Webinar presenter Jason Winsky answered a number of your questions after his presentation, Policing Vulnerable Populations: Mental Health and Substance Use Disorder Programs. Here are just a few of his responses.
Audience Question: What’s a deflection?
Jason Winsky: Deflection occurs when somebody is out in the community and is contacted by a police officer or a sheriff’s deputy. What deflection refers to is that the person might be subject to criminal charges. They might be in possession of heroin or methamphetamine or another illegal substance. A deflection occurs when a person instead of being brought to the jail on those charges is instead, taking the on-demand treatment.
Audience Question: What kind of incident would not qualify for deflection?
Jason Winsky: We try to deflect as wide of the population as we absolutely can. The two places that we run into problems during deflection would be domestic violence-related offenses, and then serious felonies that involve like an injury to a person, like a serious felony assault.
Audience Question: What about low-level probation warrants? Can they get medication, maintenance as required?
Jason Winsky: For low-level probation warrants, we try to work with our probation officers here, in Tucson. In some cases that the person needs to be revoked or we’ll take them to the jail but we also have intercepts there at the jail to capture this population. So the idea would be to book the person in the jail if absolutely necessary, but then get them back to on-demand treatment and back to stabilize in a treatment facility but back at the jail as soon as possible. In some cases, we don’t have to be those probation warrants and we can get on front of those and steer the person back into a treatment court and back into their conditional treatment.
Audience Question: What’s the Memphis model?
Jason Winsky: Memphis model refers to the crisis intervention training that I talked about at the beginning of the program. Really some of the features of the Memphis model includes a full 40-hour mental health and substance use disorder training, voluntary participation by the students, reality-based training scenario. participation by the community and advocates and a real alternative to jail that’s taught to the students in terms of where are we going to take this population instead of chasing them into the jail. Those are some of the highlights of the Memphis model.
Audience Question: What does your mental health support team look like? Who’s involved? What is the day-to-day function? And then we have a piggyback question that do you have sworn as well as non-sworn? Can you talk a little bit more of how the team is compiled?
Jason Winsky: We have a separate webinar that maybe we can show broadcast again or that we could present again that drove down way deeper into the day-to-day functions of our mental health support team. But to give you a 50,000-foot view, our mental health support team consists of both commissioned officers, we have officers – detectives and sergeants, and then non-commissioned personnel which includes the peer responders and the co-responders that are mentioned in this presentation. The day-to-day activities include serving mental health commitment orders, so in some places, those are called COT – Court Order Treatment or AOT – Assisted Outpatient treatment. One of the main functions of our mental health support team is that we centralize the service of those orders. The vast majority of those orders in our city and our county here in Tucson are served by the mental health support team. Going out to the community, serving those court orders and taking those people on an involuntary basis to a treatment facility. On the other side of our programs, the substance use deflection program which is underneath the mental health support team model. Those officers pull out, follow up on overdose investigations. They do active outreach and are part of the town areas and they are also responsible for all of the training related assessments to deflection programs as well. They also do the pro-social contact from the angel deflection that I mentioned earlier. So really that’s kind of the two sides of what’s in a mental health support team does on a daily basis.
Audience Question: Because of the US v. Lundin case, are you still going to help and pick up people for transport and that kind of thing? How are you handling that? Especially in light of the case?
Jason Winsky: I’ll be very honest. I’m not too familiar with that case. If Raul wants to connect to me via e-mail; offline, I’d be happy to drill deeper and answer that question. However, the answer is we do go and pick people up from their houses. Usually, that’s under involuntary basis, if under a court order so that’s issued by a judge. If it’s on a voluntary basis, perhaps following up with someone who was a victim of an overdose. That takes a voluntary contract with that person. They are not legally required nor do we force them to be transferred or to go with us.
Audience Question: We hear opinions on both sides. Train all in CIT versus the Memphis model – specialty units, etc. How do you address those conflicting opinions in an agency?
Jason Winsky: I get this question a lot actually when attending conferences around the country. Whatever your agency is facing, your county or your city, your sheriff’s department, your police department, whatever your jurisdiction is facing, you need to customize your CIT program. That’s wholly supported by CIT international. You might have a police department that’s only 10 people, right? If you feel like all 10 people need CIT training then I think there’s a best practice out there that says go ahead and train all 10 people on that police department CIT. What I really hate to see is people being disciplined in the CIT. I think what you have there is you have a student -that is not motivated to learn, not motivated to work with the population. It could actually be disruptive to the other members of the class. The other thing we see quite often are CIT with the training academy, again if that’s necessary from where you are, that’s what you need to do. The problem that we see with that in Tucson is that you might have younger officers that are brand new in the academy and they really might not just have a life experience yet with this population to really get a full scope of trying to really get the purpose and meaning of it. If people would like to connect with me again via email, there are actually research studies now that show that volunteering to the CIT has a better outcome from the arrest versus deflection and even the use of force, we have volunteers in CIT versus involuntary CIT.
Audience Question: Are there any special considerations that need to be taken to ensure that privacy laws like HIPAA aren’t violated in a co-responder model?
