Lee County/NACO Jail Diversion Grant Shows Success

Jan 25, 2006

FOR IMMEDIATE RELEASE                                                                       

Contact:  Ann Arnall, Lee County Human Services, 533-7920

FORT MYERS, Fla. (January 25, 2006) The National Association of Counties (NACo) is touting the results of a $5,000 grant it awarded to Lee County and four other counties in 2004 for a pilot project to divert people with mental illnesses from jail to treatment programs.

The Pre-Trial Outreach Project was intended to educate and train those in the justice system's Pre-Trial Services to proactively identify individuals with a mental illness coming into the court system and divert them to treatment programs. 

Measurable goals of the Pre-Trial Outreach Project included: 

         Demonstrate a minimum of two (2) diversions per month.

         Incorporate Pre-Trial Services representation into the Forensic Mental Health Advisory Council.

         Ongoing, informal training of Pre-Trial Services personnel (documented by liaison) related to mental health services and diversion concepts/opportunities.

         Completion of formal training for Pre-Trial Services personnel (minimum of 2 formal trainings over course of grant year) related to mental health services and diversion concepts/opportunities.

         In collaboration with the Forensic Mental Health Council, develop a long-range diversion plan, including plans for sustaining existing diversion efforts and expansion of diversion activities.

Attached is the final report on the results of the project indicating 26 individuals were served.  The grant funding was provided by Eli Lilly and Company through NACo.

The Forensic Mental Health Advisory Council includes representatives from Lee County Human Services, Florida Department of Children and Families-Substance Abuse and Mental Health Office, Mental Health Court, Office of the Public Defender, the State Attorney Office, the Lee County Sheriff's Office, Lee County Jail's mental health/medical provider group, and the mental health consumer population.   

Research indicates that prolonged incarceration and increased mental health symptoms are directly correlated; and in-patient care (jails, hospitals) is more costly than community-based treatment.

The county coordinated the effort in partnership with the Ruth Cooper Center. 

The Lee County project was selected by NACo as one of the five funded in the country.  NACo is the only national organization representing county governments in the United States.  Its goals are to improve county government, act as a liaison with other levels of government, present the county position on national issues and advance public understanding of the role of counties. 

Diversion Program: Pretrial Outreach Project
Ft. Myers, Florida, Lee County
National Association of Counties: Jail Diversion Small Grant 

Final Report 

History of Project

Based on evidence that pretrial services plays an essential role in successfully diverting individuals with severe and persistent mental illnesses (including those with co-occurring substance use disorders), Lee Mental Health d.b.a. Ruth Cooper Center implemented the Pretrial Outreach Project as an adjunct to its existing Diversion Program.  

Lee County, Florida is a rapidly growing community with a significant number of transient individuals.  The Lee County Jail continues to report a significant increase in the number of individuals incarcerated who have a mental illness.  In response to these demographics, the local community mental health center, the Ruth Cooper Center, formed the Forensic Mental Health Advisory Council, which is a comprehensive and influential group of stakeholders with the common goal of improving systemic barriers to increasing diversions and effectively using community resources.   

Further, the Ruth Cooper Center developed a Diversion Program.  The Diversion Program is intended to divert individuals with serious mental illnesses (including persons with co-occurring substance use disorders) from unnecessary institutionalization and/or criminalization.  Specifically, this program is designed to serve individuals with criminal charges in which a severe and persistent mental illness may complicate the legal proceedings.  The two primary objectives of the Diversion Program are: 1) to expedite resolution of legal issues and 2) to reduce recidivism.  In essence, the Diversion Program serves as a bridge between the Criminal Justice and Mental Health Systems.   

The primary activities of the existing Diversion Program are to 1) monitor and advocate for persons with felony charges who are at risk or have been adjudicated Incompetent to Proceed (ITP) with trial and/or Not Guilty by Reason of Insanity (NGRI) pursuant to Florida Statute 916,  2) provide community-based supports, such as case management, basic living skills training, and social skills training to individuals in the community, 3) train individuals around legal competency issues pursuant to Florida Statute 916 (offered to individuals in jail and in the community, depending on the person's situation), and 4) identify diversion opportunities and make subsequent recommendations to the Courts, advocating for the least restrictive alternatives when appropriate.  

