Recommendations for Implementation

Before the partners can develop a budget describing the costs of the joint venture, they will need to identify the number of people they will target and the needs of those individuals.  To that end, they should analyze how their clientele overlap and then quantify that overlap.  For example, the courts may work with the local mental health centers to identify a number of jail detainees who meet criteria for pretrial release and, prior to being charged, were receiving mental health services in the community.   

Example:  Department of Community and Human Services,Crisis and Engagement Services, Mental Health, Chemical Abuse and Dependency Services Division, King County (WA)

In an effort to lay the groundwork for collaboration between different service agencies, officials in King County collected data concerning the overlap between high utilizers of substance abuse and mental health services and the jail population.  By facilitating the cross-referencing of information between separate databases (with the appropriate protections for the privacy of identifying information), the Division of Crisis and Engagement Services discovered that, in fact, many of the individuals who were spending considerable time in substance abuse and mental health treatment facilities had also been arrested and incarcerated in the county jail multiple times.  Though these individuals seemed to be benefiting very little from their involvement in these services, the cost of providing those services was high - approximately $1.1 million for 20 individuals.  Gathering this data helped officials throughout the mental health and criminal justice systems in King County to better understand their shared clientele and helped spur improved collaboration there.

Obtaining new dollars to support a partnership is difficult.  Even when jurisdictions are successful in securing appropriations or a grant, this funding assistance is unlikely to cover all of the costs associated with the initiative.  Accordingly, the partnering organizations will need to review their existing resources to determine how they can be shared or shifted to make the partnership work.   In many cases, staff, space, equipment, or expertise donated by one or more of the partnering organizations is as good (if not better) than a contribution of actual dollars.

Example:  King County (WA)

Partners in King County, Washington, each made considerable in-kind contributions to make their joint effort to develop a prebooking diversion program work. The Seattle Police Department, without new staff or resources, identified more than 100 volunteers from the existing ranks of the police force, who agreed to receive 40 hours of specialized training regarding people with mental illness, drug and alcohol problems, and development disabilities.   Representatives of the treatment systems, consumers and family members conducted the training, donating their time.  For its part, the King County Hospital provided the space and part of the staffing required to reconfigure an existing psychiatric emergency room into a Crisis Triage Unit capable of managing pre-booking diversion referrals made by police officers.[1] 

When the criminal justice and mental health stakeholders begin to implement a joint response to a segment of the population with mental illness in contact with the criminal justice system, the new approach is likely to generate some costs savings for the criminal justice partner.  For example, a small study of 46 participants in Project Link in Monroe County, New York, found that the partnership among various mental health organizations in the county and county government officials reduced the mean number of jail days per month for the program participants from 9.1 to 2.1 and the mean number of hospital days per month from 8.3 to 3.  Based on per diem costs, this translates to a savings of more than $23,000 in jail costs and more than $155,000 in hospital costs for the 46 program participants.[2] 

Partners should work together (ideally, before the costs savings are even realized) to redirect the resources saved to the organization or agency assuming the expense incurred by absorbing the additional clients.  Moving fund balances to different state or county agencies is usually complex, and it often requires the involvement of a state budget authority and the legislature.

Example:  Connecticut Jail Diversion ProjectM

In Connecticut, in 2000, the General Assembly authorized the statewide replication of a successful jail diversion pilot program based in New Haven.  To provide the state mental health agency with the resources necessary to expand the program, legislators worked with the state corrections department (which also operates all facilities in the state that house pretrial detainees), whose commissioner recognized that the expansion of the program would save a number of corrections beds and thus save the agency money.[3]  The General Assembly, with the consent of the corrections commissioner, effected the shift of approximately $3.1 million from the corrections budget into the state mental health agency's budget.[4]  

Partners may also decide to apply savings generated by another initiative to an effort regarding people with mental illness in contact with the criminal justice system.

Example:  King County (WA)

In King County, Washington, partners used savings generated from the managed care system to fund the diversion programs they developed.  The managed care system, when held accountable to its stated goal of promoting increased client choice and individualized and tailored care, can support jail diversion efforts.  System integration advocates argued that a portion of the systems savings ("fund balance") generated by the Managed care model could be reinvested in services targeting those for whom the managed care paradigm worked least well - including people with co-occurring disorders involved in the justice system.  This meant that fund balance dollars produced by the managed care process could be applied to supplementing the staffing needed to create the hospital's Crisis Triage Unit and the mental health court. 

For services provided to custodial parents who qualify for Temporary Assistance for Needy Families (TANF) cash assistance or TANF-funded services, this entitlement may be an important resource. Generally speaking, TANF-funded services are more readily available than cash benefits, especially when the eligible recipient is or recently has been incarcerated.  Tapping TANF funds facilitates state and local government officials' efforts to make services such as case management, vocational rehabilitation, mental health and substance abuse counseling, and job training, search, and placement services available.  Indeed, TANF funds have the potential to ease a financial burden for corrections budgets while putting little new strain on the mental health service budget.[5]

Deciding which of the partnering organizations will be the recipient of a new appropriation or the share of a grant can be a thorny and divisive process. In some cases, it may make sense for the partners to establish an independent, not-for-profit organization, with representatives from each of the partnering organizations would help to govern, to receive and administer these funds. 

Example:  PERT, Inc., San Diego County (CA)

In San Diego County, in 1993, mental health and law enforcement professionals, consumers, and family members of consumers established a task force in response to several high-profile shootings of individuals with mental illness.  The task force developed a series of Psychiatric Emergency Response Teams (PERT) to improve the response of the criminal justice system to individuals with mental illness.  County and state agencies agreed to fund part of the initiative with a portion of the jurisdictions' share of federal block grant that the Substance Abuse Mental Health Services Administration administers.  Members of the task force could not agree on which organization should receive the grant, so they formed an independent organization: "PERT, Inc." PERT, Inc. supervises the PERT staff and coordinates billing for services rendered.   The board for PERT, Inc. is made up in part by NAMI board members and board members from the Community Research Foundation, the largest private, nonprofit  mental health service provider in the county.