Mental health screening and treatment for justice-involved individuals: Johnson County, KS
MORE ABOUT THE STRATEGY USED IN THIS CASE STUDY Transitional employment and re-entry support
At-a-Glance
Summary
Like many communities across the country, in Johnson County (KS), individuals experiencing mental health challenges are disproportionately likely to enter the criminal justice system and recidivate. In the past, individuals with severe mental illnesses (SMIs) would often enter jail but not receive treatment or follow-up care. This contributed to a cycle of recidivism.
In November 2016, Johnson County began using the Brief Jail Mental Health Screen (BJMHS), a short series of questions that are administered during the booking process for every detainee. When individuals screen positive on the BJMHS, they receive mental health care while they are detained and/or receive follow-up visits from Johnson County Mental Health staff after they are released.
Keys to this initiative's success included dedicated staff capacity and an advisory board committed to advancing cross-agency initiatives related to criminal justice, strong relationships between the County Manager's Office and the Sheriff's Office, the ease of administering the BJMHS, and the robust investments that Johnson County had previously made in data collection and sharing systems.
Major obstacles included needing to change vendors for mental health services provided in jails, ensuring that frontline jail staff consistently administered the BJMHS, conducting robust outreach to recently-released individuals during the COVID-19 pandemic, and meeting demand for mental health services given chronic underfunding from federal and state government.
Results and accomplishments
12%
With the Brief Jail Mental Health Screen in place, detainees in Johnson County who qualified for mental health outreach had a 12 percentage point reduction in recidivism after 60 days, according to an evaluation by the University of Notre Dame’s Wilson Sheehan Lab for Economic Opportunities. This decrease in recidivism was also observed after 180 and 360 days, by 10 percentage points and 9 percentage points, respectively.
23%
Individuals who screened positive on the Brief Jail Mental Health Screen and had never previously received mental health care experienced a 23 percentage point reduction in recidivism after 60 days.
44%
In a two-year period, 44 percent of individuals who screened positive on the Brief Jail Mental Health Screen were successfully contacted by Johnson County's Mobile Crisis Response Unit.
Multiple agencies collaborating and sharing data: In Johnson County, human service and criminal justice agencies are now able to share high-quality, privacy-protected data, enabling collaboration and proactive engagement with individuals with serious mental illnesses (SMIs). Platforms like My Resource Connection (MyRC) and the Justice Information Management System (JIMS) form the foundation of this collaboration, with data collected via the Brief Jail Mental Health Screen (BJMHS) serving as a critical input.
Growth in mental health professionals in sheriff’s departments: With better data on individuals with SMIs and increased collaboration, Johnson County could effectively make the case for more mental health professionals within its detention centers. It also led to the expansion of Johnson County's co-responder program, which embedded licensed clinicians in law enforcement offices across the county to respond to behavioral health crises. The program now has 21 co-responders working in municipalities in Johnson County, with the number of co-responders tripling between 2018 and 2023.
Individuals with SMIs receive support pre- and post-release: Individuals with SMIs now have several points of access to mental health support while incarcerated or after their release. Detention centers now have forensic and jail reentry teams to provide on-site services, such as diagnosing conditions, providing medication, and connecting inmates to care. Johnson County Mental Health’s Mobile Crisis Response Team also provides critical follow-up with individuals with SMIs after their release from jail.
Johnson County recognized for mental health efforts: Johnson County joined the Stepping Up Initiative in 2015, and was recognized by program leaders as an “Innovator County” just two years later. Johnson County earned the designation by accurately identifying people in their jails who were experiencing mental illnesses, connecting them to resources, and using data to inform local practices and policies.
Overview
What was the challenge?
Frequent incarceration and recidivism among individuals with mental illnesses: Like many communities across the country, in Johnson County (KS), individuals experiencing mental health challenges are disproportionately likely to enter the criminal justice system and recidivate. This pattern is similar across the State of Kansas, where individuals with mental health challenges are 3.5 times more likely to end up in jail than in a psychiatric hospital.
Inconsistent mental health screens lead to gaps in data and missed opportunities: From 2012-2016, when individuals were booked into jail, the Johnson County Sheriff’s Office worked with a third-party behavioral health provider to assess individuals’ mental health and provide mental health services. This provider was frequently unable to complete mental health assessments before an inmate’s release and did not share mental health data with the County. The inconsistent assessments and inability to share data significantly hampered the County’s ability to provide mental health services to individuals in need.