The goals of the Pretrial Outreach Project included the enhancement of a collaborative relationship with Pretrial Services and identification of opportunities for diversion of the targeted population at jail intake by assisting in the development viable release plans that include treatment.  The Pretrial Outreach Project broadened the scope of activities and opportunities in order to creatively divert individuals from jail (and forensic state hospitals) at all levels of the legal system.   

Project Planning Process
The planning process was collaborative in nature.  Representatives from the Ruth Cooper Center and Pretrial Services, including the Ruth Cooper Center's Director of Adult Resources, the Supervisor of Ruth Cooper Center's Diversion Program, the Deputy Criminal Justice Director of Pretrial Services, and the Pretrial Services Manager, met together to decide how to proceed with the awarded resources. This meeting offered opportunity to begin building a relationship between the two entities, to invite Pretrial Services to become a member of the Forensic Mental Health Advisory Council, and to discuss the details and goals of the project.  

It was clear that neither entity fully understood the other's role and goals.  All agreed that working together would be valuable, and that the Diversion Program staff should observe the intake process of Pretrial Services to determine how mental health services might offer maximum benefit to the goal of increasing appropriate diversions.  It was during this meeting that Pretrial announced the potential for going to 24/7 service during the grant year.  It was understood that developing a 24/7 service would required significant flexibility with the services provided in under the Pretrial Outreach Project.  Furthermore, transitioning to 24/7 would change the entire system and offer opportunity to improve screening for mental health issues during the Pretrial intake process. 

Project Implementation
Early on in the implementation process, Pretrial Services became an active member of the Forensic Mental Health Advisory Council.  Their input and participation closed a significant gap in the representation among this group whose primary goal is to maintain the dignity and safety of the community while ensuring a fluid process that will increase diversions and effectively use community resources for the targeted population.   

Next, the Diversion Program Supervisor and Competency Restoration Trainer observed the Pretrial intake process and developed a PowerPoint training to offer to the Pretrial Officers over several weeks.  During this time, Pretrial Services transitioned to a 24/7 service, delaying collaboration on specific cases.  We were able to provide some input into the development of questions to assist in standardizing questions/tools used to screen for potential mental health complications during Pretrial Service's intake process in an effort to improve identification of targeted population.  It was not until May that we were able to reconvene.  At that point, we presented the training to all of the new Pretrial Officers hired to accommodate the 24/7 services.    

Upon completion of the training phase, the number of referrals was far less than anticipated.  Diversion Program staff worked with key members of Pretrial Services to determine the barriers to referrals.  A collaborative decision was made to have the Diversion Program observe the Pretrial process again based on changes made during transition to 24/7.  Furthermore, the need to clarify the targeted population to promote referrals due to overlap with the local Mental Health Court became apparent.  This new approached proved successful and, once the entities clarified who should be referred to the Diversion Program, the experience of working together drove a more broad range of referrals over time.  Diversion Program staff screened all referrals, offering options for and pursuing diversions as appropriate.  Diversions generally occurred by linking the individuals with recommended services based on assessment and negotiations with the Court.   In two cases, the Project resources allowed the Diversion Program the opportunity to pilot the HCR-20 Violence Risk Assessment to support diversions. 

It was estimated that the project would produce 2 diversions per month.  Over the grant year, 26 individuals were identified and referred to the Diversion Program through Pretrial Services.  There were only two referrals between the months of February and May.  It was not until July, when eight individuals were screened, that there was finally an increase in referrals.  Of the 26 individuals served, seven have been successfully diverted from incarceration into treatment, which is approximately 27%.  One of the diverted individuals was rearrested twice since release from custody and another was rearrested one time.  The average length of incarceration for those diverted was 91 days.  It should be noted that even as the grant year is ending, we still have two diversions pending from the work under this Project.  The diversion activities in these cases will continue under our existing services.   

