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Milwaukee Seeks to Support, Not Jail, Those with Mental Illnesses

A $2 million grant will spur criminal justice transformation

Jun. 21, 2016
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There’s a growing recognition that jail isn’t the best place for those with a mental health issue who have committed low-level offenses.

Now, thanks to a $2 million grant from the John D. and Catherine T. MacArthur Foundation, Milwaukee County will be implementing strategies to provide support to those with a mental illness to keep them out of jail.

The Milwaukee Community Justice Council—a collaboration of local law enforcement, behavioral health experts, judges, prosecutors, defenders and corrections staff—was one of just 11 jurisdictions that won the foundation’s national Safety and Justice Challenge in April.

With the stated goal of reducing racial and ethnic disparities in the justice system, the Milwaukee grant is aiming to shrink the average daily jail population by 18% over two years by targeting low-level offenders who need mental health help. Since people of color are overrepresented in our local jails, the new grant will have its greatest impact on African American and Latino Milwaukeeans who are in the criminal justice system.

The new initiative represents a turning point in the local criminal justice system’s treatment of individuals whose offenses are linked to their mental health issues. An estimated 35% of those in the county jail and House of Correction receive psychotropic medication.

“It’s an opportunity for us to really focus on a comprehensive plan to keep the mentally ill out of our jails and, by extension, out of our prisons,” Milwaukee County District Attorney John Chisholm told the Shepherd. “And we do it in a way that keeps the community safe and also takes advantage of resources that exist in the community and knits all of those together so that we’re making much more informed, intelligent decisions about how we handle people who are suffering from mental illness.”

Tom Reed, the first assistant state public defender and a member of the Community Justice Council, said the MacArthur Foundation’s Safety and Justice Challenge is an acknowledgement that as a nation we need to get smarter about using law enforcement and criminal justice resources and, at the same time, not unnecessarily harm low-level offenders, some of whom have mental health issues, who could be better served outside of the system.

“There are a very large number of people in jails and there has not been a systematic analysis and review and thinking about do we have the right people in jail for the right amount of time,” Reed said.

Milwaukee County Health and Human Services Director Hector Colon emailed that the grant will provide quicker access to treatment for those with mental health or substance use issues.

“Individuals who are booked in jail but identified as suffering from mental health or substance abuse issues will be removed from jail within 48 hours and connected with appropriate services,” Colon wrote. 

The New Approach

Chisholm said the new initiative requires training, resources and staff and will be taking shape in the next few months. Specifically, the $2 million Milwaukee grant covers these key areas: 

Implementing the book and release strategy Downtown: When you’re arrested for a low-level offense in the Milwaukee County suburbs, you’re likely to be taken to the district station, given a court date and released—what’s called “book and release.” In the City of Milwaukee, however, almost every arrest—including those for misdemeanors—results in a trip to the police station for booking, then a trip to the county jail and re-booking there. The grant allows the Milwaukee Police Department (MPD) to start a book and release pilot program at the Downtown District 1 station.

Reed said the Community Justice Council’s analysis found that the MPD’s process is slow and can result in some individuals being detained in jail for up to five to eight days, which can have a very disruptive effect on that person’s health and wellbeing, employment, housing and relationships.

“The book and release strategy can be thought of a way of speaking to a set of process improvements that are designed to release people promptly who we are going to be releasing and doing that in a way that minimizes that disruption wherever possible,” Reed said. 

Chisholm said the initial pilot program would focus on those who seem to have a mental health issue, but could be expanded to include others who are suspected to have committed low-level, nonviolent offenses as well. It would also bring MPD’s policies more in line with suburban policing strategies and reduce the disparity in the treatment of disproportionately minority offenders in the city and white offenders in the suburbs.

Changing police interventions: The MacArthur grant also helps to change the way those with a mental health issue first encounter law enforcement. The grant will help Milwaukee County increase the number of those who specialize in helping individuals during a mental health crisis, the Crisis Mobile Services and the Crisis Assessment Response Team (CART).

The proposed 2017 budget for Milwaukee County’s Behavioral Health Division (BHD) adds two CART teams to the existing two teams, which only operate within the City of Milwaukee, with the help of the MacArthur grant. One of the new teams would be deployed county-wide. A budget amendment offered by Milwaukee County Mental Health Board members Mary Neubauer and Brenda Wesley would fund an additional five teams, with three focused on West Allis. The board’s finance committee whittled that down to one additional team last week—apparently because Milwaukee County Executive Chris Abele told the board he didn’t want the board to raise property taxes and board members are concerned about the amendment’s financial impact. But it could be reintroduced at the full board’s meeting on the budget on June 23.