Lack of cross-agency data hindered visibility for servicing individuals: Beyond the insufficient mental health data collected in jails, Johnson County agencies regularly engaging with people with mental health challenges— Corrections, behavioral health providers, emergency medical services, and others–were not sharing data with each other, limiting coordination in helping these individuals. Without cross-agency data on individuals with SMIs, individuals often received uncoordinated care from multiple public systems, failing to produce positive outcomes and driving significant costs for Johnson County.
What was the solution?
Recognizing the need for better data: In an effort to improve criminal justice outcomes for individuals experiencing mental health challenges, in 2015, Johnson County joined the Stepping Up Initiative, a national initiative to reduce the over-incarceration of people with SMIs. The initiative articulated four key goals: reducing bookings into jail, reducing the length of individuals’ stay in jail, increasing connection to treatment, and reducing recidivism. To accomplish these goals, leaders in Johnson County saw a clear need for better data on individuals’ mental health status as they were entering jail.
A validated assessment for identifying SMIs: Recognizing the shortcomings of how mental health data were being collected, Johnson County leaders sought a new, evidence-based mental health screening instrument. Through connections from Stepping Up, Johnson County leaders discovered the Brief Jail Mental Health Screen (BJMHS), which was developed by Policy Research Associates and proven to be an accurate instrument in determining whether individuals were potentially in need of mental health care.
A low-cost, time-efficient assessment: The eight-question BJMHS is designed to quickly assess whether individuals may need medical care for mental health challenges. Because of its simplicity, Johnson County leaders were able to incorporate it into the existing booking process and have it be administered by jail staff. The screen identifies symptoms of serious mental illness, such as bipolar disorder or major depression, and identifies when individuals have a history of psychiatric issues. Individuals who answer four or more questions positively are identified and flagged in the County’s Justice Information Management System (JIMS).
Proactive outreach to vulnerable individuals: When individuals screen positive on the BJMHS, they meet with Johnson County Mental Health staff embedded in the jails to receive support while they are incarcerated. Once these individuals are released, case managers reach out to individuals within 72 hours to offer follow-up care.
What factors drove success?
A criminal justice team dedicated to enacting evidence-based strategies: In 2008, the Johnson County Board of County Commissioners passed a resolution that established a Criminal Justice Advisory Council and created a dedicated role for a Criminal Justice Coordinator. The Council and Coordinator became critical drivers of collaboration between officials in the justice system, human services agencies, and community leaders, including the implementation of the BJMHS.
Collaborative relationship between County Manager’s Office and Sheriff’s Office: Then-County Manager Hannes Zacharias and leaders in the County's Sheriff's Office recognized the multifaceted challenges posed by the high prevalence of individuals with SMI in jails. Motivated by a shared goal to address those issues, they built a close working relationship, ultimately collaborating to deploy new methods like the BJMHS.
Selecting an easy-to-implement tool: The BJMHS was not only effective in identifying individuals who would benefit from further assessment and support; it was also simple for staff to administer at the time of booking and required little training, lowering the barriers for implementation in Johnson County jails.
Shared data allows for coordinated services: Johnson County’s longtime criminal justice database, JIMS, has been an indispensable asset for the County to gather and share accurate information about individuals with SMI in the criminal justice system. Once an individual is booked into jail and given the BJMHS, this data goes into the JIMS, which is then shared with Johnson County Mental Health for follow-up. BJMHS data is also available to cross reference with client data from My Resource Connection (MyRC), providing useful information to partners across agencies about how individuals with SMI are interacting with multiple systems.
What were the major obstacles?
Difficulties sharing data: Before the implementation of the BJMHS, the Johnson County Sheriff’s Office contracted with a third-party behavioral health provider to screen individuals with SMIs in its jails. Corrections could not access the provider's data, preventing the agency from accurately assessing the prevalence of SMIs among incoming detainees and providing mental health services to individuals after their release. Replacing the third party vendor with Johnson County Mental Health was a critical step in enabling better data collection and consistency of care.
Uptake by Corrections officers: After the first month of BJMHS implementation, there was a noticeable decline in compliance administering the screen. Then-Criminal Justice Coordinator Robert Sullivan arranged monthly meetings with Sheriff’s Office leadership to reinforce the critical role of the screen and to encourage its consistent use. Compliance in administering the screen soon returned to strong levels.
COVID-19 interfering with outreach: After the implementation of the BJMHS, individuals identified as needing follow-up from Johnson County Mental Health were contacted both by phone and through in-person visits. During the COVID-19 pandemic, in-person visits were limited, which impacted the number of people that case managers were able to reach.
