DRAFT
Mental Health aail Diversion Task Foroe

Post-Custody Alternatives
Sub-Committee Report

Supervisor Jim Bealip DIstrlot A
Deputy County Exeoutive
Aduit Probation Department

Department of Aioohoi and Drug Services
Department of Correction
District Attorney’s Offioe
Mental Heaith Department
Mental Health Board

Munlolpal Court
Pretrial Services

Public Defender’s Cffice
Public Guardian’s Office

SCVHHS Adult Custody

January 30* 1998

Concept Paper

COMPREHENSIVE MENTAL HEALTH INTENSIVE
ALTERNATIVE SERVICES

Overview
1.

The Mental Health Jail Diversion Task Force ofthe Mental Health Jail Diversion Steering

Committee has identified post-custody service strategies which seek to avoid the
inappropriate and/or prolonged incarceration ofthe mentally ill. The Task Force proposes

a comprehensive Mental Health (Intensive) Alternative Program for adults at high risk of
involvement in the criminal justice system.

2.

The Mental Health (Intensive) Alternative Program(MHAP)was developed for specified
misdemeanant and non-serious felony offenders who carry a psychiatric diagnosis of major
mental illness. MHAP is not designed to exculpate the severely mentally ill client from
criminal offenses; instead, to divert them from the correctional / criminal system into more
appropriate supervised community treataieiit services. The concept is one of diverting
appropriately identified inmates from the criminal/ correctional system to the mental
hedth system which can more effectively treat their mental illness. This, in turn,
disencumbers the over-crowded jail system ofthose who do not belong there.

3.

MHAP recognizes that successful diversion of people with serious mental illness from
arrest and jail goes beyond keeping them out ofjail. Mental health clients who tend to
come to the attention ofpolice on regular basis are some ofthe most challenging cases.
Many have other major deficits in addition to their mental illness, for example: poor
housing or homelessness, marginal employment skills, and, most ofthem have substance
abuse problems.

4.

Many mentally ill disordered offenders are at high risk to re-offend, particularly if their
mental illness is untreated. This is fiirther exacerbated by a lack of viable social support

systems and maladaptive coping behaviors in response to realities associated with day to
day survival. MHAP understand that this target population requires support, treatment,
and supervision, MHAP works collaboratively with community-based mental health
services, the Mental Health Department,'the Sheriffs and Probation Departments,
Superior / Municipal Courts, the Public Defender and District Attorney, Correctional
Services, and the Public Guardian’s Office.

2

5.

The program addresses the need for diversion and post-custody interventions for mentally
ill adults through an array offive coordinated service components:

Discharge Planning and Treatment Coordination
Intensive Case Management Service Team
Structured Day Services Program
Transitional Residential Services
Mobile Crisis Intervention

The program would serve an estimated 500 unduplicated adult mentally ill clients annually, with
the goal of avoidance of incarceration/reincarceration and further criminal justice
involvement; and successful transition to ongoing community based mental health services.

The array of services described below is intended to offer an intensive effort to address a variety
of mental health, housing, and daily support needs ofindividuals with behavioral problems which
place them at risk for incarceration. The expectation is that following up to six to nine months in
the Intensive Alternatives Program, clients will be transitioned to ongoing mental health or
other appropriate community services.

Baokground

The Mental Health Jail Diversion Steering Committee was formed under the leadership of

Supervisor Jim Beall in response to increasing need articulated by the community for diverting
non-violent mentally ill clients from jail. The initiative was started by Alliance for the Mentally HI
in 1994 and supported by the Mentd Health Board through its Adult & Juvenile Custody Issues
Task Force until Supervisor Beall lent his leadership to this project. According to a recent report
on mental illness in the criminal justice system, it is estimated that in California, as many as 20%
of incarcerated individuals have mental health problems (Shiller, Izami, Hayward, 1996). In Santa

Clara County the average daily census for 1997 ofindividuals incarcerated in the County Jail
was 4,823. The average number of patients that were receiving Mental Health Services was
between 600 - 700 inmates, which is approximately 14%.

3

5000

4500

i

4000

3500

i
3000
Number o( Inmates

2500

2000

ii?

