Sheriffs Addressing the 

Mental Health Crisis 

in the Community and in the Jails

Sheriffs Addressing the 

Mental Health Crisis 

in the Community and in the Jails
This project was supported, in whole or in part, by cooperative agreement number 2014-CKWX-0042 awarded by the Office of 

Community Oriented Policing Services, U.S. Department of Justice. The opinions contained herein are those of the author(s) and 

do not necessarily represent the official position or policies of the U.S. Department of Justice. References to specific agencies, 

companies, products, or services should not be considered an endorsement by the author(s) or the U.S. Department of Justice. 

Rather, the references are illustrations to supplement discussion of the issues.

The internet references cited in this publication were valid as of the date of this publication. Given that URLs and websites are 

in constant flux, neither the author(s) nor the COPS Office can vouch for their current validity.

Copyright © 2018 by Major County Sheriffs of America. The U.S. Department of Justice reserves a royalty-free, nonexclusive, and 

irrevocable license to reproduce, publish, or otherwise use and authorize others to use this resource for Federal Government 

purposes. This resource may be freely distributed and used for noncommercial and educational purposes only.

Recommended citation: 

Major County Sheriffs of America. 2019. Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails.

Washington, DC: Office of Community Oriented Policing Services.

Published 2019
iii

Contents

Letter from the Director of the COPS Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Letter from the President of the Major County Sheriffs of America . . . . . . . . . . . . . . . . . . . vii

Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix

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Executive Summary 1

Background 3

The Mental Illness Challenge for the Community and Law Enforcement . . . . 5

Effect of mental illness on criminal behavior . . . . . . . . . . . . . . . . . . . . . . 7

Mental +/CODs in the community 8

Effect of not providing mental health services in the community 9

Negative impacts associated with incarcerating people with mental illnesses 9

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Jails are the Largest Mental Illness Facilities

11

Jails as mental illness facilities not a new issue 15

What are sheriffs doing to address this critical issue 15

Survey Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Site Visits to Examine Programs and Initiatives that Work and Have Promise 23

Jefferson County Sheriff’s Office, Golden, Colorado 23

Hillsborough County Sheriff’s Office, Tampa, Florida . . . . . . . . . . . . . . . . . . 30

Ventura County Sheriff’s Office,Ventura, California . . . . . . . . . . . . . . . . . . . . 31

Bexar County Sheriff’s Office, San Antonio, Texas . . . . . . . . . . . . . . . . . . . . . 36

Cook County Sheriff’s Office, Chicago, Illinois 42

Los Angeles County Sheriff’s Department, Los Angeles, California . . . . . . . . . 48

Hennepin County Sheriff’s Office, Minneapolis, Minnesota . . . . . . . . . . . . 52

Summary and Conclusions 55

Practice 1. CIT-trained field officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Practice 2. Diversion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Practice 3. Mental health and problem-solving courts . . . . . . . . . . . . . . . 5
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Practice 4. Mental health screening in jail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Practice 5. Mental health treatment in jail . . . . . . . . . . . . . . . . . . . . . . 5

Practice 6. Discharge planning and re-entry 5

Additional observations 59

References 61

Appendix A. Survey Instruments 6

Chief executive officer 68

Field operations/law enforcement personnel 70

Jail personnel responders 72

Appendix B. Jefferson County Sheriff’s Office . . . . . . . . . . . . . . . . 7

Appendix C. Local Law Enforcement and Mental Health Crisis MCSA Report

Cook County Sheriff’s Office Additions . . . . . . . . . . . . . . . . . . . 77

Mental health template for American jails . . . . . . . . . . . . . . . . . . . . . 77

Rocket Docket legislation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

The Sheriff’s Anti-Violence Effort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

Cook County Sheriff’s Office Strength and Wellness Center 78

Community support van 78

Discharge Lounge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78

Appendix D. Cook County Rocket Docket Expansion Poster . . . . . . . . . . . 7

Appendix E. COPS Office Grant Team Members . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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81

About the Major County Sheriffs of America 87

About the COPS Office 88
v

Letter from the Director of the COPS Office

Colleagues:

Since the late 1960s, long-term care facilities and psychiatric beds have been replaced with community-based 

care options for individuals diagnosed with mental illness. Although the trend toward deinstitutionalization was 

intended to provide the least restrictive care, an unintended result has been a critical lack of inpatient and secure 

treatment facilities for people with serious mental illnesses. In communities today, front-line law enforcement 

officers are called upon to intercede with individuals in mental health crises, de-escalate violent situations that 

can threaten public safety, and respond to repeated service calls for individuals engaged in nuisance crimes. 

With limited inpatient and community-based mental health resources available, a growing number of individuals 

arrested and housed in jails are suffering from serious mental health and psychiatric issues.1

The Major County Sheriffs of America (MCSA) and the National Commission on Correctional Health Care (NCCHC) 

partnered with the COPS Office to identify successful practices that local law enforcement can employ to reduce 

the arrest and incarceration of people living with mental illness in their jurisdictions. MCSA and NCCHC closely 

collaborated with sheriffs’ departments in seven case study sites and engaged all MCSA partners in an optional 

questionnaire. Sheriffs, deputies, and front-line officers have identified six critical practices that have reduced 

arrest and incarceration: (1) crisis intervention teams (CIT), (2) arrest diversion, (3) mental health courts, 

(4) mental health screening during jail processing, (5) mental health treatment in custody, and (6) discharge 

planning. These practices have demonstrated success in reducing the frequency of arrests of people with mental 

illness, diverting them from the criminal justice system, and treating them when they are incarcerated. 

In addition to the seven case study sites, readers will also find a number of other innovative mental health 

practices and resources described in this publication. On behalf of the COPS Office, I want to express our 

appreciation for all the collaborative work by law enforcement agencies and community service providers to 

address this critical issue. We are also grateful to the MCSA and the NCCHC as well as the seven case study sites 

and all agencies that contributed to the research and final publication. 

With the high level of dedication and openness to new ideas demonstrated by sheriffs and police departments, we 

believe that local law enforcement leaders and stakeholder agencies across the nation can make significant progress 

in a proactive response to the current mental health crisis, thereby increasing the safety of our communities. 

Sincerely,

Phil Keith

Director

Office of Community Oriented Policing Services

1. “Jailing People With Mental Illness,” National Alliance on Mental Illness, accessed July 10, 2018, https://www.nami.

org/Learn-More/Public-Policy/Jailing-People-with-Mental-Illness. 

vii

Letter from the President of the Major County Sheriffs 

of America

Dear colleagues,

It is not a secret that correctional facilities in the United States are also the nation’s largest mental health 

providers, but it is often not considered a law enforcement priority. On the contrary, the Major County Sheriffs of 

America believes it is a major priority that needs to be addressed with a sense of urgency. It is our responsibility 

as sheriffs and community leaders to be the voice for people with mental illness in the criminal justice system.

This report addresses ways our nation’s largest law enforcement agencies are addressing this crisis head on. With 

a goal of improving behavioral health outcomes and reducing recidivism among individuals with a history of 

mental illness, MCSA member agencies are implementing innovative strategies that are having a positive impact 

on the lives of people with mental illness in their communities. 

These programs, as you will see in this report, aim to eliminate the gap in behavioral health care, strengthen 

transition into the community, and establish continuous care treatment upon release. Each program’s ultimate 

objective is to connect participants with community behavioral health providers and establish strong and longterm social, emotional, and community support networks. 

As law enforcement professionals, we are committed to helping community members who find themselves in 

unfortunate situations. We are the ones who are called to stand in the gap when all other systems have failed. I 

encourage you to study the examples in this report and then look for innovative ways to help people with mental 

illness in the communities you serve.

Sincerely,

Sheriff Grady Judd (Polk County, Florida)

President

Major County Sheriffs of America

ix

Disclaimer

The information regarding the programs, practices, 

and responses to contacts with individuals with 

mental disorders is a dynamic process that continues 

to evolve. This report is a product of examining what 

several sheriffs’ offices were doing at a point in time 

to identify efforts that are working. These sheriffs 

have undoubtedly continued to improve on the 

successes they have had. A point of contact has been 

provided for the seven sheriffs’ offices highlighted 

in this report to assist readers in gaining current 

information and for questions and updates.

1

Executive Summary

This publication is the outcome of a grant from the 

Office of Community Oriented Policing Services (COPS 

Office) to the Major County Sheriffs of America (MCSA) 

and its study partner, the National Commission on 

Correctional Health Care (NCCHC). The purpose of the 

grant was to identify successful practices conducted 

by members of the MCSA related to reducing the arrest 

and incarceration of people living with mental illness 

in their jurisdictions. There is both anecdotal and 

research evidence that the number of people with 

mental illnesses being contacted by law enforcement 

and subsequently becoming involved in the criminal 

justice system is growing (Fellner 2014; James 

and Glaze 2006; Reuland and Margolis 2003). The 

increased contact with law enforcement and continual 

involvement with the criminal justice system creates 

problems for the individuals being arrested and 

incarcerated. This is true for the law enforcement and 

correctional professionals as well, who must try to 

meet the needs of these individuals in a context and 

environment not suited to maintaining their safety or 

mental stability. 

The MCSA identified a number of jurisdictions across 

the United States that could provide expertise in 

identifying, vetting, and describing current practices 

by their peers that are demonstrating effectiveness 

in reducing the arrest and incarceration of people 

with mental illnesses. The organization then solicited 

the expertise of the NCCHC for the purpose of 

developing the structure and process for gathering 

data, analyzing data, and preparing the final report. 

Representatives from MCSA member jurisdictions and 

the NCCHC convened and developed a questionnaire to 

be sent to all MCSA members inquiring about their 

practices related to reducing the number of people 

with mental illnesses in their local criminal justice 

system at all points from first law enforcement 

contact to incarceration and subsequent re-entry to 

the community. 

The questionnaires were sent to all 78 member 

counties of the MCSA, with 29 percent completing the 

questionnaires in all three identified areas (sheriff’s 

office, field operations, and jail operations). The 

responses to the questionnaires were analyzed and 

the counties with the most effective practices across 

the board—or with particularly promising or effective 

practices in specific areas (such as diversion or reentry)—were identified and selected for site visits 

by the MCSA and NCCHC teams. Site visits were used 

to gain more information and a clear understanding 

of how the effective practices were developed, 

implemented, and monitored for ongoing performance 

and improvement. 

Across jurisdictions, the site visit teams found that 

six specific practices were occurring that had a direct 

impact on reducing the arrest and incarceration of 

people with mental illnesses:

1. Crisis Intervention Team (CIT) trained emergency 

responders, case workers, and dispatchers

2. Active diversion of people with mental illnesses 

from incarceration

3. Mental health / problem solving courts

4. Mental health screening in jail

5. Mental health treatment in jail

6. Discharge planning / re-entry
2 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

In terms of site-specific strengths, the following 

findings were most prominent:

• Jefferson County, Colorado: This sheriff’s office 

has developed excellent drop-off centers. Field 

officers are CIT trained and are therefore able to 

identify when an individual they encounter may 

be suffering from mental illness. When it has been 

determined that there is the possibility of mental 

illness, the officers are able to take the individual 

to one of several drop-off centers within the 

jurisdiction where an evaluation takes place and 

often diversion away from jail and the criminal 

justice system occurs.

• Hillsborough County, Florida: The sheriff’s office 

has made a concerted effort to implement CIT 

training, with more than 1,000 officers being 

trained as of the date of the site visit in fall 2015. 

The CIT officers are able to assist those with mental 

illness in enrolling into mental health treatment or 

other diversion programs.

• Ventura County, California: The sheriff’s office has 

implemented a program entitled Rapid Integrated 

Support and Engagement (RISE), which meets the 

needs of homeless individuals with mental illnesses 

who come into contact with law enforcement.

• Bexar County, Texas: Through collaboration with 

private partners, Bexar County provides some 

funding to Haven for Hope, which is a comprehensive 

nonprofit program providing a variety of services. 

This partnership helps law enforcement agencies in 

Bexar County divert individuals with special mental 

health needs from the jail to Haven for Hope pretrial 

programs. Programs also exist to assist posttrial 

individuals with supportive housing, rehabilitation 

programs, and training to assist them in moving back 

into the community. 

• Cook County, Illinois: The Cook County Sheriff’s 

Office has developed comprehensive treatment 

services for people with mental illnesses in the Cook 

County Jail. Most notably, the emphasis is 

on maintaining the mental health of all who are 

incarcerated in the facility rather than primarily 

stabilizing and treating those with mental illness, 

although the staff are excellent in this regard as well.

• Los Angeles County, California: The Los Angeles 

County Sheriff’s Department is the first sheriff’s 

office in the nation to develop mental evaluation 

teams, which consist of mental health professionals 

riding along with field officers, making them 

immediately available to address issues of mental 

illness as they are encountered in the community. 

The review of these programs and services yielded 

specific recommendations that counties and sheriffs’ 

offices across the country can follow, which will meet 

the goal of reducing the arrest and incarceration 

of people with mental illnesses. To summarize the 

recommendations, an awareness of the presence 

and impact of mental illness is essential across 

the continuum of law enforcement disciplines and 

agencies. It is critical to immediately identify the 

potential presence of mental illness from the time 

of first observation and contact with an individual 

through the process of incarceration (if this cannot 

be prevented) and re-entry. The awareness and 

deliberate planning and implementation of services 

designed to meet the needs of people with mental 

illnesses in a context and environment that is 

not designed or suited for them is critical if they 

are to maintain stability and avoid future relapse 

and recidivism.

As a follow-up to this grant project and study, the 

MCSA is planning to conduct trainings and hold 

conferences to further the work of improving how law 

enforcement responds to mental illness. The goal is 

to address and treat mental illness in clinical settings 

as much as possible but to also prevent people 

with mental illnesses from becoming inextricably 

entangled in the criminal justice system as the result 

of their mental illness.
3

Background

Jails and prisons are the largest providers of mental 

health treatment in the United States today as a 

result of deinstitutionalization beginning in the 

1960s and decreased funding for community-based 

treatment (Treatment Advocacy Center 2014). While 

there are critical situations where law enforcement 

must use their authority to de-escalate violent or 

potentially violent situations threatening public 

safety, all too often officers have no other option but 

to arrest and confine individuals with mental health 

issues even if order is restored. 

In many cases, after arrest and incarceration the 

criminal justice system—including prosecutors, 

defense attorneys, and the courts—is unable to 

address the mental health needs of the individual 

as a result of the same lack of resources, and the 

individual will be back in the community and 

able to re-offend. All too often the cycle of arrest, 

confinement, and release continues until the 

individual causes serious harm to themselves or 

others.

Fortunately, many law enforcement organizations 

have taken the initiative to interrupt the repetitive 

process of dealing with individuals who suffer from 

serious mental health issues at the point of contact 

either in the community or at the time of detention. 

Sheriffs’ offices have the opportunity to intercede 

in both environments, given their frequent dual 

responsibilities of policing in the community and 

operating jails. This publication presents case studies 

and resources from a number of law enforcement 

agencies that are working effectively to address this 

challenge and to identify programs and processes that 

work. Understanding what is working and why and 

how it works creates an opportunity to document and 

share the information with other law enforcement 

agencies throughout the country. As agencies 

implement these programs and practices or create 

new initiatives, the odds increase dramatically that 

individuals with serious mental health problems will 

get the help they need to break the cycle of arrest 

and incarceration.

The Major County Sheriffs of America (MCSA) believes 

that a number of its approximately 80 member sheriffs 

have developed programs and a criminal justice 

system to provide mental health care services in the 

community. The members of MCSA collectively provide 

law enforcement services to approximately 100 

million people and operate the largest jails around the 

country. Their jails not only have significant capacity 

but also have an annual turnover rate that processes 

millions of individuals who are arrested each year, 

and approximately 15 percent of men and 30 percent 

of women booked into jails have at least one serious 

mental health condition (NAMI 2018a). Therefore, 

sheriffs, their leadership and deputies, and jail and 

detention officers are the critical points of contact 

to help identify these individuals and to facilitate 

referrals to mental health services in lieu of arrest and 

incarceration when appropriate.
4 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails
5

The Mental Illness Challenge for the Community and 

Law Enforcement

The major theme of this publication is the effective 

response of law enforcement agencies to mental illness 

in their communities. In 2014, the Major County 

Sheriffs of America (MCSA) received a grant from the 

Office of Community Oriented Policing Services (COPS 

Office) to identify programs and practices used by 

its member sheriffs to divert individuals with serious 

mental health issues from incarceration in their jails 

to professional mental health providers and networks. 

The research team examines how the needs of these 

incarcerated individuals are addressed by the sheriffs 

and associated stakeholders of the criminal justice 

system when alternatives to arrest are not available. 

The operational aspects and project findings are 

described in detail in the remainder of this report, but 

a brief overview of mental illness and its complexity 

are a necessary introduction to the report and will 

help place the report in its proper context. 

Mental illness is a complex problem that historically 

has been undetected, unacknowledged, or not 

treated in a local law enforcement context. Mental 

illnesses may be more difficult to detect than physical 

illnesses as the symptoms of mental illness may be 

misunderstood and may be attributed to personal 

choices such as substance abuse or nonclinical origins 

such as poor social skills. When mental illness is 

suspected or detected by the nonclinical professional, 

a lack of training and experience on effectively 

managing patients with mental illnesses may lead to 

generalization, suboptimal management, and lack of 

appropriate initial treatment.

In addition to the discomfort and uneasiness the 

subject arouses in individuals and society, there 

continues to be much disagreement among mental 

health experts on even the definition of mental illness 

(Prins 2010; Williams, Cohen, and Ford 2014; Horwitz 

2010). It is no surprise then that professionals in 

law enforcement, criminal justice, and even general 

health care continue to debate the precise definition 

of mental illness. The fluid nature of definitions and 

treatment is underscored by the continual revision 

of the Diagnostic and Statistical Manual of Mental 

Disorders, now in its fifth formal edition (DSM-5). 

The fact that professionals from a variety of scientific 

and medical disciplines, including psychology and 

psychiatry, have difficulty adequately defining mental 

illness within and across disciplines illustrates the 

complexity of mental illness and the need to provide 

working definitions for the purposes of this report. 

The following working definition should be kept 

in mind as descriptions of various programs and 

processes for addressing mental illness and reducing 

the arrest and incarceration of people with mental 

illnesses are reviewed and considered for applicability 

across the criminal justice system. 

For the purposes of this project and this report, 

it was decided to employ a relatively simple and 

straightforward behavioral description of mental 

illness. The description (and definition) of mental 

illness is as follows:

“Any mental illness (AMI) is defined as a mental, 

behavioral, or emotional disorder. AMI can vary in 

impact, ranging from no impairment to mild, moderate, 

and even severe impairment,” the latter describing 

individuals with serious mental illness (NIMH 2018a).

Unlike AMI, “serious mental illness (SMI) is defined 

as a mental, behavioral, or emotional disorder 

resulting in serious functional impairment, which 

substantially interferes with or limits one or more 

major life activities. The burden of mental illnesses is 

particularly concentrated among those who experience 

disability due to SMI” (NIMH 2018a). Further, 

individuals with SMI represent the vast majority 
6 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

of crisis service calls that require de-escalation 

and alternative responses by law enforcement. An 

example of SMI is schizophrenia, a psychotic disorder 

that includes symptoms such as visual and auditory 

hallucinations or thought disorders that result in 

dysfunctional ways of thinking (NIMH 2018b).

Law enforcement, criminal justice, and correctional 

professionals will quickly recognize the connection 

between mental illness and disruptions in behavioral, 

emotional, or relational functioning. While mental 

or cognitive symptoms are not always clear when an 

officer approaches a suspect on the street, individuals 

with serious mental illness always display disruptions of 

varying severity in one or more of the other categories, 

which are more clearly recognized and may in fact be 

the reason law enforcement is involved. It is our hope 

that the broad and general description will provide 

context and clarity to the remainder of this report. 

Following the description of mental illness, the 

frequently observed connections among mental 

illness, substance abuse, and criminal behavior must 

be recognized, as should the linkages with criminal 

conduct, which leads to the arrest and incarceration 

of the person with a mental illness. There are several 

distinct impacts of co-occurring disorders (COD) in 

criminal behavior. These can be approached from

the perspective of how CODs lead to criminal behavior 

and how CODs affect those who are involved in 

criminal behavior.

Particularly in the context of criminal behavior, 

substance abuse that co-occurs with mental illness 

must be expected (Minkoff 2007; Goss 2016). The 

available research on the prevalence of substance use 

on the part of those who are incarcerated indicates that 

approximately 85–90 percent of inmates (adolescents 

and adults) have used alcohol or drugs in their lifetime, 

and approximately 75 percent report using alcohol 

or other drugs on a regular basis or meet criteria for 

substance abuse or addiction (Van Voorhis, Schweitzer, 

and Hurst 2009; Foster et al. 2010; NIDA 2018). 

There is a very clear connection between substance 

abuse and criminal behavior. In most circumstances, 

including all situations in which underage individuals 

are using alcohol or other drugs, substance use 

(meaning use of alcohol or illicit drugs and misuse or 

abuse of prescription drugs) is criminal behavior, but 

it also contributes to an overall attitude and pattern of 

general or broad criminality (Tripodi and Bender 2011; 

Neff and Waite 2007). Children and adolescents who 

use alcohol and drugs are doing so illegally, and yet 

the specific acts of substance use and related behaviors 

typically precede and contribute to a general pattern 

of criminal behavior that is very common among those 

who abuse or are addicted to alcohol and other drugs.

Researchers have identified eight specific behaviors and 

circumstances that have been labeled “criminogenic” 

(Andrews and Bonta 2010; Latessa and Lowenkamp 

2005), which means behaviors and circumstances 

that lead to or contribute to criminal behavior and 

criminality. Despite substance abuse being specifically 

identified as one of the criminogenic needs, mental 

illness has not been so identified and yet can 

contribute to criminal behavior and criminality. There 

are a number of specific ways that this can occur, 

including hallucinations and paranoia, general mental 

disorganization, mania, and depression.

Auditory hallucinations and paranoia can lead 

individuals to believe they are in danger and so 

must harm or kill another person in order to protect 

themselves or that they will improve their life or 

circumstance by killing one or more other people. 

An example of this is James Holmes, the shooter at 

the Century 16 Movie Theater in Aurora, Colorado. 

According to court testimony, he believed that he 

would achieve greater self-esteem and personal power 

by killing other people and that the more people he 

killed the greater personal enhancement he would 

achieve (Denver Post 2016). 

General mental disorganization often leads to 

misdemeanor-level crimes and behavior that is a 

general public nuisance. Examples include loitering, 
The Mental Illness Challenge for the Community and Law Enforcement 7

homelessness, panhandling, trespassing, shoplifting, 

or other minor theft. The mental disorganization is 

typically the result of psychotic disorders that do 

not include paranoid ideation or hallucinations that 

command the individual to be violent but rather 

make it difficult for them to accurately perceive 

reality and effectively solve problems. Tragically, 

these behaviors often result in people with serious 

mental illnesses becoming involved in the criminal 

justice system, where they spend inordinately long 

periods of time and from which they have difficulty 

extricating themselves (Bailargeon et al. 2009; Harris 

and Dagadakis 2004; James and Glaze 2006). 

Mania and depression (the two poles of bipolar 

disorder) can also contribute to criminal behavior. 

Crimes resulting from mania are often indicative of 

the poor judgment that is a hallmark of mania and 

can include theft, excessive speeding, gambling, 

prostitution, substance abuse, and violence (American 

Psychiatric Association 2013). Depression is less 

likely to lead to criminal behavior, but in severe 

episodes it can contribute to psychoses that result in 

criminal behavior. Susan Smith, who was convicted of 

murdering her two young sons in 1995, was believed 

to be suffering from severe depression that led her to 

believe she needed to kill them (Chuck 2015). 

Effect of mental illness on criminal 

behavior

Mental illness in almost all cases—and specifically 

as defined in this document—is manifested in 

behavioral, emotional, mental/cognitive, and 

relational disruptions and often a combination of 

those factors. Mental illness leads to emotional and 

cognitive disruption of one form or another (Medalia, 

Revheim, and Casey 2002). This disruption can affect 

both the individual themselves and others with whom 

the person is interacting. 

The effect of mental illness on a person who is 

committing or has committed a crime manifests 

itself in several forms. A lack of self-control has been 

proposed as the primary cause for criminal behavior 

(Gottfredson and Hirschi 1990; Buker 2011; Ronel 

2011), and when an individual is experiencing an 

episode of mental illness they are less likely to be able 

to appropriately control their behavior. It is also true 

that many people commit crimes in an inappropriate 

attempt to manage emotions that are less well 

regulated or managed in the midst of the experience 

of symptoms of the mental illness (Miller, Vachon, and 

Aalsma 2012). 

When a person is experiencing intensified anger 

or anxiety as the result of a mental illness, their 

behavior becomes less controllable and predictable. 

The anger, anxiety, depression, or panic experienced 

by people in the midst of an episode of mental 

illness can contribute to impulsive behavior, 

which often exacerbates the circumstances 

and severity of a criminal act. In addition, the 

mental illness can lead them to experience higher 

levels of guilt and hopelessness that can become 

overwhelming following the commission of a crime 

and subsequent incarceration, leaving them at 

greater risk of attempting and committing suicide 

while incarcerated. Finally, the mental illness and 

accompanying mental confusion can make it more 

difficult for a person to determine the appropriateness 

of their behavior or to choose not to commit a crime 

because their thought processes and judgment are 

impaired (Torrey et al. 2010).

