Alliance Note: Yesterday, Alameda County in California reached a settlement with Disability Rights California and the US Department of Justice to increase voluntary community based mental health services and reduce the number of involuntary hospitalizations and incarcerations for people with mental health challenges.
The settlement is the culmination of negotiations following a lawsuit filed by Disability Rights California, along with their co-counsel Disability Rights Education and Defense Fund, the Bazelon Center for Mental Health Law, Goldstein, Borgen, Dardarian & Ho, and the Law Office of Aaron J. Fischer. The lawsuit proved Alameda County was violating the Americans with Disabilities Act by not offering adequate mental health services in the community, pushing far too many people to cycle in and out of hospitals and the criminal legal system.
As part of the settlement, Alameda County must now assess and fill the gaps in community services by providing more intensive and voluntary services, create more crisis respite beds, increase mobile crisis team services to reduce unnecessary police interactions, expand culturally responsive services, and enhance discharge planning along with other provisions.
All increases in voluntary community mental health services deserve celebration, but this settlement is particularly important as California continues to attempt to address the ongoing mental health, substance use, and housing crises through coercive policies such as CARE Courts and the expansion of “gravely disabled” criteria to include people dealing with substance use challenges. We must all continue to push for what we know works, robust voluntary services within communities so we can all recover in our communities of choice.
This settlement, and the Department of Justice’s determination the County’s lack of community services is an ADA violation, offers a blueprint for pushing against involuntary treatment and creating more supportive community-based services in California and throughout the nation. Read below to learn more about the settlement and the 2021 Department of Justice findings in Alameda County.
Settlement Reached Between Disability Rights California, the County of Alameda, and the United States Department of Justice to Strengthen the County’s Behavioral Health System
November 7, 2023
(Alameda County, CA) – Disability Rights California (DRC), the County of Alameda, California, and the United States Department of Justice have entered into a comprehensive settlement agreement addressing the provision of community-based behavioral health services in the County. The settlement strengthens and expands services available to people with serious mental health disabilities with the goal of preventing unnecessary psychiatric institutionalization and incarceration.
“Alameda County Behavioral Health Care Services (ACBH) is committed to advancing expanded and enhanced community-based services that will benefit Alameda County’s clients, patients, and families as they are impacted by serious behavioral health challenges. We view this settlement as an opportunity to move forward with this commitment and our ongoing efforts,” said Dr. Karyn Tribble, PsyD, LCSW, Director of ACBH.
“We are pleased to have reached this settlement with Alameda County and we look forward to the improvements the County has promised,” said Andy Imparato, Executive Director of DRC.
Highlights of the settlement include:
- Conducting assessments of needs and gaps in mobile crisis coverage and an intensive mental-health and case-management
- Full-Service Partnership” (FSP) within one year, which will be informed by data and community/stakeholder input. The County has committed to expand mobile crisis teams and FSP service capacity based on the assessments, as reasonable and appropriate;
- Expanding and deepening linkages to services and outreach, including meaningful efforts to create a system to provide real-time appointment scheduling, timely in-the-field assessments, and authorization of services;
- Enhancing discharge planning and/or County coordination with community-based organizations and facility-based discharge planning processes and connections to services for eligible individuals in the John George Psychiatric Hospital, Santa Rita Jail, Villa Fairmont Mental Health Rehabilitation Center, Gladman Mental Health Rehabilitation Center, and Morton Bakar Center;
- Making efforts to contract with one or more community-based providers to add 25 peer respite and/or crisis residential beds;
- Continuing to expand culturally responsive and affirming behavioral health services, including through community-based and peer-run organizations, to help reduce behavioral health disparities across racial, ethnic, cultural, and linguistic groups;
- Hosting a stakeholder and community input meeting within fifteen months to seek community feedback on culturally responsive services. Within one month of the meeting, the County will post a data dashboard on the Office of Health Equity’s website showing the populations served by ACBH and their various service needs (including diverse community needs for FSP, Service Team, and In-Home Outreach Teams services in geographic areas within the County);
- Continuing operation of nine mobile crises teams to provide in-person response to behavioral health crises, with the purpose of reducing interactions with law enforcement, reducing emergency involuntary commitment rates at John George, and increasing use of voluntary community-based services.
Under the agreement, Dr. Karen Baylor, who has experience reviewing mental health programs through stakeholder engagement, data, and policy analysis and has worked in behavioral health agencies at the state and county level, will report on the County’s implementation of the settlement terms over the next three years as a designated Independent Reviewer.
