Stepping Up-Alternatives to Incarceration: Quarterly Newsletter-April 2021
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Welcome to the 6th Stepping Up-Alternatives to Incarceration Quarterly Newsletter from Southwest Iowa Mental Health and Disability Services Region (Region). The purpose of the newsletter is to keep key stakeholders in the Region informed of the status of the Stepping Up-Alternatives to Incarceration Initiative in Southwest Iowa.
IN THIS ISSUE
In this issue, we revisit the Sequential Intercept Model (SIM) that serves as the organizing framework for the Stepping Up-Alternatives to Incarceration Initiative. Our attention then turns to a review of services provided by the Mental Health Crisis Response Team (MHCRT). Finally, we take a closer look at court-ordered assessments offered by the MHCRT through the judicial system.
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What Is the Sequential Intercept Model?
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The SIM, first published by Policy Research Associates, Inc. in 2005. The SIM provides a framework for understanding the flow of individuals with mental illness through the stages of the criminal justice system, identifying existing resources and service gaps at each stage, and prioritizing implementation of community-based services. The intercepts, ranging from Intercept 0 through intercept 5, encompass the decision-making stages of the justice system. In future issues, we will continue to include the visualization of the SIM to serve as a point of reference as we discuss specific services offered throughout the Region
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WHAT IS THE MENTAL HEALTH CRISIS RESPONSE TEAM (MHCRT)?
MHCRT, a service provided by Heartland Family Service, provides immediate therapeutic intervention for mental illness and substance abuse crises. MHCRT crisis assessments are requested from five sources. Mobile Crisis Response assessments result from requests made by law enforcement officers who come in contact with individuals or respond to calls involving individuals in crisis. Jail-Based Crisis Response is requested by county jails as an intervention for inmates who experience mental health crisis. Pre-committal assessments occur when citizens who are considering filing civil commitment paperwork contact the MHCRT for assistance in determining the appropriate level of care for a family member in crisis. Court-ordered assessments occur when a judge is concerned that a civil commitment may not be the appropriate course of action in cases brought before them. Hospital-Based assessments are requested by emergency department staff to determine the appropriate level of care for individuals who present in the emergency department in non-medical mental health crisis.
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The origins of MHCRT in Southwest Iowa date back to December 2010 with the implementation of Mobile Crisis Response and Jail-Based Crisis Response in Pottawattamie County. Pre-Committal Assessments (2012) and Court Ordered Assessments (2015) were also first implemented in Pottawattamie County. By the second half of 2016, MHCRT services were made available to all counties in the Region. In spring 2018, the Region launched a hospital-based pilot program for critical access hospitals in rural communities. The current expansion status of all MHCRT services throughout the Region appear in the table above.
HOW DOES AN APPLICANT START AN INVOLUNTARY COMMITMENT PROCEEDING?
To start involuntary commitment, the applicant must file a verified application with the clerk of court in the county where the respondent resides or is located. The applicant must use the approved forms in Chapter 12 and 13 of the Iowa Court Rules, available at Iowa courts.gov website or from the clerk of court in the county where the respondent lives or is located. The application may be filed with the court in paper or electronically through the Iowa eFile system.
With the verified application, the applicant must provide:
- Two supporting affidavits that confirm the application filed with the clerk of court.
- A statement of a licensed physician in support of the application * not always required unless the respondent is in a hospital/emergency department.
It is important to remember in order to file on the respondent, the applicant(s) must have firsthand knowledge of the information provided in the affidavit otherwise this could be considered perjury by the Judge reviewing the application. It is also important to remember that just because an application has been filed on a respondent, it does not mean the person will be immediately picked up by a sheriff deputy and taken to a hospital. The Judge is required to review the application thoroughly to make sure the respondent is in need of an involuntary hospitalization.
