Prosecutorial diversion programs aid people in getting behavioral health help

(Stock photo)

When a certified peer counselor met Robert* at the courthouse, they were visibly scared — afraid for their life due to their history of self-harm and thoughts of suicide. Robert lived through a traumatic childhood, and was struggling with being on the autism spectrum. After the counselor connected Robert with intensive engagement and support, they were eventually ready to transition and begin life as Rose*.

In the Spokane County CSHCD, Rose engaged in therapy, took psychiatric medication, built skills for her anxiety, and eventually enrolled in college. The program considers her to be one of their successes in their mission to divert people with mental illnesses from being prosecuted.

The Spokane County CSHCD (officially called the Community Services, Housing & Community Development Department 5177 Diversion Program) is one of three prosecutorial diversion programs in Washington contracted by the Department of Social and Health Services. These programs — Spokane County CSHCD, King County’s Legal Intervention and Network of Care operated by Division of Behavioral Health and Recovery (through a subcontract with Community House Mental Health Agency) and the Tri Cities’ Greater Columbia Behavioral Health (which subcontracts with Lourdes Counseling Center) — together serve an average of 172 enrolled clients every month.

“These are individuals who’ve been arrested, they’re in custody, they’ve had competency to stand trial raised in their proceedings, and have then been identified as candidates who might be successful in the community getting mental health treatment, substance use treatment, and maybe some supportive employment,” said Jason Karpen, DSHS’ Office of Forensic Mental Health Services liaison and diversion specialist. “We try and identify those candidates and advocate to the court to have the court agree to release them to the community so they can receive the treatment that they need in the community as opposed to any one of the facilities.”

Most candidates for the programs face misdemeanor or low-level non-violent felonies charges. Potential clients receive assessments on their needs and whether the programs could be successful serving them in the community; all clients enter the programs voluntarily.

The prosecutorial diversion program falls under a spectrum of diversion efforts created as a result of the Trueblood lawsuit, all of which are meant to transform forensic behavioral health.

De facto mental health institutions

“The jails and prisons have become the largest de factor mental institutions in our country, and it is not the right place for people with severe and persistent behavioral health issues to be. They’re not getting their needs met, they’re not getting the treatment they needed, and these programs are really set to pull this population out of being criminalized just for being mentally ill,” said Tammie Baker, clinical director of the Community House Mental Health Agency. “I think that’s the biggest piece that people need to understand, is that we need to stop criminalizing mental illness.”

Reducing the numbers of mentally ill people in jail fits DSHS’ Behavioral Health Administration’s strategic goal to increase the number of yearly participants in state-funded prosecutorial diversion programs from 264 to 290 per year by June 2023.

The impacts of COVID-19, though, has meant less than the usual client caseload in the past couple of years. The pandemic resulted in a slowdown of arrests by law enforcement and a slowdown of the court systems, explained Karpen. In turn, fewer people who are struggling with their mental illnesses and with getting connected to services are encountering the prosecutorial diversion programs.

“For me, even if we are falling short of the targeted enrollment, if we are changing lives of even just a couple of people in each of those regions each year, these programs to me are worthwhile,” said Karpen.

Partnering with prosecutors

In King County, one client came into its prosecutorial diversion program after receiving 47 charges and incarcerations in a short period of time. Many of his charges were minor offenses — panhandling for cash, or trespassing by camping on a business property. In fact, the Community House staff outreached both through the client’s family and to the location he would panhandle. Eventually the client engaged in psychiatric services, took medications, and participated in respite housing.

“He was able to go from respite into independent housing and got an apartment, and is still in that apartment today, and is doing fabulous,” said Baker.

After a couple of more charges, soon after enrollment in the program, his involvement with the criminal legal system dropped and there was a dramatic change in the client’s recidivism.

“It’s that kind of proof over time and engagement and experiential evidence with our prosecutors that has solidified that relationship,” said Shanna Clinton, competency and intensive services coordinator with the King County Behavioral Health and Recovery Division.

In fact, that close partnership with prosecutors and defense attorneys is integral to the success of prosecutorial diversion programs.

“I think that is a pivotal piece of this program being successful,” said Baker. Her program works primarily with Seattle Municipal Court and King County District and Superior Courts, as well as with other municipal courts across the county, including Renton, Kent, and Issaquah; her staff meets weekly with prosecutors and defense attorneys to vet potential clients.

Part of the King County model is establishing dedicated prosecutorial liaisons at the Seattle City Attorney’s Office and at the King County Prosecuting Attorney’s Office. Also integral to the program is that it is low barrier rather than compliance-based, in order to engage and retain people who require significant behavioral health support as well as community services.

“That commitment to being a non-compliance-based program is really a response to the needs of the population who have serious mental health conditions and have a hard time complying with conditions of the court or very fixed structured programs that require them to present at a certain time on a certain day with a certain regularity,” said Clinton. “This program aims to be really low barrier and to invite people into care, and address the basic needs that they feel are meaningful and impactful to them, and motivate them to stay in this relationship with a behavioral health provider.”

Many clients have behavioral health issues and conditions that were not diagnosed or properly treated until their engagement with the prosecutorial diversion programs. The assistance clients receive can help address their root issues or behaviors that are causing the offenses and can help break the cycle to prevent future crimes and offenses, according to the Spokane County CSHCD.

Offering intensive outreach

While the three programs are granted flexibility in how they’re designed, they offer several similar services, such as connecting clients with behavioral health services, housing, food banks and meal sources, vocational support, and community groups. Clients also get help with transportation, financial aid, clothing and enrolling in programs such as social security. Building relationships with clients — whether through peer specialists, case managers or care coordinators — is crucial to helping them navigate through complex systems.

Baker calls it intensive outreach: “Clinicians work on building rapport, getting people engaged, helping with resources … helping them just get some stability in the community, and to be able to develop enough of a relationship to hopefully eventually get them linked to more long-term behavioral health services.”

Most clients are in the programs for 6 to 12 months; in some cases and regions charges are declined or dismissed at enrollment in the program, in others if clients successfully complete the programs, charges can be dropped.

“We hope at that point that having wrapped those services around them — housing, treatment, therapy, supported employment — they’re now in a better place in their lives to remain stable in the community and not recidivate and have to see us again in the future,” said Karpen.

Measuring success

The success of the prosecutorial diversion programs has been noted by DSHS’ Research and Data Analysis Division.

“Positive outcomes that we have seen out of that data analysis from RDA is that recidivism rates are lower overall for those who engage in our programs, although not for those with a history of competency services … we’ve also seen an increased rate of engagement by individuals with outpatient mental health treatment,” said Karpen. The programs are still exploring how to increase client participation in outpatient substance use disorder programs.

Karpen hopes to expand the prosecutorial diversion programs across the state, starting in areas that the data shows have the greatest needs.

The ultimate goal, though, is the success of the clients.

“I want to see positive outcomes for whoever comes through these programs; I want to see lives transformed; I want to see people who come to us needing these services, needing help, addressing their mental illness and/or substance abuse, getting them stabilized in their community and productive then within their community, living their best lives,” Karpen said.

*Names changed for client privacy.

(By Suzie Ovel)

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