Mental illness and the related emotional disruption 

represent a risk to others who interact with the 

person living with the mental illness. The elevated 

anger, anxiety or panic, and impaired judgment can 

lead the person who is in the midst of an episode of 

mental illness to overreact to perceived slights. They 

may become aggressive and violent towards those 

around them and ultimately commit crimes they 

would not have committed (or that would 

have been less serious) in absence of the episode 

of mental illness. Individuals who are experiencing 

mental illness are also less likely to appreciate the 
8 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

impact of their behavior on others and so are more 

likely to commit crimes that affect others when they 

are experiencing episodes of mental illness. 

There is a complex relationship between mental 

health problems and crime and the impact of mental 

health problems on criminal behavior. This complex 

relationship is made more complicated by the 

presence of substance abuse as described earlier, 

which is appropriately conceptualized as a mental 

health problem and a criminogenic need (Andrews and 

Bonta 2010; Latessa and Lowenkamp 2005). Mental 

health problems (including substance abuse) can lead 

to specific types of crimes that are often directly 

related to the symptoms of the mental illness, can 

lead to specific effects on the individuals with mental 

illness who commit crimes, and can have specific 

effects on those who are in relationships with or 

interact with such individuals.

The impact of mental health problems as they relate 

to crimes can be directly seen in emotional and 

cognitive processes (judgment, decision-making, 

problem solving). Emotions are less well regulated and 

managed during an episode of a mental illness. The 

impaired cognitive functioning makes it less likely the 

individual will respond appropriately to the emotional 

dysregulation, so they often make choices (to commit 

crimes and harm others) that they would not make in 

absence of the mental illness. 

Mental +/CODs in the community

The Substance Abuse and Mental Health Services 

Administration (SAMHSA) collects data on the 

prevalence of substance use and abuse and mental 

illness across the United States. The latest year 

for which data is available is 2014, and it indicates 

the following:

• Prevalence of illicit drug and alcohol abuse or 

dependence among those 18 years or older: 

approximately 8% 

• Prevalence of illicit drug or alcohol abuse or 

dependence among those 18 years or older: 9.5%

• Prevalence of those needing but not receiving 

treatment for alcohol abuse: 6.5%

• Prevalence of those needing but not receiving 

treatment for illicit drug use: 2%

• Prevalence of any mental illness among those 18 or 

older: approximately 19% 

• Prevalence of those with co-occurring disorders: 

approximately 2–3%

SAMHSA does not provide data on the number of 

people in the United States who need treatment for 

a mental illness and do not receive it. However, the 

National Alliance on Mental Illness estimated that in 

2009 less than 33 percent of individuals who needed 

treatment for a mental illness would receive it (Aron 

et al. 2009). 

These data present the scope of the problem as it 

relates to law enforcement and having to contact 

or address those with mental illnesses, substance 

use disorders, or both. A considerable percentage 

of the population experiences a substance use 

(alcohol or illicit drug) disorder, a mental illness, 

or both, and these people are more likely to come 

into contact with law enforcement than are those in 

the population with neither substance use disorders 

nor mental illnesses. It has been estimated that 

7 to 10 percent of all law enforcement contacts 

involve people with mental illnesses (not specifically 

substance abuse) (Reuland and Margolis 2003). Our 

survey showed that 24 to 28 percent of persons 

incarcerated are individuals with mental illness. 

This figure accounts for those who have self-reported 

or have been identified through medications 

prescribed and from incidents observed by 

correctional staff.
The Mental Illness Challenge for the Community and Law Enforcement 9

Effect of not providing mental health 

services in the community

It is well established that the availability of mental 

health treatment in the community has decreased 

since the 1980s as a result of cuts in Medicaid 

reimbursements for mental health care, non-Medicaid 

cuts in funding for mental health treatment by 

states and local jurisdictions, and the shuttering 

of state mental hospitals and other treatment 

resources (Honberg et al. 2011; Candisky 2011). This 

reduction in provision of mental health services, 

which began with deinstitutionalization of people 

with mental illnesses in the 1960s, has been proposed 

as a major contributor to what has been called the 

“criminalization of the mentally ill.” As a result, the 

current estimated prevalence of people with mental 

illnesses in jails or prisons is 14 to 31 percent, 

depending on demographics, community treatment 

supports, and state statutes (Fellner 2014; James and 

Glaze 2006; Steadman et al. 2000). Although it is not 

currently possible to identify a causal relationship 

between decreased availability of treatment resources 

and increased calls for service, it is logical to deduce 

a connection, and various research has identified a 

correlation (NAMI 2018b). The reality has become, as 

noted earlier, that law enforcement field officers are 

regularly encountering those with mental illnesses 

(and even more regularly encountering those with 

substance problems), which is contributing to the 

growing percentages of those with mental illness and 

CODs being incarcerated. 

Negative impacts associated with 

incarcerating people with mental 

illnesses

The oft-cited 2006 Bureau of Justice Statistics report 

(James and Glaze 2006) stated that only one-third of 

inmates reported receiving mental health treatment 

in state prisons and a much lower percentage (17.5 

percent) of those incarcerated in jails reported having 

received mental health treatment. In addition, a study 

done in Michigan found that 65 percent of inmates 

identified as having a severe mental illness had not 

received mental health treatment services in the past 

year (Fries 2010).

A number of other issues and problems have been 

reported related to the incarceration of people 

with mental illness. There is disagreement in the 

professional literature over the frequent claim that 

inmates with mental illness are incarcerated for longer 

periods of time than neurotypical inmates. However, 

the most common findings are somewhat dependent 

on the type of crimes for which inmates with mental 

illness serve extended sentences, as compared to 

those without mental illness (Bailargeion et al. 2009; 

Harris and Dagadakis 2004; Greenberg and Rosenheck 

2014; James and Glaze 2006).

Inmates with mental illness have also been subjected to 

higher levels of sexual abuse while incarcerated, a higher 

number of disciplinary infractions than those without 

mental illness, and higher recidivism rates (Gibbons and 

Katzenbach 2006; Fellner and Abramsky 2003; National 

Prison Rape Elimination Commission 2009).

Summary

In conclusion, mental illness is a complex problem 

with many variables, which is difficult for even 

scientific professionals—even psychologists and 

psychiatrists—to understand completely. For that 

reason, arriving at an operational definition of mental 

illness that provided context was necessary to make 

this publication and its content clear. 

The impact of reduction in treatment resources for 

people with mental illness, particularly SMI, over the 

past several decades has certainly contributed to the 

number of people with mental illness who have been 

contacted by law enforcement field officers and the 

corresponding increase in people with mental illnesses 

who are involved in the criminal justice system and 

incarcerated. Law enforcement is on the front lines of 
10 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

A major objective [of the project] was to describe successful 

efforts to divert people with mental illnesses from the law 

enforcement system and assist them in moving toward 

recovery and reclamation of their lives.

interacting with people with mental illness (including 

substance users and those with CODs) and should 

have resources for diverting those with mental illness 

and CODs into environments where they can receive 

the treatment they need. As this occurs, people with 

mental illness (those whose primary reason for law 

enforcement contact is the direct effects or sequelae 

of mental illness) will be able to avoid ongoing 

involvement and entanglement with the criminal 

justice system.

Diagnosis and treatment of people with mental illness 

should not be a primary or even significant portion 

of the duties of law enforcement field professionals. 

As is the case with substance abuse and mental 

health problems (or CODs), crime and mental health 

problems must be recognized as interrelated but 

separate problems. Individuals with other mental 

health problems become addicted to alcohol and 

drugs and then continue to use those substances 

addictively because of the nature and effect of the 

addiction—not solely because of the mental health 

problems they experience. Similarly, individuals with 

mental health problems commit crimes for a host 

of reasons that may be unrelated to the symptoms 

or effects of mental illness. Criminal behavior has 

multiple determinants and can be either the direct 

or indirect result of the symptoms of mental illness. 

However, criminal activity can also be perpetrated by 

an individual with a mental illness because of criminal 

determinants and in the absence of clear symptoms or 

effects of a mental illness. 

This report identifies a number of jurisdictions that 

are developing, identifying, and implementing specific 

programs and processes for reducing the involvement 

of people with mental illnesses in the criminal justice 

system. It is hoped that other agencies can review 

these programs, identify elements that are appropriate 

for them, and implement with the idea of contributing 

to a national reduction of people with mental illnesses 

in the criminal justice system and a corresponding 

increase in proper and effective treatment for those 

who are among the most vulnerable in our society. 

The goal of this project was not only to acknowledge 

the presence and reality of mental illness in our 

society as it relates to law enforcement but also 

to draw attention to the increasing number of 

individuals with mental illnesses who commit crimes. 

Another goal is to estimate the scope of the problem 

of people with mental illnesses encountering the 

criminal justice system based on information by 

the MCSA respondents. A final major objective was 

to describe successful efforts to divert people with 

mental illnesses from the law enforcement system 

and assist them in moving toward recovery and 

reclamation of their lives. 
11

Jails are the Largest Mental Illness Facilities

0 5000 10000 15000 20000

A jail is no place for a person with a mental illness. 

Riker’s Island in New York, the Los Angeles County 

Jail, and the Cook County (Illinois) Jail are the 

largest mental health facilities in the United States 

(Treatment Advocacy Center 2014). The Los Angeles 

County Jail has a daily average population of more 

than 16,700 inmates in its jails. More than 4,050, or 

24 percent, have been identified as having special 

mental health needs. The Cook County Jail has a daily 

average population of more than 8,750 at one site. 

Of these, more than 2,000, or 23 percent, have been 

identified as having special mental health needs. The 

fact is that our nation’s jails have become de facto 

warehouses for people with mental illnesses. Figure 1 

shows the population of inmates with mental illnesses 

as a percentage of the average daily population of 

county prisons and jails in the seven counties studied 

for this publication.

Number of inmates with mental illness

Average daily population

902 (22 percent)

4,100

2,000 (23 percent)

8,750

200 (28 percent)

710

780 (27 percent)

1,945

312 (26 percent)

1,201

4,050 (24 percent)

16,700

342 (21 percent)

1,611

Bexar County

Sheriff

Cook County

Sheriff

Hennepin 

County Sheriff

Hillsborough

County Sheriff

Jefferson

County Sheriff

Los Angeles

County Sheriff

Ventura 

County Sheriff

Figure 1. Population of inmates with mental illnesses as a percentage of the average daily 

population in seven U.S. county jails

Source: National Commission on Correctional Health Care
12 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

Since the deinstitutionalization of people with 

mental illnesses in the 1960s and the closing of 

state hospitals in the 1970s and 1980s all across the 

nation, county jails have been used as substitutes 

for hospitals, veterans’ homes, or homeless shelters. 

Deinstitutionalization happened primarily because 

of the advent of better, more effective psychotropic 

medications and a desire to reduce state budgets. The 

community mental health centers were developed as a 

response to the closing of the state mental hospitals, 

with community living and treatment thought to be a 

more humane way to treat those with mental illness. 

The county placement options envisioned in the 

1980s, options that seemed so logical when coupled 

with advancements in treatment and medications, 

were never funded to the extent promised or needed. 

In the legislative analyst’s office in California 

Legislature’s Nonpartisan Fiscal and Policy Advisor 

in 2008–09, psychologists determined that inmates 

with special mental health needs spend three times 

the number of days in jail per booking and three 

times the number of times booked as inmates 

without special mental health needs. If programs are 

adequately funded and if there are still state mental 

hospital beds (or the equivalent of them) to treat 

those who cannot function in the community, county 

placement options are still a viable solution.

That means an inmate who does not require special 

mental health needs would cost the county about 

$11,200.00 annually. An inmate with special mental 

health needs would cost the county an estimated 

$42,500.00 annually. As shown in figure 2, the cost 

of housing an inmate with mental health issues is 

two to three times that of housing an inmate without 

mental illness and accounts for the cost of security, 

health care, operations, administration, support, and 

rehabilitation programs. 

Medical care

Food

Faith-based services

Dental care

Clothing

Medical care

Psychiatric services

Pharmaceuticals

Food

Faith-based services

Dental care

Clothing

Inmate without mental health needs

Total cost: $11,232 Total cost: $42,474

Inmate with mental health needs

$748

$8,768 $26,304

$1,475

$171

$70

$2,994

$4,425

$513

$210

$5,784

$2,244

Figure 2. Housing cost comparison of inmates with and without mental health needs

Source: National Commission on Correctional Health Care
Jails are the Largest Mental Illness Facilities 13

A continuum of care, such as that advocated by the 

Dual Diagnosis Capability in Addiction Treatment 

Toolkit (SAMHSA 2009; SAMHSA 2014) and others who 

have written on co-occurring disorders (COD) (Minkoff 

2007), would result in treatment being provided to a 

wider range of individuals and fewer county residents 

suffering from untreated mental illnesses. 

Chronic low-level offenders get arrested and booked in 

our jails for trespass, vagrancy, nuisance, and crimes 

of survival (bus or train fare evasion, shoplifting for 

food). Many of these criminal behaviors are a function 

of chronic or co-occurring problems (or both): mental 

illness, alcohol or chemical dependency, homelessness, 

and poverty. These individuals cycle over and over 

through our courts and criminal justice system, 

adding criminal records to their mounting burdens. 

One need only look in our jails to see that the jails 

have become a convenience in far too many cases. 

For a case in point, “Robert” was recently held in a 

county jail infirmary because he was identified as 

vulnerable considering his age, physical appearance, 

and diminished mental status. Robert has been 

booked in the jail 31 times—15 times just since 2012. 

He has been a defendant in 59 criminal cases, but he 

has never had a felony charge. Robert’s most common 

offenses are trespass, vagrancy, and disorderly 

conduct; even worse, most of Roberts arrests were for 

bench warrants for failure to appear in court. 

In November 2013, a civil commitment action was 

filed against Robert. He was committed as chemically 

dependent in January 2014 and discharged in August 

2014. But then he was booked four times again in the 

following year. 

Robert has no place to live. His Social Security 

payments are not enough to pay for housing, and 

although he is a veteran he cannot afford the housing 

options available to him. By the time the county social 

worker came to see Robert in jail, Robert was planning 

to be released the following day. She tried to schedule 

a follow-up meeting with Robert a few days later, but 

he had no glasses, so he could not read her business 

card, and he did not have a cell phone so he could not 

follow up with her. He had no place of residence before 

his arrest and no place to go after release.

The county knows of Robert’s problems and his 

medical and mental health history, but there was no 

intervention. There were no solutions, and nothing 

changed for him except that he was scheduled for 

yet another follow-up criminal court date—a court 

date that he is likely never to get to without another 

intervening arrest or bench warrant. 

The jail environment is not conducive to maintaining 

mental health. This fact can be seen in the higher 

rate of suicide for those in jail than those in the 

community or in prison and that those who are 

incarcerated in jail from one week to one month are 

now the group at highest risk of suicide in jail (Hayes 

1983; Hayes 2012). It is further demonstrated in the 

research that the rate or incidence of mental illness in 

the jail is higher than the incidence of mental illness 

at the time of booking. Finally, there is a significant 

body of research indicating that incarceration in its 

many forms erodes the mental health of those who 

experience it.

As a result of these very complex problems, the nation’s 

sheriffs have been leading the charge in insisting upon muchneeded changes in making services available to people with 

mental illnesses in the criminal justice system.
14 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

Conversely, those individuals who have mental 

illnesses and are booked into jails can be stabilized 

and receive effective treatment for their mental illness. 

Most of the jurisdictions that participated in this study 

reported providing screening, assessment, treatment, 

and discharge planning for those with mental illnesses 

in their jails and that these processes were effective in 

stabilizing those with mental illnesses. 

As a result of these very complex problems, the 

nation’s sheriffs have been leading the charge in 

insisting upon much-needed changes in making 

services available to people with mental illness in the 

criminal justice system. As peace officers, we swear an 

oath to serve and protect—including and especially 

the most vulnerable among us, who have lost their 

liberty and are confined to prisons and jails. 

Everyone knows that law enforcement officers serve 

as first responders; calling 911 gets an immediate 

response from law enforcement. But more and more 

they are responding to people exhibiting symptoms 

of illness. And more and more we house and manage 

inmates who suffer from mental illness. Accordingly, 

a number of jurisdictions have implemented crisis 

intervention training in our nation’s law enforcement 

agencies, implementing de-escalation techniques 

and developing innovations and initiatives to make 

improvements in the way we respond to calls and 

manage inmates. Law enforcement agencies have been 

working to address the crisis on a broader level and 

have proposed reforms in three general categories:

1. Develop arrest and jail alternatives for low-level or

chronic offenders (instances of overincarceration).

2. Advance the sequential interceptor model that

helps to identify the pivotal points in the criminal

justice system where we have the best chance of

successfully intervening to provide the services

needed. Can we intervene before the crisis, as an 

alternative to arrest, or before these inmates are 

released from jail? 

3. Develop strong transition and re-entry programs that

help to reduce recidivism, and provide offenders the

best opportunity for success in the community.

The Major County Sheriffs of America (MCSA) is 

leveraging its national influence by partnering 

with like-minded associations such as the National 

Association of Counties, the Council of State 

Governments, the American Psychiatric Association, 

the National Alliance on Mental Illness (NAMI), 

and others. One such collaborative effort is the 

Stepping Up Initiative, which engages a wide range 

of stakeholders at the county level to reduce the 

population of people with mental illnesses in the 

jails by providing appropriate and timely intervention 

and treatment.

A project team from the MCSA, comprising selected 

subject matter experts from the correctional health 

profession and law enforcement practitioners 

supervising jails and field operations, focused on 

identifying the catalysts for change in the sheriffs’ 

offices visited. In a few cases, it seemed the catalyst 

was a federal investigation or legal challenge resulting 

in prompt and immediate action to avoid further legal 

action or a consent order for agreed-upon reforms. 

The bottom line in every county visited: Getting the 

right people with decision-making authority to the 

table and motivated to work together was the real 

catalyst for change. All of these counties had in some 

way or another successfully engaged key stakeholders 

in partnerships (the County Mental Health Services 

provider(s), the County Board of Commissioners, 

courts, sheriff, prosecutor and public defender, 

public/private hospitals), and in some cases, the 

business and nonprofit community played key roles in 

accomplishing transformation.
Jails are the Largest Mental Illness Facilities 15

Jails as mental illness facilities not a 

new issue

There has been a decades-long practice of relying 

on sheriffs and other law enforcement organizations 

to address mental health issues in the community 

through arrest and detention. While there are critical 

situations where law enforcement must use its 

authority to de-escalate violent or potentially violent 

situations threatening public safety, all too often the 

only recourse after order has been restored is arrest 

and confinement. 

Unless action is taken after arrest and incarceration 

by elements of the criminal justice system 

(prosecutors, defense attorneys, and the courts) to 

address the mental health needs of the individual, 

it is highly likely the individual will be back in the 

community to reoffend. Law enforcement action, 

arrest, and confinement will start the cycle all over. 

All too often the cycle continues until the individual 

causes serious harm to themselves or others.

Fortunately, there are law enforcement organizations 

and related stakeholder groups that have taken the 

initiative to interrupt the repetitive process of dealing 

with individuals with serious mental health issues at 

the point of contact, either in the community or at 

the time of detention. In the case of sheriffs’ offices, 

they have the opportunity to intercede in both 

environments given the frequent dual responsibilities 

of policing in the community and operating jails. 

It would therefore seem appropriate to study what 

sheriffs’ offices are doing to address this challenge 

and to identify programs and processes that work. 

Understanding what is working and why and how 

it works creates an opportunity to document and 

share the information with law enforcement agencies 

and other stakeholders throughout the country. As 

agencies implement these programs and practices or 

create new initiatives the odds increase dramatically 

that individuals with serious mental health problems 

will get the help they need to break the cycle of arrest 

and incarceration.

One of the primary purposes of this grant from the 

COPS Office is to identify what is working in some 

of the largest sheriffs’ office operations around 

the country, particularly those ideas that are 

transportable and scalable.

What are sheriffs doing to address this 

critical issue

The MCSA, at the direction of an advisory board 

comprising Sheriff-Coroner Sandra Hutchens (Orange 

County [California] Sheriff’s Department), Sheriff 

Richard W. Stanek (Hennepin County [Minnesota] 

Sheriff’s Office) and Sheriff Michael Chapman 

(Loudoun County [Virginia] Sheriff’s Office) and a 

team of professionals from these agencies studied 

a number of practices, processes, and strategies 

MCSA sheriffs’ agencies are using to successfully 

reduce arrest and incarceration of people with 

mental illnesses. 

These law enforcement professionals were 

complemented by expertise from the National 

Commission on Correctional Health Care (NCCHC) 

in an effort to provide a broader perspective to 

the assessment of what is being done currently by 

sheriffs and in the larger community of mental health 

specialists.

Further, these subject matter experts reviewed 

program information to identify potential 

weaknesses, risks, and opportunities for improvement. 

Consultants with expertise in field operations, jail 

management, crisis incident management, and deescalation techniques, as well as law enforcement 

administration, were used in conjunction with 

expertise in the field of law enforcement and 

correctional mental health issues. 
16 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

The project was broken down into four phases 

as follows:

Phase I – Hold an initial planning and organizational 

meeting resulting in a detailed list of activities and 

actions to be taken during different phases of the 

project and responsibilities assigned; develop a data 

collection instrument and process focused on problem 

identification and initiatives designed to address the 

problem; analyze the data collected.

Phase II – Organize and execute site visits to locations 

identified in phase I having initiatives in place that 

meet criteria established by the Sheriffs’ Advisory 

Board for programs worth further review; analyze and 

organize data and information collected; and produce 

an interim report of findings.

Phase III – Based on the interim report in phase II 

identifying sheriffs’ office programs, analyze results 

and prepare a draft report. After examining the 

results of phase II, report on sites visited and review 

the data collected from all sites and develop the 

outline for the final report. Develop a briefing outline 

of the project results to present to the MCSA at their 

winter meeting in Washington, D.C., in February 2016.

Phase IV – Prepare final report, project deliverable.

As a result of the initial meeting, a survey instrument 

was developed and distributed to the 78 members of 

the MCSA. Each agency received three separate survey 

tools: one designed for the sheriff or elected official, 

one for field operations, and one for jail operations, 

with instructions for each element to complete the 

survey independently. The surveys that were sent 

appear in appendix A of this report.

Each survey consisted of topics dealing with mental 

health training, drop-off facilities, CIT teams, 

alternatives to arrest, mental health databases, 

community stakeholders, mental health responses 

and use of force, points of contact, collaboration 

with the justice system, mental health screening, 

mental health resources, average daily population of 

facilities, significant events involving mental illness 

events in communities, and what resources agencies 

wish they had. 

There was great success with the survey distributed 

to the MCSA for Sheriffs’ Response to Mental Illness 

in the Jails and Community. Nationally, the average 

response rate on surveys sent in this manner is 10 to 

20 percent. The response rate for complete surveys 

across all three tracks was 29 percent. If the partial 

response rate was included, 58 percent of the agencies 

targeted was achieved.

Complete with a rubric and instructions on how to 

score the surveys, these team members reviewed 

surveys pertinent to their particular law enforcement 

track and returned those to the NCCHC team. Dr. David 

Stephens, PsyD, and a team from the NCCHC analyzed 

and aggregated the data from all of the surveys and 

the team’s scores. 

The NCCHC team used both qualitative and 

quantitative data in identifying the sheriffs’ 

offices selected for site visits on the basis of 

providing demonstrably effective overall programs 

or particularly effective program components. The 

quantitative data was analyzed by means of assigning 

a point value to each response and then obtaining 

an overall score for each of the sheriffs’ office 

respondents. The qualitative assessment consisted 

of reviewing narrative responses and coding them to 

identify the responses reflecting effective programs or 

practices. 

Once the overall scores were calculated for both the 

qualitative and quantitative data, the respondent’s 

scores for each category (sheriff or elected official, 
Jails are the Largest Mental Illness Facilities 17

field operations, and jail operations) were broken 

into quartiles, with the top 25 percent of scores in 

each category being the first quartile, the second 25 

percent of scores in each category being the second 

quartile, and so on. 

To qualify for the site visit, each category of response 

from each MCSA member had to fall into either the 

first or second quartile compared to the scores of 

all respondents in each category. In addition, if 

a program reported the presence of a particularly 

outstanding practice in a given area, that was 

included in the final analysis of top programs.

It was the responsibility of the project team members 

to review the data in an effort to identify six sites 

that appeared to have interesting approaches, were 

able to describe some level of success, involved 

outside stakeholders, and were committed to reducing 

the number of people with mental illnesses who were 

incarcerated and were frequently brought to the 

attention of law enforcement. 

The consulting team from the NCCHC took the input 

and developed a list of sites worthy of additional 

review. Quantitative and qualitative data were 

analyzed in addition to specific individual site specific 

programs in an attempt to identify programs capable 

of being replicated. Based on specific quartiles, the 

team identified the following counties’ sheriffs’ offices 

as the top four agencies:

1. Hennepin County, Minnesota 

2. Hillsborough County, Florida 

3. Ventura County, California 

4. Jefferson County, Colorado 

Additional substantive and personal knowledge of 

specific agencies was discussed within the team. 