If the Judge determines there is not adequate information in the application, the Judge can order an assessment by HFS MHCRT to confirm the information in the affidavits. HFS therapist then contact the applicant(s) regarding the information in the affidavits to confirm the information is accurate and true. HFS therapist then provides the Judge the results of the assessment. At that point the Judge could state there is not enough evidence to warrant a civil commitment or the Judge could proceed with the civil commitment and call for immediate pick up of the respondent.
A CLOSER LOOK AT COURT-ORDERED ASSESSMENTS CONDUCTED BY MHCRT
Court-ordered assessments are requested by a Judge when he/she is concerned that a civil commitment may not be the appropriate course of action in cases brought before them. After receiving a call from the Judge, HFS therapists provide on-site, face-to-face or technology assisted risk assessments to prevent unnecessary hospitalization, protective custody, and/or incarceration. The MHCRT refers all individuals assessed to a Regional Crisis Service Coordinator to ensure the individual has the information they need to successfully seek services. The Crisis Service Coordinator then follows up with individuals to provide necessary referrals in order to prevent future crises.
Although MHCRT court-ordered services are available to all counties in the region, 6 counties utilize the service as of April 2021. Feedback from Judges that have implemented the service have been positive. They find it not only saves them time, it also provides a quality service to individuals.
The data below represent Court-Ordered assessments completed in FY20 (July 1, 2019-June 30, 2020) and part of FY21 (July 1, 2020-February 28, 2021)
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Of 336 total assessments completed by all MHCRT sources in FY20, 27 or 8% were the result of a court order. Of those, 93% were in Pottawattamie county.
The data indicates that 93% percent of court ordered assessments conducted in FY20 determined that the individual did not meet criteria for involuntary committal. When this occurs, MHCRT develops a safety plan with the individual to help them remain safe while remaining in their home and or community.
A Crisis Service Coordinator is assigned to those individuals that want follow up care after the assessment by MHCRT. The Crisis Service Coordinator conducts the follow-up with the client to make sure they are seeking or attending mental health/substance abuse treatment at local mental health centers. They also coordinate other services the client may need including housing or applying for benefits.
Assessment outcomes comparing July 1 through February 28 for FY20 and FY 21 appear below.
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From the data above, the reader can see that there was a reduction in the number of court-ordered assessments conducted in FY21 compared to the previous year, this was due to COVID-19. Most County Courthouses and or offices were closed to the public for a period of time therefore less civil commitments were being filed by the public.
The Region would like to encourage more judges in our region to utilize MHCRT services. For more information, please contact Suzanne Watson, Region CEO at swatson@swiamhds.org.
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The SWIA MHDS Region's Crisis Stabilization Services
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Mental Health Crisis Response Team
Provides multiple crisis service
Precommital screening for residents of the SWIA Region
Assessments for court ordered committals
Telehealth Crisis Response available to SWIA Region residents. Services include assessment, stabilization and referrals to community services. This service can only be initiated by Law Enforcement
These services are expanding into all counties in the Region
For further information, Law Enforcement can contact Jenny Stewart (Director) at 712-325-5619
"To avoid the need for an Emergency Protective Custody hold or inpatient psychiatric hospitalization"
Service provided by Heartland Family Service
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Call (712) 303-7066 to make a referral
Referrals accepted 24 hours a day
A screening set up within 24 hours
Accepts referrals from friends, family, emergency departments and outpatient providers
Accepts referrals from Cass, Fremont, Harrison, Mills, Monona, Montgomery, Page, Pottawattamie and Shelby counties
"Provides a safe, caring, and home-like environment to those with a mental illness in crisis while modeling skills needed to successfully navigate in the community"
Service provided by Waubonsie Mental Health Center
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Call (844) 673-4469 for help and support
Crisis line available 24/7, toll free and confidential
Connects individuals in crisis to a helping hand and the resources to address and improve mental wellness
Anyone can call, including service providers on behalf of clients and patients
For residents of Cass, Fremont, Harrison, Mills, Monona, Montgomery, Page, Pottawattamie and Shelby counties
"Improving mental wellness, hope and outcomes for residents of Southwest Iowa in times of crisis"
Service operated by Boys Town
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