Memorandum

City of Lawrence

City Manager’s Office

 

TO:

David Corliss, City Manager

FROM:

Brandon McGuire, Assistant to the City Manager

CC:

Diane Stoddard, Assistant City Manager; Casey Toomay, Assistant City Manager

DATE:

May 22, 2015

RE:

Inventory of City Services Addressing Mental Health

 

Background

Every day City of Lawrence employees serve and interact with individuals with mental illness and mental health service providers in conducting departmental business. The City does not segregate service data based specifically on mental illness, so service levels specific to individuals with mental illness is not available. Department leaders recently evaluated their departmental services in order to identify existing interactions between staff and the mental health system as well as opportunities to enhance the City’s impact on mental health needs. This report provides an overview of those opportunities.

 

Outside Agency Funding

In 2015, Bert Nash Mental Health Agency received an allocation of $168,114 from the General Fund. In 2008 the Bert Nash Working to Recognize Alternative Possibilities (WRAP) program allocation was discontinued and the $250,000 General Fund portion of that allocation was shifted to the City’s School Resource Office program. Bert Nash WRAP serves children in schools across Douglas County. In 2007 the City provided $350,000 to the WRAP ($250,000 from General Fund and $100,000 from Special Alcohol Fund).

 

Numerous programs that support mental health needs to some degree are provided by outside agencies that receive resources form the City’s General Fund, Special Alcohol Fund and Special Recreation Fund. The 2015 allocations to those programs are detailed in the accompanying table.

 

Examples of Existing Opportunities

City employees interact daily with individuals with mental illness and with mental health agencies. Several examples of those interactions are highlighted below.

 

Public Safety Functions

Lawrence-Douglas County Fire Medical Department serves individuals with mental illness through the following.

Ø  Incident response and pre-hospital care. Data on individuals with suspected mental health issues is not tracked separately, so specific service levels are not available.

Ø  EMS billing works with individuals facing hardships to make payment plans that work for work for their personal financial situations.

Ø  The Department works with Bert Nash on the Juvenile Fire Setter program.

Ø  Department employees received training through the Bert Nash Mental Health First Aid program.  

 

Lawrence Police frequently interact with individuals with mental illness and/or special cognitive needs.

Ø  Officers check the welfare of those who may be unable to care for themselves, individuals exhibiting unusual behavior, people threatening suicide, subjects threatening assault against others, and individuals experiencing other mental health problems or crises.

Ø  The Department has developed working relationships with a number of local support agencies including Lawrence Memorial Hospital (LMH), Bert Nash Mental Health, and Headquarters Counseling Center.

Ø  Interagency agreements are in place with agencies the Department frequently works with in order to provide guidance on resolution of common problems and incidents. The Department provides training and support to these agencies and also participates in joint training with the agencies.

 

The Lawrence Municipal Court has daily, person-to-person and telephone contact with individuals experiencing a full spectrum of mental health problems. Interactions with mentally ill individuals vary in service provided depending on the position of the staff person involved in the interaction. The Court’s Judge, Probation Officer, Prosecutors, Bailiff, and the clerks assigned to the customer window have the most contact with mentally ill individuals. Examples of the most intensive interactions with mentally ill individuals include explaining the criminal justice process to defendants, conducting basic inventory and assessment of mental health issues, encouraging behavior change, providing referrals for treatment, and crisis deflation and safety/threat assessment.

 

Informal referral relationships exist between Municipal Court and community social service agencies including Bert Nash and other community mental health care providers. Agencies often provide progress reports for people who suffer from mental illness. The Court’s Probation Officer and Judge frequently refer mentally ill individuals to service providers and attempt to collaborate with the community mental health centers and private mental health counselors. Collaboration involves coordinating services and ensuring that clients have the opportunity to access medication and treatment to manage mental health needs, if these services are available in the community.

 

Other Core City Functions

Parks and Recreation interacts daily with individuals with mental illness across the department in facilities and parks.

Ø  Providing shower facilities and day-shelter for homeless individuals at City recreation centers.

Ø  Staff occasionally interacts with individuals camping in City parks.

Ø  Service agencies, particularly those serving individuals with special needs, bring clients/consumers to socialize and exercise in City parks and recreation facilities.

Ø  Program scholarships and free entrance at swimming pools are provided to clients of The Shelter, Inc., Family promise, Bert Nash, and Willow Domestic Violence Center.

Ø  The Department provides educational programs at no charge to The Shelter, Inc. and Headquarters organizations.

Ø  The Department partnered with Bert Nash to develop the Sandra J. Shaw Community Health Park and nature trail.

 

Planning and Development Services employees interact with individuals with mental illness as applicants and through the code enforcement process.

Ø  Code Enforcement interacts with individuals with mental illness by way of hoarding and un-kept property cases.

Ø  The Community Development Division administers Community Development Block Grant (CDBG) funding to certain agencies, but the CDBG funding levels are declining.

 

Transit serves numerous individuals with mental illness but because passengers can ride without specific recognition, information on the percentage of Transit riders facing mental illness is not available.

Ø  Transit sells tickets and passes to most of the mental health support agencies in the community.

Ø  Over 15,000 bus tickets are provided to the Lawrence Community Shelter annually.

