J_MICJS_2021A 09/01/2021 09:03:44 AM Committee Summary

Representative Benavidez, Chair, called the meeting to order.  The meeting agenda was distributed to the committee members (Attachment A).

Jagruti Shah, Director, Forensic Services, Department of Human Services, presented to the committee on forensic services and competency. She provided a handout to the committee (Attachment B). Ms. Shah explained the process for competency evaluations. She discussed the different settings for the evaluations, which are in-patient, jail-based, or community-based evaluations. Ms. Shah reviewed the components that are considered during the evaluation.

The committee recessed.

Ms. Shah continued her presentation. She explained how restoration services are provided if someone is found incompetent to proceed. Ms. Shah discussed outpatient restoration services, which are provided statewide and currently do not have a waitlist. She discussed inpatient restoration services, which includes jail-based restoration services.

Ms. Shah responded to questions about the various locations for inpatient restoration services and how placement is determined. She discussed the forensic support team's role in the process.

Ms. Shah discussed the length of time it takes to restore a person to competency and the average wait time for inpatient services. She responded to questions about the waitlist for services, and said she could provide additional information about fines assessed against the department due to a settlement agreement addressing competency evaluations. Ms. Shah discussed instances of individuals who are determined restored, but then competency is raised again in the court process. She answered questions about utilizing psychiatric nurses in the evaluation process. She discussed the pressures on inpatient services and the need to look at ways to divert individuals.

Ms. Shah responded to questions about whether someone who is waiting for inpatient restoration services is eligible for bail.

Laura Ferguson, 27-65 Manager, Office of Behavioral Health, Department of Human Services, made a presentation about the mental health hold process. She provided a handout to the committee (Attachment C). She outlined the mental health hold process, which involves initial custody, evaluation, and further treatment. Ms. Ferguson explained the certification process. She responded to questions about the effectiveness of mental health holds and the availability of placements for mental health services.

Lauren Snyder, State Policy Director, Mental Health Colorado, presented on peoples lived experience with 72-hour mental health holds. She provided a handout to the committee (Attachment D).

Sabah Muhammad, Legislative and Policy Counsel, Treatment Advocacy Center, presented to the committee on mental health holds.  She provided the committee with a handout (Attachment E) and a Washington Post opinion article, which can be accessed here:  https://www.washingtonpost.com/opinions/2020/09/07/daniel-prude-death-policing-mental-illness/. She referenced the grading of the states documents that her organization has developed. She reviewed elements of Colorado's process and laws related to mental health holds. Ms. Muhammad discussed that Colorado does not have citizen access to the courts and the need to sufficiently detail the procedures to guide practitioners for assisted outpatient treatment. She further discussed limitation in Colorado law to assisted outpatient treatment.

Ms. Muhammad continued to discuss the issues people with severe mental illness face and how medical issues become criminal issues. She discussed the assistance to legislators that the Treatment Advocacy Center can provide to address matters concerning the severally mentally ill.

Dr. David Iverson, Director of Psychiatry, Colorado Coalition of the Homeless, and Chair of the Task Force Concerning the Treatment of Persons with Mental Health Disorders in the Criminal and Juvenile Justice Systems (MHDCJS Task Force), presented on the criminalization of mental illness. He referenced a Frontline documentary that can be found here:  https://www.pbs.org/wgbh/frontline/film/showsasylums/. Dr. Iverson discussed how the continuum of care has disappeared. He discussed the lack of civil beds for people with serious mental illness and the effects of deinstitutionalization.  Dr. Iverson discussed mental health holds, diversion programs, and the importance of peer support.

The panelists responded to questions about mental health holds and the impacts of various payment methods on the length of mental health holds. The panelists discussed the need for additional data on mental health holds, especially why mental health holds are terminated. Dr. Iverson discussed how discharge plans are addressed for someone who was admitted for a mental health hold.

The panelists continued to respond to questions about discharge plans and the requirements and oversight of those plans. Ms. Snyder referenced changes related to emergency departments that were made by Senate Bill 17-207.

