RD327 - Crisis Intervention Team Assessment Centers (CITAC) Expansion Plan (Item 320.FF. of the 2020 Appropriation Act.) – October 1, 2020

Executive Summary:

Crisis services are a critical link in the public behavioral health and developmental disability continuum of care. A key function of our crisis response network is law enforcement-based jail diversion efforts that work to keep those in mental health crisis from entering the criminal justice system, including the Crisis Intervention Team Assessment Site (CITAC) program. The 2020 Appropriations Act Item 320.FF. requires a report on the feasibility of expanding the CITAC program. CITAC program staff have been working closely with grantees to find ways to expand services in a number of areas. Based on information from previous funding cycles, this report includes costs estimates and recommendations for enhancement including expansion of some CITAC locations into regionally based crisis receiving centers by FY2022.

A workgroup of subject matter experts was convened to receive input from stakeholders including six Community Services Boards (CSBs), Mental Health America of Virginia, the Virginia Association of Chiefs of Police, the Virginia Sheriffs’ Association, the Virginia Association of Community Services Boards, and the Virginia Healthcare & Hospital Association. These entities either host or are stakeholders in various Crisis Intervention Team (CIT) programs in Virginia and represent interests of critical pieces in a mental health response system.

Entry into the criminal justice system or lengthy emergency department (ED) stays for someone with mental illness is not in the best interest of recovery for the individual and can create unnecessary burdens for law enforcement, jails, courts, and public mental health systems. Jail diversion programs like the CITAC program provide a resource for individuals in crisis that offer calming locations, access to timely emergency mental health evaluations, and treatment options other than inpatient hospitalization or incarceration. This report details current challenges, research on best practices, and options for how the existing Assessment Sites can be leveraged to provide more opportunities for consumers and potentially reduce additional burden on medical facilities, jails, the court system, and law enforcement agencies.

Key Findings of the Workgroup

• Time spent in emergency departments takes law enforcement officers away from their primary duties of community service and protection for extended periods of time.

• Arrest and incarceration are not the most appropriate options for many cases involving individuals experiencing symptoms of mental health crisis.

• Services that aid in reducing the overall number of temporary detention orders will benefit consumers, jails, and help reduce the number of TDOs to state hospitals.

The primary recommendations of the Workgroup include:

1. Establishment of up to five Crisis Receiving Centers, one in each behavioral health region, to provide opportunities to reduce the number of misdemeanants incarcerated with mental illness, reduce the number of psychiatric emergencies waiting in EDs, and provide access to a wider system of care for those in crisis. Crisis Receiving Centers should contain, at a minimum, basic medical evaluation, immediate access to psychiatry, staffing by peer specialists with lived experience, extensive case management, 23 hour observation, and stabilization.

2. Retaining existing Assessment Sites that provide too great of a geographical challenge for regional participation until further data can be collected, thereby maintaining a safety net for all localities.

The total cost estimate for these recommendations is $20.3 million annually. $12.3 million of these funds can be utilized from the existing CITAC budget, and $8 million in new funds would be required. The accompanying research explains the numerous benefits these services offer the crisis system, jails, emergency departments, and state hospitals.