Mental Health Diversion Court (MHDC) and other Treatment Courts

In the spring of 2019 and in the wake of Assembly Bill 1810, and after meetings with a diverse group of criminal justice stakeholders, the County of San Luis Obispo and the Superior Court began operating a pilot mental health diversion court.  Stakeholders included representatives from the District Attorney, Public Defender, conflict public defender attorneys, private defense attorneys, Behavioral Health, Superior Courts, Probation, Sheriff-Coroner, and the Administrative offices. The aim of the Mental Health Diversion Court is to enhance public safety by diverting defendants from jail and prison. It provides wrap-around services, supervision and random drug testing, and intensive mental health outpatient treatment grounded in evidence-based practices, such as cognitive behavioral therapy, medication management and other case management services.  While the County and the Superior Courts have operated a post-plea Behavioral Health Treatment Court (BHTC), this pilot program diverts justice-involved individuals with mental illnesses from the criminal justice system prior to their sentencing. Upon successful completion of the program, the charges are dropped, which eliminates many of the future barriers associated with having a criminal history.  Because of increased funding secured by County Behavioral Health, up to 33 justice-involved individuals can participate in the MHDC. The program began operating with 10 slots in May 2019, and was expanded to 33 slots by the end of 2019 through grant funded programs.

A total of 21 individuals have participated in MHDC since May 2019, many of which have been living in supported housing (e.g. recovery residences, Transitions Mental Health Association Adult Transitional Program). The first two graduates of MHDC completed the program in October. MHDC participants will be in treatment for an average of 12 to 18 months and the courts follow the case to the end of the two-year diversion period.  The Superior Court and County continue to partner to increase participation in MHDC.

Other treatment court programs including Behavioral Health Treatment Court, Adult Drug Court, Veteran’s Treatment Court, Adult Treatment Court Collaborative, and Family Treatment Court have also been operating on-going to meet the needs of offenders with mental health and substance use issues. While these programs are not covered in detail as part of this report, they have regularly had a positive impact on their participants and helped to reduce the number of individuals incarcerated and/or the individual’s duration of incarceration.

Mental Health Evaluation Team (MHET)

The MHET provides mental health evaluations, support to emergency department staff, facilitation of transfer to inpatient facilities, and referral to community-based resources and services.  The goal of these services is to reduce the lengths of stay in emergency rooms for patients in psychiatric crisis and to facilitate appropriate discharge to the community, County Crisis Stabilization Unit, or inpatient psychiatric facility, or to other receiving psychiatric facilities as appropriate. Additionally, in 2018, the Behavioral Health department received a Mental Health Wellness Act of 2013 grant, made available by the Mental Health Services Oversight and Accountability Commission (MHSOAC).  The grant program was established to strengthen and expand the county mental health services system by augmenting existing county crisis services and creating linkages to new services for children and youth aged 21 and under in need of assistance.  The grant provides triage services, including crisis intervention, crisis stabilization, mobile crisis support, case management, and linkages to services for youth.  The County and Sierra Mental Wellness Group collaborate to provide the Youth Triage team to address the need to improve coordination and collaboration of the current crisis response system for children and youth.

In FY 2019-20, the MHET program reported:

• 1,456 total calls.
• Approximately 50% of calls resulted in a 5585 or 5150 hold (involuntary 72-hour psychiatric holds for youth and adults).
• Of those not placed on a hold, approximately 78% received follow up from the team. Reasons for not following up include, for example, follow up appointments were already set up before an individual left an emergency department, an individual refused, or could not be reached.

In FY 2019-20, the Youth Triage program reported:

• 171 total calls.
• Approximately 41% of calls resulted in a 5585 or 5150 hold.
• Of those not placed on a hold, approximately 93% received follow up from the team. 

Jail Based Competency Treatment (JBCT)

The JBCT program began operating in the County Jail in July 2019. The program has five beds and treats mentally ill inmates charged with a felony and deemed incompetent to stand trial. The program costs an estimated $776,000 per year, all of which is reimbursed by the Department of State Hospitals (DSH) and is a net neutral cost to the County. This program is part of the previously approved contract with Wellpath, the County’s contracted jail medical service provider. The program has allowed inmates to be restored to competency without awaiting transfer and treatment at state hospitals, dramatically decreasing average time in custody. It is estimated that the program saves approximately 90 jail days per participant who does not have to wait for a state hospital bed. 

