AUSTIN, Texas – Across the country and within Travis County, a disproportionate number of people living with mental health and substance use disorders end up in jail instead of getting the mental health treatment and support they need.
Mental health experts in Dell Medical School at the University of Texas at Austin are joining forces with the Travis County Commissioners Court and a wide range of community partners to address this problem by rethinking – and ultimately redesigning – the local intersection of criminal, legal and behavioral health systems. The goal of the effort, known as the Travis County Forensic Mental Health Project, is to create solutions rooted in person-centered, evidence-based care for people stuck or constantly cycling through this intersection.
About 2 million people with serious mental illness are incarcerated each year in the U.S. One in 5 adults in the U.S. will experience a mental illness in a given year. In Travis County, 37% of people incarcerated in October 2021 were receiving mental health care in jail. By May 2022, the rate had risen to 42%.
“This planning effort brings together innovators, experts and advocates to understand the challenges and opportunities, and to help us achieve a coordinated system of mental health care in Travis County for people who have been stuck or are cycling to jail “, he said. District Judge Andy Brown.
Based on a proven model
“To address the complexities around the intersection of the criminal, legal and mental health systems, we need to pull back and work collaboratively across both systems,” said Steve Strakowski, MD, associate vice president for regional mental health and professor in the Department of Psychiatry and Behavioral Sciences at Dell Med. “It will take a ‘people first’ approach to find workable solutions to this mental health crisis, with health equity as a guiding principle.”
This approach is based on a proven model, Strakowski said. Since 2016, Dell Med has collaborated with the Texas Health and Human Services Commission, along with other partners, to develop an innovative model for a mental health care continuum at Austin State Hospital (ASH). The state-funded project includes a new hospital facility with 240 beds to support a new way of dealing with mental health issues.
Construction of the new ASH is expected to be completed in late 2023. The ASH brain health redesign model’s use of a steering committee of community stakeholders from all backgrounds and expertise cascading into a series of working groups supports a true collaboration in a complex system. Using a similar model for Travis County, it engages more people than is usually possible to support and provide insight into the best solutions for Travis County residents.
“For too long, we have overlooked the most valuable perspective when designing the intersection where criminal justice involvement meets mental health care: the perspective of the people receiving services,” said Parker LaCombe, director of peer support services at Austin State Hospital. “We have seen during the redesign of the new ASH how valuable the input of people with lived experience really is and using ‘people first’ as our guiding principle for both the work of the County’s Forensic Mental Health Project Travis and for the redesign of ASH, we are able to provide a person-centered approach rooted in the belief that recovery is possible for all people experiencing mental health and/or substance use challenges,” LaCombe said. .
The steering committee includes more than 15 experts and organizations that include academia, law enforcement, the judicial system, health care systems, advocacy groups, substance use experts, and people with lived experience and their families, among others.
Applying a health equity lens to find transformative solutions
The Travis County Forensic Mental Health Project will apply a health equity lens to its search for transformative solutions, seeking to address and redress longstanding sociodemographic disparities, Strakowski said.
Already underway since May, the project is currently evaluating existing systems, has formed a steering committee and will establish working groups to conduct an environmental scan and data analysis to produce actionable recommendations. By February 2023, the group plans to provide actionable and fundable recommendations to county commissioners.
“The lack of adequate behavioral health care for people experiencing mental health crises in the criminal justice system has forced jails to be among the largest providers of mental health care in the state,” said Travis County Sheriff Sally Hernandez. “Prisons were never designed to function this way. It is a travesty that causes unnecessary suffering and seriously depletes resources. This is a program that is desperately needed.”
The project could result in the expansion of existing programs or the creation of new programs or services, a central building space for services, and other innovative and distributed community components, said Strakowski, who chairs the steering committee. Ultimately, the group hopes to form a scalable and repeatable model of care for the nation’s mental health system.