Based on this information, Cook County, Illinois, and 

Bexar County, Texas, were added to the site visit list. 

These six initial sites were selected by the MCSA. 

In addition to the six sites that were ultimately 

identified, a seventh location, the Los Angeles 

Sheriff’s Department, was added to the list based on 

documented ongoing efforts to reduce the inmate 

population of inmates with mental illnesses, develop a 

comprehensive approach to mental illness in the field, 

and the sheer size of its jail population. 

Once the sites were identified, each selected agency 

received a letter indicating that the COPS Office grant 

team would like to schedule a site visit to request 

important documents relating to their approach to 

addressing individuals with mental disorders in the 

community and in the jails. Information such as 

relevant policies and procedures, training, evaluation 

protocols, and partnership agreements was requested. 

These documents were then reviewed by the site visit 

team to develop an understanding of what the sheriff 

was doing to formulate appropriate lines of inquiry, 

and to identify individuals for potential interviews.

Teams looked at how the program or practice 

was initiated and to what extent has there been 

development and maintenance of collaborative 

relationships with community services. In addition, 

they looked at what costs, training, policies, and 

related resources were needed to start and maintain 

the program. Were there “red flags” that raise 

questions about the success, viability, ethical 

practice, or appropriateness of the program, and 

how can the program be improved upon, expanded, 

or further developed?

Ultimately, teams looked to see if programs as 

a whole could be used as model programs and 

whether there were individual program components 

that are particularly noteworthy and deserving of 

acknowledgement in addition to or independent from 

the overall program.
18 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

Site visit teams looked to determine the extent 

to which the program being reviewed meets 

these criteria:

• Can it be replicated? Can this program or 

practice be repeated in other jurisdictions, 

given inconsistencies in resources, policies and 

procedures, and facility design and operations?

• Is technology being used that allows the program 

to be maintained and replicated, and is it being 

used appropriately?

• Can the development of the program be 

identified and sustainable?

• Is the methodology of the program sound?

This means it meets acceptable law enforcement, 

criminal justice and jail, and community mental 

health standards. In addition, it should not include 

practices or procedures that introduce risk or 

require active and high levels of risk management 

processes and procedures to be implemented.

Teams made every attempt to interview individuals 

such as the sheriff, designated members of the 

sheriff’s executive team as recommended by the 

sheriff, sheriff’s command staff for patrol, jail 

staff, and community law enforcement as they 

have involvement in addressing people with mental 

illnesses and issues related to mental illness. This 

included deputies and officers who are involved in the 

identification, diversion, referral, or management of 

people with mental illnesses; CIT-trained officers if 

they are present in the county; community partners 

as designated or referred by the sheriff or others in 

the sheriff’s office; and jail health care and mental 

health care administrators and providers. 

Site teams reviewed the processes and documents. 

These included policy and procedure manuals, program 

manuals and documents, memoranda of understanding 

or intent (MOU/MOI), and related documents. When 

available, the teams looked at annual reports if those 

reports addressed issues related to the identification, 

diversion, referral, or management of people with 

mental illnesses; financial reports (as available) of the 

impact of addressing people with mental illnesses and 

issues of mental illness; process of interacting with 

people with mental illnesses from first contact on the 

street through incarceration and re-entry; documents 

or forms used for all aspects of the programs and 

processes; and program marketing or public awareness 

documents or literature.
19

Survey Results

On March 27, 2015, 78 sheriffs’ offices were surveyed 

from around the United States. Of those, 40 different 

sheriffs’ offices responded; however, not all sheriffs’ 

offices responded to every question. The responses 

from those who responded to the survey were 

distributed to the entire COPS Office grant team 

for review and analysis. Initial observations were 

as follows:

• Of those responding, 34 (87%) stated that they 

have a specialized program in place. Only five 

(13%) of the respondents stated that they do not 

have a specialized program.

• The length of time agencies had a program in place 

varied. Of those responding, 21 (61%) stated that 

they have had a program for more than 10 years. 

Six (17%) stated that they have had a program 

between 5 and 10 years. Seven (20%) stated that 

they have had a program between one and five 

years. None of those responding stated that they 

have had a program one year or less.

• Four agencies (11%) stated that they have met 

resistance to their mental health program. Thirty 

(88%) stated that they have not met resistance 

to their mental health program. Those who have 

met resistance include various agencies refusing 

to assist with any type of fund-sharing. They also 

noted cost factors to build more facilities or have 

more beds rather than jail cells. They also reported 

that community resources are lacking including 

funding for training and staffing.

• A respondent from an agency who has not 

met resistance stated, “In and out of custody 

mental health care treatment/support is critical 

to success. Our program includes all of the 

stakeholder resources previously documented in 

this survey. Adequate local facilities that are safe 

and secure, with a primary focus of programming 

and treatment are also critical to success. Sheriffs 

need adequate, appropriate facilities to provide 

mental health care treatment. Engaging both 

inmate medical/mental health care providers 

as well as mental health care clinicians is part 

of our program services. Our in-custody mental 

health care programs deploy deputy sheriffs 

who are specifically and exclusively assigned to 

working with mental health care providers. Those 

team members work together to provide services 

necessary for in-custody mentally ill offenders.”

Responding agencies are very interested in continuous 

improvement of their programming if sufficient 

resources are available. The sheriffs recognize they 

need the commitment of relevant stakeholders to 

ensure success in addressing mental illness issues. 

Following are some of their comments on how they 

envision the best strategies to effectively deal with 

special mental health needs:

• We would increase the number of mental evaluation 

teams in the field. We would collaborate with 

hospitals, rehabilitation centers, churches, and 

community groups. In the custody environment, 

we would work with organizations designed to 

assist with reintegration for inmates with mental 

health needs. A dedicated drop-off center with bed 

space will be the most effective service to better 

our program. All of our partnering stakeholders 

support this effort, but funding and approved bed 

space is the key element needed.

• Use crisis intervention teams (CIT) and add 

more training early on in the Police/Corrections 

Academy with refresher courses that are already 

in the works.

• We need a program that links incarcerated 

individuals with mental illness with programs and 

support once released.
20 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

• Such programs should foster an environment 

that encourages employees to deal with persons 

in street contacts and during interviews with an 

understanding of and attention to the problems 

they may be experiencing with mental or emotional 

difficulties or substance abuse. Employees should 

be able to recognize that such individuals may 

require law enforcement assistance and access 

to community mental health and substance 

abuse resources.

• I would envision a specific mental health (MH) unit 

located within the jail with sufficient staffing of 

MH and correctional professionals. This population 

assigned to this unit could receive specific MH 

programming and other services specific to their 

needs while residing in a secure and safe setting.

• It is our opinion that the best option for 

individuals with mental illness is to divert them 

from jail if possible. Because of state laws and 

limited resources, there are far more options 

and resources available to persons who are not 

incarcerated. For those individuals that are 

incarcerated, forensics staff should focus on their 

treatment as well as developing a plan for when 

the individual is released back to the community. 

This will help ensure their success and continue 

their treatment post incarceration.

• Community mental health agencies, county 

commissioners who provide funding, and other 

community leaders would be stakeholders and would 

need to take part in a program that effectively 

identified those in need, provided immediate MH 

care, and provided a long-term plan of care.

• I believe that the best services are wrapped around 

services that continue even after the inmate is 

released. Ideally, I would love to see this happen 

• in every instance where an individual with 

mental health needs has been released back 

into the community.

As expected, most law enforcement agencies around 

the country conduct mental health screenings at 

time of arrest or booking. Of the sheriffs surveyed, 

all of the respondents reported they conduct mental 

health screenings on all arrestees, commitments, and 

bookings. Of this same group of reporting sheriffs, 

97 percent conducted mental health screening for 

co-occurring substance use disorders. Most screenings 

are conducted during classification or during the time 

of arrest or at the time of the medical screening. Of 

those responding, five (12%) stated that they screen 

at the time of arrest. Thirty-five (88%) stated that 

they screen at booking.

Survey responses reveal some individuals’ mental 

illnesses are recorded and the information is shared 

with pretrial services, prosecutors, defense counsel, 

and the courts in an effort to promote safety for both 

arrestee and staff. Twenty-one agencies (53%) stated 

that they share with pretrial services, prosecutors, 

defense counsel, and the courts. Ten agencies (25%) 

stated that they do not share this information. 

Eighteen agencies (46%) stated that they share this 

information in one of the following manners:

• We share information in response to any request 

with a signed release.

• What information is shared and with whom 

is situation-based. There is no specific 

“notification tree.”

• We share information with county behavioral 

health services and the court-appointed 

psychiatrist.
Survey Results 21

• Information is verbally communicated to court 

staff so precautions can be made to protect the 

arrestee and other staff.

• This information is not shared on a regular basis 

but can be upon request. Our mental health staff 

works cooperatively with other agencies and the 

courts system.

• We do not share information on a routine basis, 

but we will share information with court personnel 

when there is a specific concern.

The current prevalence of individuals with mental 

health needs in facilities surveyed varied. The range 

varies so widely for a number of reasons including 

the lack of a consistent definition of mental illness; 

reporting mental health needs versus mental illness; 

individuals come to jail with a high number of 

diagnoses; some facilities report diagnoses selfreported by inmates at intake while others wait to 

determine if an assessment reveals mental health 

needs or a mental illness; and some facilities only 

report and count those with a severe and persistent 

mental illness (SPMI), which typically includes only 

depression, bipolar disorder, and schizophrenia and 

neglects diagnoses such as panic disorder, PTSD, etc. 

Divergent screening and assessment processes, 

differences in the training level of those who assign 

diagnoses or identify individuals as having a mental 

illness, inclusion or exclusion of personality disorders 

as mental illness, varying definitions of serious mental 

illness (SMI) versus mental illness, varying practices 

across jurisdictions related to the detainment and 

booking of those with mental illness, and counting 

only those on psychotropic medications accounts for 

most of the other variance in rates of mental illness in 

individual jails. 

The average daily population of facilities responding 

to the survey varied. Based on the responses received, 

the daily population average was 2,659. However, 

there was a significant difference between the 

numbers within the facilities of the respondents. 

The highest recorded average daily population was 

more than 18,000. The lowest recorded average daily 

population was 380 in Loudoun County, Virginia.

Twenty-seven agencies (69%) stated that the 

percentage of individuals with mental illness needs 

in their facilities has increased in the last two years. 

Thirteen agencies (33%) could not provide this 

information. On average, agencies reported the 

rate has raised between 5 and 20 percent from 2016 

to 2018.

Of those responding, 24 agencies (61%) stated that 

they have adequate resources to support the mental 

health needs of the inmate population in their 

facility. Sixteen agencies (41%) stated that they 

do not have resources to adequately support this 

initiative. Some of those who do not have adequate 

resources gave the following reasons for the shortfall:

• Our jail is a pretrial facility, so emphasis is on 

medication maintenance of inmate MH condition. 

Treatment, per se, is a missing element.

• We need additional bed spaces, treatment areas, 

offices, and discharge planning.

• The recently established Mental Health Transition 

Center needs the resources to expand to provide 

services to more individuals as well as supplemental 

services to those individuals who are not enrolled 

in one of our existing programs. Resources are 

desperately needed to provide additional services.
22 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

• There has been an increase over the last two years 

and rising expectations of what is considered 

quality treatment for mental illness needs. We are 

short providers and counselors.

• There is such a large volume of inmates identified 

as having mental health issues. The resources we 

have are just limited and are being spread so thin.

• Our psychiatric staff has seen a workload increase 

of 16.5% (mental health worker) and 21.5% (psych 

doctor contacts) in the last four years. There is 

always a need for increased services in custody for 

this population.

• While we are fortunate to have mental health staff 

on 24/7, the needs of this population far exceed 

our capabilities. We do not have any designated 

special needs space of any type and are often 

forced to rely on restrictive housing to ensure the 

safety and security of all.

With regard to discharge planning for individuals 

with mental health needs, approximately 90% of 

responding agencies stated that they participate in 

discharge planning for individuals with mental health 

needs. Four agencies (10%) stated that they do not. 

It was found that a majority of the respondents do 

not track information or could not provide data 

about how long inmates with mental health issues 

stay in their facilities. Three reporting agencies stated 

their average length of stay (ALOS) was between 12 

and 54 days. 

The ALOS for a person with a mental illness is an area 

that needs to receive greater attention on the part of 

all jurisdictions, and that is a finding of the study. In 

some respects, jurisdictions are reducing the days of 

incarceration for those with mental illness through 

diversion efforts, stabilization of the mental illness 

while individuals are incarcerated, and effective 

discharge and re-entry planning. That is not to say 

that jails should not focus on specifically reducing 

ALOS for inmates with mental illnesses but rather that 

other indirect efforts are having a positive impact on 

this important issue. 
23

Site Visits to Examine Programs and Initiatives that 

Work and Have Promise

Jefferson County Sheriff’s Office, Golden, 

Colorado

Jefferson County is the fourth-most populous county 

in Colorado with a population of more than 550,000. 

The county seat is Golden, and the most populous 

city is Lakewood. Jefferson County is included in 

the Denver-Aurora-Lakewood, Colorado, Metropolitan 

Statistical Area. Located along the Front Range of the 

Rocky Mountains, Jefferson County is adjacent to the 

state capital of Denver (JCSO 2018a).

Jefferson County has reported that 79.9 percent of 

the population is White, less than 1 percent Black, 

0.5 percent American Indian and Alaska Native, and 

2.63 percent Asian or Pacific Islander. As of 2010, 14.3 

percent of Jefferson County’s total population was of 

Hispanic or Latino origin, which is considerably lower 

than the 20.66 percent reported Hispanic origin for 

Colorado (JCSO 2018b). 

The Jefferson County Sheriff’s Office (JCSO) was 

founded in November 1859 and today serves the 

residents of Jefferson County with a patrolling 

responsibility to 189,720 residents in the 

unincorporated areas of the 773 square miles of 

the county. As chief law enforcement officer of the 

county, Sheriff Jeff Shrader oversees the largest 

full-service sheriff’s office in Colorado with 542 

state certified deputies and 283 professional staff. 

In addition, about 300 volunteers support sheriff’s 

operations. The daily average population of the 

Jefferson County Jail is approximately 1,250 inmates. 

Approximately 26 percent of JCSO inmates have been 

identified with some degree of mental illness.

In the wake of the Columbine High School shootings 

in 1999; the Aurora, Colorado, movie theater shooting 

in 2012; and the mass casualty event at Sandy Hook 

Elementary School in Newtown, Connecticut, in 2012; 

Colorado Governor Hickenlooper focused attention 
24 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

and funding to develop mental health crisis programs 

throughout the state of Colorado. Much of the money 

for these programs has come from marijuana sales 

tax revenue, which went into effect in January 2014. 

There have been other sources of funding as well. In 

2013 Jefferson County received a Justice Assistance 

Grant (JAG) that enabled it, in conjunction with 

the Jefferson Center for Mental Health (JCMH), to 

create a robust, multiagency crisis management and 

diversion team. What follows is a summary of their 

comprehensive and balanced system.

From the information gathered during the site visit by 

members of the MCSA study team, Jefferson County’s 

approach to mental health issues is best described 

from its own JAG grant application summary:

“In the spirit of community policing problem 

solving, we initiated a dialogue with other 

criminal justice entities, as well as mental health 

treatment organizations such as the Jefferson 

Center for Mental Health, in an effort to create 

collaborative partnerships to address the issue. 

The response we received was outstanding and 

resulted in the creation of a monthly multidiscipline round table meeting, where we 

discussed specific problematic cases, and began 

to create a response protocol.” 

In addition, the county recognized early in the 

process that one of the biggest breakdowns in 

treatment is a result of the program’s structure. 

They went on to explain:

“Mentally ill people are not always good at 

following through with commitments or with 

taking their prescribed medications and they 

don’t easily trust in many cases. This ‘gap’ in 

follow-through is precisely what our mental 

health collaboration team is attempting to 

address in promoting the funding of CIT Case 

Managers. . . . This partnership will go a long 

way in proactively addressing and managing a 

national phenomenon. It is our hope that we will 

ultimately be able to create an effective overall 

mental health response strategy and model that 

others will be able to replicate.”

Between 2014 and 2018, JCSO reported an increase 

in mental health related calls and mental health 

consumers’ use of resources and stakeholders’ time. 

Unfortunately, Colorado has had several high-profile 

and active shooter incidents that were mental health 

related. This prompted statewide funding for mental 

health resources and crisis drop-off centers using tax 

revenues from marijuana sales. 

JCSO, like many other law enforcement agencies across 

the country, recognized the need for collaboration 

and crisis intervention teams (CIT). The sheriff’s office 

has also been involved in alternatives to arrest those 

with special mental health needs for many years. This 

included supporting CIT as a regional training program 

to ensure consistency in the community. In addition 

to field officers, JCSO also provides CIT training for 

dispatchers.

There has been a cultural change in the agency 

relating to the importance of dealing with individuals 

with mental illness as JCSO executives, as well as 

all layers of the command and supervisory team, 

frequently discuss this important topic. There is a 

clear message from the sheriff, and he has made a 

concerted effort to get all stakeholders involved. The 

JCSO’s motto is not “How can we afford this (proactive 

approach to mental illness)” but “How can we afford 

not to do this?”

The program within the JCSO began with courts and 

branched out to additional stakeholders. The program 

uses CIT as the base or standard for training, but it 

maintains the flexibility to modify this tool to meet 

the needs of the agency. The CIT is an innovative firstresponder model of police-based crisis intervention 

with community, health care, and advocacy 

partnerships. The CIT model was first developed in 
Site Visits to Examine Programs and Initiatives that Work and Have Promise 25

Memphis, Tennessee, after local police shot and killed 

a man with mental illness who had charged at them 

with a knife. 

The Memphis model provides law enforcement and 

emergency responder–based crisis intervention 

training for assisting those individuals with a 

mental illness. The goal is to improve the safety of 

emergency responders, consumers,2 family members, 

and community members. The Memphis model 

provides the foundation necessary to promote 

community and statewide solutions to assist 

individuals with mental illnesses. It reduced both 

stigma and the need for further involvement with the 

criminal justice system. The Memphis model (CIT 40-

hour) course is the foundation for the countywide CIT 

program in Jefferson County. Like many current CIT 

programs, Jefferson County’s participants (sheriff’s 

office and police departments) have modified the 

program and added additional content to fit the 

needs of Jefferson County’s specific population. 

Nationwide examples include adding veteran service 

PTSD modules near military bases and adding 

Alzheimer’s and dementia training in areas with large 

retiree populations.

The JCSO believes role playing is vital to achieving 

successful program results rather than the traditional 

instructor-focused lectures frequently used in 

many training courses. Statistical data provided by 

the JCSO support the assertion that CIT training 

reduces the incidents of use of force when compared 

with deputies who have not attended the training 

program. While it would be helpful to track the use 

of force events involving individuals perceived to be 

impacted by mental illness, this information was 

not collected by JCSO. Given the complex nature 

of having laymen assess the mental state of the 

individuals they confront, any assertions about 

the use of force involving individuals with mental 

disorders should be considered a gross estimate. 

Numerous stakeholders who were dealing with 

individuals with special mental health needs were 

included by JCSO at the outset of the collaboration 

effort. Stakeholders included the offices of the 

county attorney and public defender, probation, 

courts, county police departments, jail medical 

and mental health staff, NAMI, and Colorado Crisis 

Services. Additional stakeholders were brought in 

to fill gaps as they were identified or when they 

became aware of the initiative and believed they had 

something to contribute. 

Once the collaborative group became established 

and relationships were built, gaps in the initial 

programs were more easily filled as associations, 

groups, and individuals recognized the value of the 

programs and the synergy achieved through team 

work. The successes were due in no small part to the 

relationships and overall direction of the stakeholders 

acting with the same goal and mindset. NAMI was 

instrumental in the effort to build a countywide 

mental health database to better identify the needs 

of the individuals and coordinate intervention 

services. The database is primarily designed as a 

resource for better mental health care information 

on individuals who come in contact with law 

enforcement. This helped deputies to view those with 

mental illness as individuals in need rather than just 

criminals to process. 

2. The term consumer is used by many advocates, treatment providers, and others as an alternative to patient, SMI, or 

individual with mental health issue because the term conveys empowerment of the person over their illness. In addition, using 

consumer means the individual is proactively engaged in their treatment and is not defined by their mental health diagnosis. 

(Kersting 2005).
26 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

The resources within the JCSO include

• a crisis hotline;

• walk-in and drop-off centers;

• hospitals;

• juvenile assessment center;

• detox center; 

• mobile crisis unit;

• CIT-trained deputies.

In the JCSO program, CIT case managers (CM) are more 

than just discharge planners. They are co-located 

in the main patrol station near the deputies’ work 

locations and are a readily available resource for the 

field patrol staff. In addition, they work with the 

jail staff so that they have relationships with both 

field operations and corrections staff. In the jail 

operations, counselors interview and screen arrestees 

at intake as part of the booking process so they can 

refer inmates to appropriate programs or resources 

while they are in custody. 

In situations where taking someone with special 

mental health needs into custody is the best course 

of action, the JCSO uses an approach that begins to 

lay the foundation for the development of a discharge 

plan. The co-location of CIT CMs allows for better 

collaboration, as relationships have been built that 

may not have evolved if the deputies and CMs were 

not able to see one another on a daily basis. Rather 

than waiting for a situation or call for service to 

force a business-related phone call between the 

deputies and CMs, the deputies walk by CMs on the 

way to briefings, which facilitates open, impromptu 

meetings and dialogue. Seemingly trivial questions 

that deputies and CMs may never ask one another are 

commonly asked, answered, and discussed because 

of the co-location, and gaps are filled often without 

convening a committee or working group. Because 

of this strong and credible relationship, along with 

immediate access and response, patrol deputies 

often call the CMs for advice rather than wait for 

mobile crisis teams to respond. This has become 

an unforeseen added benefit for Jefferson County 

sheriff’s deputies in their patrol operations.

The Jefferson County Detention Policy Manual 

supports this approach to planning for release at the 

earliest opportunity. The JCSO policy manuals are well 

written and revised on a regular and as-needed basis. 

The electronic manuals consistently have links to 

supporting documentation or additional information. 

They have well-written, comprehensive policies for 

all aspects of inmates’ mental health needs including 

suicide prevention, mental health, counseling, and 

medical support. They are written in accordance with 

the guidelines and accreditation of the American 

Corrections Association (ACA), National Commission 

on Correctional Health Care (NCCHC), or Commission 

for Accreditation of Law Enforcement Agencies 

(CALEA) and are so noted in the manual. JCSO’s 

policies and procedures manual is available to its 

employees electronically or on a DVD. The DVD’s label 

denotes JCSO is ACA-, NCCHC-, and CALEA-accredited. 

The inmate’s booking, triage, and classification 

processes all consider the issues presented with 

those with special mental health needs. The JCSO has 

deputies assigned to work in special mental health 

housing units who receive additional training for 

dealing with those individuals with special mental 

health needs. Deputies who work in these areas are 

screened based on special qualities that fit best in 

this environment. MH housing unit deputies (Special 

Housing Unit [SHU] deputies) first have a desire to 

work in the MH housing unit. They have demonstrated 

excellent communication skills with staff (sworn, 

professional, medical, mental health), community 

members, and mental health consumers. They work 

well in a team environment, showing good deescalation techniques and patience. These posts are 
Site Visits to Examine Programs and Initiatives that Work and Have Promise 27

typically highly sought-after positions by the sworn 

staff as evidenced by having more highly qualified 

candidates than position vacancies. 

In addition, the JCSO has a discharge planner 

who coordinates outside resources for an inmate’s 

reintegration into the community. A single CIT CM 

(discharge planner) position was grant-funded for the 

first year through Jefferson County MH. Because of its 

success, Jefferson County MH picked up the cost when 

the one-year grant expired and supplied a second CIT 

discharge planner to be co-located in the sheriff’s 

office. Since the positions began, the JCSO has seen a 

reduction in call-backs and calls for service regarding 

the behavior of the same individuals. Some of the 

resources the discharge planners help inmates access 

prior to release are housing, identification cards, 

Medicaid benefits, veterans programs (including acting 

as a liaison to Veteran’s Court), and working with the 

non–discharge planner CIT CMs to assist the families 

with the re-entry process. 

During discharge planning, CMs assist inmates in 

getting IDs or replacement driver’s licenses, for 

which the fees are waived. Personal information, 

photos, incarceration dates, criminal history, and 

important mental health information is collected in a 

computer-aided dispatch (CAD) accessible electronic 

database. Inmates are also provided with a 30-day 

supply of prescription medications upon release. 

Suicide assessments are conducted on all inmates 

with special mental health needs who are being 

released to determine if they need additional followup evaluations at local hospitals. These assessments 

and other elements of the re-entry program have 

contributed to a positive outcome for an estimated 54 

percent of inmates who have remained in successful 

programs one year after their discharge with a 0 

percent recidivism rate. 

The initial JAG grant was used in part to fund two 

full-time mental health case managers who provided 

liaison functions between the Jefferson Center for 

Mental Health and the JCSO. The case managers are 

certified mental health professionals who provide 

nontraditional clinical case management services. 

Essentially, they receive referrals from deputies who 

have identified individuals and situations in the field 

that would benefit from their expertise.

