of mental health disorders or trauma by medical professionals, including pediatricians, can help individuals effectively manage their mental health.

Screening & Assessment

Screening for behavioral health disorders should be a priority throughout points of contact within a community, including by pediatricians, teachers, and emergency room practitioners. Early identification of mental health issues and trauma can help individuals more effectively manage their mental health issues and create appropriate treatment plans.

More specific screening and assessment are also critical once an individual has contact with the justice system in order to ensure the system’s treatment and supervision responses are tailored to the individual’s criminogenic risks and needs. All individuals coming into jail should be screened for mental health and substance use disorders using an evidence-based tool validated for the population that is screened. Then, if indicated by the screening instrument, an appropriate assessment should follow..

Learn more about screening for substance abuse disorders:

Substance use disorders are associated with worse criminal justice outcomes and therefore require special and dynamic treatment strategies. Once in custody, valid and reliable screening tools should be used to identify substance use disorders to provide detention partners with an informed picture of treatment and custody needs. These tools are typically less than a dozen items, can be administered by non-clinicians, and are often in the public domain and free. Many screening tools also now implicitly recognize the reality that mental health needs co-occur with substance use disorders. An excellent treatise on why and how to effectively use screening and assessment in a justice context is SAMHSA'S Screening and Assessment of Co-Occurring Disorders in the Justice System.

Examples of brief SUD screens include;

Learn more about screening for mental health disorders:

Using valid and reliable mental health screening instruments both out of custody and at jail intake can identify new treatment needs (or initial treatment needs) pending pre-trial release. Screening and assessment information can also be provided directly to the court to facilitate more appropriate and tailored pre-trial orders, referral to an appropriate treatment court, and in-court responses to individuals. Common mental health screens include:

The two most prevalent correctional or jail-specific mental health screens are:

Screening for trauma is important both to identify appropriate treatment interventions and to avoid re-traumatizing the person. Widely validated and used tools include:

Other resources:

Learn more about pretrial risk assessments:

Pretrial release decisions are particularly impactful on arrestees with behavioral health needs. Incarceration, even for a short period of time can have disproportionately negative consequences for this population. Pretrial release without incarceration also represents an important opportunity for connecting people with behavioral health needs to services.

Pretrial risk assessments can inform these pretrial release decisions. Numerous assessment tools exist. One validated and publicly available assessment is the Public Safety Assessment tool, released by the Laura and John Arnold Foundation in 2017. The Public Safety Assessment tool uses nine factors to assess the risk of a defendant to fail to appear as required or to commit a new offense before trial.

Learn more about criminogenic risk and needs screening and assessment tools:

Risk and needs screening and assessment at all stages of the criminal justice process is a universally accepted evidence-based practice. Screens and assessments can be accomplished using a variety of tools, but all of these tools should be validated for the target population and for predictive soundness before use. This process should occur at jail booking, as a prerequisite for court treatment program placement, upon commencement of criminal justice related behavioral health treatment, prior to sentencing, and an ongoing basis to assess treatment progress in reducing criminogenic risk. Common risk and risk/need screens and assessment instruments include:

Resources related to evaluating and selecting risk/need instruments:

The effectiveness of behavioral health interventions also depends on identifying other factors that may need to be assessed and addressed, such as suicide risk and trauma history. The evidence based tools that should be used to screen and assess these factors are discussed in the SAMHSA screening and assessment document listed above.

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Pre-Crisis Community Resources

 
Schools & Education
Community Services
Food Banks
Shelters & Supported Housing
Supported Employment
Transportation
Schools & Education

Early identification and intervention in schools can provide for better long-term outcomes for those with mental health issues or who have experienced or are experiencing trauma. This support is also important for individuals with intellectual and/or development disabilities (IDD). Half of those who will develop mental health disorders show symptoms by age 14. Therefore, early identification of risk factors or signs of adjustment difficulties provide an opportunity to intervene before problems develop into more significant and costly impairments. A continuum of school mental health resources leads to better educational and mental health outcomes.

Learn more about schools and education:

Community Services

Robust community resources can provide a lifeline to individuals with mental health issues. Access to services can greatly improve long-term outcomes, even in the absence of treatment. Public and private human and social services agencies often directly provide meaningful programs, coordinate with other service providers, and provide referrals to other external resources. Religious, service-based, and other philanthropic organizations also provide valuable outreach and resources. They also might serve as a “first stop” if individuals do not meet qualifying requirements for other resource agencies.