1500

I
i

1000—1

Ol
1 L
Feb March April

UL

500-^

Jan

11

May

June

July

Aug

Sept

Oct

Nov

Dec

Average Daily Census In Custody
20% of the Average Daily Census
# of inmates treated while In custody by Mental Health

In addition, police agencies report that a significant number of calls received, particularly in the
central and downtown areas of San Jose, are to incidents which involve obviously mentally

impaired and/or intoxicated individuals. The San Jose Police Department alone places an average
of six individuals on Welfare and Institutions Code 5150 involuntary psychiatric holds every
twenty-four hours.

In February, 1997, the Mental Health Jail Diversion Steering Committee supported a
collaborative effort between the San Jose Police Department and the Mental Health Department,

Health and Hospital System to implement a Mobile Mental Health Team. This team of mental
health staff provides immediate evaluation, crisis intervention, and linkage services to clients in
the community in response to police officer requests in the field. In the first six months of

operation, the team provided services to 241 individuals. Over 35% ofthose served were able to

remain in their residences; another 37% were transported for immediate psychiatric emergency or

hospital care. Less than 1% were transported to jail. A survey of44 police personnel involved
in utilizing the Mobile Mental Health Team showed that a majority rated the service as
4

good/very good on four dimensions: response time(85%), clinical competence(81%),value
to police(88%),and value to client/citizens(98%).

In July, 1997, the Mobile Mental Health Team also began to provide linkage and follow-up
services to individuals served in the County Sobering Station. It was discovered that a significant

number(approximately 30%)ofthe individuals served by that program had histories of
involvement with the mental health system.

While the Mobile Mental Health Team and increased linkage service to Sobering Station clients

appear to be successful diversion services to individuals at the point of potential incarceration, it is
evident that there is a need for a more comprehensive intervention effort if a significant

impact on the problem of mentally ill in the criminal justice system is to be achieved. The
individuals with highest risk for involvement in the system often have significant problems in
multiple areas oftheir lives. Some examples of the kinds of problems these individuals have
are; major mental illness, substance abuse problems, chronic medical and dental
conditions, homelessness, low employment skills, language barriers, illiteracy, non-existent
support systems, estranged families, and minimal effective social skills.

The service components outlined below are believed to provide services which address the

multiple needs of clients and assure the greatest possibility of successful and permanent diversion
of mentally ill adults fi-om avoidable involvement in the criminal justice system. A budget
summary of each program, including offsetting Medical revenues and net county costs, is
presented in Attachment A.
Mental Health Intensive Alternative Services Program
Components
I.

Discharge Planner/Treatment Coordinator

This component would establish a full-time discharge planner and treatment coordinator assigned
to the Adult Custody Mental Health program. The primary function ofthis position would be to
facilitate linkage ofinmates with the Mental Health Intensive Alternative Services and other
appropriate mental health community services upon discharge from the jail. The Discharge
Planner would work closely with jail mental health staff and would be a member ofthe Intensive
Alternative Services Coordination Team to identify individuals within the jail system who are

appropriate for Alternative Services. He/she would be involved in the development ofthe array
of services, the development ofreferral and admission protocols, and would function as the liaison
to community based services for high risk mentally ill inmates. The new Discharge Planner
would also act as liaison with the legal team which works on the monthly mental health calendar,
an offspring of the Felony Advanced Resolution (FAR)calendar system, which focuses on the

early resolution offelony cases presenting mental health issues. This calendar is highly effective
and fulfills the need for a specialized mental health calendar. No additional resources are
necessary for the purposes of this calendar.
5

1.0 FTE Psychiatric Social Worker/Marriage Family Child Counselor II

Staff:

Net Cost:

Yearly Unduplicated Clients Served:

II.

$70,594
500

Mental Health Intensive Alternative Servloes Treatment Team

This component would consist of a multidisciplinary team with specialized skills to provide
intensive case management and treatment services to clients referred according to protocols
established by the Intensive Alternative Services Coordination Team. The Mental Health
Intensive Alternative Services Team will serve a caseload of 100 clients for an average of six to
nine months. Each client will be provided a comprehensive assessment to determine their
psycho-social needs, and will have an individualized plan which identifies behaviors and needs
which specifically place that client at risk oflaw enforcement involvement. A variety of services

will be provided, including: evaluation and referral, intensive case management, time appropriate
problem focused therapy, 24-hour crisis intervention, medication services; and support services
such as linkage to day and residential services, benefits assistance, housing search, and vocational
service linkage. As clients problems specific to jail involvement risk are ameliorated they will be
referred to mainstream mental health, substance abuse, and other social services. The Mental
Health Intensive Alternative Services Team will be a referral source for the Mobile Mental

