Mental health experts at 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 establish solutions rooted in person-centered and evidence-based care for people stuck at or repeatedly cycling through this intersection.
Across the nation 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.
About 2 million people with serious mental illness are incarcerated annually in the U.S. One in 5 U.S. adults will experience a mental illness within a given year. In Travis County, 37% of people incarcerated in October 2021 were receiving mental healthcare in jail. By May 2022, the rate had increased to 42%.
“This planning effort brings innovators, experts and advocates together to understand the challenges and the opportunities, and to help us achieve a coordinated system of mental healthcare in Travis County for people who have been stuck in or are cycling pointlessly through jail,” said County Judge Andy Brown.
Based on a Proven Model
“To address the complexities around the criminal, legal and mental health system intersection, we have to step back and work collaboratively across both systems,” said Steve Strakowski, M.D., 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 actionable 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 continuum of mental healthcare at the Austin State Hospital (ASH). The state-funded project includes a new 240-bed hospital facility to support a new way of treating 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 work groups supports a true collaboration across a complex system. By using a similar model for Travis County, it engages more people than usually possible to support and provide insights for the best solutions for Travis County residents.
“For far too long, we have overlooked the most valuable perspective when designing the intersection where criminal justice involvement meets mental healthcare: the perspective of people receiving services,” said Parker LaCombe, director of peer support services at Austin State Hospital. “We have seen throughout the redesign of the new ASH how valuable the input of people with lived experience truly is, and by using ‘people first’ as our guiding principle for both the work of the Travis County Forensic Mental Health Project and the ASH redesign, we are able to ensure a person-centered approach rooted in the belief that recovery is possible for all people experiencing mental health and/or substance use challenges,” said LaCombe.
The steering committee includes more than 15 experts and organizations spanning academia, law enforcement, the judicial system, healthcare 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 in its quest for transformative solutions, striving to address and correct longstanding sociodemographic inequities, Strakowski said.
Already underway since May, the project is currently evaluating existing systems, has formed a steering committee and will establish working groups to perform an environmental scan and data analytics to produce actionable recommendations. By February 2023, the group plans to provide actionable and fundable recommendations to the county commissioners.
“The lack of adequate behavioral healthcare for people experiencing mental health crises in the criminal justice system has forced jails into being among the largest mental healthcare providers in the state,” said Travis County Sheriff Sally Hernandez. “Jails were never designed to function in this manner. It’s a travesty that causes needless suffering and seriously depletes resources. This is a program that’s desperately needed.”
The project may result in expanding existing programs or creating new programs or services, a central building space for services, as well as other innovative and community-distributed components, said Strakowski, who leads the steering committee. Ultimately the group hopes to form a scalable, replicable model of care for the nation’s mental health system.