Request for Information: Forensic Diversion Pilot

Information Due Date: Monday, March 19, 2018 , 12:00pm CST

Introduction:

The Illinois Department of Human Services (IDHS) would like to thank you in advance for reviewing this Request for Information (RFI) and assisting the State of Illinois (State) in this effort. IDHS, Division of Mental Health (DMH), is Requesting Information (RFI) to assist in identifying strategies and program gaps that may create options for restoration of competency for individuals found unfit to stand trial (UST) due to a mental illness.

Illinois, like many other states, has experienced an increase in the number of individuals being referred for competency restoration services over the past few years. In Illinois, restoration of competency is the responsibility of the State Operated Psychiatric Hospitals (SOPH) when a suspect is in custody and determined to be in need of inpatient restoration services. As a result, the composition of the state's psychiatric hospitals has changed. With an increasing demand to serve forensic patients, there is a corresponding reduction in the availability of civil beds.

Through this RFI, Illinois is seeking specific information from six counties, outside of Cook, that make some of the largest number of UST referrals. We want information regarding your county's awareness of issues, past efforts to address concerns and interest in developing programs and strategies to successfully divert individuals from both the hospital and the criminal justice system, whenever appropriate, and to help Illinois decrease the time that it takes to admit UST individuals who require competency restoration services.

The State wants to identify evidence based and innovative intervention strategies that can successfully divert individuals from justice settings to treatment systems, determine their success, and see if innovative programs can be replicated (and sustained) in other counties or communities. Successful interventions can operate at any intercept points across the sequential intercept framework - Law Enforcement, Initial Detention/Court Hearings, Jails/Courts, Reentry or Community Corrections (Probation/Parole) - but they need to function in collaboration with appropriate correctional systems.

DHS/DMH anticipates working with 2-3 counties that have high utilization of UST beds to develop alternative programs. Some of these programs could include Outpatient Restoration, Misdemeanor Diversion Programs, Jail-based Competency Restoration Programs and/or Conditional Release Programs. Mentors from counties that have low utilization of UST beds due to past interest and local initiatives are welcome partners in this endeavor.

Background:

Across the United States an estimated 2 million people with serious mental illnesses are booked into jails annually, and almost three-quarters of these people also have substance abuse disorders. These persons tend to stay longer in jail, are at higher risk of returning to jail than those without mental illnesses and cost county jails two to three times more than those without treatment needs, according to the Stepping Up Initiative, a national movement to reduce the number of people with mental illnesses in jails. The Stepping Up Initiative is led by the National Association of Counties (NACo), the Council of State Governments, and the American Psychiatric Foundation with the goal of reducing the number of people with mental illnesses in jails. Nationwide, nearly 40 percent of people with a serious mental illness end up in jail at some point in their lives. It is difficult for jails to provide the recovery and treatment services that individuals with mental illnesses need, and being jailed makes recovery more difficult and increases recidivism for this population. The Stepping Up Initiative wants to improve the criminal justice system for individuals with mental illnesses by (1) reducing the number of people with mental illnesses in jails; (2) reducing the lengths of stay for these individuals; (3) increasing connections to community treatment resources upon release from jail; and (4) reducing recidivism rates.

Serving as Illinois' mental health authority, DMH has: no control over the number of referrals it receives, - a finite number of beds available, and limited control over the court's decision on cases. This creates both a long waitlist and long length of time on the waitlist. In 2017, Illinois had an average of 75 individuals on its UST waitlist. The average wait-time for admission to a state operated hospital was 35 to 45 days. The average length of stay in treatment and discharge back to jail has been 3-4 months, at which point, the misdemeanor case was usually dismissed or adjudicated as "time served". This scenario highlights an inefficient use of scarce and expensive forensic beds in cases where an individual may have been more appropriately and more quickly treated in a civil or community hospital setting.

1. Information Requested

As an initial step, Illinois is interested in learning about the experiences and current landscape regarding the criminal justice system from various counties throughout Illinois, with a focus on those with high referral rates to an SOPH. In particular, we are looking for the following information:

  • Has your county adopted the Stepping Up Resolution?
  • Has the county assembled a task force/representative team?

a. Who is on the task force?

b. Does it meet regularly/how often does it meet?