While the case manager positions were created with 

JAG grant money, they were later funded fulltime by the county mental health office when the 

grant expired. The decision to fund these positions 

was based on what the JCSO and Jefferson Center 

for Mental Health noted as a significant increase 

in referrals to the CIT CMs with a corresponding 

reduction in time deputies spent handling mental 

health related calls. Overall, the program was deemed 

to be successful and an efficient and effective use of 

limited county resources. 

The JCSO and its collaborating partners have a shared 

philosophy with an emphasis on finding the best, 

most efficient way to handle a mental health client. 

Currently, case managers are only housed in one 

precinct with a significant distance between all three 

precincts. All of the precincts would benefit from the 

presence of CMs because of the ease of interaction 

their presence creates between the deputies and 

clinicians. Whether serendipitously or by design, the 

JCSO has created a program that naturally crosses 

over between the jail system and patrol operations. 

By being attached to the jails through their mission

of discharge planning and “walking” the jail housing 

units, the CIT CMs interact with and receive referrals 

from the jail, medical, and mental health staff. This 

interaction has built relationships inside of the jails. 

By doing their desk work near the patrol briefing 

room, they have a relationship with the deputies 

there as well. If their work location(s) were in the 

jail, (possibly) their only relationship with or resource 

to patrol would take place during an occasional ridealong or patrol briefing.
28 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

The mobile crisis unit used by the JCSO has about 

a 30-minute estimated time of arrival in the field. 

The unit comprises a CIT deputy and a mental health 

professional. CIT deputies are selectively recruited for 

an intense 40-hour training course, which involves 

expert lecturers, role-playing scenarios with actors, and 

visits to local mental health facilities. Once certified in 

crisis intervention, all CIT deputies wear a CIT pin on 

their uniforms that denotes their certification.

One of the most important aspects of a successful 

program was the ability of the patrol officer, regardless 

of jurisdiction, to have a centralized crisis center to 

assist with people who fall into a grey area where 

their violations of the law are petty crimes such as 

vagrancy, trespassing, etc., and the individuals are not 

exhibiting moderate or severe mental illness behaviors. 

This includes a broad spectrum of people the patrol 

officer recognizes in need of assistance rather than 

incarceration or involuntary hospitalization. 

One collaborating partner in this effort is the Colorado 

Crisis Walk-in Center administered by the Jefferson 

Center for Mental Health. The walk-in center offers 

a variety of services to the general public. It is a 

24/7 facility that allows law enforcement officers to 

bring individuals who may be experiencing a mental 

health crisis. The officers can release the individual 

to the Crisis Walk-in Center staff and be back inservice in the community within about 15 minutes. 

This is a remarkably efficient alternative to sitting 

in a hospital emergency room for several hours, and 

it is much more beneficial to the individual than 

arrest and incarceration for petty offenses. The crisis 

center can provide the services on a voluntary basis 

or perform involuntary holds if there are no other 

mitigating medical concerns.

During regular meetings of all stakeholders (including 

the sheriff’s office, Jefferson Center for Mental 

Health, probation, county attorneys, fire and rescue 

services, Adult Protective Services, and several local 

police agencies), members of the group discuss how 

they can better incorporate a community caretaker 

philosophy into their current training and training in 

the community. 

The JCSO and the sheriff’s executive team support 

the need for good mental health programs both in 

the community and in the jails. They are also very 

supportive of an efficient crisis center drop-off 

facility. A detailed flow chart describes exactly how 

to handle mental health field contacts. This flow 

chart appears in appendix B of this report. The chart 

includes

• a comprehensive and current list of available 

resources;

• detailed policies regarding referrals to the CIT CMs;

• detailed policies regarding referrals to the jailbased behavioral health services;

• effective and frequently used deputy referral forms 

(used as the basis for much of their statistical 

records).

Their detailed record keeping of relevant statistics 

include

• number of referrals from law enforcement to 

county mental health services;

• number of referrals from caseworkers to law 

enforcement;

• number of referrals by caseworkers to outside 

treatment programs or resources;

• number of follow-ups with law enforcement and 

caseworkers; 

• number of repeat calls or call-backs for “frequent 

fliers.”

The JCSO conducted more than 20,000 initial 

screenings at all bookings and approximately 4,900 

follow-up MH screenings during 2014 (documented 
Site Visits to Examine Programs and Initiatives that Work and Have Promise 29

in their annual report). The follow-up MH 

screenings have been increasing at a rate of 10 to 

15 percent each year. The JCSO also tracks inmate 

reclassifications, follow-ups, crisis calls, collateral 

consultations, MH referrals, suicides (as well as 

attempts, flags, and watches), and MH status exams. 

In addition, the sheriff’s office keeps statistics on 

inmate program participation, including programs 

related to MH issues (addiction, coping skills, stress 

management, self-esteem). Referrals to CIT CMs, CIT 

CMs’ referrals, and placements and resources are also 

tracked, along with success rates.

The JCSO is constantly looking for additional fiscal 

resources to support its work with individuals 

with mental illness who come in contact with law 

enforcement and the criminal justice system. With 

additional funding, the JCSO would

• increase its effort to assist with offender 

re-integration and re-entry services;

• provide better medication support, when 

warranted, upon release from jail; 

• work with other stakeholder groups to secure more 

mental health beds in the community and add to 

additional specialized lodging units in the jail.

Jefferson County in general and the JCSO specifically 

has a flexible, fluid, and organic approach to dealing 

with mental health clients throughout their justice 

system. From the deputy on the street to the clinician 

in the jail to the judge at the diversion court, 

everyone had the same goal in mind. The goal was to 

reduce the number of MH-related calls for service and 

jail bookings, which branched into the comprehensive, 

inclusive program that exists today.

The JCSO initially began to address the MH concerns 

because field operations personnel saw an increase 

in MH-related calls and bookings. As they began 

reaching out to stakeholders, starting with the courts, 

they discovered all of the stakeholders were also 

experiencing increased numbers of MH consumers, were 

attempting to get their arms around the issue, and 

were looking for solutions and partnerships. The JCSO 

discovered they were not alone and other stakeholders 

were ready for a change (first driven by the courts and 

Sheriff Shrader). Their specific programs may not work 

for everyone, but the amount of support and dedication 

from all their stakeholders has certainly provided a 

level of success that would not exist otherwise. 

In and beyond Jefferson County today, families are 

relied upon to provide stability and resources for 

those in need. The sheriff’s office, as well as other 

county stakeholders, provides education, referrals, 

and resources to support family members, who in turn 

can provide resources to their loved ones. Families 

may have one or more members with specific needs, 

including seniors with limited mobility, those with 

physical illnesses, and those with mental health issues. 

The JCSO currently maintains the mobile crisis unit in 

the county as well as short-term, crisis management, 

and de-escalation techniques within the agency. 

Families play a significant role in treatment and are 

heavily relied on to help law enforcement and social 

services respond effectively. But families with even 

the best intentions may sever contact with a family 

member suffering from mental illness if resources and 

supports are not made available. With the appropriate 

support and resources from all stakeholders, families do 

not have to go it alone and communities are ultimately 

safer and more harmonious.

Contributions to case study by Lt. Shawn Allen.
30 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

Hillsborough County Sheriff’s Office, 

Tampa, Florida 

Hillsborough County is the fourth-most populous 

county in the state of Florida with a population of 

more than 1,279,000. Tampa, Florida, is the county 

seat and the most populous city in Hillsborough 

County. Hillsborough County Sheriff’s Office is the 

primary law enforcement agency and is responsible 

for 980 square miles of patrol response as well as 

operating two jails and a work release center and 

staffing courthouses (Hillsborough County Sheriff’s 

Office 2018). 

Statistics show that 71 percent of Hillsborough 

County is White (total White population is 876,137), 

while the Black or African-American population is 17 

percent (total Black population is 205,073). The Asian 

population is 3 percent with a total Asian population 

of 42,076. Native Americans, Pacific Islanders, and 

individuals reporting more than one race make up the 

remaining 9 percent. (The total Hispanic population 

is 306,635, for 25 percent of the population; this is 

considered an ethnicity rather than a race.) There are 

three incorporated cities within Hillsborough County: 

Tampa, Plant, and Temple Terrace, each of which has 

an independent police department (United States 

Census Bureau 2018a).

Florida is ranked last in the United States when it 

comes to its financing of the mental health crisis. 

Although there appears to be no single event as the 

catalyst for change, the Pre-Arrest Intercept Program 

(PIP) Jail Diversion Central Receiving Center (CRC) 

Model Program (PIP-CRC) was developed as a result 

of a several years–long planning process carried out 

by a group of diverse and dedicated stakeholders in 

Hillsborough County. 

The Hillsborough County Sheriff’s Office (HCSO) was 

founded in 1845. The HCSO employs 2,485 sworn 

personnel under the leadership of Sheriff David Gee. 

Out of the sworn personnel, 1,061 are in corrections 

and 1,424 personnel are in the patrol division. 

The HCSO has 13 divisions: four jail divisions, one 

training division, one homeland security division, one 

investigation division, one child protective division, 

four patrol divisions, and a community outreach 

program (CIT-trained deputies). The main booking site 

is located on Orient Road and services 26 local, state, 

and federal agencies; the second detention center 

is Falkenburg Road Jail and is located on 142 acres. 

HCSO most recently reports a daily population of 

2,882 inmates with approximately 18.4% identified as 

having a mental health illness (Florida Department of 

Corrections 2018).

The Orient Road location is the primary receiving 

facility that services more than 27 local law 

enforcement agencies. It offers offender re-entry 

programs and is the primary juvenile facility for the 

county. It is also the central breath test location for 

driving under the influence (DUI) and for individuals 

who voluntarily self-arrest. It is one of the largest 

facilities in the United States. The HCSO is able to 

house 4,947 persons, which includes 3,300 beds at 

the Falkenburg Jail. Both HCSO jails offer educational 

and vocational education such as cooking, general 

educational development (GED), and sewing. 

Any arrested individual can be booked into HCSO at 

either jail location, and each location is staffed with 

a mental health professional who can assist during 

the screening, which is completed immediately 

after the individual is searched. However, the main 

county jail (Orient Road location) also offers prebooking interventions that can be engaged by 

patrol officers and deputies. This is a pilot program 

designed to address unmet needs of individuals with 

mental health and CODs, with a single point of entry 

into the behavioral health system. A behavioral 

health provider, jail medical staff, and the booking 

sergeant are part of the process. They determine if 

these individuals qualify for Agency for Community 

Treatment Services (ACTS), who respond to the 
Site Visits to Examine Programs and Initiatives that Work and Have Promise 31

jail within a two-hour window and transport the 

individuals to mental health facilities rather than 

arrest and booking into the jail facility. 

The jail also works with consumers who act as peers in 

the booking area. In order to participate in the ACTS 

program from booking, individuals must volunteer 

for this service. Consumers can provide peer support 

and answer questions that individuals have prior to 

arrest and booking. Also, if no treatment beds are 

available in a timely manner, ACTS can refer diversion 

individuals to available hospitals for care until a 

treatment bed is located. The Jail Diversion Program is 

a collaboration between Hillsborough County Board of 

County Commission, HCSO, Tampa Police Department, 

court administration, the Office of the Public Defender, 

the State Attorney’s Office, Hillsborough County Jail’s 

medical provider, and several behavior health providers.

Hillsborough County holds the 40-hour crisis 

intervention team (CIT) training one week after its 

full academy training. New recruits are not chosen to 

become CIT deputies until two years later when they 

have gained either the road experience or correctional 

experience needed to appreciate the CIT program. If 

they decide that they wish to become part of the CIT 

program, they take the 40-hour CIT program a second 

time and become certified in CIT. Hillsborough holds 

up to 50 students both from patrol and corrections. 

When they come to the role-playing exercises 

required by the Memphis model, they break into their 

respective career assignments to obtain the maximum 

training specific to their career path. HSCO first 

launched its CIT program in 2003 and has trained more 

than 1,000 deputies from both corrections and patrol.

It is apparent that having the correct champion to 

lead the CIT program is imperative to the success of 

this program. Patrol Services Colonel Greg Brown’s 

recommendation is to have the CIT coordinator report 

directly to the sheriff or at least to the Colonel of 

Patrol Operations. With the support of the sheriff 

or the colonel, the CIT coordinator is able to work 

without restrictions that would normally need a chain 

of command consent. This works in Hillsborough 

without a doubt. Sheriff Gee is a long-time champion 

of the program.

Hillsborough has both a crisis response team and a 

robust CIT program. Five CIT deputies are part of a 

homeless community outreach program in which they 

keep track of this special population and are there to 

get individuals into treatment or make sure they have 

access to other resources. Gracepoint Mobile Crisis Unit 

is available 24 hours, seven days a week, for acute 

mental illness for adults. The Gracepoint Foundation 

was formally established in 2002 as the Mental Health 

Foundation, a 501 (c)(3) nonprofit organization. As 

the fundraising charity for Mental Health Care (MHC) 

Inc., they changed their name to the Gracepoint 

Foundation when MHC became Gracepoint in 2013. The 

foundation’s mission is to educate, advocate for, and 

give hope to all people touched by behavioral health 

and developmental challenges. Since its beginning 

in 2002, the Gracepoint Foundation has focused on 

developing a solid base of support. The foundation 

solicits and receives gifts from Gracepoint’s operating 

and foundation boards, medical staff, employees, 

vendors, corporations, foundations, and private 

donors. They respond to the individual’s home, school, 

or other safe environment.

Contributions to case study by Maj. Paul Adee.

Ventura County Sheriff’s Office,Ventura, 

California 

Ventura County covers 1,882 square miles, stretching 

from beaches to rugged mountains. Three-quarters 

of a million people call Ventura County home. Five of 

the county’s 10 incorporated cities (Thousand Oaks, 

Camarillo, Moorpark, Fillmore, and Ojai) contract with 

the sheriff’s office to provide police services. These 

cities, plus the unincorporated areas of the county, make 

up nearly half of the county’s population and 95 percent 

of its land area (Ventura County Sheriff’s Office 2018). 
32 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

Ventura County is the 13th-most populous county in 

California with an estimated population of more than 

850,000. The county seat is San Buenaventura (also 

known as Ventura). Ventura County is a semiurban, 

semirural county. The largest Ventura County racial 

group is White, non-Hispanic (45%) followed by Asian 

(8%). The county is 43 percent Hispanic. In 2014, the 

median household income of Ventura County residents 

was $77,335. Approximately 11.1 percent of Ventura 

County residents live in poverty. The median age for 

Ventura County residents is 36.9 years (United States 

Census Bureau 2018b).

The Ventura County Sheriff’s Office (VCSO) was 

founded in February 1873 and today serves the 

residents of Ventura County and provides law 

enforcement for the unincorporated areas of Ventura 

County as well as several cities within the county. 

Geoff Dean is the 19th sheriff of Ventura County and 

a 35-year veteran of the VCSO. The VCSO is staffed by 

approximately 1,200 personnel, including allocations 

for more than 700 sworn positions. 

Five to seven percent of all law enforcement calls for 

service can be directly linked to a mental illness. In 

addition, fatal shootings of individuals with mental 

illnesses doubled between 1997 and 2002, with six 

fatal incidents in 2001 alone. In 1999, the VCSO and 

Ventura County Behavioral Health Agency formed a 

strategy committee with various community health 

organizations including NAMI, the Mental Health 

Board, and mental health consumers. 

The committee designed a two-phase action plan 

to provide a comprehensive range of services to 

the population of offenders with mental illnesses. 

Phase one began assisting the offender with mental 

illness post-arrest in 2000. Phase two started the 

implementation of a crisis intervention team (CIT) 

program based on the Memphis model. As a result of 

this effort, 72 percent of all law enforcement officers 

in the county are currently trained in CIT. This has led 

to a significant reduction in use of force incidents since 

2001 and increased integration of law enforcement 

and medical services for mental health clients. What 

follows is a summary of Ventura County’s mental health 

diversion options and CIT training program.

Ventura County’s CIT program has four main goals 

with regard to mental health concerns: 

1. De-escalate crisis situations.

2. Reduce the use of force.

3. Reduce jail incarcerations. 

4. Decrease recidivism.

With this in mind they use the classic Memphis 

model CIT training program that has been updated 

with modern scenarios and relevant local and state 

laws. In addition to the training, a component of the 

CIT program is the collection of information via a 

CIT card (essentially a mental health field interview 

card) when law enforcement comes in contact with 

an individual who needs mental health services. Each 

documented contact is included in a database at 

Ventura Sheriff’s Central Station where it is reviewed 

and recorded by CIT staff and then distributed to 

patrol briefings, courts, and county behavioral 

mental health.

All five of the municipal police departments in the 

county provide funding for the CIT program. Along 

with financial support, each agency fills out the CIT 

cards and provides additional staff members including 

an officer of the day, evaluators and actors at the CIT 

training, and a CIT coordinator. In addition, California 

State University Police, Ventura County Community 

College District, the California Highway Patrol, and 

Naval Base Ventura County Police all participate in the 

CIT Academy and filling out the CIT cards.

Staff members from at least six area hospitals attend 

regular meetings to work toward a better relationship 

with their law enforcement partners. Mobile crisis 

teams can respond in the field to perform mental 

health holds and assist with transportation. They also 

provide a child-specific crisis response team (CIRT, 
Site Visits to Examine Programs and Initiatives that Work and Have Promise 33

the Children’s Intensive Response Team). Additional 

stakeholders, members of all of which attend regular 

meetings together, include Adult Protective Services, 

NAMI, Autism Society, Brain Injury Center, and 

various veterans’ services. 

Nonviolent de-escalation of crisis situations in the 

field and a reduced recidivism rate in the county 

is well documented since the inception the CIT 

program. A decrease in use of force by officers and 

an increase in contacts that result in “contact onlyresources offered” is evidence that the CIT philosophy 

is producing positive results. Injuries to officers 

and mental health consumers have also drastically 

declined. The rate of use of force during contacts 

with a consumer in crisis by a CIT-trained officer is 

low, with “verbalization only” techniques used 95 

percent of the time. Unanticipated benefits have 

been an increase in public and consumer support 

and a building of confidence in Ventura County law 

enforcement from consumer advocates. 

A new program in the Ventura County Behavioral 

Health System (VCBH), Rapid Integrated Support 

and Engagement (RISE), is funded by a large grant 

from the state of California and is up and running in 

Ventura County.

RISE teams are resources for the population of 

homeless people and those with mental illnesses who 

do not meet the requirements of California’s Welfare 

and Institutions Code § 5150 (the state mental health 

hold statute) but are frequently incarcerated in 

jails; disruptive; and in need of care, resources, and 

outreach. These repeat-call consumers are reported to 

VCBH for follow-up. Teams frequently include families 

in the recovery and resource process and Homeless 

Liaison Officers (HLO). Each agency and sheriff’s station 

has a CIT coordinator. The sheriff has a headquarters 

program manager for all outlying coordinators.

RISE is intended to help hard to reach and difficult 

to serve clients in the county. Staff from the RISE 

program visit Hillmont Psychiatric Unit every day 

to identify people who may not yet be enrolled in 

services. They do whatever they can to help get the 

unserved or underserved patient enrolled and involved 

in services. The RISE program will make appointments 

and then provide rides for the person to attend the 

appointment. They will also assess for other needs 

besides appointments, such as food and tokens for 

public transportation.

Included in the grant proposal was a psychiatric 

emergency room inside Hillmont Psychiatric Unit, 

which is currently under development. The Psychiatric 

Emergency Service (PES) will provide psychiatric 

evaluations, intervention, and referrals for voluntary 

and involuntary patients 24 hours a day, seven 

days a week. It will provide crisis intervention and 

medication assessments. An individual will be able to 

stay up to 24 hours. Some will be discharged to home, 

others to the acute inpatient unit, and others will be 

referred to community mental health resources. This 

seems to be a good model and something that is fairly 

easy to replicate in other jurisdictions.

Ventura County uses funding from the Mental 

Health Services Act of 2004 to fund a VCBH staff 

person assigned to work in the jail as a screener of 

mental health services for those being released from 

custody. These intensive services employ an Assertive 

Community Treatment (ACT) model directed at 30 

voluntary clients with a goal of engaging them in 

long-term treatment to reduce recidivism. Results 

from the program have been encouraging. Jail staff 

referred 218 individuals to long-term treatment 

through outreach and engagement efforts between 

2007 and 2012. The reduction in jail days for those 

engaged in services and treatment was found to be 

statistically significant.

Ventura County has a history of specialty mental 

health courts reaching back to the late 1990s. 

Early mental health court efforts were prompted 

and partially funded by Mentally Ill Offender Crime 

Reduction (MIOCR) grants from the State of California. 

Ventura County has maintained mental health courts 
34 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

since 2009 without MIOCR grant funding. A mental 

health court is a post-plea, interagency endeavor where 

both misdemeanor and felony defendants may be 

referred. Successful completion of the program takes an 

average of 18 to 24 months and usually results in the 

elimination of the suspended jail sentence, termination 

of formal probation, and forgiveness of fines and fees. 

The courts currently analyzing 565 referrals made 

between 2009 and 2013. Results that will examine both 

incarcerations and hospitalizations are pending.

A dramatic rise in misdemeanor defendants found not 

competent while facing trial has focused Ventura County 

on outpatient efforts ranging from augmented board and 

care to independent living with competency training. 

Felony defendants may ultimately be placed in locked 

psychiatric settings on civil commitments to receive 

long-term psychiatric care under conservatorship.

County and sheriff executive-level support, 

specifically CIT, exists for good mental health 

programs both in the community and in the jails. 

Ventura County effectively and frequently uses CIT 

contact cards. Detailed quarterly reports, including 

numerous statistics derived from the CIT cards, help to 

track critical information. These reports include

• number of referrals from each local jurisdiction;

• corresponding use of force incidents;

• disposition of contact.

Ventura County has a shared philosophy among 

multiple stakeholders with an emphasis on finding 

the best, most efficient way to handle a mental health 

client. They maintain shared medical records (within 

Health Insurance Portability and Accountability 

Act of 1996 [HIPAA] rules) between the sheriff and 

Behavioral Health, and access to data via improved 

technology is a great resource to officers (80 percent 

have department-issued iPhones with a County app to 

check on consumer status). 

Ventura County recognizes that there is a need for 

additional discharge planning from the jails and would 

like to form a regional task force dedicated to dealing 

with mental health crisis situations.

There is a national movement to deal with community 

mental health needs in a safe and professional 

manner. Ventura County needs to maintain its current 

level of professionalism and diligence by continuing 

with its CIT program. Relevant, accurate statistical 

record keeping will continue to validate the county’s 

current successes and make it easier to maintain longterm support of the program.

Ventura County identified the need for additional 

funding for a sobering center and a dedicated crisis 

drop-off program. Further, county officials mentioned 

they did not have enough mental health housing beds 

either in the community or the jail system to address 

demands and fear that longer inmate sentences will 

result in the need for a higher level of care for those 

with mental health issues without the appropriate 

resources to meet those needs in custody. The jail will 

need to expend more resources to treat those with 

mental illnesses if they are given longer jail sentences. 

In addition, the State of California now diverts a 

percentage of inmates away from the state prison 

system back to county facilities. This results in longer 

sentences and older inmates without supporting funds 

at the county level. The county jail is now responsible 

not only for older inmates with medical issues but also 

for longer periods of care for individuals with mental 

illness, and the corresponding medical standard of care 

must rise to meet all of the needs of this population—

including additional staff, housing needs, and 

medication costs—without any additional funding. 

An innovative way the VCSO is sharing information on 

consumers is the creation of I Cop, an application for smart 

phones for all patrol and many critical assignments.
Site Visits to Examine Programs and Initiatives that Work and Have Promise 35

Those interviewed referred to the VCSO as having 

a “small town attitude” and a “nonantagonistic 

relationship” with other County agencies. They 

unanimously stated they had a “holistic” (rather 

than “militaristic”) approach to dealing with people 

with mental illnesses from a law enforcement 

perspective. This stems from the philosophy instilled 

in their officers and deputies during 15 years of CIT 

training. They feel they have an organic approach 

that is flexible and not overly bureaucratic. Combined 

with top-down support and effective use of grants 

and local resources, Ventura County has much to 

offer in terms of diverting mental health offenders 

away from custody. Recent efforts in dealing with 

those with mental health needs and the CIT process 

have contributed to a lowering of officer involved 

shootings, use of force, repeat bookings, and

repeat calls. There are no direct statistics regarding 

these events. However, the referral rate to the

CIT program resources has steadily increased since 

2012. These efforts help divert cases away from 

custodial arrests.

In 2014, there were several shootings in the county 

that involved individuals with mental health issues, 

and the increased public awareness led to a new 

cooperative effort of the sheriff’s office and the 

county’s five municipal police agencies to commit to 

CIT training for every officer in the county. Chiefs of 

police and the sheriff had a positive, long-standing 

relationship that benefited the process. CIT has been 

used since the mid-2000s but was initially taught 

to only a small percentage of deputies. CIT has now 

expanded to all VCSO and law enforcement personnel. 

The County has modified the CIT program to include 

jail deputies who are about to be transferred to 

patrol. Currently 100 percent of patrol is CIT 

trained; the VCSO offers CIT training for 100

percent of dispatchers.

