20240129-113452-32

Analysis Area 1:?Facilitate a cross-system data match between DHHS and county jails to identify the overlapping population of people who have behavioral health challenges who move through local criminal justice systems and identify high utilizers of both systems. CSG Justice Center staff will conduct an in-depth descriptive analysis of the matched Medicaid claims data to provide information on trends in services accessed in the community by people incarcerated in each participating jail. CSG Justice Center staff will also analyze county jail data related to demographic information, booking and release information, screening and assessment information, medications, and programming and treatment information to understand the criminal justice and behavioral health characteristics of locally incarcerated populations.?
Background:?County and state officials report a high prevalence of people with behavioral health needs moving through local county department of corrections (jails) and state prisons, with an increasing reliance on using incarceration at the local level to address behavioral health challenges. In at least one of the state?s 10 county jails, a data match found a 76 percent overlap between the populations for both the county jail and the community mental health center.[i]?In another county, the majority of people held in jail reported using drugs on a regular basis;[ii]?another county estimated that about a quarter of its jail population had an opioid use problem.[iii]?Improving criminal justice and public health outcomes for people with behavioral health conditions who are high utilizers of the health and jail systems can impact public safety and state budgets.?
Update:?In December, CSG Justice Center staff met with the New Hampshire DOC commissioner and data staff on site to discuss the DOC data analysis. CSG Justice Center staff also presented to the Governors? Advisory Commission on Mental Illness and the Corrections System on the next potential phase of technical assistance and data analysis plan. The Commission expressed enthusiasm about the state-level data analysis and implementation technical assistance, specifically the potential data system coordination and monitoring of trends.
?CSG Justice Center staff also learned that New Hampshire DHHS is still in the initial planning and implementation phase of propping up the Crisis Receiving Centers (CRCs) and will work with the CSG Justice Center to strategize on the best way for CSG Justice Center staff to provide technical assistance and support that work. Finally, CSG Justice Center staff met with the New Hampshire DOC commissioner to discuss future scheduling and continued use of the Governor?s Commission on Mental Illness and the Corrections System (?Commission?) through the anticipated next phase of technical assistance. Due to some new appointments to the Advisory Commission, CSG Justice Center staff learned the schedule for upcoming meetings may shift. At this juncture in the project, CSG Justice Center staff do not expect the potential shift in scheduled meetings to impact the project?s timeline or meeting goals.
[i]?Meeting between The Council of State Governments Justice Center and Sullivan County, Department of Corrections on November 18, 2020.
[ii]?Merrimack County, ANNUAL REPORT For the year ending December 31, 2019 (Concord, NH: County of Merrimack, 2020). ?69% of inmates self-reported regular drug use.? Self-reported drug use statistics were not available for all counties.
[iii]?County of Co?s, Annual Report of Co?s County for the Year Ending December 31, 2019 (Lancaster, NH: County of Co?s, 2020). Information on substance use in jails was not available for all counties.
Analysis Area 2:?Conduct a qualitative assessment on the availability, quality, and data collection practices of jail-based mental health and substance use disorder programming and treatment. CSG Justice Center staff will conduct interviews and focus groups with superintendents, jail staff, and contracted behavioral health providers to provide information on the identification of people with behavioral health needs, services, programming, and options within jails for care coordination to support connections to community-based care. CSG Justice Center staff will review jail policies that guide the practice of identifying, tracking, and referring people with behavioral health conditions to services. This assessment will provide qualitative data on local trends in jail populations, behavioral health needs, and participation in jail-based treatment and services.
Background:?While less is immediately known about the nature and prevalence of behavioral health needs among people who are incarcerated in and frequently move through county jails, stakeholders have indicated, and preliminary data analyses show that people with behavioral health needs may also make up large proportions of local jail populations.?In Merrimack County, over two-thirds of people in jail in 2019 reported using drugs on a regular basis.[i]In Cheshire County, 84 percent of people in jail who received a mental health assessment in 2019 met the criteria for alcohol and/or drug abuse or dependence, and 64 percent had co-occurring mental illness and substance use disorders.[ii]?However, data collection systems are not consistent across county jails and often lack behavioral health indicators and metrics. Additionally, despite the reported prevalence of behavioral health needs, there are gaps in the availability and quality of jail-based behavioral health programming.?
