KY Jail Mental Health Crisis Network KY’s New Service Delivery System

1. KY Jail Mental Health Crisis NetworkKY’s New Service Delivery System Council of State Governments Southern Regional Meeting July 31, 2006 Rita Ruggles, KY Dept. MH-SA Services and Connie Milligan & Ray Sabbatine Bluegrass Regional MH-MR Board

2. A Model of Partnership…Handshake between Jails and Mental Health • People with mental illness filling KY jails – suicide rate high • CJ report in 2002 • Mandatory training for jail staff • Jails still wanted services • Developed Telephonic Triage • Success of pilot in ’03 prompted legislative lobbying • Legislation passed 2004 • Implementation 2004 - 06

3. Implementation Process • Statewide protocols • Software, phone & data connectivity • 86 jails – 14 CMHC regions have MOU and MOAs • Collaborative training • CMHC initiates on-call system • Jails put in screening instruments

4. Jail Mental Health Crisis Network Identify Triage Level Respond Charge Shame Crisis Counseling Critical Intake Assessment Substance Abuse Diversion High Booking Screening Telephonic Triage Suicide Risk Assessment Follow-up Referral 202A504 Institutional Alert Moderate Mental Illness Observation Psychiatrist Low Mental Retardation Request Hospital Acquired Brain Injury

5. Risk Assessment Levels Leveling Process Charge Related Risk Critical Substance Abuse Suicide Risk High Mental Health Symptoms Depression Moderate Mania Psychosis Low Personality Disorder MR/ABI/ SA

6. Jail Risk Protocols Housing Safest Location Supervision Frequency of Observation Clothing Instrument of self harm Property Instrument of assault or self harm Food Instrument of self harm

7. KJCN Program Summary • 90% jail participation • 80% reduction in-custody suicide • Triaging 5-15% of bookings • Protocols provide consistency • Follow-up provides immediate MH expertise • Diversion is increased • Collaboration/interface with pretrial release services, courts, forensic hospitals and substance abuse diversion

8. Triage Program Data • Over 12,000 Triages • 36% hospitalized in the last year • 65% have some suicide risk - 35% have critical or high suicide risk • 36% have substance abuse risk • 77% have symptoms of mental illness • Summary of Mental Health Risk Level • Critical = 2% • High = 37% • Moderate = 46% • Low = 15% • 45% of all Triages have CMHC visit with 98% response time compliance