Our second measurable goal was to incorporate Pretrial Services representation into the Forensic Mental Health Advisory Council (meeting minutes attached).  This goal was achieved early on.  The addition to the Council is just one example of the relationship between the Diversion Program and Pretrial Services, which is a direct outcome of this project.  Moreover, this relationship has been very beneficial to other Diversion Program activities, suggesting that many of the other diversions resulting from existing program services may have been influenced by collaboration with Pretrial Services.   

The final measurable goal is that of on-going training provided to Pretrial Services personnel related to mental health services and diversion concepts/opportunities.  In addition to the three formal trainings provided over the course of the grant year (for which the presentation evaluations forms are attached), the Diversion Program provides less formal education to Pretrial Services related to available services and diversion concepts/opportunities specific to mental illness during interactions related to individual cases and also through the Forensic Mental Health Advisory Council.  However, it should be noted that this education is mutual, as the Diversion Program continues to improve understanding of the local justice system through interaction with Pretrial personnel. 

Lessons Learned
The Pretrial Outreach Project provided an invaluable opportunity to improve Lee County's ability to identify and intervene in cases early on where individuals involved in the Criminal Justice System have a mental illness.  The most obvious lessons learned through this experience is the value in opening lines of communication between the Mental Health System and all levels of the Criminal Justice System.  The ability to navigate the system and expedite resolution in these difficult cases is maximized when there is a mutual understanding and sense of collaboration among stakeholders.  Common goals exist and neither entity can be effective in addressing the problem of increased incarceration of individuals with mental illnesses without the support of the other. 

What became equally evident are the obstacles resulting from the length of time spent and the level of complexity in trying to navigate the legal system to facilitate a diversion.  The Diversion Program is not nave to the challenges inherent in trying to penetrate this system from the outside because the existing services exist to confront that very barrier.  However, adding this new point of access to the Diversion Program services uncovered a new level of complexity. 

Originally, identification was the primary problem.  Now, finding those who need help is not the biggest problem; rather, the barrier is often bringing a release plan to fruition or finding appropriate community resources to offer a viable alternative to incarceration in the first place.  Getting all involved parties on board with a diversion plan and moving it along is difficult in and of itself, but doing so at intake offers a number of new barriers.  For example, at that early stage the defendant often does not have an attorney, so facilitation of a diversion is reliant on Diversion Program staff and Pretrial Services alone.  Even with years of experience and a positive reputation of assisting in the Court's efforts to uphold the safety of the community, diversions take a long time from identification to getting the person out of the jail. 

Future Plans/Sustainability
Fortunately, the Diversion Program's existing service array will be able to address many of the referrals generated by Pretrial Services through existing funding sources.  However, there may be some individuals who will not meet criteria for these services. 

For that reason, the Diversion Program continues to identify and pursue opportunities to secure additional funding to build upon existing services.  Doing so is one part of the strategic plan for the Ruth Cooper Center and essential to success in serving the targeted population.   

The benefits of spending the past year developing a relationship and working with Pretrial Services to address a variety of cases are absolutely sustainable.  Furthermore, the Forensic Mental Health Advisory Council hopes to continue to benefit from the valuable input provided by Pretrial Services personnel. 

The Pretrial Outreach Project is replicable across counties as well as various organizations within the Criminal Justice System.  For example, the Diversion Program recently made contact with Pretrial Services in Charlotte County (directly north of Lee County) in attempts to begin receiving referrals for individuals that might meet criteria for existing Diversion Program Services.  Further, the Diversion Program replicated the Pretrial Training to introduce our services and offer assistance to the Department of Corrections' local probation offices in effort to improve the problem of recidivism among the targeted population. 

The primary requirements of attempting to reproduce the project include a level of interest and awareness of the increasing incarceration of individuals with mental illness on the part of the Criminal Justice and Mental Health Systems along with a willingness to learn from one another.  Obviously, funding is needed to spend time developing the relationships and providing education.  

Project Contact Information 

Tessa Tayyab, MPA

Diversion Program Supervisor

Lee Mental Health d.b.a. Ruth Cooper Center

2789 Ortiz Avenue

Fort Myers, FL  33919

(239) 791-1543

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