Learn more about community resources:

Food Banks

Food insecurity decreases quality of life and can force tough decisions, like whether to spend money on food or medication. Food banks or pantries can help provide stability, increase self-sufficiency, and provide support. In addition to offering food, food banks often offer co-located services, like supported employment, educational information, civil and criminal legal aid, and informational about other community resources.

Learn more about food banks:

Shelters & Supported Housing

Supported housing provides a key layer of stability for individuals with behavioral health issues. Individuals may seek different housing types: from group housing (supervised and unsupervised) to rental housing and home ownership. Supportive housing is a middle ground option that features independent living with the potential for support and intervention as needed. For those individuals on parole or probation, they may transition from progressively less restrictive housing as their treatment and reentry progresses (e.g., from step-down housing to supervised or unsupervised group homes to supportive rental housing). The goal is to avoid releasing someone into an unstructured or homeless setting where decompensation is more likely.

Learn more about shelters and supported housing:

Supported Employment

Employment support should include resume preparation, interview guidance, coordination of skill classes, and coordinating transportation services to job sites. Stakeholders should consider identification of volunteer opportunities as well as more traditional employment paths.

Learn more about supported employment:

Transportation

People need to be able to reach treatment, services, and their jobs. Accessible transportation is especially important for individuals who are required to go to treatment and services as conditions of their probation or parole. Public transportation should be reliable and affordable. If not, communities should develop alternative transportation options or remote service opportunities. For example, telehealth services can facilitate continuity of medical care even if the individual is unable to visit a doctor's office.

Learn more about transportation:

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Family & Public Outreach

 
Family & Peer Support
Individual Awareness
Public Outreach
Family & Peer Support

Often family or friends are the first to respond to a crisis for a loved one and are relied upon for support both before and after a mental health crisis. Organizations such as National Alliance on Mental Illness (NAMI), and the Treatment Advocacy Center (TAC) provide guidelines for how to respond to a mental health crisis, including how to navigate the Health Insurance Portability and Accountability Act (HIPAA), knowing how to find available resources within the community, and how to navigate the justice system (both civil and criminal).

Learn more about family and peer support:

Individual Awareness

Identifying mental health issues is the first step to an effective response. Individuals can seek medical assistance and treatment if they are able to assess and recognize that it is necessary to seek help and comply with prescribed medications and/or treatment. Comprehensive treatment plans that are proactive and focus on developing protective factors against mental illness provide long-term effects.

Learn more about individual awareness:

Public Outreach

Public outreach and campaigns to enhance mental health awareness enable citizens, loved ones, and professionals to identify and correctly respond to the need for mental health interventions before a crisis occurs. Health fairs and mobile health clinics are examples.

Learn more about public outreach:

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Civil Justice

 
Advanced Directives
Civil Interventions
Civil Legal Aid
Guardianship
Advance Directives

Advance directives are legal tools that allow individuals with mental health issues to articulate their treatment preferences prior to a mental health crisis. Advance directives can also be used for guardianship appointment, which allows an agent to give consent or make decisions on an individual’s behalf concerning medical, mental health, and financial issues. When used appropriately, advance directives and guardianships protect the autonomy and preferences of individuals with mental health issues. State laws govern the availability and legal structure of psychiatric advance directives, but at least 25 states now have specific laws authorizing their use.

Learn more about advance directives

Civil Interventions

Civil interventions refers to legal processes by which people other than the person with mental illness can initiate treatment and includes initiation of civil commitment proceedings and court-ordered treatment, including assisted outpatient treatment (AOT). Civil commitment processes and AOT do not require involvement of the police or the criminal justice system. Recently states have begun to provide for civil interventions for behavioral health conditions other than mental illness, including substance use disorders.

Court ordered treatment can be provided in the community or in an inpatient setting as determined by a clinical evaluation. Inpatient and outpatient treatment can be delivered sequentially or, alternatively, beginning with outpatient options and utilizing inpatient settings as needed.

Fewer than half of the states have laws that explicitly authorize assisted outpatient treatment, but that number is increasing as the success of AOT as an intervention grows.

Learn more about civil commitment:

Learn more about assisted outpatient treatment:

Civil Legal Aid

Civil legal issues affect many individuals with mental health and co-occurring disorders. Without assistance, the legal system can be confusing, time-consuming, and intimidating. Affordable legal services help individuals and their families navigate the legal system and resolve issues that may otherwise go unaddressed. For example, civil legal aid services can help individuals access government benefits, healthcare, housing, disability, and employment services. Some states, such as Arizona, have designed resources specifically for those who need help accessing the courts to address a mental health issue.