In the first year of the program, there were 34 patients admitted to the program and 30 were restored to competency. The County restores patients to competency in an average 31 days, compared to a statewide JBCT average of 51 days. One reason for the reduced average length of stay in the program is that JBCT is physically located in the Kansas Max housing unit, which allows for a seamless transition into and out of the program.

Kansas Max Security Housing Unit in the County Jail

The Sheriff’s Office created a 77-bed housing unit, Kansas Jail Max (KJ Max), specifically for inmates with special needs, including for individuals with serious mental illnesses, and made significant modifications to the housing pod in KJ Max for the new JBCT program. In KJ Max, jail staff introduced a Behavioral Health Incentive Program to assist in transitioning these inmates out of lock down, into the JBCT program, and back into the community. The incentive program rewards inmates when they practice proper hygiene, clean their cells, assist in cleaning shared/common areas, engage in programs offered, exercise, comply with medication, attend mental/medical health appointments, and associate/interact with others. The incentive program promotes participation in these activities by “paying” in points for each task completed; then, each week, they redeem their points for incentive items. Medication compliance and participation in programming within KJ Max have all increased as a result of the incentive program. Programming includes yoga, exercise, journaling programs, ministry, Alcoholics Anonymous (AA), Narcotics Anonymous (NA), Narcan training, and a canine program. The program honors individuality and encourages personal responsibility, and Custody staff learn new ways to manage, communicate with, and support individuals with mental health concerns.
In the first year of implementation of the Behavioral Health Incentive Program, coupled with the JBCT Program, the Sheriff’s Office has recorded a decrease of safety cell placement hours of 9.8% (40.5/month) and a decrease in jail assaults of 19.4% (22 less since KJ Max opened).

Behavioral Health Unit (BHU) in the Jail

Beginning in October of 2018, Stahl Hall was remodeled through community support via the Sheriff’s Advisory Foundation. ​The BHU provides immediate, intensive, high-quality and individualized behavioral therapy services for inmates suffering from mental illness and substance use disorders. The goal of the BHU is to provide a therapeutic and inviting setting in which to deliver expanded mental health services, including programming, therapy, acute crisis management, medication visits and psychiatry. The unit is operated by jail staff and WellPath mental health and substance use staff. It provides a safe, calm environment where needed services can be delivered to inmates. 

Medication Assisted Treatment (MAT) for Opiate Use Disorders

MAT for individuals with opiate use disorders is available both in the Jail by Wellpath and in the community through County Behavioral Health and its contracted provider Aegis. The County plans to apply for MAT grant funds in FY 2020-21 to focus on individuals with co-occurring serious mental illness and substance abuse disorders.

Behavioral Health Community Action Teams (BHCAT)

BHCAT teams, which are partnerships between law enforcement and County Behavioral Health, focus on working with homeless and other high-risk individuals, and individuals in mental health crisis situations. Behavioral Health staff dispatch with officers and deputies assigned to the Community Action Teams (CAT) to help engage and assess individuals, and provide access to services, referrals, or assistance in transport for those meeting the criteria for an involuntary hold. In addition to field interventions, CAT teams identify frequently encountered individuals and reach out to those individuals proactively to offer services and support to reduce recidivism.

Currently, the County funds Behavioral Health staff who partner with the Sheriff’s CAT, City of San Luis Obispo Police Department CAT, and the Paso Robles and Atascadero Police Departments - some of which are funded by grants through September 30, 2023. For the Sheriff’s CAT and Paso Robles/Atascadero CAT, which have Behavioral Health staff funded by grants that accompany law enforcement, there were 198 encounters in the last year and treatment was provided to 72 individuals.

Crisis Intervention Training (CIT)

The Sheriff’s Office coordinates a 40-hour Crisis Intervention Training program. The program incorporates speakers and content from law enforcement, subject matter experts, clinicians, community-based organization, and more. The training has now been attended by 352 individuals, which includes 195 from the Sheriff’s Office and 157 from other law enforcement agencies, the Probation Department, and other departments. The Sheriff’s Office goal is to have all Sheriff Patrol and Custody Deputies attend the 40-Hour course and become CIT certified (approximately 72% have attended the training to date). The last three scheduled trainings were delayed due to COVID-19; it is hoped trainings can resume in January 2021. Further development of the CIT course includes break out groups for first responders including fire, EMT, dispatchers, and other specialized areas of public safety.