Jason Winsky: Yes. Here’s what we’ve done in Tucson, again the Los Angeles Police Department their co-responder model is just phenomenal. We’ve learned a lot from them and they’re learning site as well. There’s funding available to go visit them. A couple of things that we gave to address the HIPAA concern, first is we train around it. Whenever we get a new co-responder or a new office to do lots and lots and lots of training around HIPAA. We have the treatment community come in and talk about what can be shared. Second that we do is we have a standalone computer system. Our co-responders are not using our police computers and our police officers are not using co-responders computers. The third thing we do is we never take the crisis exception for granted. We all understand that there is an exception in HIPAA when somebody is in a major crisis, danger to self, danger to others. As a mental health team, really that’s what we do all day. That’s the whole population we’re doing. Just because our police officers and co-responders get to know each other, doesn’t mean we just assume that there is a public safety exception on every case that we investigate. We train our officers to clearly articulate and even in emergency situations, our co-responders the necessity of information. I want to mention one more quick thing, our co responders put up barriers around HIPAA to our police officers even though they are friends and know each other and close working together, co-worker. Oftentimes our co-responders will make private phone calls and private emails to treatment providers and actually not share that information with our police officers. I think it’s important to remember that one of the things that’s effective in a co-responder model is a police officer shares with a co-responder a ton of information about what’s happening with a client or the patient involved. The co-responder is then able to link that information to the assigned navigator or case manager. In some cases actually reports very little facts to the police officer other than they received the information in terms of what the medications going to be, what the treatments going to be, is the person going to hospitalized or not, we try not to focus our police officers on those outcomes. That’s between the community to tackle.
Audience Question: Jason, as you know in some jurisdictions, jails are effectively used as de facto mental health hospital. How can we change this philosophy in our own city and move towards deflection?
Jason Winsky: I hesitate on answering this question because I can hear the advocate in my head, their voice was in my NAMI friend. I think the question I would have to ask back that person who asked the question is where really are we seeing that jails are effective treatment centers? Let me caution that because I hear someone typing a response already right. I think if you’re in a limited jurisdiction if you’re in a small jurisdiction, you’re in a rural area or a county, and we’ve had learning sites that deal with counties. If jail is the only option where you can administer medication, where you can make the person safe, or you can make the community safe, well then yeah, that happens here too. In some cases we’re going to have to book that person into the jail and there’s really no other way around it. What I would say though for sure is that I think there’s a volume of data and studies published on this that say really only in rare cases is jail is going to be the most effective place to take a person who’s in crisis or in need of induction or on-demand treatment. So I would answer that question by saying the idea, because the question really is how do we move towards deflection, right? What I would say is start studying the cost of your jail and the efficiency of your jail. We were absolutely shocked when we did that here with our team accounting partners. When you find out who’s in your jail and why they’re in jail and what the cost is of putting that person to jail. That’s when deflection and diversion solutions are really going to become viable. If you look at people being repetitively taken into jail because again, that’ll be an indicator that that doesn’t work.
Audience Question: Have you done any kind of cost-benefit analysis that shows how these programs- each of these different types of programs, how they saved, their county department’s time, funds, staffing, what does the cost-benefit analysis show in terms of all different programs?
Jason Winsky: So we do. When I started the presentation and said that were far from perfect, this is definitely one of the areas, I mean, who isn’t struggling with capturing this data right now and kind of proving that these things work? A lot of these programs right we know anecdotally that they work. We can see the outcomes but the question is how do we really improve it using the data? From our law enforcement perspective, our county here owns and operates the jail. We have studies, I mean without question, that show that reducing our jail population unequivocally saves money. I mean that’s one of the most expensive options that we have at least here in Tucson is booking the person. So we have data that shows we’re driving down bookings and driving down both county and city costs in that scenario. I can also make available via email. Our treatment providers also have data surrounding reduced crisis bed usage and reduced ER or emergency room or emergency department bed as well. As I’ve mentioned before with the co-responders in particular; one of the things that they can do very effectively really with very limited police assistance other than just making the situation safe is connect people with their existing treatment. So it’s beyond just not booking the person into the jail. That hurdle we’ve kind of, at least on our mental health support teams, have had pretty much clear. But we also don’t want to not book the person in jail and then just take them to an emergency department somewhere. We totally understand that that’s not a resource savings as well. So what the co-responders are able to do, again outside of our presence, interacting one on one in those tough one on one communication with consumers is they’re able to identify, but wait a minute, this person does have a case manager. They do have a navigator. They are able to make an appointment even in some cases for that person and what does is that saves you the jail, that saves you the crisis bed, and the ER bed when your co-responder is able to do all three of those.
Audience Question: Knowing that you’ve been operating now for a while, and certainly you’ve helped other agencies, what are some of the biggest challenges, other agencies have faced, maybe you did too when you first started, when they’re first starting out, what are some of those big first step hurdles that people need to pay attention to, think through, maybe anticipate as they are trying to either propose this to their leadership or get this approved. What’s your advice?
Jason Winsky: So we certainly made a lot of mistakes launching this thing. We’re six years in and I would say we still make mistakes. One of the first things that I would say from a law enforcement perspective is really, I can’t emphasize this enough and I know I said that really start studying, really start compiling data on who is in your jail and why and how long is the average length of stay in your jail and who’s repetitively getting into your jail. That I guarantee you almost anywhere in the country will be a conversation starter around what is the cost of that and that would answer funding and what are we actually are we trying to do and what outcomes are we measuring. The second thing I would emphasize the most is leadership buy-ins. Police Chief Chris Magnus and Sheriff Mark Napier, they have pushed this program and really funded it and really made resources available to have these and keep them going. How do you get leadership buy-in? That’s a whole other webinar. Very shortly that leadership buy-ins start having community stakeholder meeting. If you have a NAMI, start with your local NAMI. If you have an advocacy group, get out there and get to know them and start having that high-level key stakeholders meetings about what you want to do. The last thing is this is something I stumbled over when we very first started although we were able to correct it later, is the second you start operating, collect all the data they can from day 1 or even before day 1 so that later on you are able to actually show what’s your data before you started and after.
Click Here to Watch a Recording of Policing Vulnerable Populations: Mental Health and Substance Use Disorder Programs.