20240626-120331-76

"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 February, CSG Justice Center staff met with the DOC commissioner and data staff to preview the preliminary DOC data analysis presentation ahead of the presentation to the Governors’ Advisory Commission on Mental Illness and the Corrections System (Advisory Commission). CSG Justice Center staff also discussed the Phase II subaward funding opportunity with the DOC Commissioner and the New Hampshire DHHS Director of Behavioral Health during the site visit when CSG Justice Center staff presented the DOC preliminary data to the Advisory Commission. The presentation was well received by the Commission members, who engaged with the data analysis, asked questions about how CSG Justice Center staff would be incorporating Medicaid data into the analysis, and offered feedback to inform the final presentation.  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 Coös, Annual Report of Coös County for the Year Ending December 31, 2019 (Lancaster, NH: County of Coös, 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 February, CSG Justice Center staff met with DOC stakeholders and held focus groups to gather information on their policies and procedures for clinical mental health (MH) and substance use disorder (SUD) treatment in their facilities. CSG Justice Center staff also conducted focus groups with the director and deputy director of the Division of Medical and Forensics and their Licensed Drug and Alcohol Counselors. CSG Justice Center staff learned about available services and the level of care provided by the New Hampshire DOC, which will inform policy recommendations moving forward. Overall, CSG Justice Center staff’s impression of the clinical services provided to people within the New Hampshire DOC is positive. [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 February, CSG Justice Center staff connected Lakes Regional CMHC, one of New Hampshire’s new Crisis Receiving Centers (CRCs), to a peer resource in Illinois who met with them and provided insight on how they developed their crisis center. CSG Justice Center staff hosted representatives from the CMHCs and DHHS at an Implementation Working Group (WG) meeting and drew upon their expertise to inform the group’s next steps regarding implementation. [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 February, CSG Justice Center staff invited law enforcement and corrections representatives to be on the WG and engaged their expertise in the implementation technical assistance. CSG Justice Center staff met with the director of Public Protection at the New Hampshire Attorney General’s Office to provide a project update and learned that part of his role is to serve as an advisor on public policy, and he will support policy recommendations that come out of the JRI work. Research Monthly Status: This month, Research staff collaborated with DHHS to negotiate the extension of the current data use agreement for prolonged access to DOC data. While awaiting the receipt of accurate files from DHHS, Research staff utilized the available data for coding purposes. Thorough data cleaning and analysis were conducted on both DOC and Medicaid datasets. During a site visit, Research staff presented preliminary DOC data to the Advisory Commission and met with various stakeholders. Research staff began work on the next presentation, focusing on preliminary Medicaid findings. Aggregated tables were prepared to retain valuable information beyond the jail data deletion date on March 31, 2024. Research staff met with DOC to discuss data clarification questions, analysis plan, and project next steps, and with DHHS to discuss the analysis plan, Medicaid data match, service descriptions, and costs."