Health Team, the Courts, Pre-Trial Services, Probation Department, Adult Custody Mental
Health, Public Defender, District Attorney and others. Emphasis will be on hiring bilingual,
bicultural staff especially Vietnamese and Spanish speaking, with expertise and skill in working
with the client population. The Mental Health Intensive Alternative Services Team will be
available 24 hours a day, seven days a week to support its caseload. It is proposed that this
team be combined with the current Mobile Mental Health Team to increase cost efficiency,
and to enhance the continuum of services available to individuals served by both program
components.
Staff:

See Attachment A

Net County Cost:

$405,152

Caseload:

100

Length of Stay:

6-9 months

Annual Unduplicated Clients Served:

200

III.

Mental Health Intensive Alternative Structured Day Program

This Program component will offer clients a structured day activity program that will offer a four
to six hour, five day-a-week program. A particular focus ofthe program will involve “jail
diversion” skill building. Using the Individualized Care Plans developed for clients by the Mental
Health Intensive Alternative Services Team, clients will be challenged and supported to address
the particular behaviors that make them at high risk for involvement with law enforcement, and to
identify needs for housing, vocational training, and social support which contribute to that risk.
6

The program will include a variety of skill building activities including drug/alcohol rehabilitation,
conflict resolution, activities of daily living, communication skills, pre-vocational training, time
resource management, stress/anxiety reduction and violence prevention. Treatment, case
management and medication would be provided by the Mental Health Intensive Alternative
Services Team or other service teams. Program staff will be made up of professional and
paraprofessional staff, volunteers, and consumers, with an emphasis on bilingual bicultural
Spanish and Vietnamese speaking staff. This program will involve collaboration with Department
of Correction, Adult Custody Mental Health, Probation Department, Courts, District Attorney’s
OfiBce, Public Health Department, Public Guardian, Public Defender, Pre-Trial Services, Social
Services Agency, Alcohol & Drug Department, Mobile Mental Health Team, and Alliance for the
Mentally 111.

The provider of this service would be selected through an Request for Proposal(RFP)process,
and would require Medi-Cal certification in order to drawn down Medi-Cal reimbursement to
offset county costs ofthe program.
Staff:

See Attachment A

Net County Cost:

$447,750

Caseload:

20-30

Length of Stay:
Annual Unduplicated Clients Served:

3-4 months

IV.

120

Mental Health Intensive Alternative Transitional Residential
Program

The fourth component ofthe Mental Health Intensive Alternative Services would be a
transitional residential program targeted specifically to Mental Health Intensive Alternative
Services clients. This Program would provide twelve beds of residential care and would accept
clients referred by the Mental Health Intensive Alternative Services Coordination Team.
Many ofthe clients would also be involved in the Mental Health Intensive Alternative Services

Day Program, and as with that program, direct treatment, case management, medications and
ongoing care planning would be provided by the Mental Health Intensive Alternative Services
team. It would serve clients 18 to 59 years of age. Waivers with Community Care Licensing
would be sought for those individuals over 60. The program would provide rehabilitation
services in a non-institutional residential setting where individuals are supported in their efforts to
restore, maintain and apply inter-personal and independent living skills and access to community
support systems. The maximum length of stay would be six to nine months. Within the
therapeutic community there is a range of activities and services for individuals who would be at
risk of incarceration, or other institutional placement. In coordination with the Day Program and
the Mental Health Intensive Alternative Service Team, clients are assisted in dealing with

outstanding justice issues and to learn skills and behaviors that foster community living and
avoidance ofjustice involvement. The program would be provided in compliance with Title 19,

Community Care Licensing and Medi-Cal Rehabilitation Option requirements, in order for Medi7

Cal reimbursement to offset the cost ofthe program.

As with the other Mental Health Intensive Alternative Services components, collaboration

with Social Services Agency, Probation Department, Public Guardian, Public Health Department,
Alcohol & Drug Department, Physical Health clinics. District Attorney’s Office, Department of
Correction, Adult Custody Mental Health, and the Mobile Mental Health Team, Public Defenders,
Pre-Trial will be an essential aspect ofthis service.

The provider ofthis service would be selected through an Request for Proposal(RFP) process,
and would require Medi-Cal certification. The objective would be to develop a new resource or
redirect existing residential care facility to this special population.
Staff:

See Attachment A

Net County Cost:

$381,786

Caseload:

12

Length of Stay:
Annual Unduplicated Clients Served:

6-9 months

V.