Learn more about civil legal aid:

Guardianship

Guardianships give court designated individuals responsibility over a range of personal care decisions on behalf of someone the court determines is incapacitated, sometimes referred to as a ward. General guardianships generally give the guardian plenary decision-making authority for the ward. Limited guardianships are preferred under most state laws, and delegate to the guardian only specific surrogate decision-making authority, based on a determination of specific areas in which the ward has impaired decision-making capacity. Guardianships can facilitate treatment and mitigate ancillary consequences that can result from neglected mental health care. Guardianship is subject to ongoing court oversight and typically requires regular reporting and check-ins.

Learn more about guardianship:

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Data & Information Sharing

 
Data Collection
Information Sharing
Data Collection

Data-driven indicators measure the effectiveness of behavioral health interventions, and allow adjustments to be made to increase the effectiveness of those interventions. Data can also measure the cost effectiveness of behavioral health programs and allow policy makers to allocate resources more effectively. Coordinating data offers an opportunity to identify high cross-system utilizers. Data should be collected about individuals' progress and needs, responses to those needs, and efforts to improve mental health responses.

Learn more about data collection:

Information Sharing

Information sharing is necessary for effectively coordinating services and treatment across resources. All data sharing protocols should be put in writing and be in compliance with relevant state and federal laws. Sharing data facilitates more effective individual treatment responses and can help leverage scarce resources, particularly for high system utilizers. Stakeholders should consider HIPAA, 42CFR part 2, FERPA and state laws related to sharing behavioral health information.

When data is shared between different agencies or partners, best practices recommend development of memoranda of understanding (MOUs) between partners to solidify working partnerships and data agreements.

Learn more about information sharing:

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New Uses of Technology Across the Intercepts

 

The 2020 pandemic imposed a new reality on all aspects of our society, including both the justice and the behavioral health systems. By necessity face to face interactions are reserved for the rare circumstance, and for most interactions remote or virtual technology options have emerged.

Generally, research tells us that using remote technology solutions for screening and assessment, competency evaluations, behavioral health treatment, and community supervision produces outcomes that are as good or better than in-person versions of the same interventions. As we rebuild our systems of service delivery post-pandemic we may want to consider when and where continuing to use tele-services, even when in-person options are available, might be less expensive and just as effective.

Remote assessment and treatment
Remote court proceedings
Remote supervision
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Intercept 0: Community Services

 

This intercept addresses the escalation of mental health and behavioral needs following a mental health crisis but without the involvement of law enforcement.

Collaboration and Case Management Teams
Crisis Services
Deflection
Collaboration and Case Management Teams

Case management teams are collaborations among local agencies that help provide a more holistic response to mental and behavioral health needs. Specialized staff can ensure services across domains (e.g., housing, employment, life skills, etc.) that consider and respond to the full spectrum of an individual’s needs. Team members also ensure that traditional information silos are broken down to best serve their client and position them for success.

Learn more about case management teams:

Crisis Services

Crisis services include the universe of resources available to individuals who are undergoing a mental health crisis. This can include stabilization units, mental health hotlines, mobile crisis units, and residential units. A strong presence of supportive resources at this stage can reduce the number of law enforcement contacts with individuals who have mental health issues. It is important that stakeholders and the public know of these services and that they are affordable and accessible.

Learn more about crisis services:

Deflection

Rather than referring someone in the midst of a mental health crisis to the emergency room or to law enforcement, individuals can be deflected to triage services, embedded mobile crisis units, or a peer specialist. If alternatives are not available, emergency room visits provide an opportunity to identify and refer individuals to mental health treatment and services. Screeners and targeted questioning can help identify underlying mental and behavioral health needs even if not the presenting reason for the emergency room visit. Proper training for professionals and hospital staff is key at this intercept, and care must be taken to not “board” people with behavioral health needs in emergency rooms while waiting for other service connections to be made.

Learn more about deflection:

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Intercept 1: Law Enforcement

 

Law enforcement play a gatekeeper role to the criminal justice system and contact with law enforcement provides opportunities for diversion to a response that more effectively addresses mental health crises.

First Responder Training
Mobile Crisis Teams
Pre-arrest / Pre-booking Diversion
Wrap-around Services
First Responder Training

First responder training includes dispatcher training, specialized police response, mental health first aid, and training for EMTs and other first responders. An example is Crisis Intervention Training (CIT). CIT focuses on identifying signs of mental health disorders, de-escalating a situation that involves those signs, and connecting people to treatment. The importance of crisis training has increased in recent years as a way to avoid escalation into the use of force. All law enforcement officers should receive crisis and de-escalation training as well as regular updates on related best practices.