Update:??In December, CSG Justice Center staff discussed the Implementation Working Group (WG) with the president of the New Hampshire Superintendents Affiliates. The president was enthusiastic about the WG and plans to recommend a superintendent that fits the needs of the WG and can participate in implementation planning. CSG Justice Center staff began the initial planning for the qualitative assessment portion of the project, which includes assessing behavioral health programming and reentry services, community supervision, in-community services, and focus groups with impacted individuals.?
[i]?Merrimack County, ANNUAL REPORT For the year ending December 31, 2019 (Concord, NH: County of Merrimack, 2020). ?69% of inmates self-reported regular drug use.? Self-reported drug use statistics were not available for all counties.
[ii]?County of Cheshire, Report of the County Commissioners County Treasurer and Other Officers of Cheshire County New Hampshire for the Year Ending December 31, 2019 (Keene, NH: County of Cheshire, 2020). Of the 1,610 people booked in calendar year 2019, 280 received a mental health evaluation. Information on mental health in jails was not available for all counties.
Analysis Area 3:?Conduct a community-based behavioral health assessment with mental health center staff, substance use disorder treatment and recovery support service providers, housing and homeless service providers, and people with lived experiences. CSG Justice Center staff will identify and geographically map current behavioral health services, crisis response, and alternatives to incarceration programs to provide an overview of availability of services in each county. This assessment will inform stakeholders on the current gaps in behavioral health resources and care coordination with criminal justice systems.??
Background:?The behavioral health needs in New Hampshire are significant, but mental illness and substance use disorder (SUD) treatment and service providers are limited in their ability to meet these needs generally, let alone for people involved in the criminal justice system.?In 2017 and 2018, an estimated nine percent of adults in New Hampshire needed substance use treatment but did not receive it, the seventh-highest rate in the nation.[i]?This assessment will inform recommendations on how to address people who have frequent contact with county jails and behavioral health systems, including increasing diversion opportunities and access to services for people reentering communities from jails, such as mental illness and SUD treatment, affordable housing, and other effective community-based support services.
Update:?In December, CSG Justice Center staff met with the deputy director of the New Hampshire DHHS Division of Behavioral Health on site and discussed the potential WG and who they recommend to represent DHHS. CSG Justice Center staff also met with the president of the NH Community Mental Health Centers (CMHCs) Association to provide a project update and discuss their recommendation for representation on the WG. The president of the NH CMHCs shared more thoughts on care coordination between the prisons and the CMHCs and is enthusiastic about having CMHC representation on the WG.
[i]?Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality, 2017-2018 NSDUH State Estimates of Substance Use and Mental Disorders (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2019). Percentages are annual averages for 2017 and 2018; rates for individual years were not available. Adults are people 18 years of age and older.
Analysis Area 4:?Connect with criminal justice stakeholders (law enforcement, judges, defense attorney, prosecuting attorneys, and community-based corrections) to examine the extent to which law enforcement, courts, and other criminal justice stakeholders have viable, evidence-informed community resources available for people in the criminal justice system who have behavioral health and housing needs, including access to effective crisis and treatment services. CSG Justice Center staff will also identify and geographically map current alternatives to incarceration programs to provide an overview of availability of options for criminal justice agencies in each county. This assessment will inform stakeholders on the current gaps in alternatives to the criminal justice system for people with behavioral health conditions.?
Background:?County officials report significant gaps in how the state is currently able to respond to and provide behavioral health services to people. Without more effective and available community-based services to respond to people with SUDs or mental illnesses or both, New Hampshire has increasingly relied on incarceration in jails or prison to address behavioral health challenges, which increases fiscal pressure on counties.?
Update: In December, CSG Justice Center staff met with the chief justice of the NH Supreme Court to provide him with a project update and discuss the WG so that he can recommend a member to represent the courts once Phase II is approved.

Research Monthly Status:?In December, CSG Justice Center Research staff presented the DOC and Medicaid data analysis plans to the Governor?s Advisory Commission on Mental Illness and the Corrections System while on site. Research staff participated in on-site meetings by providing data analysis insights and answering stakeholder questions. Research staff worked with multiple agencies to get the Medicaid Data Use Agreement completed and signed. Finally, Research staff cleaned, coded, and analyzed the preliminary DOC data and worked on the DOC initial findings presentation scheduled for February.