Another way that VCSO has increased response 

effectiveness to service calls involving people with 

mental illness is the use of CIT field interview cards; 

the responding officer notes pertinent information 

that is then entered in a countywide database 

for future reference. Field interview cards provide 

important information such as family, friends, and 

contact information; de-escalation techniques used; 

and prior calls for service, to be shared with other 

responding officers. In addition to the field interview 

cards, dispatchers also have access to a list of CIT 

deputies available and best prepared to respond. 

An innovative way the VCSO is confidentially sharing 

information to help in response with individuals 

who suffer from mental health issues is the creation 

of I Cop, an application for smart phones for all 

patrol and specialized assignments such as CIT. The 

application gives law enforcement officers access to 

a field interview database, probation, parole, photos, 

tattoos, booking records, and CIT contact cards. Forms 

are also available through a CIT icon or app along with 

resources and policies.

The VCSO has a newly created medical and mental 

health liaison sergeant position in the jail. This 

supervisor works with the Legal unit (DNA collection, 

jail records and Public Records Act requests, mailroom, 

public defender, district attorney, courts, and persons 

who are remanded into custody by the court while 

making an appearance before the judge) and the VCBH 

discharge planner. The discharge planner works with 

voluntary pre-releases to be released and transported 

to facilities by the contract discharge program 

coordinator. The philosophy for discharge is “housing 

first.” The medical administrator advised that the 

positive relationship between the sheriff’s office and 

medical staff leads to better outcomes, less liability, 

less death, and less public and media scrutiny and 

believes it is crucial for the medical liaison sergeant to 

have credibility with “the troops.” Despite the strides 

VCSO has made, the sheriff’s office would like to see 

additional psychiatric staff and a detox drop-off center.

Contributions to case study by Capt. Robert Davidson.
36 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

Bexar County Sheriff’s Office, San 

Antonio, Texas 

Bexar County is the fourth-largest in Texas and the 

16th-largest in the United States. It has a population 

of 1.8 million, covering 1,257 square miles. San 

Antonio is the largest city (the seventh-largest city 

in the nation), representing 1.4 million of the county 

population, with its own large police department. 

More than half the population claims at least some 

part Hispanic or Latino (of any race); 42 percent 

speak a language at home other than English. The 

median household income for the county is $51,900 

(United States Census Bureau 2018c). 

Texas did not agree to Medical Assistance expansion 

under the Affordable Care Act, so the State and County 

must provide for a much larger percentage of health 

care costs for the indigent than in some other states. 

There are several military installations in the area, 

including Fort Sam Houston, the home of the Army 

Medical Training and Education Campus; Lackland Air 

Force Base; and Randolph Airforce Base, collectively 

known as Joint Base San Antonio. There are also a 

number of police departments in the county, such as 

San Antonio Police Deparment and smaller Hill County 

Police Department. Beyond those agencies, Texas 

Highway Patrol also has a station in the county. 

The team met with Sheriff Susan Pamerleau, critical 

partners, and participants from the sheriff’s office, 

San Antonio Police Department, courts, public 

Defender, regional mental health coordinator, and 

representatives who operate and facilitate the publicprivate partnerships that have been indispensable to 

the county’s many achievements in four areas:

1. Pre-arrest diversion

2. Conditional release and other jail diversions

3. Jail mental health 

4. Post-conviction and release services

The visiting project team traveled to the county’s 

restoration center and Haven for Hope (described in 

the sections that follow) and the county jail’s mental 

health unit. In addition, the team observed the last 

day of the sheriff’s office’s crisis intervention team 

(CIT) training program. All sheriff’s detention and 

sworn personnel are trained through the intensive 

week long CIT program. While at the Haven for Hope, 

the team also had an opportunity to meet with the 

mental health patrol officers who are part of the 

sheriff’s office mental health unit. 

One of the primary goals of the visit was to examine 

the aspects of their policies, practices, and strategies 

that would be of interest to other sheriffs and law 

enforcement agencies in general. It was important 

to consider whether the work being done in Bexar 

County was both scalable and transportable to other 

organizations. Another significant goal was to learn 

of the leadership and development involved to achieve 

their level of successful services. 

The sheriff’s office has approximately 1,500 personnel; 

roughly half work in detention positions. The jail 

houses about 4,100 inmates per day (preadjudication 

and those sentenced up to 365 days). In August 2015, 

the San Antonio Express-News reported that Bexar 

County Jail had one of the highest rates of suicide (15 

suicides since 2009) (Zavala 2015). Inmate suicides 

were a significant concern during the 2012 sheriff 

election, won by Sheriff Pamerleau, and they continue 

to be an important challenge for the sheriff today. 

The programs developed in Bexar County come as a 

result of 10 years of work and a strong catalyst: a 

court order in 2002 that would require the addition 

of up to 1,000 beds in the county to address 

overcrowding. One of the district judges convened a 

working group to determine how to divert inmates 

from jail who were not “appropriately housed in 

the jail.” This is a critical part of the project study 

relative to how significant programs were initiated 
Site Visits to Examine Programs and Initiatives that Work and Have Promise 37

through the process of getting the decision-makers to 

the table and empowered to make timely, meaningful, 

and system-wide changes. 

Source: Haven for Hope

The original group of criminal justice stakeholders 

included private and public hospital representatives 

and has evolved into the current medical directors 

group that meets once per month. Gilbert R. Gonzales, 

the Director of the Mental Health Department and 

representing the Office of the County Manager, was 

a founding member of the group and seems to be 

the lynchpin (he refers to himself as the “bridgespanner”) in maintaining positive communication 

and affirmations among members and their respective 

organizations. The success of this group appears to 

be due to its agility and resourcefulness, developing 

innovative programs and making adjustments and 

even course corrections in a very constructive process 

that depends upon trusting partnerships. The medical 

and mental health advocacy communities and private 

partners, through their membership in this working 

group, have been pivotal to the success of their efforts. 

The Haven for Hope is a 117-acre campus two blocks 

from the sheriff’s jail in downtown San Antonio. The 

facility site is reclaimed industrial property located 

between two railroad tracks. A private philanthropist 

purchased the land and built the facilities despite 

the objections of local property owners. Sixty-one 

percent of the funding for the $100 million project 

came from the private sector, 22 percent from the 

City, 11 percent from Bexar County, and 6 percent 

from the State of Texas. The operating budget for 

facilities is approximately $15 million from a variety 

of government, private sector, and charitable sources. 

A fundamental reason for the apparent success of this 

initiative is the layout. All residential and service 

resources are located on one campus and are set up 

to encourage a sequential progress in eliminating 

criminal justice barriers, obtaining housing and 

employment, addressing chemical dependency and 

physical and mental health issues, etc. Proximity 

was key. There were representatives from courts 

on site to deal with new court dates and probation 

and parole resources on site to assist in keeping 
38 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

people in compliance. The barriers exist elsewhere 

as these systems are not located in close proximity 

to the clients. Placing all services in close proximity 

to one another eliminates barriers that can exist 

in other jurisdictions that have all of the same 

resources but whose resources are spread throughout 

the community. Spreading resources across a large 

geographical area creates insurmountable obstacles for 

those the services are intended for.

Multiple buildings provide every critical service 

needed for this vulnerable population living with 

medical illnesses, drug dependency, and homelessness. 

Services are provided to voluntary participants and 

those diverted from the jail either pre-booking or 

post-booking on conditional release. Some of the 

services and requirements at Haven for Hope include 

the following:

• Short-term residential dormitories for men,

women, and families are available, with longerterm subsidized apartments available on adjacent

properties. There is some storage available for

possessions, but residents are required to leave the

dorms each day at 8:30 a.m. to engage in work,

services, treatment, etc.

• Located on the property are a pharmacy, primary

care, dental care, childcare and school buses,

banking, post office, gym and recreation areas,

a reading and learning environment for parents

and children, a barber, and a kennel; all meals

are provided. It should be noted that the Haven

for Hope administration not only provides these

services but also considers carefully issues of

dignity of the clients they serve. For example,

the children of residents are picked up first by

the school buses and dropped off last so they 

will not be stigmatized for being at the facility. 

Further, with the support of the school district, 

the children are bussed to the schools they 

attended before their parents brought them to 

Haven for Hope. This attention to detail was 

evident throughout the entire operation.

• Thirty nonprofit service providers run offices in

the transformation services building (and 40 more

are accessible off campus) where residents can

make appointments to seek assistance or services

(among others, social services, help in clearing

warrants, getting a government identification,

language classes, general educational development

[GED], family counseling, parenting, programming,

housing, and employment assistance).

• Mental health treatment and chemical dependency

treatment are provided.

• Security is extensive, with about 40 cameras, and

locked and restricted access points to separate

families from the general population. Further, there

is a specially trained security staff on site 24/7

that patrols the entire campus.

• The external community participates through

volunteers, and faith groups pick up and drop off

residents to attend services. In addition, these

volunteers and faith groups assist the residents to

transition back to the community.

• Residents generally stay an average of 12 months

but can stay for up to two years.

• The dormitories are running between 92 and 98

percent occupancy.

Children of residents are picked up first by the school buses 

and dropped off last so they will not be stigmatized for being 

at the facility. Further, with the support of the school district, 

the children are bussed to the schools they attended before 

their parents brought them to Haven for Hope.
Site Visits to Examine Programs and Initiatives that Work and Have Promise 39

The Courtyard is an outdoor, partially covered area 

designed to allow up to 400 homeless persons to 

voluntarily stay without being required (or allowed) 

to access services. There are peer counselors trained 

to work with these individuals to encourage them to 

enter the facility with an agreement to seek the services 

necessary for the transformation to a better way of 

life. These residents receive primary medical care, three 

hot meals per day, and lockers to store their personal 

belongings. While designed to serve 400, the area 

regularly reports a daytime count of 776 and a high 

of 870. The shelter area where the meals are served 

is a certified Federal Emergency Management Agency 

(FEMA) shelter and therefore can receive funding 

from additional sources for emergency preparations. 

The necessary funds are used to operate the area and 

support general facility maintenance. 

The Haven for Hope operates as a private-public 

partnership. The facility is owned and operated by a 

nonprofit, essentially leasing space to nonprofit service 

providers who seek reimbursement for services through 

the County and State. It could be argued the fact that 

this is not a government-owned and -operated facility 

is critical to its success. It would be impossible to get 

the kind of political support necessary to provide and 

maintain access to all of these services without privately 

funded enterprises that can accept charitable donations, 

work with religious and for-profit organizations to 

conduct business, and provide the types of services for 

the residents that would be subject to annual budget 

review and authorization for taxpayer funding. 

The Haven for Hope was intended to eliminate or at 

least significantly reduce homelessness. While the 

homeless no longer gather on the business district 

streets (which was part of the motivation of the 

business community), the Vice President of Operations 

acknowledged that homelessness has not declined in 

the county. In fact, he believes the programming has 

brought more people to the county to seek the service 

provided. The Haven for Hope draws funds from the 

City’s Community Development Fund and new markets 

tax credits, as well as $22.5 million contributed by the 

City, $11 million from the County, and $9.5 million from 

the State of Texas at the start. As a result, a qualifying 

residence police force was recently implemented to 

reduce the number of homeless individuals who migrate 

from other locations around the country. 

Haven for Hope is celebrating its fifth anniversary 

in 2018 and reports great success since it was 

established:

• 2,367 people have left the transformation center 

and moved to permanent housing.

• 1,553 have attained employment.

• In one year, 90 percent of the people that exited 

did not return to homelessness.

• The in-house wellness program providing treatment 

for mental illness has served 691 individuals with 

a success rate (engaging in treatment and finding 

long-term housing) of 51 percent.

• The in-house recovery program provides 

designated housing for people with addiction; 

1,119 individuals have successfully completed the 

program with a 58 percent success rate, meaning 

that they successfully complete a rigorous 90-day 

treatment program and move to a stable living 

situation. This is significantly higher than the 

national average of 30 percent (American Addiction 

Centers 2018). 

• Jail recidivism for those who have accepted 

services at Hope is 24 percent since opening, while 

the County average is 80 percent.

• Approximately 5,000 fewer jail bookings occurred 

in Haven’s first year of operation than in the 

prior year. 

• 40,000 medical, dental, and vision care services are 

provided annually. 
40 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

There are other County-run facilities providing similar 

services in more traditional and expected formats. 

This program is innovative and shows why so much 

time was spent learning about the model. 

The Restoration Center was the first diversion site at 

this location. Built in 2008 and located on adjacent 

property, it provides sobering and detoxification 

services to people who walk in or are dropped off 

by law enforcement officers in lieu of arrest and 

incarceration. While remaining at the drop-off center 

is voluntary, the individuals are informed that if they 

leave the facility while still under the influence of 

drugs or alcohol or exhibiting disruptive behavior, 

the police department will be notified. Families or 

peer counsellors dismissed from Haven for Hope 

because of drinking or intoxication also are sent 

here. An unlicensed, very informal section is staffed 

by emergency medical technicians (EMT). Across the 

hall is a licensed, locked facility for those individuals 

who volunteer to participate in a substance abuse 

rehabilitation program. 

The center also has designated housing and support 

services for those in immediate need of psychiatric 

care (72-hour holds and others diverted by law 

enforcement are brought to a separate entrance). 

From the Restoration Center, residents can be 

evaluated, treated, and released or transitioned to 

other services as appropriate. 

The Restoration Center has also documented great 

success: 

• It has provided services to 35,000 people.

• It claims $50 million in five years of documented 

cost avoidance for operating city and county jails, 

emergency rooms, and courtrooms. 

Law enforcement has a very wide leeway in diverting 

people from jail to the Haven for Hope, the 

Restoration Center, or other County services facilities. 

The fact that so many (including dispatchers) have 

been trained to identify mental illness, addiction, and 

homelessness issues and de-escalate each contact is 

critical to the success of these diversions. 

The sheriff’s office and the San Antonio Police 

Department both operate patrol mental health teams 

with officers in nontraditional uniform attire and 

with customized equipment to assist in response to 

mental health and public order calls. The sheriff’s 

office teams (14 people in teams of two patrols in 

two shifts between 7:00 a.m. and 2:00 a.m.) have 

been operating since 2005 and are regularly called 

upon by their City partners for calls relating to their 

expertise. Officers assigned to this patrol team said 

this assignment allows regular patrol units to move on 

to other duties and calls, as the mental health calls 

take so much longer.

One of the key metrics for Bexar County—and of 

high importance to the Medical Director partners 

from private and public hospitals in the area—was 

the number of and wait time for law enforcement 

at drop-offs. They all claim this has been markedly 

reduced through the operation of these teams and the 

availability of facilities like the Restoration Center. 

Bexar County operates 24-hour magistrates’ courts 

that see arrestees immediately. This is a striking and 

critical fact instrumental in diverting people from 

the criminal justice system either through release on 

their own recognizance or on conditional release to 

facilities like the Haven for Hope. The conditional 

releases work as a result of a Texas Criminal Code, 

which authorizes, and some suggest mandates, the 
Site Visits to Examine Programs and Initiatives that Work and Have Promise 41

release of any inmate with a treatment plan approved 

and presented by a public defender and mental 

health clinician. 

Addressing mental illness issues and conditional 

release options prior to and at the individual’s first 

encounter with law enforcement provides for a more 

reasoned approach to the problem of criminalization 

of individuals with mental illness. Far too often, in 

too many jurisdictions, the court process does not 

allow for such intervention until after a person has 

been charged, made a first appearance, been assigned 

a public defender, and been evaluated for competency. 

Also of note is the fact that the mental health 

clinician must guarantee immediate access to the 

treatment outlined in the plan. This immediate access 

has given the judges the assurance that public safety 

needs have been met in a non-jail setting. 

A probate judge hears competency and commitment 

motions at a mental health court for diverting people 

with mental illnesses charged with misdemeanors. 

The court monitors a docket of approximately 80 

defendants closely to ensure proper services are 

provided, and the defendants are given every chance 

to succeed. This specialty court is similar to others in 

operation across the country. While the monitoring of 

80 cases may be significant for the resources available 

to the court, it seems to fall short of addressing the 

needs of the mental health population associated with 

4,100 inmates housed in the Bexar County jail. 

Bexar County Jail maintains two mental health units 

(MHU) of 15 cells each. Around-the-clock nursing staff 

is available, medications are given, and a psychiatrist 

or other clinician meets with inmates regularly. 

Mental illness is managed—not treated—in the jail. 

Inmates leave here to go to competency restoration or 

to commitment facilities as appropriate. 

This MHU did not seem to be much different than 

MHUs operated by other counties studied. One 

interesting element is an automated system requiring 

15-minute to 30-minute cell checks. It was noted 

during the site visit that several of the inmates were 

severely disturbed and could be housed here for as 

many as 365 days for a variety of reasons. Upon 

inquiry, the Director of Mental Health acknowledged 

that so much more could and should be done to 

provide better a facility and care and treatment for 

these inmates, but no other options were available. 

One of the most interesting aspects of Bexar County’s 

operations relating to mental illness and drug 

abuse are the facilities and resources now under 

construction. The County is building a video visitation 

center for families of inmates, situated at a location 

separate from the jail. Visitors connecting with 

inmates will be treated like Bexar County residents 

seeking sheriff’s services. The center features very 

little waiting for access to the inmate (families simply 

schedule an appointment and arrive 10 minutes 

early). There is room for two people in each of 60 

booths, and there are to be three to five family 

visiting areas to allow multiple family members 

to visit at the same time. There is no concern for 

contraband at this separate facility, and all of the 

calls are monitored for safety and for intelligence 

gathering. For inmates, each pod will have its own 

monitor screen so inmates can have visits all day 

long; no transports or escorts are necessary. This is 

exceptional in that the plan allows for mobile screens 

to allow visitors to connect with inmates even in 

isolation. Further, the commercial company that 

provides the equipment and services offers a plan that 

permits the families to visit from their own homes for 

a monthly fee. 

Across the street from the visitation center, the 

county plan includes a work release and re-entry 

services facility for inmates leaving the jail. Only 

limited information regarding these new services 

was available during the site visit. In an informal 

conversation, it was mentioned that this facility may 

allow for medications and even a short (voluntary) 

stay for inmates leaving the jail in immediate need of 
42 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

services (housing, mental health treatment, addiction 

treatment or counseling, employment assistance, 

etc.). For additional information about Haven for 

Hope, visit www.havenforhope.org.

Bexar County Court also has a felony mental illness 

docket for post-conviction offenders, again serving 

approximately 80 offenders with mental illnesses and 

a propensity for violence. Individuals on this docket 

are closely monitored. 

Bexar County has been addressing justice involved 

mental illness since the mid-2000s. Several aspects of 

their efforts are worth emulating, and are all arguably 

scalable and transportable, at least in principle:

• Focus on a cost-benefit analysis of jail diversion.

The financial information is persuasive in all

political and operational efforts to address jail

overcrowding, emergency room overcrowding, and

homelessness.

• Focus on ensuring committees formed to address

these issues are attended by those with decisionmaking capability, who are committed to working

collaboratively with a sense of common mission.

It is imperative such committees include not only

public officials but private sector partners as well.

• The Bexar County court system has developed

its policies and practices so mental illness issues

can be detected, addressed, and diverted when

appropriate: at the very front end of the process

rather than after a case is well under way. This

requires 24/7 resources and commitment from

all justice involved entities—courts, prosecutors,

defense, probation, medical, law enforcement, etc.

• Homeless, chemical dependency, mental illness, and

jail diversion resources are located in close proximity

to one another and have developed in a coordinated

manner to ensure sequential progress and success.

Again, the success of these programs is due to the

private-public partnership and the overwhelming

common mission of all entities involved.

• Bexar County has created a stand-alone mental

health department with a director whose mandate

is to coordinate all efforts in the county to address

mental illness, including and especially justiceinvolved cases.

• Bexar County law enforcement has recognized the

value of and has committed to ensuring all law

enforcement and dispatchers received CIT training

to more properly deal with people in mental health

crisis. This is a huge undertaking and a significant

time commitment but the benefits are obvious

and documentable.

• Finally, the Bexar County Jail has established a

dedicated mental health unit with mental health

professionals and clinicians who manage the

population of those with mental illnesses. Like

most correctional facilities, however, they struggle

with the problem of management versus treatment

of this subset of inmates.

Contributions to case study by Capt. Martin Molina, Lt. 

Brian Barrick, and Sgt. Alice Lopez.

Cook County Sheriff’s Office, Chicago, 

Illinois

Cook County, Illinois, is the second-largest county in 

the nation (Los Angeles County is the largest) with a 

population of 5.2 million, representing 40 percent of 

the state’s population in an area of 1,635 square 

miles. Chicago, the third-largest city in the nation, 

serves as the county seat. The county has 135 

municipalities (54 percent of the population) and 30 

townships (36 percent of the population) (Cook 

County Government 2018). 

More than 20 percent of the population in Cook 

County is foreign born; 24 percent are Black or 

African American and 26 percent Hispanic; 35 

percent speak a language at home other than 

English. Median household income for the county is 

$54,548, but for the city of Chicago the median 

income drops to $38,625 (United States Census 

Bureau 2018d).
Site Visits to Examine Programs and Initiatives that Work and Have Promise 43

For several years, the State of Illinois has struggled 

with severe budget deficits, credit downgrades, 

dysfunction, and the most severely underfunded 

pensions in the nation. Illinois passed a temporary 

tax increase of 67 percent in 2011, but that 

temporary tax expired in 2016 and the state faces 

a current deficit of $5.8 billion. The State has been 

unable to provide funding resources for the County 

and has shifted the expense of housing inmates to the 

counties (one reason for the overcrowding and lack 

of resources leading to a U.S. Department of Justice 

investigation into substandard facilities and services 

of constitutional proportion). The FY 2018 budget 

does not account for the earlier $6.6 billion deficit, 

and the proposed FY 2019 budget cuts prison funding 

further (Geiger, Garcia, and Lukitsch 2018).

The Cook County Sheriff’s Office employs 6,900 

under the leadership of Sheriff Tom Dart. The 

Cook County Department of Corrections (generally 

referred to simply as the jail) has 14 divisions (at 

least 12 buildings on one single site), and houses 

approximately 9,000 preadjudication inmates and 

those sentenced to jail for less than 365 days. Prior 

to the agreed order (United States v. Cook County et 

al.), also called a consent decree, the Cook County 

Jail reached a high of 10,000 inmates. Bringing down 

the high numbers of inmate incarceration was one of 

the sheriff’s goals. Currently the county jail has 8,750 

inmates, 2,000 of whom are on the mental health 

caseload, and county staffers also supervise 2,100 

people sentenced to home monitoring. 

Cook County operates three hospitals and 30 clinics 

and provides all of the prescribed medical and mental 

health services to inmates in the jail. Cermak Health 

Services is a stand-alone facility on the jail campus 

that provides those services for inmates not in need 

of a hospital level of care. 

In February 2007, the Civil Rights Division of the 

U.S. Department of Justice notified the County of its 

intention to investigate constitutional violations in 

the jail relating to use of force, jail security, medical 

treatment, mental health care, fire safety, and 

environmental health. As a result of the investigation, 

the County, Sheriff Dart, the Cook County Board of 

Commissioners, and Board President all stipulated to 

an Agreed Order filed with the U.S. District Court in 

May 2010 that they all still operate under, requiring 

remediation regarding the following: 

• Proper staffing levels and supervision

• Use of force reporting

• Inmate discipline and classification

• Internal investigations

• Medical and mental health services

• Facilities

• Suicide prevention

• Fire and life safety

• Sanitation and environmental conditions

The consent decree was very detailed, especially 

regarding the development of an interagency written 

agreement delineating the respective mandates, roles, 

and responsibilities of Cermak, the County, and the 

sheriff operating as the Cook County Department of 

Corrections (CCDOC).

Mandates for Cermak range from timely responses 

to clinician orders to processing sick calls to daily 

rounds and a 24-hour screening process; detailed 

requirements for emergency, chronic, and acute care 

and disabilities; record keeping, mortality reviews, 

cleaning, lighting, maintaining medical exam rooms, 

providing hand washing stations, and the removal 

of medical waste; and stable leadership and staffing 

plans, ensuring qualified personnel with adequate 

licensing and certification.

Additional requirements for the County and CCDOC 

included building a new clinical space within three 

months of the order, providing additional and 
44 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

sufficient clinical space (building, remodeling, or 

renovating space as required to meet the demands 

for services), completion of a staffing study with 

requirements to hire as reported, provide training to 

correctional officers for recognizing and responding 

to medical and mental health emergencies and drug 

and alcohol withdrawal, and proper and timely 

transport for all inmates with medical or mental 

health emergencies. 

In June, 2017, the U.S. District judge ruled that 

the sheriff’s office and the Cook County Jail were in 

compliance with all standards and ended the Agreed 

Order successfully. Cook County Jail had been under 

federal oversight for more than 40 years—since 1974 

(Cook County Sheriff’s Office 2017).

Both before and since the end of the Agreed Order, 

Cook County has adopted an innovative approach to 

serving people with mental illness in jail. Following 

assessments and diagnoses, inmates are classified and 

housed according to their P-Levels: 

P-1: An inmate with no known behavioral health

issues is housed in general population.

P-2: An inmate with mental illness that can be

managed through outpatient levels of care (regular

medication, weekly group meetings, a psychiatrist

visit every three months). These inmates also are

housed in general population.