The panelists responded to questions about mental health holds and involuntary versus voluntary treatment. The panelists discussed potential changes may be needed to the mental health hold process and laws. Dr. Iverson discussed involuntary medication restrictions and ending certification for treatment.

Ms. Muhammad provided additional comments about assaults on professionals. She discussed the issues that can occur when police are the first responders to mental health crisis.

The committee recessed.

The committee came back to order. 

Aimee Janvrin, Director of Mainstream Services, Behavioral Management System, presented on mental health diversion programs in Rapid City, South Dakota. She discussed how her organization reaches out to people experiencing homelessness, the crisis care center, and the mental health diversion court operating in the area. Ms. Janvrin responded to questions about the service area of her organization, the operation of the mental health diversion courts and crisis care centers, and data collection related to the cost-savings of the diversion program.

Chris Richardson, Associate Director of Criminal Justice Services, Mental Health Center of Denver, presented on the Support Team Assisted Response (STAR) Program, which deploys an emergency response team to address people experiencing mental health crisis. He discussed the Crisis Assistance Helping Out On The Streets (CAHOOTS) Program in Oregon that the STARS Program is modeled after. Mr. Richardson discussed the services that the STAR Program provides.

Kara Martin, Mental Health Diversion Program Coordinator, Office of the State Court Administrator, presented on the Mental Health Diversion Program, which was a pilot program. She provided a handout to the committee (Attachment F). She discussed the impacts that COVID-19 had on the mental health diversion pilot program. Ms. Martin reviewed how the mental health diversion program operated. She reviewed the recommendations from the pilot program, including involving all critical stakeholders early on in the process and maximizing points of entry. Ms. Martin also highlighted the importance of case management beyond compliance monitoring.

Ms. Martin explained the differences between the mental health diversion program and the adult diversion program.

Captain Jamison Brown, President, Colorado Jail Association, and Denver County Sheriff's Office, presented on a diversion center being established in Denver.

Mr. Richardson responded to questions about the impact of workforce shortages on the STAR Program and potential cost-savings the program can offer. Captain Brown and Ms. Martin responded to question about diversion programs, including potential next steps for the mental health diversion program. In response to a question, Mr. Richardson discussed the need for dispatch training to evaluate what type of response should be dispatched to a crisis situation.

In response to a question, Captain Brown further described the diversion center that is being established in Denver.

Meghan Baker, Facilities Team Leader Attorney, Disability Law Center, presented on persons with mental health disorders and assaults on professionals. She reviewed a powerpoint during her presentation (Attachment G). Ms. Baker reviewed the types of felony assault, the related state laws, and the differences between assaults on a professional versus someone who is not defined as a professional. She discussed statistics about assaults on a professional charges filed against people who are incompetent to proceed. Ms. Baker reviewed information about the treatment of people with mental illness in the Department of Corrections. She referenced House Bill 14-1214 that required the Commission on Criminal and Juvenile Justice (CCJJ) to provide a report to the General Assembly on enhanced penalties for assaults on professionals.

Ms. Baker discussed not guilty by reason of insanity related to assaults on professionals.

Tim Lane, Legislative Liaison and Policy Analyst, Colorado District Attorneys' Council, and MHDCJS Task Force member, presented on assaults on professionals. He discussed crisis intervention training and mental health first aid training that could help prevent assaults on professionals. Mr. Lane reference House Bill 21-1030 that expanded the Peace Officers Mental Health Support and Community Partnerships Grant Program. He discussed mental health division programs and efforts by the CCJJ to address felonies for assaults on professionals.

Lucienne Ohanian, Chief Deputy, Colorado State Public Defender, presented on assaults on professionals. She discussed competency laws and the length of time it may take for someone to be released after a charge of an assault on a professional.

The panelists responded to questions about bail and competency restoration. In response to a question, Mr. Lane referenced Senate Bill 20-181, which addressed competency reports, and how other states address assaults on professionals. The panelists addressed questions about the Disability Law Colorado lawsuits related to competency restoration.

Representative Benavidez discussed the upcoming meetings of the committee.