Learn more about first responder training:

Mobile Crisis Teams

Mobile crisis teams are a law enforcement and mental health co-response to crisis situations in the community. Mobile teams may be housed within law enforcement or include team members from law enforcement and other mental health agencies. Mobile teams have been found to reduce incidents of arrest and psychiatric hospitalization. Co-responders may provide follow-up care coordination after a mental health crisis.

Learn more about mobile crisis teams:

Pre-Arrest/Pre-booking Diversion

Pre-arrest and pre-booking diversion or redirection adopts the concept that mental health responses are most appropriate outside the justice system. Individuals can be redirected to wrap-around services, including stabilization units, inpatient care facilities, or temporary housing units. Communities should work to make sure law enforcement has the discretion to use pre-arrest diversion rather than make an arrest. Law enforcement can be incentivized to use these resources through speedy drop-off processes and security procedures.

Learn more about crisis stabilization units:

Crisis stabilization units are facilities that seek to stabilize a person and enable community reintegration while offering supportive outpatient services. Stabilization units are less restrictive than a hospital and can serve as great resource for law enforcement to divert people in crisis who exhibit signs of a serious behavorial health issue.

Learn more about pre-arrest and pre-booking diversion:

Wrap-Around Services

Wrap-around services embrace cross-sector engagement. Law enforcement knowledge of and referral to community resources and service providers is key to ensuring a true wrap-around response for individuals with behavioral health needs. Special law enforcement units and community outreach efforts enable better relationships and a stronger knowledge base.

Learn more about wrap-around services:

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Intercept 2: Initial Detention/Initial Court Hearings

 

Initial detention and court hearings provide the first opportunity for broader criminal justice system partners to be involved in mental and behavioral health responses.

Screening & Assessment
Diversion
High Utilizer Response
Pretrial Orders
Screening & Assessment

Screening and assessment are critical once an individual has contact with the justice system in order to ensure the system’s response is tailored to the individual’s criminogenic risks and needs. All individuals coming into jail should be screened for mental health and substance use disorders, criminogenic risk, and trauma using an evidence-based tool validated for the population that is screened. Then, if indicated by the screening instrument, an appropriate assessment should follow.

Learn more about screening for substance abuse disorders:

Substance use disorders are associated with worse criminal justice outcomes and therefore require special and dynamic treatment strategies. Once in custody, valid and reliable screening tools should be used to identify substance use disorders to provide detention partners with an informed picture of treatment and custody needs. These tools are typically less than a dozen items, can be administered by non-clinicians, and are often in the public domain and free. Many screening tools also now implicitly recognize the reality that mental health needs co-occur with substance use disorders. An excellent treatise on why and how to effectively use screening and assessment in a justice context is SAMHSA’s Screening and Assessment of Co-Occurring Disorders in the Justice System.

Examples of brief SUD screens include:

Learn more about screening for mental health disorders:

Using valid and reliable mental health screening instruments both out of custody and at jail intake can identify new treatment needs (or initial treatment needs) pending pre-trial release. Screening and assessment information can also be provided directly to the court to facilitate more appropriate and tailored pre-trial orders, referral to an appropriate treatment court, and in-court responses to individuals. Common mental health screens include:

The two most prevalent correctional or jail-specific mental health screens are:

Criminogenic risk screening (and assessment if indicated by the screen) informs corrections, supervision, treatment, and court components of the system about how to engage with the arrestee/defendant, consistent with the risk need responsivity principle. Common risk and need screens and assessment instruments include:

Trauma is a frequent responsivity factor that should be identified as early in the process as possible. Screening for trauma is important both to identify appropriate treatment interventions and to avoid re-traumatizing the person. Widely validated and used tools include:

Other resources:

Diversion

Stakeholders should consider diversion options throughout the entire criminal justice system from initial intake to the initial court hearing. Once in custody, diversion options may vary from jail-based (i.e., pre-trial supervision and treatment outside of jail) to court-based (i.e., establish outpatient treatment plan and enter deferred adjudication). In addition to exploring AOT and other civil diversion options, this is also a point in the criminal justice process that problem-solving court eligibility should be considered.

Learn more about diversion:

High Utilizer Responses

High-system utilizers place an out-sized strain on system resources. Therefore, specifying criteria to identify high-system utilizers as well as targeting and developing responses tailored for these high utilizers can not only interrupt the cycle for individuals and affected families, but it can lead to significant resource savings across systems.