P-3: An inmate with mental illness that needs a

heightened level of care (medication, regular group

meetings, and weekly psychiatrist visits).

These inmates are housed in division 8 Residential 

Treatment Unit (RTU), men on one level and women 

on another. 

P-4: An inmate with acute care needs (medication,

daily meetings, and a daily care plan with psychiatrist

visit); these inmates are housed on the second floor

of the Cermak Health Services facility described on

page 45.

CCSO and Cermak staff coordinate all of their work at 

the superintendent level weekly and at least monthly 

at the operations level (the CCDOC Director, and Chief 

Operating Officer for Cermak Sheriff Dart implemented 

a jail management system that has a direct interface 

with the Cermak electronic medical record. Cermak 

also has authorization for “Jail Data Link” that tracks 

mental health records for state forensic hospitals, 

allowing for early identification of individuals with 

histories of mental illness. Housing assignments for 

inmates are made based on these records and the 

assessments completed at booking.

The order noted earlier reads like a checklist (or early 

warning system) for any sheriff operating a jail. In 

addition, MCSA may want to create some reformatted 

version of many of the items included in the list 

as areas warranting special consideration in jail 

management.

Between 1,200 and 1,300 of the inmates on the 

mental health caseload are housed in general 

population; between 700 and 800 have specialized 

housing assignments. 

Each correctional building on the jail campus is named 

a division. Division 1 is the oldest building on the 

campus, which opened in the 1920s. The basement of 

this building was where the County formerly housed 

the most dangerous or infamous inmates (Al Capone 

was housed in division 1). The sheriff was able to 

close the division as the jail population decreased.

Division 8 RTU is a new building that includes a stateof-the-art booking and medical and mental health 

assessment facility. Visiting the pre-bond area (a 

drop-off site for inmates where they wait to be moved 

to booking) makes it clear just how necessary this 
Site Visits to Examine Programs and Initiatives that Work and Have Promise 45

new facility was. At the pre-bond area, arrestees are 

housed in large empty stalls that look like cages. The 

staff writes numbers on the inmate’s hands in black 

indelible ink as they are checked in for hearings. 

Those with behavioral issues are moved to separate 

fenced areas.

Following arraignment, inmates are moved to the 

new booking facility in the basement of division 8 

RTU. This space has walk-through metal and object 

digital screening systems; a space for changing into 

jail attire (Cook County uses a shrink-wrap bag for 

inmate possessions, which are sent to storage in a 

sub-basement); and clinic-level spaces for medical 

assessments, mental health and psychiatric screening 

and assessment, and documentation. Each inmate is 

given a separate color wristband for staging through 

regular and specialized assessment.

It was apparent this facility was built as part of 

compliance with the order, and pursuant to the Order 

each inmate is required to be assigned to a bed within 

eight hours of the assessment. 

Division 8 RTU housing for P-3 inmates

The upper levels of division 8 RTU provide housing for 

P-3 level inmates, with women and men on separate

floors. Again, these facilities are state-of-the-art, with

rooms for group therapy, therapeutic programming,

outdoor activity space, and a barber and salon. The

inmates are housed in large numbers in bright, clean,

and open wings for easy supervision (from behind onesided glass). Each floor has a nursing and staff station

for charting and care decisions. But each wing also

has a separate booth for medical staff to access and

distribute medication one inmate at a time without

actually going into the wing. In this housing unit,

inmates distribute their own meals as well as clean. As

P-Levels are continually assessed, inmates in general

population may be moved here as the need arises.

Cermak second floor for P-4 inmates

This floor of Cermak was reserved for the P-4s, the 

more seriously ill inmates. It looked nothing like a jail 

but was far more similar to a hospital ward, managed 

mostly by medical staff with a nursing station for 

directions, charting, and supervision. The correctional 

staff also participates in inmate supervision. During 

the site visit, one officer was providing one-on-one 

observation of an inmate on suicide watch. The rooms 

were clean and well cared for, all with windows, 

and there was also space designated for out-of-cell 

activities. The site visit team observed a meeting for 

one inmate where the doctor, nurse, and correctional 

staff were all in the room developing a daily 

psychiatric care plan for that inmate. It was clear 

that Cook County has worked to fully implement the 

court’s goal of focusing their efforts and the necessary 

resources on inmates with the most critical need.

Cook County is unique in many ways, principally 

because the sheriff appointed a licensed clinical 

psychologist as Executive Director of the Cook County 

Department of Corrections. He has also brought on 

doctors as the Chief of Programs and Director of 

Behavioral Health within the sheriff’s office.

The sheriff has implemented several of his own 

initiatives to address jail mental health issues. These 

initiatives operate separately from Cermak, offering 

biopsychosocial programming to detainees identified 

by Cermak as higher functioning or P-2. 

The sheriff’s office website home page is dedicated 

to messaging about jail mental illness and includes 

18 separate inmate profiles as unjust incarceration 

case studies.
46 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

Mental health assessment at jail intake for 

diversion

Sheriff’s personnel have made a great effort to assess 

the incidence of jail mental illness. Not relying on the 

Cermak screening process, the sheriff has appointed 

a social worker to assess the self-reported incidence 

of jail mental illness. She and nearly a dozen social 

workers separately assess inmates as they are brought 

in to pre-booking and prepare an assessment. They 

work to identify special cases that they bring to the 

public defender, the prosecutor, and the courts for 

possible diversion. This initiative has drawn attention to 

those with mental health issues who may benefit from 

community-based services rather than incarceration. 

Cook County was selected as one of the recipients of 

the MacArthur Foundation grant working to identify 

alternatives to incarceration. 

Mental Health Transition Center intensive 

re-entry program

The sheriff has invited dozens of chronic low-level 

offenders to participate in a targeted and very 

intensive program assisting inmates with reintegration 

and re-entry: jobs, housing, mental health treatment, 

and adult basic education. This is a cognitive and 

behavioral restructuring program operated out of the 

former boot camp facility on the jail campus. Qualified 

inmates (mostly in the P-2 level) are bussed to the 

facility for programming that the inmates discussed 

with the site visit team personally. More than 200 

graduated in the first year of the program, which 

includes an alumni program and family support group. 

Several inmates stated they were very grateful for 

the program, all reporting a new awareness of selfrespect and responsibility and positive encouragement 

for making a fresh start with family and potential 

employers (even from within the jail). Key correctional 

staff members run the program, and a number of the 

participants claim the program to be highly successful. 

Currently the program is a day program but the hope 

is to expand it to include residential participants. 

The County follows up with these inmates with 

post-release programming and services. More than 10 

former detainees return to the jail twice monthly to 

receive ongoing mental health services and support 

from the mental health and correctional staff.

Mental health treatment and programming

The sheriff has made a deep investment in 

programming for inmates, with the philosophy that 

even a very short-term inmate can benefit from 

therapeutic programming, learning coping or living 

skills that may help them address mental health 

challenges they face while incarcerated or stresses and 

challenges faced when released. The goal is to provide 

therapy and programming for all spectrums of mental 

illness in particular keeping the population busy and 

active in an effort to reduce incidents and improve the 

quality of life for staff and detainees, even those not 

on the Cermak mental health caseload. Accordingly, 

the sheriff has implemented the following innovative 

programs in addition to individual and group therapy:

• Yoga and meditation

• Mindfulness and emotional intelligence

• Culinary and barber schools

• Urban farming

• Creative arts and expressive therapies

• Literacy

• Health education

• Discharge planning services

• Photography and advertising skills

• The Sheriff’s Anti-Violence Effort (SAVE) program
Site Visits to Examine Programs and Initiatives that Work and Have Promise 47

Perhaps the most interesting aspect of these programs 

is the fact that the sheriff has linked these efforts to 

a reduction in inmate incidents and grievances. The 

sheriff’s office has also trained its own correctional 

and clerical employees (who are given time away from 

their regular duties) to run these Working for Change 

programs. The employees report back that they find 

this to be a rewarding aspect of their employment.

The sheriff’s office has promoted a crisis hotline 

specifically to address the risk of inmate suicide 

and to identify detainees in need of treatment and 

support services. Top managers and directors in the 

Cook County Jail take turns answering the 24-hour 

hotline. They want families to make them aware 

when there is bad news to share with an inmate or to 

report an inmate that may need urgent mental health 

attention. Only top-level personnel are assigned to 

this duty, because they are knowledgeable of the 

entire system and services and have the authority to 

access and secure an immediate response. They receive 

roughly 15 to 20 calls per month from families.

Sheriff Dart partnered with the Cook County Health 

and Hospitals System and a community treatment 

provider to assist inmates in signing up for CountyCare 

(under the Affordable Care Act) and securing 

other benefits, accessing community providers, 

and developing a plan for ongoing medication and 

treatment. The County also has a contract with 

a residential community treatment provider for 

homeless detainees who are court-ordered to submit to 

electronic monitoring (up to 200 at one time).

The Sheriff’s Training Academy provides all sworn 

employees with more than 100 hours of training on 

mental health topics and an additional 40 hours of 

crisis intervention team (CIT) training. In addition, 

sworn staff receive training on effective engagement 

with the public, interpersonal skills, and cultural 

diversity. The academy is located at the local Cook 

County Community College, and participants get 

college credit toward an associate’s degree. 

The following summary lists the aspects of the Cook 

County program that are scalable and transportable 

and would be worth replication:

• Above all else, the Cook County Sheriff’s initiatives

benefit from an obvious and deliberate mandate

from Sheriff Dart and senior leadership. The

program is infused with a sense of “can do” and is

void of common concerns and shortcuts due to a

lack of support or funding. This atmosphere is the

foundation for the Cook County program.

• Cook County is deliberate in deploying resources

towards intercepting individuals with mental illness

throughout the criminal justice process (sequential

intercept model). This was most apparent in the

following areas:

 Sheriff’s Pre-Bond Initiative, in which all new

arrests are screened by sheriff’s office personnel

even prior to being remanded to the sheriff’s

office’s custody. Information from this screening

is shared with the court prior to arraignment in

an attempt to divert those who would be better

served by not criminalizing the behavior that

led to the arrest.

 Sheriff’s Transition Center, in which inmates

who have traditionally “churned” through the

criminal justice system are engaged in cognitive

and behavioral programming designed to assist

them with reintegration into the community

with the goal of reducing recidivism. A byproduct of this program has been a reduction in

behavior issues for enrolled inmates while they

remain in custody.
48 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

• Mental health screening for all inmates upon

initial booking by medical staff. Various colored

wristbands are used to ensure inmates are not

inadvertently passed through the system without

the proper follow-up. Cook County has established

criteria for programming and treatment based

on P-Level. This ensures that each inmate in

each P-Level receives the designated amount

of programming and treatment each month.

Designated inmates participate in a more thorough

mental health assessment and are then assigned

a “P” (Psych) level—P 2, 3, or 4. The P-Levels are

used to appropriately house inmates and ensure

they receive a designated level of programming

and treatment. This P-Level system also allows

the sheriff’s office to maintain a clear picture

of their mental health population and devote

resources appropriately.

• Cook County has established a designated

mental health hotline to better facilitate critical

information from family members specific to the

mental health needs of an incarcerated individual.

The hotline is also innovative in encouraging

family members to pass potentially upsetting (to

an inmate) news on to the sheriff’s office rather

than directly to the inmate so jail staff can prepare

the best way to deliver potentially upsetting news

to the inmate and provide support. Finally, the

hotline serves as a resource for former Cook County

inmates needing assistance after release.

• Cook County Sheriff’s CIT training is designed

specifically for correctional officers to deal with

individuals with mental illnesses in a correctional

environment. As a result of the program design,

Cook County has made physical changes to their

mental health housing areas to include lighting

and baffling to reduce noise.

• The 2010 consent decree from the U.S. Department

of Justice was the result of a federal investigation

dating back to 2004 and details the interagency

agreements between key stakeholders in Cook 

County. This document may be very useful for 

those sheriffs in the process of or interested in 

reviewing their interagency agreements for the 

provision of facilities and medical and mental 

health services. It is exhaustive in delineating 

the respective roles and responsibilities for key 

stakeholders in providing housing and services for 

inmates with mental illnesses. As a result of these 

efforts, Cook County and the Cook County Sheriff’s 

Office now are recognized nationally for their 

innovations and for their leadership in improving 

the services provided to people with mental illness. 

For those interested in reviewing this order, it can 

be found online at https://www.justice.gov/sites/

default/files/crt/legacy/2010/12/15/CookCountyJail_

AgreedOrder_05-13-2010.pdf.

Contributions to case study by Dr. Nneka Jones Tapia.

Los Angeles County Sheriff’s Department, 

Los Angeles, California 

The County of Los Angeles is the most populous 

county in the United States with a population of 

more than 10 million people. The county seat is Los 

Angeles, which is the second-most populous city in 

the nation and the most populous that lies entirely 

in a single county. The County of Los Angeles has 88 

incorporated cities and many unincorporated areas. It 

is one of the original counties of California, created 

at the time of statehood in 1850. As the population 

increased, sections were split off to organize San 

Bernardino, Riverside, Kern, and Orange counties. 

Most of the population of Los Angeles County is 

located in the south and southwest, with major 

population centers in Los Angeles Basin, San Fernando 

Valley, and San Gabriel Valley. Other population 

centers are found in the Santa Clara Valley, Pomona 

Valley, Crescenta Valley, and Antelope Valley (Los 

Angeles County Sheriff’s Department 2018).
Site Visits to Examine Programs and Initiatives that Work and Have Promise 49

The racial makeup of Los Angeles County is 26 

percent White, 15 percent Asian, 9 percent African 

American, 1 percent Native American, and less 

than 1 percent Pacific Islander. Hispanic or Latino 

residents of any race made up 49 percent of Los 

Angeles County’s population. The median income 

for a household in the county was $42,189, and the 

median income for a family was $46,452 (United 

States Census Bureau 2018e). 

The Los Angeles County Sheriff’s Department (LASD) 

was founded in 1850 and today serves the residents 

of Los Angeles County. The LASD provides general 

law enforcement services to 40 contract cities; 

90 unincorporated communities; 216 facilities, 

hospitals, and clinics located throughout the county; 

nine community colleges; the Metropolitan Transit 

Authority; and 47 Superior Courts. The LASD also 

provides services such as laboratories and academy 

training to smaller law enforcement agencies within 

the county. In addition, the LASD is responsible in 

securing approximately 18,000 inmates daily in seven 

custody facilities, which includes providing food and 

medical treatment.

The LASD supports mental health programs in a variety 

of important ways. The LASD and LA County Mental 

Health provide deputy and clinician mental evaluation 

teams (MET) in the field from 10:00 a.m. to 1:00 a.m. 

These teams are specially trained and will respond 

to calls where mental health issues may be involved, 

which include domestic violence, violent or bizarre 

behavior, and suicide threats. The team’s involvement 

supports better outcomes for those with mental illness 

or mental health problems who come into contact with 

LASD field officers while also helping area deputies 

focus on other duties. 

In addition, mental health alert teams (MHAT) are 

available to tactical and SWAT (special weapons and 

tactics) teams as a resource during call-outs. MHAT is 

a Los Angeles County Department of Mental Health 

resource. MHATs provide mental health response to local 

and federal law enforcement agencies in facilitating a 

negotiated solution to barricade and hostage situations. 

These are separate from METs and are used more for 

barricaded, violent, stand-off situations.

The LASD was the first agency in the nation to have 

METs. Like other teams across the United States by 

the same or similar names, METs pair a deputy with a 

Department of Mental Health clinician. Each deputy 

receives additional pay, and selectees include both 

deputies and clinicians vetted for these positions. 

Patrol personnel receive the baseline mental health 

(MH) training of three hours (Peace Officers Standards 

and Training Commission [POST]–certified). Others 

move on to the eight-hour intermediate class (POSTcertified) and others continue through the 40-hour 

crisis intervention team (CIT) course. METs and JMETs 

(jail mental health team) receive at least the 40-hour 

course. These professionals operate in nonuniform 

assignments. There are currently eight teams with an 

expectation of expansion to 23 teams (one MET team 

for each station).

In addition to METs, a 25-person JMET walks the 

housing areas to identify those who may need MH 

resources but were not identified during booking. 

As part of providing better mental health call 

outcomes and resources, a mental health committee 

with representation of all available stakeholders was 

convened. A call may be a call for service from central 

dispatch or a self-initiated field contact reported and 

logged in a daily field activity report. JMETs were 

MHAT is an LA County Department of Mental Health resource. 

MHATs provide mental health response to local and federal 

law enforcement agencies in facilitating a negotiated solution 

to barricade and hostage situations.
50 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

provided training by national authorities such as the 

National Alliance for Mental Illness (NAMI) and the 

National Institute of Corrections (NIC). NIC provides 

40 hours of training similar to the Memphis model 

CIT training.

In the law enforcement community, mental health 

“flags” are placed in a CAD system for mental 

health related calls, locations, and availability of 

responding deputies who have been trained in how 

to deal with individuals with special mental health 

needs. Sergeants in the field direct when use of force 

incidents are necessary and a watch commander 

monitors all use of force anticipated calls. When 

possible, they look for disengagement opportunities 

on possible use of force calls. If possible, viable 

alternatives are reviewed and discussed between the 

field sergeant and watch commander. Each shift has 

CIT-trained personnel on duty and ready to respond. 

LASD provides a variety of training in the form of 

various mental health learning blocks, which are 

provided according to assignment and rank. Each CIT 

trained personnel receive the following:

• Six hours in the academy

• 32 hours while working custody (de-escalation and

verbal resolution training or DeVRT)

• Three hours for lieutenants and below

• Eight hours intermediate

• 32 hours of advanced techniques (Memphis model)

• Eight hours recertification for all every three years

• Patrol School resource officers have a two-hour MH

block covering

 policies and procedures;

 field ops directives;

 department newsletter information.

An additional layer of support is provided by 

jail compliance teams (JCT). These were created 

in response to litigation and subsequent federal 

oversight. JCTs and all other stakeholders (including 

mental health staff) were present in the U.S. 

Department of Justice negotiations from the outset. 

Two attorneys are embedded with the JCT to make 

sure the department is in compliance with U.S. 

Department of Justice agreements, including those 

pertaining to mental health. 

The LASD has made a number of positive changes in 

how it treats people with mental illness who have 

not been diverted into community treatment and are 

incarcerated in the jail. It is currently conducting 

a pilot program in which inmates have access to 

electronic tablets that are used for contacting mental 

health clinicians in the jail and for requesting mental 

health services. Although this initiative remains in 

the pilot stage, the feedback the team received from 

inmates indicated that it is improving the response 

time on the part of clinicians and helping inmates 

stay better connected to the clinicians in the facility.

All inmates at the main men’s facility in downtown 

Los Angeles who are currently experiencing suicidal 

ideation or intentions or are identified as being at risk 

of self-harm are being housed in direct observation 

and supervision units. This means they are 

continuously monitored by staff members and have 

no opportunity to secretly engage in self-injurious 

or suicidal behavior. It was reported that there have 

been no successful suicides in the two years since the 

sheriff’s department began managing suicide and selfinjury risk in this manner, and there have been only 

two incidents of self-injurious behavior. Many smaller 

jails may not have the physical space that is needed 

to maintain a suicide prevention housing unit such 

as this one, but the model and practice appears to be 

one that is worthy of replication. 

The jail provides access to a variety of services at 

the time of discharge from the facility. One hallway 

consists of a number of offices, each one providing a 
Site Visits to Examine Programs and Initiatives that Work and Have Promise 51

distinct discharge planning or re-entry service such as 

planning for housing, medications, vocational needs, 

etc. This design is similar to the “treatment mall” 

concept that has been developed at a number of state 

mental hospitals and is effective in that it provides 

access to all services in a single location, which is in 

the same area where inmates must go to be processed 

out of the facility. 

The LASD is under a consent decree or settlement 

agreement related to its provision of services for 

people with mental illnesses in its jail facilities. The 

facility administration has developed a strategic 

approach to ensuring that all staff members are 

receiving the training they need to effectively 

manage the inmate population with specific focus 

on those inmates with mental illness and that the 

processes in the jail not only meet the requirements 

of the consent decree but also provide appropriate 

care for those incarcerated. In addition to addressing 

the needs of inmates and the requirements of the 

consent decree, the LASD administrators’ approach has 

been to proactively engage with the monitors of the 

consent decree to ensure there is clear communication 

between them and a consistent approach to 

monitoring compliance.

In addition to all of these efforts, as a part of overall 

jail planning and to stay in front of future issues, 

the LASD is working with the University of California 

Irvine (UCI) to forecast the jail population and 

demographics, thus identifying future staffing and 

resource needs. A Correctional Offender Management 

Profiling for Alternative Sanctions (COMPAS) 

risk management tool is used for jail population 

management. COMPAS is a standard assessment tool 

in the criminal justice system, and is used primarily 

for detecting criminogenic needs, including substance 

use disorders. It has been presented in professional 

journals and is used by both jails and prison systems.

The LASD continues to address the problem of people 

with mental illness within its jurisdiction to include 

care of those with special mental health needs. 

Housing and jobs for individuals with mental health 

needs are an important part of discharge planning, 

and the LASD uses a specific outprocessing system 

with discharge and resource windows available to 

staff and inmates as they are discharged from jail 

as noted earlier. 

At a systemic level, the LASD is trying to find a 

balance in the mindset that directs the way deputies 

operate. This includes making a cultural change 

from warrior to guardian. Specific activities include 

creating videos for internal and external use. The 

sheriff’s department has brought on a senior media 

figure to serve as a strategic communications 

manager and provide a link on their website called 

guardian-lasd.org. Although LASD has several videos 

available, the one that was highlighted and related to 

community relations was the Guardian Project, which 

can be viewed at http://lasd.co/the-guardian-projectwhat-is-it/. In addition, the department has created 

tri-fold fliers of resources for the field for families of 

individuals with special mental health needs.

The paring down occurred when the communications 

manager saw an early draft of the tri-fold, which 

contained numerous phone numbers and resources. 

Being new to LASD and the project, she inquired 

as to the reason or purpose for the tri-fold and 

the intended audience. She was told it was meant 

for those in need and their families, who required 

resources (24/7). It also serves as a quick reference 

for the deputies. She felt the tri-fold was too busy and 

did not communicate a clear message (to the deputies 

or public). Many of the numbers in the earlier version 

of the tri-fold were not staffed 24/7 or only led to 

recorded messages or unanswered phones. The paring 

allowed for an easy-to-navigate guide with a few 

simple numbers and resources that were the most 

user-friendly and effective (the ones that were already 
52 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

being used the most). As mentioned elsewhere, even 

the most willing families at their wits’ end may give 

up without effective, 24/7 resources.

Contributions to case study by Chief Stephen Johnson.

Hennepin County Sheriff’s Office, 

Minneapolis, Minnesota 

Hennepin County has a population of 1,212,064 with 

the overall population for Minnesota at 5,457,173. 

The county has a total area of 607 square miles, of 

which 554 square miles is land and 53 square miles is 

water (Hennepin County, Minnesota 2018). The White 

population of Hennepin County is 69 percent; the 

Black or African-American population is 13 percent. 

The American Indian population of Hennepin County 

is 1 percent, and the Asian population is 8 percent 

(United States Census Bureau 2018f). 

The Hennepin County Sheriff’s Office (HCSO) employs 

800 sworn and civilian members of the agency 

under the leadership of Sheriff Richard Stanek. The 

Hennepin County Department of Corrections (generally 

referred to simply as the jail) has six divisions and 

houses approximately 839 preadjudication inmates 

and those sentenced to jail for less than 60 days. 

The divisions are broken down into Patrol, Special 

Operations, Water Patrol, Transportation, and K-9. The 

Patrol division covers Greenfield, Hanover Medicine, 

and Rockford Counties. The primary law enforcement 

response for Minneapolis is the Minneapolis Police 

Department. The jail capacity is approximately 839, 

of whom 539 are held at City Hall and 300 are in the 

public safety facility. 

Average daily bookings are almost 100 per day, with 

a similar number of inmates being released daily. 

The average length of stay is 13.07 days for felonies 

while for gross misdemeanors the average is 1.87 

days. Approximately 75 percent of persons booked are 

detained for less than 72 hours. It should be noted 

that Hennepin Jail is a pretrial detention facility, 

and once the inmate is convicted they are transferred 

to local or state correctional facilities. The average 

morning count is 707.

Minnesota uses rule 6 of the Minnesota courts’ Rules 

of Criminal Procedure, which sets forth the decisionmaking criteria on arrest, detention, and release on 

citation for warrantless arrests for individuals with 

mental illness.

The Minneapolis Police Department and the HCSO 

adopted a crisis intervention initiative as a result of a 

confrontation with an individual with a mental illness 

who confronted them with a deadly weapon. During 

that event, on June 12, 2000, Minneapolis police 

interacted with Barbara Schneider. Schneider opened 

the door with a large knife and confronted the police. 

The police ended up shooting and killing her. Much 

like the Memphis case from 1987, citizens became 

upset with how this was handled and the Barbara 

Schneider Foundation was established to ensure law 

enforcement is trained on crisis intervention. 

Another significant historical event occurred in January 

2011, when the jail command staff attended an order 

to show cause hearing compelling the Minnesota State 

Department of Human Services (DHS) to explain why it 

was taking so long to move civilly committed individuals 

with mental illnesses from the jails to state-operated 

treatment locations. The HCSO began a working 

relationship and partnership with the civil court judge 

to collaborate on how to improve or streamline aspects 

of the court system as it relates to the population of 

those with mental illnesses in the jail.