The Mental Health Board is also looking at ways to expand resources in the community and decrease reliance on visits to the emergency room and in-patient services. The 2017 BHD budget includes funds for a North Side community hub, where individuals with a mental health issue can get help, but offers no funds for a planned South Side counterpart. The budget does include funding for 24-7 staffing of crisis resource centers, which Abele had vetoed in last year’s budget.

Chisholm said he’d welcome as many CART teams as possible, but his current focus is along the Wisconsin Avenue and State Street corridor, from the river to 27th Street, where his office’s data show is where it’s needed most. 

Screening for mental health issues: The grant also allows the county to provide assistance to those who are booked on a low-level crime largely as a result of a mental health issue.

“Somewhere between two thirds and three quarters of the people who are incarcerated with mental health issues are there for misdemeanors and extremely low-level, nonviolent felony cases,” Reed said. “Those felony cases can be like spitting at someone.”

Instead of booking them into the jail and disrupting their lives, the MacArthur grant would allow the county to begin offering supportive services to this vulnerable population and stabilize them so that they don’t become even more ill while being held in jail.

“People can get trapped in the court system,” Reed said. “What the post-booking stabilization offers is the ability to find someone before they are charged and we get them into the mental health care that they really need and then they are stabilized so if they are facing criminal charges they are competent when they are facing them.”

Reaching out to heavy users of the system: A Community Justice Council analysis found that there’s a strong overlap between high law enforcement encounters and high mental health needs. They found that in one year, 85 Milwaukeeans used $4.8 million of behavioral health services and also consumed a high amount of law enforcement resources. Instead of arresting and jailing these heavy system utilizers, the grant would set the stage for connecting them with comprehensive mental health services and support.

Recognizing trauma: The vast majority of men and women with mental health issues in the criminal justice system are victims of trauma—either experienced personally or as a witness to it. Major trauma has a physiological impact on the brain and changes the way the individual responds to stress or other triggering events. The MacArthur grant will allow the county to develop a trauma-informed training program for those working in the criminal justice system so that they’re more aware of the signs of trauma in the individuals they encounter.   

Chisholm said victims of crimes currently are screened for trauma exposure. Going forward, offenders will be screened for it as well, just as they’re screened for mental illnesses or substance abuse problems.

“We spend a lot of our time directing victims to trauma-informed care,” Chisholm said. “The question that becomes so abundantly clear to me is the distinction between the offender and the victim is on a spectrum. Sometimes the victims have been offenders and sometimes the offender has been a victim. It just seems that if we’re aware of that, why not introduce some sort of trauma-informed screening toward behavior change?”

Better data collection: Chisholm’s office has become a data-driven one, and this grant would allow for better data collection and sharing so that members of the criminal justice and behavioral health systems can make better decisions about this targeted population.

Looking beyond this grant, in the long term Chisholm said he’d like the county to have a mental health court, similar to the drug treatment court, for those who are charged with crimes related to their mental health issues. 

Advice from Florida

To help support and inform local leaders, the Milwaukee Community Justice Council and the state public defender’s office brought in Judge Steven Leifman of the Miami-Dade Criminal Mental Health Project to speak about pioneering efforts there to reduce the number of low-level offenders with mental illnesses. Leifman told the audience at Marquette University on June 14 that as a judge he realized that he was a gatekeeper to the largest psychiatric institution in Florida—the jail—since more mentally ill people were incarcerated than getting treatment in hospitals. Even worse, the local jail was crowded and filthy, inmates weren’t getting necessary support, and policy-makers were disconnected from the impact of their decisions about mentally ill offenders, he said. Leifman realized that jail wasn’t the best option for these individuals.

“In many ways, we made mental illness a crime,” Leifman said.

Over the course of a decade, Liefman and other stakeholders have transformed their system and offer more services for those with mental illnesses who have gotten caught in it. Resources have been freed up, recidivism is down and, best of all, these individuals are getting the help they need so they can live their best lives.

Leifman said the problems encountered in Miami and Milwaukee are experienced throughout the nation as we fund jails but not mental health services. 

“As you start to peel back why this is occurring you’re going to find a parallel track of untreated mental illness and substance abuse and massive cuts in those areas in this country,” Leifman said. “We have replaced hospitals with our jails. It has become a very shameful American tragedy, one that has not worked to serve anyone very well. It’s one that must be reversed. And the good news is that it can absolutely be reversed.”

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