Learn more about high utilizer identification and responses:

Pretrial Orders

Pretrial release decisions are particularly impactful on arrestees with behavioral health needs. Incarceration, even for a short period of time can have disproportionately negative consequences for this population. Pretrial release without incarceration also represents an important opportunity for connecting people with behavioral health needs to services.

Pretrial risk assessments can be one component of a pretrial decision-making process. In some jurisdictions, these tools are used to inform pretrial release decisions, including conditions of release and supervision. Numerous assessment tools exist. One of the most extensively researched and publicly available pretrial risk assessment instruments is the Public Safety Assessment (PSA), released by Arnold Ventures in 2017. The PSA uses nine factors to assess the risk of a defendant to fail to appear as required or to commit a new offense before trial.

Learn more about pretrial best practices:

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Intercept 3: Jails/Courts

 

This intercept addresses the importance of continued and concerted mental health responses in the criminal justice system.

Jails
Caseflow Management
Competency & Restoration
Court Liaison
Prosecution
Criminal Defense
Problem-Solving Courts
Diversion & Alternative Sentencing
Jails

Best practices in jails include universal screening, appropriate case management, training of jail personnel, and performance measurement.

Learn more about best practices in jails:

Caseflow Management

Following caseflow management best practices keeps cases from languishing in the justice system. Strong continuance policies and meaningful hearing/trial dates help maintain case momentum. Courts can also leverage case management reports to monitor case progress. This is particularly important in cases with behavioral health-involved individuals, who might require additional hearings or filings around competency, rehabilitation, and treatment. In the criminal context, case management should also factor in important concerns like the right to a speedy trial and consider principles of differentiated case management.

Building on extensive research and findings from a four-year effort by the National Center for State Courts (NCSC) to determine the best way to conduct criminal case management, the Effective Criminal Case Management resource, which will be released in 2020, and CourTools, a way to measure a court’s performance using principles of caseflow management, should be applied to and integrated with the behavioral health population.

Learn more about caseflow management:

Competency & Restoration

A criminal prosecution may not proceed unless the defendant has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding, and has a rational as well as factual understanding of the proceedings against him. Competency determinations generally include psychiatric evaluations followed by an in-court hearing.

If an individual is found competent the case will proceed to determine adjudication. If found incompetent, judges can order services, including mental health treatment and medications that attempt to restore the defendant to legal competence. These services can be provided on an outpatient basis in the community, in jail, or in a mental health facility. Competency determinations can significantly impact case timelines, which is especially important if an individual is incarcerated. Every effort should be made to streamline determinations and related proceedings. There is also a growing consensus that because of the likelihood of an increased length of incarceration and confinement, the competency process should be reserved for defendants who are charged with serious crimes, and others should be diverted to treatment.

Learn more about competency and restoration:

Court Liaison

Court liaisons provide a vital link to mental and behavioral health service providers during the life of court cases. Liaisons are typically clinically trained and connected with a provider or agency.  They are trained to conduct assessments and are adept at providing program and treatment recommendations. Court liaisons are boundary spannerCourt liaisons, also referred to as boundary spanners or court navigators, provide a vital link between behavioral health service providers and the court. Liaisons are typically clinically trained and connected either with a behavioral health provider or with the court. They are trained to conduct assessments and are adept at providing program and treatment coordination and linkages.s and communicate with services providers and agencies outside of the court.

Learn more about court liaisons:

Prosecution

Prosecutors have discretion to make charging decisions, bail and pre-trial release recommendations, plea bargain offers, and sentence recommendations. Their position in the justice system gives district attorneys and prosecutors the opportunity to provide leadership in the community to address the needs of those with mental health issues. Prosecution can create special units within their office to handle cases involving individuals with mental health issues.

Learn more about prosecution:

Criminal Defense

Some public defense offices have specific divisions for mental health experts. These divisions include social workers who work alongside attorneys and caseworkers to more effectively handle cases of clients with mental health issues. In any event, defense counsel advocacy will be more effective when lawyers are fluent in behavioral health best practices and when they are proficient in accessing behavioral health resources in their community.

Problem-Solving Courts

Mental health courts are specialized dockets for individuals with mental health issues. These dockets embrace a non-adversarial, problem-solving approach to qualifying cases. Mental health courts provide a greater focus on treatment and individualized case plans than traditional criminal dockets. Mental health court models vary, especially around the timing of participant entry. Strong coordination and judicial leadership influence the success of mental health courts. 