In February 2013, a comprehensive review of the 

civil commitment became an issue, so in May 2013 

Judge Kerry Meyer was named as the presiding judge 

of the Criminal Mental Health Court. Her job was 

to determine the competency on all rule 20s. Rule 

20 relates to the issue of a defendant’s competency 

to stand trial. If the defendant lacks the ability to 

understand their rights when communicating with 

their attorney or cannot understand the degree or 
Site Visits to Examine Programs and Initiatives that Work and Have Promise 53

the nature of charges, the possible punishment for 

their actions, or the nature of the proceedings, they 

may not meet the standard for competency. As a 

result, the prosecutor or defense must make a motion 

challenging competency, or in the alternative the 

court may raise the issue. At the time, a committee 

was created that included the public defender’s office, 

the state attorney’s office, the probation office, and 

social services who were given the responsibility to 

review all case dockets. 

In December 2013, the Hennepin County Department 

of Human Services and Public Health created a 

social service team within the jail. Because there is 

a large number of individuals with mental health 

disorders returning to the jail as repeat offenders, the 

HCSO along with the Department of Social Services 

established the integrated access team (IAT). This 

team, comprising social workers and correctional 

deputies, works in the jail specifically tasked to focus 

on low-level offenders with mental illness who have 

a risk of recidivism. They make a recommendation 

to the inmate and if they agree to accept the 

social services, they begin an intensive 90-day case 

management plan.

The HCSO also provides two mental health nurses, 

and a psychiatrist is in the jail two to three times a 

week but is also available for consult with inmates 

24/7. They have an inmate classification system that 

is operated by selected jail deputies. They have CITtrained deputies that work in the special management 

housing units, which houses inmates with mental 

disorders and drug dependency issues. This specialized 

unit within the jail was developed to address inmates 

with mental illness whose interaction requires greater 

management to ensure the safety, security, or orderly 

operation of the jail.

One of the initiatives, led by Sheriff Stanek, 

involved a change to state legislation to compel the 

Department of Human Services and Public Health to 

accept civil commitments from the jail settings within 

48 hours of incarceration. 

Hennepin County has an excellent judicial process 

designed to address offenders dealing with mental 

disorders. The Hennepin County Criminal Mental 

Health Court was established in 2008 and is a working 

collaboration between courts, corrections, human 

services, and public health and medical professionals. 

This court is focused on a problem-solving model 

designed to serve the defendants with mental illness 

or co-occurring disorders. The individuals processed 

by this court go through an intense 12-to-18-month 

voluntary program that works toward sobriety and 

stability. It is closely monitored by the courts and 

by mental health and corrections professionals. This 

program allows immediate access to services such 

as mental health professionals, individual housing 

specialists, chemical health counselors, and the U.S. 

Department of Veterans Affairs. The individual’s 

progress is closely monitored by probation and the 

judicial system. All parties (i.e., state prosecutor, 

defense attorney, and the client) must consent to 

have the matter handled by the mental health court.

While Hennepin County is moving in the right 

direction, it recognizes there is more to be done 

to effectively address this vulnerable population. 

For example, there is a lack of community-based 

housing options available to those who need 

community-based housing—a common problem in 

most communities across the country. They are also 

looking at repurposing the vacant juvenile detention 

center to use as a treatment facility for those in the 

justice system who are suffering from mental illness. 

Hennepin County has demonstrated a willingness 

to address the needs of individuals struggling with 

mental disorders both in the community and in the 

jails and will continue to seek innovative ways to 

improve the outcomes for individuals who come in 

contact with the law enforcement and the criminal 

justice system.

Contributions to case study by Julianne Ortman.
54 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails
55

Summary and Conclusions

As the result of this assessment of the participating 

members of the Major County Sheriffs of America 

(MCSA), it is possible not only to identify a number of 

programs, processes, and systems that are effective in 

reducing the number of people with mental illnesses 

in the criminal justice system but also to present 

in-use programs and components that are central or 

foundational in achieving this goal. This review of 

participating sheriffs’ departments and offices has 

revealed important descriptions and observations 

of successful programs and practices that may in 

turn serve as models, guides, or inputs for other 

jurisdictions confronted with similar challenges of 

caring for people with mental illnesses. This report 

represents a point-in-time examination in an everevolving challenge of dealing with mental disorders 

and co-occurring drug dependency. It should be noted 

the sheriffs’ offices and departments identified in 

this report and others not highlighted continue to 

innovate and initiate programs to address contact 

with individuals in the field and in the jails. 

As this report points out, there are a number of ways 

to achieve reductions in the number of people with 

mental illnesses who become involved or reinvolved 

with the criminal justice system. These interventions 

go beyond basic diversion efforts and include the dayto-day management, clinical treatment, and re-entry 

processes for people with mental illnesses who are 

involved in the system, up to and including periods 

of incarceration. For example, adequately identifying, 

assessing, and treating an individual’s mental illness 

during a period of incarceration can prevent him or 

her from deeper systemic penetration into or 

extended involvement with the criminal justice 

system because it can facilitate successful re-entry 

and prevent future incarcerations. 

Perspectives concerning people with mental illness 

in the criminal justice system as identified by the 

MCSA members who participated in this study include 

the following:

• Jail is not the ideal clinical setting for managing 

mental illness.

• There has been a significant increase in the number 

of people with mental illness in the criminal justice 

system since the deinstitutionalization of people 

with mental illness that began in the 1960s and 

has continued to the present time.

• Sheriffs’ offices are increasingly the primary point 

of contact for those with mental illness, whether 

this is by patrol officers or custody staff. 

• Sheriffs’ offices, largely out of necessity, have 

developed programs to more appropriately and 

effectively interact with those with mental illness 

both in the community and in the jail.

• All MCSA members who participated in the study 

have had programs for addressing mental illness 

in place for longer than one year at the time of 

the review. 

• Sheriffs’ offices are actively gathering and 

implementing ideas, policies, procedures and 

practices for effectively interacting with, housing, 

and treating those with mental illness with whom 

they come into contact.
56 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

The results of this study indicate that the following 

programs or practices are being implemented by a 

number of the MCSA members with great benefit to 

those with mental illness in terms of 

• reducing the frequency with which they 

are arrested;

• diverting them from jail or minimizing the amount 

of time spent in jail;

• appropriately treating those who are incarcerated;

• helping them successfully re-enter the community, 

which includes reducing the frequency with which 

they recidivate. 

In addition to the demonstrated effectiveness of 

these programs and practices as described earlier, the 

following practices can be viewed as a template for 

law enforcement officials specifically and the criminal 

justice system generally in how to best interact with 

and treat those with mental illness who encounter 

law enforcement officers, whether or not they have 

committed any criminal acts. 

Practice 1. CIT-trained field officers 

Every one of the seven jurisdictions selected for 

site visits had an active program for training field 

officers in crisis intervention teams (CIT), and a high 

percentage of their field officers had already received 

CIT training. In Los Angeles County and a number of 

other jurisdictions, there is an active effort to further 

mold the ethos of deputies from that of warrior to 

that of guardian of the public and their safety. CIT 

training dovetails with this mindset and is a critical 

component of a field officer effectively encountering 

those with mental illness. When a patrol deputy 

has a better understanding of the ways in which 

mental illness may affect an individual’s attitude 

and behavior, they are able to distinguish criminal 

behavior from clinical illness and therefore more 

safely and effectively interact with that person. 

Jefferson County, Colorado, and Hennepin County, 

Minnesota, took this practice a step further by 

providing CIT training for mental health professionals 

who are then assigned to the patrol station of the 

sheriff’s department. This provided an additional 

level of mental health expertise to patrol deputies 

which, per the report staff, has contributed to better 

outcomes when interacting with people with mental 

illness. In addition, the Los Angeles County Sheriff’s 

Department (LASD) has also established mental 

evaluation teams (MET) that accompany deputies on 

patrol and are available to immediately assess and 

clinically intervene for those who have mental illness 

and are encountered on the street.

The Bexar County Sheriff’s Office has, for a number of 

years, required CIT training for all of their deputies, 

a practice that has spread to the San Antonio Police 

Department. They have also opened up their training 

program to the fire service, emergency medical 

services, and radio dispatchers. Further, they also 

permit first responders outside of Texas to attend 

the training as well. As a result, Bexar County 

has experienced a significant drop in use of force 

occurrences with people with mental illnesses since 

the mid-2000s.

Recommendation. CIT training for all deputies 

should be considered a necessary component for 

those jurisdictions that desire to reduce the number 

of people with mental illness who become involved in 

their criminal justice system.

Practice 2. Diversion

All sheriffs’ offices selected for site visits have an 

active program for diverting from jail those with 

mental illness who have been arrested but can safely 

and appropriately be sent into another setting. The 

site visits revealed that the most effective early 

diversion effort is having a drop-off center or mobile 

crisis unit, where officers can take an arrested 

individual with mental illness for an assessment and 
Summary and Conclusions 57

then treatment rather than booking into jail. The 

drop-off centers or mobile crisis units can process 

individuals relatively quickly. Field officers in 

Jefferson County, Colorado, report that processing an 

individual at the drop-off center often requires no 

more than 30 minutes, so officers are not required to 

invest large blocks of time in the diversion effort that 

would make them unavailable on the street. Bexar 

County also has an important drop-off center for 

individuals who have a mental illness, abuse drugs, 

or are under the influence of alcohol. The center 

is staffed with emergency medical services (EMS) 

personnel and other professional staff at their City of 

Hope facility. This drop-off process ties up deputies 

only for about 10 minutes and provides a gateway 

to other psychological, medical, and social services 

which are co-located at the center. 

In addition to drop-off centers or mobile crisis 

units, Cook County, Illinois; Hillsborough County, 

Florida; and other jurisdictions screen individuals 

who are brought to the jail for mental illness and 

the possibility of diversion prior to being officially 

booked into the jail. Although this occurs later 

in the arrest process than dropping an individual 

off for an assessment, it still results in those with 

mental illness who are appropriate for diversion being 

diverted away from jail and into more appropriate 

treatment settings. 

Recommendation. The ability to divert an individual 

with mental illness away from jail and into a more 

appropriate assessment or treatment setting is critical 

to reducing the penetration of people with mental 

illness into the criminal justice system.

Practice 3. Mental health and 

problem-solving courts 

All sheriffs’ offices that were visited for this study 

had active mental health or problem-solving courts. 

Bexar County, Texas; Hennepin County, Minnesota; 

and Ventura County, California; have longstanding 

problem-solving courts (i.e., drug abuse courts and 

veterans’ courts) that have demonstrated effectiveness 

in reducing incarceration and recidivism. Problemsolving courts should be considered within the 

diversion continuum and are strong contributors to 

the goal of reducing the inappropriate incarceration 

of those with mental illness. The establishment of 

these specialty courts focused on at-risk populations 

require a significant collaboration between the courts, 

prosecutor’s office, defense attorneys, and related 

professional services organizations. While the effort 

to establish such an arrangement is significant, the 

beneficial impact was very apparent in each of the 

MCSA jurisdictions studied.

Recommendation. All jurisdictions should consider 

establishing specialty noncriminal courts (e.g., 

drug courts or mental health courts) The results 

of this review indicate that these specialty courts 

are effective in diverting those with mental illness 

away from incarceration and into more appropriate 

treatment settings. 

Practice 4. Mental health screening 

in jail 

Underscoring the importance of screening activities, 

the National Commission on Correctional Health 

Care (NCCHC) Standards for Health Services in Jails 

require that all individuals who are booked into jail 

must have a screening of their mental health history 

and needs. All sites surveyed for this study conduct 

mental health screenings for those booked into the 

jail. Appropriate screening identifies current mental 

status and functioning, including the potential risk of 

suicide, along with the history of or current symptoms 

of mental illness. Being arrested and incarcerated is 

traumatic in and of itself and has the potential to 

reactivate latent or exacerbate active symptoms or 

experiences of mental illness. It is not possible to 

effectively address the risk of suicide and symptoms 

of mental illness without effective screening.
58 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

Cook County, Illinois, conducts initial screening of 

all those booked into the jail but has implemented a 

system that goes beyond appropriate initial screening. 

They have a mental health classification system that 

mirrors that of many state Departments of Correction. 

Based on the results of the screening, individuals are 

assigned a mental health level that helps determine 

the level and extent of treatment services needed and 

provided to that individual. 

Recommendation. It is an accrediting body 

requirement and an operational necessity that all 

individuals who are booked into a jail are screened 

for the presence of suicide risk and need for 

mental health monitoring or services. Further, it is 

recommended that the screening be initiated at the 

earliest possible opportunity in the intake process.

Practice 5. Mental health treatment 

in jail

As is the case with mental health screening, the NCCHC 

standards require that mental health treatment be 

provided to all those in jail with a mental illness or 

those who have been identified as needing mental 

health treatment. All sheriffs’ offices that were visited 

provide professional mental health treatment to those 

who require it in the jail. Stabilization should occur for 

all inmates who enter the facility, primarily meaning 

they are supported and their needs addressed so they 

are no longer in crisis. It is very common for inmates 

to experience symptoms of depression and anxiety at 

the time of booking into a facility. Stabilization helps 

the offender deal with those feelings and return to a 

relatively calm emotional state. Treatment refers to 

providing diagnoses, treatment planning, medication, 

psychotherapy, homework, and other interventions 

by a mental health professional to specifically address 

either disruption in mental health or the presence and 

symptoms of a mental illness.

Mental health and jail management professionals are 

beginning to recognize the need not only to provide 

treatment for those in jail who have a mental illness 

but also to actively work to maintain or support the 

mental health of all those who are incarcerated in the 

jail. Cook County, Illinois, has developed an array of 

services specifically designed to maintain—or at least 

prevent deterioration of—the mental health of those 

who are incarcerated. This is an innovative approach 

and one that should be adopted by all jurisdictions. To 

manage expense, sheriffs’ offices should explore public 

and private community resources for bringing these 

services into the jail as well as the more traditional 

approach of directly providing mental health staff.

Recommendation. Providing some level of care for 

people with mental illness while in jail should be 

considered a requirement for increasing continuity of 

supervision and reducing mortality while a patient 

is in custody and supporting successful re-entry, 

which then reduces the risk for future arrest and 

re-incarceration of those with mental illness. In 

addition, it is highly recommended that jails review 

and monitor their policies, procedures, and practices 

to identify those that contribute to deterioration of 

mental health and work to remove or alter those that 

contribute to worsening mental health in the jail.

Practice 6. Discharge planning and 

re-entry

It is another NCCHC standard that those who are 

incarcerated be provided discharge or re-entry 

planning services. All jurisdictions visited provide 

discharge planning for those who have been 

incarcerated in the jail. The importance of adequate 

re-entry or discharge planning is widely recognized 

in the field and is an indispensable component of 

preventing future incarceration or re-incarceration of 

those who are in the jail.
Summary and Conclusions 59

Recommendation. Provide comprehensive 

re-entry planning that begins early in the 

incarceration process.

Additional observations

Some additional observations were made over the 

course of this study that did not rise to the level of a 

recommendation as their application may be limited 

by resources, practices, and philosophies relating 

to the role of law enforcement and jail operations. 

Two of the most significant observations relate to 

the development of a multidisciplinary residential 

campus versus geographically dispersed services and 

the development of a high-level treatment facility 

incorporated into the jail complex.

In the first instance, co-located versus geographically 

dispersed services require a significant commitment 

by the agencies that comprise the criminal justice 

system and the treatment and social communities. The 

commitment includes compromise and contributions 

that focus on the greater good for the individual 

rather than the accomplishment of individual 

organizational goals and objectives.

The second observation goes to the question of the 

role of the jail operation as it relates to treatment 

versus stabilization and maintenance. In facilities 

represented by Cook County, Illinois, a decision was 

made to create a high-quality treatment facility to 

make every effort to help the individual leave the jail 

far better than when they entered. Considering that 

individuals with mental illness stay longer and have 

more frequent recidivism rates (Treatment Advocacy 

Center 2014), such an approach is realistic because 

these individuals will spend more time in jail than the 

average inmate. Further, community-based treatment 

may be interrupted by periods of incarceration that 

can impact medication regimes, counseling and other 

supports. This approach requires significant financial 

commitment, facilities, and staffing. The counterargument to this approach is that jails should limit 

their efforts to stabilization and maintenance of the 

individual, with treatment the responsibility of others 

in the mental health community. 

Sheriffs and other members of the criminal justice 

system should use their voices and political influence 

to support agencies and organizations that are better 

equipped, and have as their mission the treatment 

of those dealing with mental disorders and various 

forms of drug abuse. In other words, we need to 

return to a model that does not create jails as the 

largest mental illness and drug abuse centers in their 

states. Decisions as to how this should play out are by 

necessity left to the individual communities based on 

a wide range of considerations.

This report has identified a number of effective 

practices that go beyond the six listed in this 

summary, but these six in some form are used by 

all MCSA members as critical components of their 

programs to reduce and prevent the arrest and 

incarceration of those with mental illness. In one 

form or another, these practices should be carefully 

considered as potential essential components of 

sheriffs’ office operations. 

61

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67

Appendix A. Survey Instruments

This appendix contains the text of the survey that was sent to sheriffs in 2015. The formatting has been 

changed to conform to COPS Office publication standards.

The Major County Sheriffs’ Association has made addressing individuals with mental health needs, both in our communities and in our jails, a priority issue for the past several years. As a result of our association’s focus, we received a grant 

from the Office of Community Oriented Policing Services (COPS Office) to survey our membership and determine what our 

sheriffs are already doing to deal with individuals with mental health needs. 

Our project begins with a survey instrument that is divided into three tracks of questions targeting the Office of the 

Sheriff, jails, and field operations and law enforcement personnel. By breaking this data collection effort into tracks, the 

questions can be answered by the most appropriate individual as determined by the sheriff. 

This data collection survey, the first step in this project, will be used to identify several sheriffs’ offices for site visits over 

the next year. We will use these visits to learn more about what is being done in your communities to respond effectively 

to individuals with suspected mental health needs in the community and to those who are arrested and confined in our 

jails. Your answers to this survey will be considered confidential and only shared with the COPS Office grant team. 

The following questions pertain to the manner in which your agency deals with individuals with mental health needs in 

law enforcement. Please answer the following questions from the perspective of an administrator or elected official. Space 

has been provided to expand on answers when necessary. Your answers and your agency’s specific information will be kept 

in strict confidence and will not be released to the public. 

If you have any questions, please contact us.

Name and rank: ________________________________________________________________________________

Agency: ______________________________________________________________________________________

Sheriff’s name: _________________________________________________________________________________

Address: ______________________________________________________________________________________

City/Town: ____________________________________________________________________________________

State: [select state]

ZIP:__________________________________________________________________________________________

Position: ______________________________________________________________________________________

Email address:__________________________________________________________________________________

Phone number: _________________________________________________________________________________

Please provide us the following information:

Total number of sworn employees: __________________________________________________________________

Total number of employees assigned to the jail:_________________________________________________________

Total number of employees assigned to motor pool/operations: _____________________________________________
68

Chief executive officer

1. Does your agency have a specialized program that identifies and addresses individuals with mental health needs? (If 

yes, please continue. If no, please indicate as such and you may stop. The remaining survey questions pertain to sheriffs’ 

offices that have a program in place.)

Yes  No

2. Was there a significant event that caused you to implement a program that addresses individuals with mental health 

needs?

Yes  No

If yes, please describe: ___________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

3. What were your most important considerations when developing and implementing your program that addresses 

individuals with mental health needs?

Legal issues

Cost

Training of corrections or road patrol deputies

Obtaining support from the community

Engaging important stakeholders (e.g., courts, prosecutors, community mental health professionals, others)

Developing specialized facilities

Other (please specify) 

4. Using your selections from question 3, what were the two most important considerations? Please select only two:

Most important:

Second-most important:

5. How do you track the impact of your program or practice when addressing individuals with mental health needs? Please 

describe. 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

6. How long has your program that addresses individuals with mental health needs been in place?

10 years or more

5–10 years

1–5 years

One year or less
69

7. Do you engage or coordinate with stakeholders to execute and guide your program?

Yes  No

8. If the answer to question 7 is “yes,” identify with whom you engage and coordinate. (Select all that apply.)

Community mental health professionals

Hospitals and other medical or mental health facilities

Community leaders or support groups

Prosecutors

Courts

Other (please specify): 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

9. Have you encountered significant resistance to your mental health program?

Yes  No

If yes, please describe: ___________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________

10. When talking about your agency’s program with others, what are the three most important points you mention about 

the program?

Point 1: ______________________________________________________________________________________

 ______________________________________________________________________________________

 ______________________________________________________________________________________

Point 2:

Point 3:

11. What are three things that will increase your program’s success?

First benefit: ___________________________________________________________________________________ 

Second benefit:

Third benefit:

12. If your agency had sufficient resources, how would you envision the best program to effectively deal with people with 

mental health needs, both in your jails and in encounters with deputies in the field? What stakeholders need to be part of 

this effort? Please describe. 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

Appendix A. Survey Instruments
70

13. What other partners would need to be part of the effort? Select all that apply.

Community mental health professionals

Hospitals and other medical or mental health facilities

Community leaders or support groups

Prosecutors

Courts

Other (please specify): 

Field operations/law enforcement personnel

1. Does your agency have training that focuses on identifying, addressing, and intervening with individuals with mental 

health needs?

Yes  No

2. Does your jurisdiction have a mental health dropoff facility?

Yes  No

3. Does your agency have a deputy and mental health professional response team (psychiatric assessment team) in the field?

Yes  No

4. If your jurisdiction does have a mental health dropoff facility, does it operate 24 hours a day and 7 days a week?

Yes  No

5. Are mental health resources and alternatives to incarceration for persons with mental health needs available to your 

field operations/law enforcement personnel?

Yes  No

If yes, briefly explain what is available: 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

6. Are your field operations/law enforcement personnel given discretion to use alternatives to incarceration for persons 

with mental health needs, deferred prosecution of such individuals, or both?

Yes  No
71

7. If your field operations/law enforcement personnel are given discretion to use alternatives to incarceration for persons with mental health needs, deferred prosecution of such individuals, or both, are those cases tracked using statistical 

information? (Check all that apply.)

Yes, by number of persons with mental health needs

No, persons with mental health needs are not tracked

Yes, including rates of recidivism

No, recidivism is not tracked

8. Is there a central (countywide) database of past individuals with mental health needs that is available to field operations personnel at the time of contact?

Yes  No

9. Does your county have an existing mental health focus group made up of mental health stakeholders?

Yes  No

10. If your county has an existing mental health focus group made up of mental health stakeholders, identify which 

agencies are involved. (Check all that apply.)

County sheriff’s office

County or city attorney

Police chief(s)

County health department

Jail mental or medical health staff

County mental health department

Social service program(s)

Public defender’s office

Courts

Volunteer groups or agencies

Other (please specify): 

11. If your agency tracks uses of force, does it track individuals with mental health needs separately?

Yes  No

12. Does your agency’s mission or culture support field operations/law enforcement’s activities related to investing time, 

problem-solving, and follow-up activities when dealing with individuals with mental health needs?

Yes  No

If so, how? ____________________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________

Appendix A. Survey Instruments
72

13. Please provide data for the last three years on the number of individuals with mental illness identified by field operations/law enforcement personnel. (If no data exist, please signify by indicating N/A.)

2012:

2013:

2014:

14. Please provide data for the last three years on the number of individuals with mental illness contacted but not arrested by field operations/law enforcement personnel. (If no data exist, please signify by indicating N/A.)

2012:

2013:

2014:

15. Please provide data for the last three years on the number of individuals with mental illness diverted from jail to mental health services in the community. (If no data exist, please signify by indicating N/A.)

2012:

2013:

2014:

Jail personnel responders

1. Does your agency conduct mental health screenings on all arrestees/commitments/bookings?

Yes  No

2. Does your agency conduct mental health screenings for co-occurring substance use disorders? (A co-occurring substance use disorder may include alcohol or drug use, alcohol or drug dependence, or both.)

Yes  No

3. At what point in the processing of individuals in your facility are these screenings conducted?

Arrest

Booking

There are no mental health screenings done in our facility

Other (please specify): 

4. If an individual’s mental illness is recorded, is the information shared with pretrial services, prosecutors, defense 

counsel, and the courts, promoting safety for both arrestee and staff?

Yes  No

We share with the following stakeholders: 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________

Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails
73

5. How does your facility count how many people with mental health needs are housed there? (Check all that apply.)

Individuals who receive medication for psychiatric illness

Individuals who receive treatment

Individuals who self-identify at admission to the facility

Individuals who are identified during an assessment

Other (please specify): 

6. As a percentage of your average daily population, what is the current prevalence of individuals with mental health 

needs in your facility? If not tracked, please enter N/A. 

7. What is your facility’s average daily population? 

8. Has the percentage of individuals with mental illness needs in your facility increased or decreased in the last two years?

Increased by ___% in the last two years (2013–2014)

Decreased by ___% in the last two years (2013–2014)

Our facility cannot provide a percentage because we do not track increase or decrease

9. What percentage of individuals with mental illness needs in your facility increased or decreased? 

10. Has your jail established partnerships with local mental health agencies or providers and other community partners 

related to incarceration, status, and discharge planning for people with mental illness?

