Catching those who fall through cracks of crisis, criminal justice
PITTSFIELD — There's a significant disconnect between the criminal justice, addiction treatment and mental health care systems. That fact is nothing new.
What is new is the way local law enforcement, behavioral health and human services sectors are coming together to talk about it to create more options for prevention, treatment and care rather than incarcerating people who are struggling with these issues.
Nearly 60 local, regional and state experts in the above fields — most of them with 10-plus years of experience — sat down for a day and a half last week in the Crowne Plaza ballroom to do a walk-through of different case scenarios a person might face when an addiction or behavior might result in a brush with the law.
"To be quite honest, jail really isn't the best place for someone with an addiction or substance abuse disorder," said Jennifer Kimball, coordinator of the Berkshire Opioid Abuse Prevention Collaborative.
The Pittsfield Community Justice Project, part of a state-funded statewide initiative, was coordinated by Marisa Hebble of the state Office of the Trial Court, in collaboration with the state Departments of Mental Health and Public Health.
"We look at the community and how, when [people] flow through these systems, where their needs are being identified, and how they should be connected with different treatment and support," Hebble said of the project, formally known as sequential intercept mapping.
The term "intercept" characterizes the depth of a subject's involvement with an intervention system. Intercept 0 means someone is living freely within a community. Intercept 1 is when law enforcement or emergency services gets involved; Intercept 2 is initial detention and/or court hearings; Intercept 3 is time spent within the court or prison systems; Intercept 4 is the point at which a person is re-entering society having been through a system; and Intercept 5 involves community corrections and support, like parole board determinations and probation needed before a person is classified back to Intercept 0.
But transitions between intercepts are far from seamless and can get complicated by different agencies and experts not communicating and working with one another.
When someone gets involved in the criminal justice system because of a drug abuse or behaviors relative to a mental illness, getting individuals treatment hasn't historically been a top priority, especially when it comes down to criminal charges and incarceration. And often, a substance abuse issue is compounded when a person has a pre-existing mental health disorder.
One such example is how an addicted person, or someone who should be taking medications to balance their mental health symptoms, can fall through the cracks is when they become incarcerated for 24 hours or longer. An incarcerated person who has been using any kind of substance could face withdrawal symptoms from either the illegal substance they were using or the medication they were using to treat an illness or addiction. The longer they're away from it, their health conditions, behaviors and abilities to think clearly and make good decisions become diminished.
By having representatives from multiple agencies, including the courts, Berkshire County House of Correction, Brien Center and others sitting down together using the sequential intercept mapping approach, these cracks are better highlighted.
Al Bianchi, assistant deputy superintendent for programming, re-entry classification and education for the Berkshire County Sheriff's Office, said while it makes sense for an offender to get the medications they need, personnel at the House of Correction or at local police stations may not have the authorization needed to obtain and administer drug addiction treatment medications like Suboxone or methadone, or even medications to treat things like anxiety or psychosis.
Bianchi, Hebble and Kimball agreed that the different agencies involved in the criminal justice, mental health and substance abuse treatment systems all have a role to play in a person's outcomes, but that the work is subject to the silo effect, where decisions and actions are being made separately instead of in collaboration, despite the fact that they're all dealing with the same person.
"Not all things are being done in cooperative ways, and sometimes that results in duplicating service where we could be doing something else to help people," Bianchi said. "This process lends us this opportunity to see where those situations lie."
"We're all working with different populations," Kimball said. "By taking the time to do some mapping that will show our strengths and challenges it will also help us better share information. For example, the criminal justice system needs to know where I'm coming from and they need to let me know what's going on."
Dr. Jennifer Michaels, medical director for the Brien Center, which provides mental health and substance abuse services, said any response to the issues identified through the mapping workshop should be "informed by urgency and tragedy."
"Forty people died in Berkshire County from overdoses last year," she said, noting that this means that the families and loved ones of those 40 people have also been impacted.
Both Michaels and Kimball referred to a state public health study released last month that noted how people who are struggling with addiction who are released from prison are 56 percent more likely to overdose within the first month, and also face a high risk of re-entering the system. This mostly happens because of lack of treatment and lack of support upon re-entry.
Michaels said statistics also indicate that for every one overdose death, there are 120 other people who are "in the grips of severe addiction." Using last year's overdose deaths, that means 4,800 residents were at risk of losing their struggle with addiction.
"They represent our community, our brothers and sisters, parents, sons and daughters," Michaels said.
After participating in the Berkshire community justice and mapping workshop, Hebble said she's impressed with local agencies' willingness to strategize solutions. Some of the attendees of this workshop were among the 200-plus people who also attended earlier in October a forum about creating a trauma-informed Berkshire County, which relates to the issues the mapping project highlights.
Hebble said the Berkshire County Sheriff's Office is being looked to by the state to help support a follow-up on the workshop in 30 days.
In addition to doing this behind-the-scenes work, both Bianchi and Michaels said highlighting to the community the programs that Berkshire County does have and processes that are effective is also important.
Bianchi, for example, highlighted the Sheriff's STOP (Short-Term Opioid Prevention) and HARP (Heroin Abuse Relapse Prevention) programs that involved pretrial treatment programs, as well as other longer-term programs designed to help divert those struggling with substance abuse from the prison system.
Michaels said she also would like to see more people who have successfully navigated through the systems and living healthily share their stories. Both she and Bianchi said they're certainly out there, but that some people still feel ashamed to have a history with law enforcement or substance abuses.
"We need people in recovery who are role models," Michaels said. "And we need to support those people and to tell their stories, too."
Jenn Smith can be reached at 413-496-6239.
Five priorities ...
The community justice mapping workshop participants looked at the gaps the county is facing and came up with five priorities to address:
• Having more law enforcement members go through crisis intervention team training and developing a co-responder model, meaning both police and social workers can respond to a crisis situation to assess the issue together.
• Becoming more trauma informed and providing training across intercepts to work with populations that historically face a high concentration of trauma.
• Developing ways to support peer recovery and recovery learning centers as they face budget cuts. For example, in Massachusetts, only a few drug courts utilize recovery coaching prior to reentry, despite evidence of its effectiveness.
• Increase transition support services including the number of beds for substance abuse and addiction care and treatment.
• Continue exploring options by convening a cross-sector coalition task force for community justice.
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