Ø  Transit partnered with the Lawrence Police Department and the Lawrence Community Shelter to address a large increase in service disruptions related to individuals with mental illness coming from and going to the Community Shelter. Each disruption impacts service levels, resulting in missed trips and extended passenger wait times system-wide.

 

Management, technical and administrative functions support the field operations that directly interact with the mental health system. Employees in management and support roles also directly interact with individuals with mental illness through phone calls, meetings and walk-ins that occur each day at City offices. City employees work with individuals to help identify needs, answer questions, solve problems, provide referrals, and offer direct assistance.

 

Examples of New Opportunities

Departments identified a number of new opportunities that would better enable their employees to address mental health issues and needs.

 

Public Safety Functions

The Fire-Medical Department identified the following new opportunities.

Ø  Developing an appropriate intake system for patients who have been assessed by medical professionals could reduce the number of repeat Fire-EMS responses.

Ø  Developing the mental health system’s capacity during off-hours would improve the City’s ability to respond to metal health needs. There is currently no place within Douglas County to access mental health services after hours, on weekends and on holidays other than the LMH Emergency Department.

 

The Police Department has implemented a number of relatively new approaches to address the needs of community members with mental illness over the past several years. Both examples provided below are proven programs that focus on identifying individuals with mental illness and safely bringing crisis situations under control. 

Ø  All employees participated in the Mental Health First Aid program to develop awareness level training.

Ø  The Crisis Intervention Training (CIT) program provides critical skills needed to safely resolve calls involving individuals experiencing a mental health crisis. The week-long Crisis Intervention Training is first being provided to frontline responders, with the goal of more broadly training other officers who may have a role in these types of calls. Please see accompanying memorandum for details.

 

Municipal Court would benefit from movement towards an evidenced-based and/or problem-solving court model that includes validated methods for screening/assessing defendants for mental illness along with a data system that enable confidential documentation of mental health histories.  Additionally, closer coordination of services with mental health service providers and specific agreements with those providers to serve Municipal Court defendants would significantly improve the Court’s ability to respond to mental health issues.

 

Other Core City Functions

Parks and Recreation identified the following new opportunities.

Ø  Develop partnerships with community service providers (e.g. Bert Nash)

Ø  Create parks, programs and trails that are specifically designed to serve mental health needs.

Ø  Create a city-wide wellness coordinator position to offer programs (e.g. continuing education, lunch and learn sessions, wellness seminars) to City employees and community agencies.

Ø  Develop a dedicated wellness center.

 

Challenges to Addressing Mental Health Needs

The City does not currently provide mental health services directly to consumers and does not compete with mental health agencies and service providers in the community. City services compliment the services provided through the mental health system, but the direct provision of mental health services would represent new business functions for the City. Identifying new revenue and resources to provide new services could be challenging, especially if the City competes with existing agencies and service providers for the same resources (e.g. grants). Diverting funding from core City services and re-allocating that funding to new mental health services would result in service reductions in those City services.

 

Public Safety Functions

Maintaining adequate staffing levels creates challenges for the Police Department in addressing mental health needs. Between January 1st and April 30th, officers responded to approximately 750 calls related to suicide-related calls or requests to check an individual’s welfare (6.25 per day). These calls commonly last four to six hours and require multiple officers to safely and effectively respond. Time is spent responding to the initial call, safely contacting the individual in crisis, and transporting them to LMH for a mental health screening. Officers remain with the individual through the mental health screening at LMH and often transport them afterward to Osawatomie State Hospital (a 2 ½ hour round trip), Douglas County Jail, or back to where they were first contacted. These calls commonly occur simultaneously and they impact officers’ ability to respond to other types of calls. Additionally, officer attendance at specialized training programs, such as the CIT program, takes officers away from regular duties and other officers must cover the duties of those participating in the training.

 

These functions are necessary to provide the appropriate level of care and support expected by the community but they strain personnel resources which challenges the Department’s ability to respond to law enforcement calls for service.

 

Municipal Court’s current staffing and resources do not allow the adoption of an evidenced-based or problem-solving court model. Additionally, the availability of adequate mental health services in the continuum of care is needed in order to effectively implement policy changes and court initiatives that impact defendants with mental illness.

 

Other Core City Functions

Parks and Recreation identified the following challenges to expanding its role in serving mental health needs.

·         Increased safety concerns involving negative or violent interactions with homeless individuals, mentally ill individuals, and individuals under the influence.

·         Increased need for staff training related to mental illness needs, event de-escalation training, and diversity training.

 

Planning and Development Services is challenged by code enforcement cases involving individuals with mental illness. These cases are very challenging to process as usually the enforcement or compliance issue is a symptom of the mental illness.

 

Conclusion

Numerous existing opportunities and new opportunities to serve mental health needs in the community have been identified. Factors that challenge to the City’s ability to address these needs have also been identified. City departments look forward to continued opportunities to partner with mental health agencies to leverage resources and enhance service to individuals with mental illness. City staff may also be useful in engaging and facilitating efforts with outside agencies to assess the community’s continuum of care in order to and identify and address service gaps. City staff also looks forward to receiving direction from the City Commission regarding the City’s role in serving mental health needs.