24

Mobile Mental Health Team

This program component would incorporate the existing Mobile Mental Health Team into the
continuum of services provided through the new Mental Health Intensive Diversion Services.
Through consolidated management and coordination ofthe five components (four new and the
current Mobile Team), it is expected that clients currently being seen by the Mobile Mental
Health Team would have priority for referral to the intensive programs. In addition, the Mobile
Team could be utilized to provide needed mobile, community response to crises which involve
any ofthe clients served by Mental Health Intensive Alternative Services program
components, in addition to those new clients who may be served and linked to other ongoing
services.

Comprehenislve Service Coordination

The service components outlined above are envisioned to be a set offive levels of service
available to a distinct population ofindividuals at highest risk of criminal justice involvement.
This comprehensive Mental Health Intensive Alternative Services “program” would provide
intensive, transitional support to approximately 500 unduplicated adults each year. All
components would be coordinated through a collaborative Mental Health Intensive Alternative
Services Coordination Team which would be comprised of management level stafffrom

involved agencies(Adult Custody Mental Health, Police agencies. Department of Corrections,
Probation Department, Public Guardian, Alcohol & Drug Department, District Attorney’s Office,
8

Public Defenders Office, and Pre-Trial Services). This team will be an essential aspect ofthe
proposed service continuum and will be responsible for the following;
Definition of the population(s) to be served

Development of referral and admission protocols

Development of programmatic design of each program component and
interface expectations and functions

Development of RFP process and provider selection
Development of Mental Health Intensive Alternative Services performance
outcome measures and data collection procedures

Development of Interagency Memos of Understanding among partner
agencies

Ongoing monitoring and coordination of Interagency efforts
Reports to Mental Health Jail Diversion Steering Committee and Board of
Supervisors

9

Attachment A

Mental Health Intensive Diversion Services - Proposal
FY98/99 Budget Summary
—:

I
'i

'Hi
mm

L

^
Total

Mcdi-Cal

Cost

Revenue

Kct

-

■■■■ri".

:r

i

■itSli
tM iiiiilipiiiii
m

Mi

11

Discharge Planning and Treatment Coordination

:

$70,594

$0

$70,594

1.0 Y41 PSW/MFCC Clinician *

* Possible MediCal administrative claiming needs to be determined. May bring
in revenues to offset County cost of position.

n. Intensive Case Management Service Team
1.0 P16 Health Services Supervisor
2.0 Y41 PSW/MFCC Clinicians

3.0 E07 Community Worker
.5 P55 Psychiatrist
1.0 S87 Psychiatric Technician
1.0 D36 Advanced Clerk Typist
Object 2

$580,152

$175,000

$405,152

$562,500

$114,750

$447,750

$ 76,285
141,188
128,379
69,685
50,062
41,911
$ 72,642

Day Services Program

<

Rehab. Day Services @ $90/day X 25 average census each day = $2,250
$2,250 X 250 days open = $562,500 gross costs
EsL 40% Medi-Cal days = $225,000 @ 51% = $114,750 Medi-Cal revenue
IV. Transitional Residential Services

ll

$465,330

$83,544

$381,786

Residential Tx @ $110/day X 12 patients X 365days @ 85% occupancy = $409,530
MediCal Revenue @ 40% X 51 % FFP = ($83,544)
Unsponsored (No SSI) = $775/month X 6 beds X 12 months = $55,800

V.

Mobile Mental Health Services

TOTAL Program Costs

1/15/98

a:\jaildivbud.wpd

NA

$1,678,576

NA

$373,294

$1,305,282

%

AttachmftniJB
Department of Correction

Total Average Monthfy Jail Populatioa
Con^jaxing 1995,1996 and 19S>7

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Attaclunentj^;

Statigtic^sforAdult Omodv Mental T-Tp.aith
1997

Ave. Census

Ave. Census

Month,

-Main Jail

January

fitaffiCi:

238

February
March

April

May
June

July
August
September
October

November
December

)

238

248
248

236
240
226
242
265
275

284
277

Ave. Census

Sutolal

M.

IQTAL

est. 335

573

+

28

601

est. 340

578

+

29

607

est. 345

593

+

25

618

est. 345

593

+

30

623

347

583

+

29

611

373

613

+

29

642

609

+

27

636

389

631

+

21

652

385

650

+

23

673

411

686

+

19

705

426

710

+

24

734

411

688

+

35

723

383

S3

I

\