  • Do you feel the leadership in the county is committed (including the planning team, elected bodies, sheriff's office, Mental Health/Behavioral Health Center(s), etc.)?
  • Is there a chairperson/designated individual who is leading things?
  • Has the planning team participated in process analysis/sequential intercept modelling/tracing each step of a person's involvement in the Criminal Justice system? What was learned? Any unknowns? Where were the gaps in service?
  • Are the county-specific needs clear? And priorities?
  • Has a concrete plan of action been developed? What does this include?
  • What have been the biggest challenges?
  • What does the county need to move forward?

Please answer the following questions:

  1. Are you aware that your county's rate of UST referrals is high?
  2. If so:
    1. What efforts have you made to address this? (i.e. have you pursued any planning grants, what have you learned?)
    2. What would you propose to do as a next step?
    3. What type of support from the State would be required to implement?
  3. If not:
    1. Are you interested in working with the state to analyze and plan?
    2. Who would the partners from your community need to be?
    3. What type of support from the State would be required to implement?
  4. Who are the key stakeholders that need to be involved in forensic diversion and the degree to which they are already engaged and involved in seeking solutions?

Additionally, Illinois is interested in learning more about the following efforts undertaken by communities to understand/address the forensic challenges.

  • What types of research/data collection have you conducted regarding criminal justice issues in your county?
  • Have you worked with the Jail Data Link Program, universities or other partners to collect or analyze local data? Are data collected electronically?
  • Based on community conversations and collaborations, what patterns and/or trends are you seeing regarding mental illness and criminal justice systems overlap?
  • Are reports routinely created on the jail population?
  • Number of total and unique individuals identified as having a serious mental illness (SMI) booked into jail and as percent of total jail population
  • Average length of stay for people with SMI, by release type (pretrial population, sentenced population, etc.)
  • Percentage of people with SMI connected to community-based behavioral health services upon release, by release type
  • Percentage of people with SMI connected to community supervision and/or treatment programs, by release type
  • Percentage of failures to appear and/or re-arrest for people with SMI released pre-adjudication, and re-arrest for post-jail sentences population with SMI
  • Percentage of technical violations and new criminal charges for sentenced population with SMI who are assigned to community supervision
  • Number of prior jail admissions for people identified with SMI

The complexity of this population requires multiple strategies for diversion of individuals with mental illnesses from the criminal justice system, reducing inpatient waitlists, and addressing budget concerns at all levels. Individuals with mental illnesses should have the opportunity to receive the care and support to best manage their symptoms, live in the least restrictive settings possible, and reduce their risk of recidivism. The benefits are immense; from individuals who will receive the right services at the right time in the right place, to those who are on waiting lists for services to commence, to effective utilization of state funds to better serve individuals. This initiative is expected to impact - and hopefully alleviate - jail overcrowding and the financial burden on the county and state budgets.

Helpful resources may be found in the attached PDF file or in the links below:

http://www.naco.org/resources/reducing-mental-illness-rural-jails

https://stepuptogether.org/toolkit

2. RFI Schedule and Submissions

Responses to this RFI must be submitted on-line to Sharon.coleman@illinois.gov. Submissions are due no later than 12:00 p.m. CST on Monday, March 19, 2018.

All RFI responses are confidential and will only be shared with the leadership at the Illinois Department of Human Services and our technical assistance partners.

  • RFI Released: January 31, 2018
  • Responses due: March 19, 2018 - 12:00 pm CST

For questions, please contact:

Sharon.Coleman@illinois.gov

This RFI does not constitute any commitment by the State to follow any particular procurement course of action. This RFI is for informational purposes only and will not result in an award of contract. The purpose of this RFI is to determine what services your agency can offer IDHS. Failure to respond to the RFI does not preclude subsequent participation in any procurement process that may be developed as a result of this RFI. Any and all information provided in response to this RFI shall be considered to be the exclusive property of the State and will be kept confidential to the extent permitted by law. Any information provided in response to this RFI claimed to constitute a trade secret and/or otherwise claimed to be confidential, proprietary and/or privileged (See section 7(1)(g) of the Illinois Freedom of Information Act 5 ILCS 140/7), must be supported at the time of submission by a detailed statement and written justification, or any such claim(s) shall be deemed waived. Please be advised that the State cannot reimburse any expenses that may be associated with responding to this RFI.