The settlement agreement is the result of over two years of negotiations between the County, the U.S. Department of Justice, and DRC, as well as its co-counsel, Goldstein, Borgen, Dardarian & Ho, the Bazelon Center for Mental Health Law, Disability Rights Education & Defense Fund, and the Law Office of Aaron J. Fischer. The parties identified mutually desirable commitments to community-based behavioral health services. The County is seeking to further improve and deepen community-based services in an effort to best serve the residents of the County of Alameda.
Additional details of the final settlement agreement can be found here: https://www.disabilityrightsca.org/cases/disability-rights-california-lawsuit-against-alameda-county
Likely Broad Impact for a U.S. Department of Justice Finding on Incarceration of People with Mental Illness
By Ira A. Burnim | Safety and Justice Challenge | June 29, 2023
A pivotal moment has come in the long and complex effort to reform the U.S. criminal justice system. The U.S. Department of Justice (DOJ) has directed officials in Alameda County, California, to fundamentally change the way it deals with people with mental illness.
DOJ did so by issuing a formal “letter of findings“, taking the county to task for failing to meet the needs of people with mental illness and entangling them in the criminal justice system. Policy makers and lawyers are watching the situation closely, and the outcome is likely to have an impact far beyond the Bay Area.
The DOJ letter recognizes that people with serious mental illness can live productive lives in our communities. Many of them do so by receiving services funded by the government, such as mental health treatment, peer supports, and housing. Many others, however, do not get the services they need, and those individuals are disproportionately Black, Indigenous, and people of color. Among those who lack services are people commonly called “frequent fliers.” People with mental illness are repeatedly jailed for low-level offenses such as trespassing, shoplifting, and disorderly conduct. Their mental health care consists of visits to emergency rooms and short hospital stays. They typically lack stable housing. They cycle between jails, hospitals, and the streets.
The Cycle as a Single, Failing System of Care
The DOJ letter is a turning point in remedying the cruel trap that this cycle creates, harming people with mental illness, their families, and their communities. The letter recognizes that, as a practical matter, jails, emergency rooms, and hospitals operate as a single, failing system of care. The letter requires the county to abandon that failed system and instead provide community-based treatment and housing to people who cycle in and out of the criminal justice system. It directs the county to deliver evidence-based mental health services, such as mobile crisis teams, assertive community treatment, intensive case management, peer support, supported employment, and supported housing.
DOJ’s letter shows that the political and legal landscape is changing. The letter is a sign of new priorities, reflecting a changed federal approach to criminal justice reform. And it also reflects a renewed federal commitment to civil rights enforcement. Much of the letter is a legal analysis of why Alameda County’s practices violate the Americans with Disabilities Act, a federal statute, enforced by DOJ, prohibiting discrimination against people with disabilities, including people whose disabilities stem from mental illness.
Assuring that people who cycle in and out of jails get the community-based treatment and housing they need is not “pie-in-the-sky.” It is achievable. The expertise exists. The MacArthur Foundation’s Safety and Justice Challenge, which is helping to reduce jail populations across the country, has provided a blueprint.
First, we must identify the individuals who are trapped in the cycle and work with them to identify better ways of providing them services. Second, we must invest in the community-based services we know are effective.
Fortunately, new federal funding is available through President Biden’s new American Rescue Plan. It increases the federal Medicaid contribution for community mental health services, including an 85% federal Medicaid contribution for the cost of mobile crisis teams. It also provides new federal funding for housing.
Funding can come as well from savings generated by reducing jail populations. When people with mental illness receive needed services, far fewer go to jail. Far fewer people in jail should yield substantial cost savings, which can be reallocated to pay for an expansion of community services.
Third, we must shift responsibility from the criminal justice system to the mental health system. It is not acceptable to rely on the criminal justice system to address what is, at its core, a mental health care problem. Moreover, it is dangerous to have police respond when people with mental illness are in crisis or need services. Far too many people have been killed in such encounters. Fully one-quarter of the people killed in police shootings are people with mental illness.
The current system, which takes lives, also exacts an enormous financial cost. We are squandering millions of dollars on maintaining the trap of cycling. For example, it costs Alameda County in the vicinity of $120,000 per person per year for avoidable jail and hospital stays. For substantially less, it could provide an apartment and quality community-based treatment. It may be that Alameda County could fund the reforms sought by DOJ entirely from the money it spends on practices that consign many people with mental illness to repeated and avoidable stints in jail, hospitals, and the streets.
Taking these steps would dramatically improve, indeed transform, the lives of many people with mental illness. It would recognize them as deserving members of our communities with much to contribute. Taking these steps would also promote greater equity in the health care and criminal justice systems, since those who would benefit are disproportionately Black, Indigenous, and people of color.
No one should be caught in a futile system of harm. DOJ has now joined and given a big boost to the effort to dismantle that system and replace it with effective community-based treatment and housing. It will be a long road, but such systemic reform is within our grasp.