Yes  No

If yes, whom have you partnered with? 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

11. Does your facility screen for health insurance or Medicaid status and eligibility upon admission?

Yes  No

If yes, does your facility suspend or terminate the individual’s Medicaid benefits on admission?

Yes  No  N/A

12. Does your agency place a priority on mental health treatment in the facility?

Yes  No

Please explain: _________________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________

Appendix A. Survey Instruments
74

13. Does your agency have resources to adequately support the mental health needs of the inmate population in your 

facility?

Yes  No

Please describe: ________________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

14. Does your agency conduct or participate in discharge planning for individuals with mental health needs?

Yes  No

If yes, please describe: 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________

15. If your agency provides mental health services, does the provider share pertinent mental health information with local 

community resources upon release?

Yes  No

16. As a result of any mental health interventions your agency has implemented, can you provide data to demonstrate 

any of the following? (Check all that apply.)

Reduced recidivism

Reduced bookings or return to the facility

Reduced number of assaults on staff

Reduced cost for mental health treatment

Other (please specify): 

17. Does your agency provide an assessment for suicide risk upon release?

Yes  No

18. What has been the average length of stay in jail for inmates with mental illness each year for the past three years? If 

you do not track, please enter N/A in the appropriate boxes.

2012: ________________________________________________________________________________________

 ________________________________________________________________________________________

 ________________________________________________________________________________________

2013:

2014:

19. Do you have specific interventions or processes in place for reducing the length of stay for inmates with mental 

illness?

Yes  No

If yes, please describe: ___________________________________________________________________________ 

_____________________________________________________________________________________________ 

_____________________________________________________________________________________________
75

Appendix B. Jefferson County Sheriff’s Office 

77

Appendix C. Local Law Enforcement and 

Mental Health Crisis MCSA Report: 

Cook County Sheriff’s Office Additions

Mental health template for American 

jails 

In 2015, the Cook County Sheriff’s Office led the 

development of a Mental Health Template for 

American Jails: http://www.cookcountysheriff.org/

MentalHealthTemplate.html.

The template serves as a step-by-step resource for 

sheriffs’ offices looking to implement thoughtful 

approaches to the mental health crisis affecting their 

jails. With common sense reforms that save lives and 

money, including proof points from Cook County Jail, 

the template serves as a comprehensive “add-water” 

resource for other counties. 

The template targets 10 areas of focus for 

reform: (1) public advocacy, (2) advanced mental 

health training, (3) pre-bond diversion, (4) insurance 

enrollment, (5) population knowledge, (6) advanced 

treatment, (7) discharge planning, (8) family 

support, (9) post-incarceration employment, 

and (10) legislation. 

Rocket Docket legislation 

In 2014, Sheriff Dart authored state legislation 

to launch a “Rocket Docket” in Cook County. The 

legislation decreed that defendants charged with 

either retail theft or criminal trespassing without a 

background of violence were to be discharged from 

jail—either on their own recognizance or on house 

arrest—if their cases were not disposed of within 30 

days of assignment to a judge. The Rocket Docket bill 

passed the legislature overwhelmingly and was signed 

into law by the governor. 

In 2016, Sheriff Dart introduced legislation that 

expanded the Rocket Docket to include minor traffic 

offenses and petty drug possession. This measure was 

signed and took effect January 1, 2017. 

Since its introduction, 100 cases have been referred as 

Rocket Docket and 97 individuals have been released. 

The Sheriff’s Anti-Violence Effort

SAVE is designed to instill positive social norms and 

values in participants who are most likely to return 

to one of Chicago’s most violent communities. Up to 

48 participants are housed together and participate 

in an intensive, eight-hours–a-day, five-days-a-week 

program. The cohort-based programming is grounded in 

an effective form of psychotherapy known as cognitivebehavioral therapy (CBT), widely recognized as an 

evidence-based component of effective rehabilitative 

programming. This well-researched treatment has been 

shown to be successful in reducing crime and violent 

behaviors. For example, a review of 269 meta-analysis 

studies found that CBT resulted in better outcomes than 

six other treatment options, as well as control groups 

(Hofmann et al. 2012). It aims to provide a set of prosocial problem-solving techniques that work to alter 

negative patterns of thinking and behavior. To prepare 

for eventual release into the community, participants 

will engage with Chicago community leaders while they 

are still incarcerated in the jail. These leaders will work 

with participants on self-development and on increasing 

their understanding and appreciation of the impact of 

violence in their neighborhoods. Once the participants 

are released into the community, social workers from 

the sheriff’s office provide intensive case management 

services to help them stay focused and connected to 

community supports.
78

Cook County Sheriff’s Office Strength and 

Wellness Center

In 2012, Chicago made national news when the city 

closed six of its 12 mental health clinics (Corley 

2012), and since then the sheriff has worked to 

provide support services for individuals with mental 

health issues. He encouraged the city to allow the 

Cook County Sheriff’s Office to restaff one of the 

closed facilities with his own mental health staff 

when he recognized that many of the detainees with 

mental illness in his custody were returning to areas 

surrounding the closed clinic (Tafoya 2017). The 

Strength and Wellness Center, located on Chicago’s 

west side, offers individual, family, and group therapy 

supports to individuals sentenced to the sheriff’s 

electronic monitoring or others who have been 

released to the community.

Community support van

Through his frequent interactions with detainees, 

Sheriff Dart often encountered examples of how a 

lack of reliable transportation negatively impacted 

individuals’ ability to obtain and maintain stable 

employment and compliance with treatment, thereby 

increasing their likelihood of engaging in criminal 

behavior. To aid in the success of former detainees, 

Sheriff Dart used a donated passenger van to provide 

transportation services to those impacted by the 

criminal justice system who needed assistance 

with transportation to medical and mental health 

appointments, alumni support meetings offered 

at the Mental Health Transition Center, and court 

appointments. 

Discharge Lounge

Detainees who are identified as having mental illness 

(identified by their P level) are targeted in the Cook 

County Jail’s Discharge Lounge, where they are able to 

receive support services and case management before 

entering the community. The Cook County Sheriff’s 

Office has worked with Cermak Health Services of Cook 

County to identify individuals who are returning to the 

community and in need of medications. The individual’s 

prescriptions will then be coordinated to be picked up 

at an identified hospital location in the community. 

The sheriff’s office has also collaborated with Treatment 

Alternatives for Safer Communities (TASC) to offer case 

management assistance. In addition, those who have 

been identified as homeless receive additional support 

at discharge by receiving care packages and assistance 

getting to community shelters. 

Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails
79

Appendix D. Cook County Rocket Docket 

Expansion Poster

81

Appendix E. COPS Office Grant Team Members

Sheriff Sandra Hutchens, Orange County Sheriff’s 

Department, Santa Ana, California, is the 12th Orange 

County Sheriff and the first woman to serve as the 

county’s top cop. She was named sheriff by the Board 

of Supervisors in 2008 after a nationwide search 

which included a field of 48 candidates. She was 

elected in 2010 to her first full term.

In her 10 years as sheriff of Orange County, Sheriff 

Hutchens has made numerous changes to the Orange 

County Sheriff’s Department with the goal of restoring 

honor to the department. New leadership staff has 

been added, and policies have been revised all with 

a commitment to the department’s core values: 

“Integrity without compromise; Service above self; 

Professionalism in the performance of duty; Vigilance 

in safeguarding our community.”

Sheriff Richard Stanek, Hennepin County Sheriff’s 

Office, Minneapolis, Minnesota, is the 27th Sheriff of 

Hennepin County. He was first sworn in on January 

1, 2007, was re-elected in 2010 and 2014, and is 

currently serving his third term.

Throughout his career, Sheriff Stanek has been 

committed to connecting at-risk kids with positive 

role models. He founded the Hennepin County Sheriff 

Foundation to provide programs for disadvantaged 

youth and support sheriff’s office volunteers. In 

addition, he serves in leadership roles for local 

nonprofit groups that help youth, including Treehouse 

and the Boys and Girls Clubs of the Twin Cities.

Sheriff Stanek also serves in leadership positions with 

several national organizations. The U.S. Secretary 

of Commerce appointed him to FirstNet, which is 

working to develop a wireless broadband network 

for public safety nationwide. He is on the board of 

directors for the National Sheriffs’ Association and is 

also the immediate past president of the Major County 

Sheriffs of America. 

Sheriff Stanek earned a bachelor’s degree in criminal 

justice from the University of Minnesota and a 

Master’s Degree in Public Administration from Hamline 

University. He and his family live in Maple Grove.

Sheriff Michael Chapman, Loudoun County Sheriff’s 

Office, Leesburg, Virginia, was elected Sheriff of 

Loudoun County in 2011 and took office January 

2012. He directs operations for the largest fullservice office in the Commonwealth of Virginia, which 

handles countywide law enforcement, the jail, and 

the courts. The sheriff’s office employs approximately 

750 people: 600 sworn deputies and 150 civilian 

personnel. The Loudoun County Sheriff’s Office 

serves a population of 350,000 and an area of 519 

square miles. 

During his five years in office, Sheriff Chapman 

expanded the Drug Abuse Resistance Education 

Program (D.A.R.E.) to include both elementary 

and middle schools; established a cold case squad; 

enhanced media outreach through integrated 

technology and a restructured website; introduced 

online reporting; professionalized the human 

resources and hiring processes; and improved training, 

accountability, and efficiency. He also initiated a 

countywide internet safety training program for 

parents (which has now been expanded to middle 

and high school students), added prescription and 

synthetic drug awareness with assistance from the 

Drug Enforcement Administration (DEA), partnered 

with county schools for a No Texting and Driving 

campaign, helped integrate mental health services, 

and initiated CIT training for deputies and dispatchers. 

Sheriff Chapman formerly worked for the Howard 

County (Maryland) Police Department in the divisions 

of patrol, SWAT, and criminal investigations and for 

the DEA as assistant special agent in charge, Northern 

District of California; as Acting Regional Director of 

the Far East; as chief of public affairs; as the country 
82 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

attaché for Seoul, Korea; as a supervisor in McAllen, 

Texas; and in field assignments in Florida (Miami 

and Tampa) and Pakistan. In the private sector, 

Chapman worked as a subject matter expert on the 

global security and law enforcement team with Booz 

Allen and Hamilton. He has a bachelor of science in 

business management from the University of Maryland 

and a master’s degree in public administration from 

Troy State University in Alabama.

Michael Ferrence, Jr., Alexandria, Virginia, was the 

executive director (retired 2017) of the Major County 

Sheriffs of America, a professional law enforcement 

association of elected sheriffs representing counties 

or parishes with populations of 500,000 or more. 

Ferrence represents the MCSA membership and works 

to promote a greater understanding of strategies to 

address future problems and identify law enforcement 

and correction challenges facing members of the 

organization. Ferrence has more than 45 years 

of experience in high visibility leadership and 

educational roles specializing in examining complex 

organizational systems and determining underlying 

causality of human performance problems. 

Complementing his experience with graduate degrees 

in public administration, adult learning, and human 

resource development, he is viewed as an academic 

practitioner able to successfully blend the best of 

both worlds. A frequent consultant to federal, state, 

and local law enforcement, Mr. Ferrence has extensive 

experience in the design and delivery of programs and 

courses for a myriad of domestic and international 

agencies. After retiring from the FBI as chief of the 

Leadership Development Institute and an assistant 

to the FBI Academy Director, he created the firm 

Academy Leadership Associates, LLC, with the specific 

focus of working with law enforcement executives 

and high level managers to help them reach their full 

leadership potential. In 2013 he was selected to serve 

as the executive director of the Major County Sheriffs 

of America, whose members operate the largest 

sheriffs’ offices across the nation.

Lieutenant Andy Ferguson, Orange County 

Sheriff’s Department, Santa Ana, California, began 

his law enforcement career as an officer with the 

San Clemente (California) Police Department in 

1985. While with the department he worked patrol, 

including as a field training officer, and was a 

detective in both general and narcotics investigations. 

He was a member of the SWAT team and was the 

department’s law enforcement driving instructor. He 

is also the past president of the San Clemente Peace 

Officers’ Association.

In 1993, the San Clemente Police Department 

merged with the Orange County (California) Sheriff’s 

Department, and Lieutenant Ferguson remained 

assigned to the narcotics investigations detail through 

the transition. He was promoted to sergeant in 2000 

and was assigned to the custody operations and 

classification sergeant positions. He went on to work 

several years in patrol and administrative assignments. 

Upon being promoted to the rank of lieutenant in 

2009, he was assigned to the department commander 

position, which oversees patrol operations, dispatch, 

and emergency communications.

In 2010, Lieutenant Ferguson successfully competed 

for the position of chief of police services in the 

contract city of Laguna Niguel. He held the position 

of chief for four years, acting as a department head 

for the city and a liaison to the sheriff’s department.

Since 2014, Lieutenant Ferguson has been the 

executive aide for Orange County Sheriff Sandra 

Hutchens. In addition to the duties of the aide 

position, he has participated on many local, state, 

and national committees and projects. He is also the 

department’s legislative advocate.

Lieutenant Rob Gardner, Orange County Sheriff’s 

Department, Santa Ana, California, is currently 

the administrative lieutenant for the Central Jails 

Division, a 1,400-bed facility comprising the Central 

Men’s and Central Women’s Jails. He was hired as a 
83

deputy sheriff in 1995 and has served the County in 

a variety of assignments as a deputy—including the 

Central Men’s Jail, City of San Juan Capistrano, and 

the City of Stanton (FTO)—and as a sergeant at the 

Theo Lacy Jail Facility, Central Justice Center, and 

North Patrol Operations.

Lieutenant Gardner graduated with a bachelor of 

science degree in physical education from California 

State University Fullerton and earned a master of 

science degree in emergency services administration 

from California State University Long Beach. He also 

recently completed the 36-week Law Enforcement 

Agency Leadership Certificate program through 

Brandman University and the 40-hour FEMA/Incident 

Command System operations section chief training.

Lieutenant Gardner has been an associate instructor 

through Santa Ana College for the Orange County 

Sheriff’s Regional Training Academy since 2006. He 

has taught a variety of subjects including report 

writing, lifetime fitness, scenario training, and the 

correctional officer core course.

Julianne Ortman, Hennepin County Sheriff’s Office, 

Minneapolis, Minnesota, is an attorney in the Hennepin 

County Sheriff’s Office and serves currently as director 

of the Office of Sheriff and Community Engagement. 

She joined the sheriff’s office in 2007 and previously 

served as the HCSO’s finance director. She practiced 

law in Virginia and Washington, D.C., before moving 

to Minnesota and managing Ortman & Associates, an 

active business-civil litigation and trial practice. 

Ms. Ortman has been elected to public office in five 

elections and currently serves in the Minnesota 

State Senate. For many years, she has served on the 

Senate’s Judiciary Committee, and she was the first 

woman to chair the Senate Tax Committee; she served 

as the Senate’s Deputy Majority Leader in 2012 and 

Assistant Minority Leader in 2005–2006. Prior to 

her service in the State Senate, Ortman served as 

an elected County Commissioner for Carver County, 

Minnesota, from 2001 to 2002. 

Captain David Zimmer, Hennepin County Sheriff’s 

Office, Minneapolis, Minnesota, is a captain with 

the HCSO. He was hired as a deputy in 1988 and 

has served as a deputy, supervisor, and manager 

in investigations, enforcement services, special 

operations, and most recently the jail. He has a 

bachelor of arts degree in criminal justice studies 

from St. Cloud State University and is a 2008 graduate 

of the Police Executive Research Forum’s Senior 

Management Institute for Policing. 

Captain Zimmer is the current commander of the 

Hennepin County Jail and oversees the operation 

of this facility, which holds approximately 750 

preadjudication inmates, an estimated 30 percent of 

whom are dealing with mental illness.

Major Michael Manning, Loudoun County Sheriff’s 

Office, Leesburg, Virginia, graduated from Wheeling 

Jesuit University in Wheeling, West Virginia, in 1992 

with a Bachelor of Arts degree in political science. He 

has served with the Loudoun County Sheriff’s Office 

since 1993. All 23 years of his service have been in 

the corrections and court services division. During 

this time, he has served, supervised, and managed in 

every capacity within the division. 

He has attended numerous supervisory and leadership 

schools throughout his career including attending 

the 235th session of the FBI National Academy in 

2008. He currently serves on the Peumansend Creek 

Regional Jail Authority Board and the Metropolitan 

Washington Council of Government Corrections Chiefs 

Committee. 

Sergeant Linda Cerniglia, Loudoun County Sheriff’s 

Office, Leesburg, Virginia, has been with Loudoun 

County Sheriff’s Office since March 1995. Prior to 

the sheriff’s office, she volunteered as an emergency 

medical technician/firefighter (EMT/FF) for seven 

years. She rose to the rank of sergeant and became 

vice president for two years.

Appendix E. COPS Office Grant Team Members
84 Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

She has been part of the critical incident stress 

management (CISM) team since 1987. From 2000 

to 2006 she was the coordinator for the County 

of Loudoun’s response team. She was one of three 

deputies to respond to work with the New York City 

Police Department after the September 11, 2011, 

terrorist attacks for CISM. She assisted in bringing 

CISM to the Loudoun County Sheriff’s Office in the 

early 90s for law enforcement and corrections.

She has been a negotiator since 1996 and has been 

on more than 100 hostage and barricade incidents. 

She has also served as assistant commander to the 

crisis negotiation team. She has presented at the 

Council of Governments for the Washington, D.C., 

area on negotiations. 

Starting out as a dispatcher, she moved into patrol 

where she became a field training officer for two 

years. In 2003 she was promoted as an investigator 

to the Loudoun County Gang Unit. She was assigned 

to the unit for five years and served on the Northern 

Virginia Gang Task Force for two of those years. After 

working gangs and narcotics, she was promoted to 

sergeant and was transferred to patrol. 

In 2011, she initiated the CIT program for Loudoun 

County in collaboration with Loudoun’s Mental Health 

Department. She continues to be the lead coordinator 

for CIT for Loudoun County and chairs the Northern 

Virginia CIT Coalition.

Dr. Brent Gibson, National Commission on 

Correctional Health Care, Chicago, Illinois, is a boardcertified physician executive with extensive and broad 

experience serving in a variety of government and 

commercial positions. He is chief health officer for 

the National Commission on Correctional Health Care 

(NCCHC) and a trusted advisor and implementer to 

that group’s president and CEO, providing clinical and 

strategic perspective for both technical programs and 

corporate governance. He has broad responsibilities 

across the organization’s many services lines with a 

special emphasis on policies and programs. 

Dr. Gibson specifically supports sustainment and 

growth in the areas of accreditation, educational 

programs, certification, publications and resources, 

and technical assistance. He provides executive 

oversight and liaison services to numerous and diverse 

critical association activities such as standing and ad 

hoc committees, the accreditation program, and the 

cloud-based association management system (AMS). 

He is a Certified Correctional Health Care Professional 

and has earned the specialty certification for 

physicians (CCHP-P).

Dr. David Stephens, Colorado Springs, Colorado, is 

a licensed psychologist, a consultant, and an expert 

in correctional mental and behavioral health. He has 

consulted with jails on issues related to mental health 

services, accreditation, suicide prevention, quality 

assurance, and program development, as well as 

having been responsible for all aspects of the mental 

health program in jails in 11 states. He is on the 

editorial board of the Journal of Correctional Health 

Care and developed the only correctional mental 

health concentration in a clinical psychology doctoral 

program in the United States. 

As a consultant for the NCCHC, he has written the 

curriculum for a National Institute of Corrections 

grant project, Planning and Implementing Effective 

Mental Health Services in Jails, and he is the subject 

matter expert for a COPS Office grant with the Major 

County Sheriffs of America, Identification of Programs 

Designed to Reduce Arrest and/or Incarceration of the 

Mentally Ill. 

Lieutenant Jim Martin, Vanderburgh County Sheriff’s 

Office, Evansville, Indiana, was sworn in as a deputy 

sheriff with the Vanderburgh County Sheriff’s Office 

in January 1994 and served Vanderburgh County for 

nearly 23 years. 
Appendix E. COPS Office Grant Team Members 85

He graduated with a bachelor of science degree in 

communications with an emphasis on public relations 

in 2001 from the University of Southern Indiana. In 

2012, Lieutenant Martin received a master’s degree in 

public service administration from the University of 

Evansville. He currently serves as an adjunct professor 

at the University of Evansville in the organizational 

leadership and public service administration programs. 

During his career with the sheriff’s office, Lieutenant 

Martin has been a motor patrol deputy, K-9 handler, 

supervisor in the jail and the court security unit, 

and an investigator in the professional standards 

unit. He is a certified instructor through the Indiana 

Law Enforcement Academy, and through the Indiana 

Department of Homeland Security he is a graduate 

of the Police Executive Leadership Academy (PELA) 

and served as the assistant jail commander. As the 

assistant jail commander, he has served as a liaison 

for the Vanderburgh County Jail and mental health 

community partners and as an accreditation specialist 

with the NCCHC. 

87

About the Major County Sheriffs of America

The Major County Sheriffs of America (MCSA) is a 

professional law enforcement association of elected 

sheriffs representing counties or parishes with 

populations of 500,000 or more. We are dedicated to 

preserving the highest integrity in law enforcement, 

corrections, and the elected office of the sheriff. 

Our membership represents law enforcement officers 

serving more than 100 million Americans and works 

to promote a greater understanding of strategies 

strategies to address future problems and identify 

law enforcement challenges facing the members of 

our organization.

The nation’s largest sheriffs’ offices are united to 

ensure public safety in the communities we are 

elected to serve. The MCSA is a united and powerful 

voice of community leaders on issues of public 

concern through the following:

• Sense of urgency. Serving with speed and accuracy 

for maximum positive outcomes because America’s 

safety is always at stake

• Communication. Delivering real-time, relevant 

communications with stakeholders using all stateof-the-art systems

• Education. Developing and promoting innovative 

law enforcement and detention training

• Advocacy. Educating and fostering relationships 

with legislators, government agencies, and 

stakeholders while proactively identifying 

relevant issues

• Research. Establishing standards and processes 

based upon science, technology, and time-proven 

best practices with public and private partnerships
88

About the COPS Office

The Office of Community Oriented Policing 

Services (COPS Office) is the component of the U.S. 

Department of Justice responsible for advancing the 

practice of community policing by the nation’s state, 

local, territorial, and tribal law enforcement agencies 

through information and grant resources.

Community policing begins with a commitment to 

building trust and mutual respect between police 

and communities. It supports public safety by 

encouraging all stakeholders to work together to 

address our nation’s crime challenges. When police 

and communities collaborate, they more effectively 

address underlying issues, change negative behavioral 

patterns, and allocate resources. 

Rather than simply responding to crime, community 

policing focuses on preventing it through strategic 

problem-solving approaches based on collaboration. 

The COPS Office awards grants to hire community 

policing officers and support the development and 

testing of innovative policing strategies. COPS Office 

funding also provides training and technical assistance 

to community members and local government leaders, 

as well as all levels of law enforcement. 

Since 1994, the COPS Office has invested more than 

$14 billion to add community policing officers to the 

nation’s streets, enhance crime fighting technology, 

support crime prevention initiatives, and provide 

training and technical assistance to help advance 

community policing. Other achievements include the 

following:

• To date, the COPS Office has funded the hiring

of approximately 130,000 additional officers

by more than 13,000 of the nation’s 18,000

law enforcement agencies in both small and

large jurisdictions.

• Nearly 700,000 law enforcement personnel,

community members, and government leaders

have been trained through COPS Office–funded

training organizations.

• To date, the COPS Office has distributed more

than eight million topic-specific publications,

training curricula, white papers, and resource CDs

and flash drives.

• The COPS Office also sponsors conferences, round

tables, and other forums focused on issues critical

to law enforcement.

COPS Office information resources, covering a wide 

range of community policing topics such as school 

and campus safety, violent crime, and officer safety 

and wellness, can be downloaded via the COPS Office’s 

home page, www.cops.usdoj.gov. This website is also 

the grant application portal, providing access to online 

application forms.

Law enforcement has increasingly become the primary point of contact for individuals living with mental 

illness, and the presence of these individuals in jail and prison populations has grown to crisis proportions. 

This report—developed by the Major County Sheriffs of America (MCSA) in partnership with the National 

Commission on Correctional Health Care (NCCHC)—identifies innovative practices that have proven 

successful in reducing the arrest and incarceration of individuals living with mental illness in jurisdictions 

across the country. The programs have shown promise in several areas: diverting those who live with mental 

illness away from the criminal justice system, supporting individuals in the court system, identifying and 

treating those who have been incarcerated, and helping individuals successfully re-enter their communities 

after discharge. The report includes case studies of seven jurisdictions and resources developed by law 

enforcement executives and experts in the field.

U.S. Department of Justice

Office of Community Oriented Policing Services

145 N Street NE

Washington, DC 20530

To obtain details about COPS Office programs, call 

the COPS Office Response Center at 800-421-6770.

Visit the COPS Office online at www.cops.usdoj.gov.

Major County Sheriffs of America

1450 Duke Street

Alexandria, VA 22314

To obtain details about MCSA programs, call the 

Major County Sheriffs of America at 703-778-1381

Visit the MCSA online at www.mcsheriffs.com.

e031801866 

Published 2019