Reducing Risk and Responding to Mental Health Needs: Kentucky's New System of Care
Milligan, Connie, Sabbatine, Ray, Corrections Today
Imagine a simple solution to some of America's detention centers' most complex problems, a solution that involves a system of care that would reduce suicide and expand mental health services, and would not increase cost to the jails. That was the task and the accomplishment of the Kentucky Jail Mental Health Crisis Network. After the first year of implementation, the data appear to show that this new network of services, fully funded by legislative action through an increase in court cost, is reducing suicides and increasing service connections.
Why was this needed? In 2002, the Louisville Courier Journal did an investigative report on 17 suicides and two deaths in restraints that had occurred in Kentucky jails in the previous 30 months. (1) The articles highlighted the disconnect between proper risk assessment and the appropriate delivery of services. It was clear that detention center personnel were being asked to provide services to population they little understood without the training and skills to manage them, while mental health professionals were not adequately involved.
Kentucky legislators took notice of the problem, and during the 2002 legislative session, four hours of mental health training was mandated for all detention center personnel. The authors, who were involved in the development and the delivery of that training, heard from the jailers that, although the training was helpful, it was not a substitute for actual services. In 2003, the authors began to develop a consultation service--the Telephonic Triage program--and piloted it in five jails. It was clear from the outcomes of the pilot program that the jails needed a more comprehensive service delivery system. Because of limited local and state resources for new jail services, legislative funding was sought for the program in 2004. With the passage of the legislation and more than a year of implementation across the state, Kentucky has a new program that takes a different approach to solving a problem that plagues detention centers across the nation.
The solution, implemented by legislative action in 2004, is a new statewide program that involves a four-step process to clearly define protocols for integrating mental health services into the state detention centers. (2) It includes the use of two standardized detention center risk-screening instruments; a telephonic triage to assess the level of mental health risk; recommended management protocols defined for each risk level; and follow-up services provided by the regional community mental health boards.
The goals of this program are to identify suicide and/or acute mental health symptoms, reduce self-harm and suicide in jails, provide a secondary level of assessment by a licensed mental health professional, and to increase possible diversion and treatment.
Rationale for Kentucky's Solution
In Kentucky, most of the 86 jails are in rural areas, are governed by local fiscal courts, and have difficulty accessing and affording services. In many areas, the use of criminal charges and jail time has become the most frequent solution for difficult social problems that would be better served by extensive professional involvement. This includes behavioral problems related to mental illness, suicidal behavior, domestic violence and substance abuse. Alternatives such as court diversion programs and extensive treatment programs are unavailable in rural areas. Although some of the larger detention centers have contracts for mental health services, most small to medium-size jails are dependent upon limited medical staff for risk assessment. Thus, the day-to-day management decisions and response to these complex behavioral problems are left to officers. Staff discretion in caring for and responding to people with mental illness and/or who are suicidal can pose tremendous risk. It becomes clear that the more those decisions are taken out of the hands of staff who are not trained or considered mental health experts, the better. …