While mental health courts may be the most appropriate fit for individuals with mental health issues, other problem-solving courts such as veterans court or co-occurring treatment courts (integrating substance use disorder and mental health treatment) should also be considered. Probation-based or post-adjudication problem-solving courts are also excellent interventions in later intercepts. Eligibility should be based on objective criteria and assessments, and generally problem solving courts should target high risk/high need individuals.

Learn more about problem-solving courts:

Diversion/Alternative Sentencing

Post-trial diversion and alternative sentencing options provide opportunities to direct individuals to rehabilitation-focused interventions that balance the interests of justice with treatment. Most importantly, they avoid incarceration for individuals who meet certain sentencing conditions. Often involving suspended sentences and/or probation, alternative sentencing can be as creative and flexible as a judge and community resources will allow. Examples of alternative sentencing include community service, assisted outpatient treatment, and other required participation in appropriate treatment, including problem solving courts.

Learn more about diversion and alternative sentencing:

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Intercept 4: Reentry

 

This intercept focuses on an individual’s post-incarceration life. Reentry must be well-planned, resourced, and individual-centric to help set individuals up for success.

Benefits Enrollment
Community-Based Treatment
Co-location of Services
Peer Support
Transition Plans
Benefits Enrollment

Health and behavioral health benefits enrollment sustains an individual's access to medications and treatment that are critical to successful reentry in the community. Enrollment can be facilitated by enrollment officers and case managers. Medicaid eligibility can be key to obtaining behavioral health services, and a number of states are receiving waivers related to providing increased eligibility to justice-involved individuals. 

Learn more about benefits enrollment:

Community-Based Treatment

Community-based treatment involves the broad spectrum of services and treatment an individual with behavioral health needs may require. The goal is to connect individuals with the least restrictive setting in which to receive appropriate treatment services. Treatment offerings may require use of several different providers, but co-location can facilitate retention of treatment participation. In areas with few to no treatment providers, remote services and treatment may become an option.

Co-location of Services

Service co-location eases the burden of seeking and providing mental health treatment for detained individuals. Even for individuals released on their own recognizance, service co-location provides an answer to transportation and resource barriers that mental health-involved individuals often experience. Service co-location also increases the likelihood of participation and service retention rates, while reducing rates of failure to appear.

In areas with few or no treatment providers, remote services and treatment is increasingly becoming a good option.

Learn more about community-based and tele-health treatment:

Peer Support

Peers provide individualized support to those re-entering a community. Sharing unique experiences and challenges is helpful in navigating common challenges. Moreover, peer support groups can provide insight to identify potential triggers and relapses.

Learn more about peer support:

Transition Plans

Transition plans offer guidance for community reentry. A comprehensive plan identifies expectations, resources, and services to guide individuals towards independence.  Individuals should play an active role in creating their transition plan.  

Learn more about transitional plans:

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Intercept 5: Community Corrections

 

As an extension of the justice system, parole and probation balance justice-system monitoring with individual-focused service coordination to establish a safe and healthy life outside of the justice system.

Risk Needs Responsivity
Specialized Caseloads
Team-Based Programming
Risk Needs Responsivity

Risk and needs assessments provide the foundation for understanding an individual’s criminogenic risk and needs, which in turns dictates the level of community supervision the individual requires, and the level and type of supportive services they need to be successful. Responsivity refers to the ways in which those services should be provided in order to be effective. Assessment tools identify needs, but it may be the responsibility of parole or probation officers to identify resources and services that will be responsive to those needs. Coordination with providers and liaisons is key to understanding both service availability and fit.

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Risk-based monitoring tailors the monitoring intensity and frequency with one’s criminogenic risk. Widely accepted as a best practice, risk-based supervision should be used for individuals with mental illness to ensure the least restrictive monitoring appropriate to the individual. Professional administration of a validated risk assessment tool should determine individual risk.

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Specialized Caseloads

Parole and probation should have specialized caseloads or units that are dedicated to individuals with mental and behavioral health needs. Officers should be specifically trained to work with these types of clients and educated about available community resources. Clients should have individualized treatment plans that consider medication, behavioral health needs, and substance abuse treatment.

Team-Based Programming

Team-based treatment models march hand in hand with case management teams. Assertive Community Treatment (ACT) is a treatment model that focuses solely on mental health responses and integrates a shared caseload approach to provide treatment within a community. Forensic Assertive Community Treatment (FACT) is an adaptation of ACT for individuals in the criminal justice system.

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