Limited funding for mental health: Across the United States, mental health services are significantly underfunded by the federal and state governments. Because of this, individuals who could benefit from hospitalization or mental health treatment go without access to services and often end up incarcerated. While high-quality data collection and sharing processes have enabled more targeted and coordinated mental health services in Johnson County, insufficient funding remains a major barrier to better local outcomes.
Timeline
The Board of County Commissioners of Johnson County passes a resolution to create a Criminal Justice Advisory Council and Criminal Justice Coordinator position. The Council brings together justice system officials, human service agencies, and community leaders to promote public safety. The Coordinator is made responsible spurring greater collaboration across a range of criminal justice and human service partners.
United Community Services of Johnson County publishes the “Mental Health and Criminal Justice Intercept Project Report”, which recommends a series of interventions to improve outcomes for adults with mental illness in the criminal justice system. The report calls for enhanced collaboration between Corrections and Johnson County Mental Health, including sharing data and connecting individuals to support after they are released.
Then-County Manager Hannes Zacharias spearheads the creation of MyRC, the County’s platform for connecting residents with social services, integrating it into several health and human services agencies. MyRC enables agency staff to see what services clients are already receiving and any interactions they have had with a range of public systems. Data from MyRC is used in conjunction with the Justice Information Management System (JIMS) to enable coordination of services between health and human services agencies and Corrections.
The Criminal Justice Advisory Council creates a “map” of all encounters a person with mental illness could potentially have with law enforcement. This process sparks the creation of the co-responder program, which seeks to staff police departments with trained mental health clinicians to assist officers with incidents involving people with SMIs. The City of Olathe’s police department is the first in Johnson County to introduce the co-responders.
The Board of County Commissioners of Johnson County passes a resolution to join the Stepping Up Initiative and commits to reducing the population of individuals with SMIs in jail. As part of its participation, the County seeks to identify and implement evidence-based strategies to reduce bookings into jail, reduce length of stay, increase connection to treatment, and reduce recidivism.
While participating in the Stepping Up initiative, Johnson County leaders seek to collect more consistent and higher-quality mental health data in the County's jails. To address this issue, Criminal Justice Coordinator Robert Sullivan introduces the BJMHS, a validated assessment that can be administered by deputies to identify individuals who may need mental health evaluation. Deputies incorporate the BJMHS into standard procedure for booking, and Johnson County Mental Health becomes Corrections’ new behavioral health partner.
As BJMHS data becomes available in the JIMS and MyRC, health and human services agencies and emergency medical services are able to see critical information that informs their response and support to shared clients in crisis calls, wellness visits, hospitalizations, and more.
Johnson County Mental Health partners with the Department of Corrections to become the new behavioral health provider in the County’s detention facilities. When a person flagged by the BJMHS is released, an automated notification is sent to the Johnson County Mental Health’s Mobile Crisis Response Unit in real-time. The unit reaches out to individuals within 72 hours, assesses their needs, and connects them to services. The Mobile Crisis Response Unit attempts to make contact by phone first, and after two failed attempts, visits the released individual in-person at their last known address.
Leveraging comprehensive BJMHS data on individuals with SMIs and their needs, Johnson County successfully advocates for additional co-responders to be hired and placed within law enforcement agencies. These licensed clinicians, integrated within sheriff's offices, specialize in responding to behavioral health crisis calls. The number of co-responders working in Johnson County tripled between 2018 and 2023.
Implementation process
How did leaders confront the problem?
County leaders identify gaps in mental health care across agencies: After being appointed County Manager in 2009, Hannes Zacharias realized that human services agencies in Johnson County were not sharing data sufficiently. Recognizing that this fragmentation hindered the County's ability to provide effective mental health support, Zacharias initiated the creation of MyRC, which became a foundational tool for departments to confidentially share information in compliance with HIPAA regulations.
Johnson County joins Stepping Up Initiative: During Zacharias’s tenure as County Manager, Johnson County joined the Stepping Up Initiative, which called on local governments to reduce the over-incarceration of individuals with mental health challenges. As a Stepping Up partner, Johnson County received resources and tools from the Council of State Governments Justice Center, the National Association of Counties, and the American Psychiatric Association Foundation to advance cross-agency reform.
Criminal Justice Coordinator oversees strategy for intervention: Acting as Johnson County’s point person for the Stepping Up Initiative, then-Criminal Justice Coordinator Robert Sullivan recognized that mental health data collection practices in the county’s jails were inadequate. Sullivan begins working with the Department of Corrections to find new ways to collect and share more reliable mental health data.
Corrections explores new data methods: The Department of Corrections’ existing behavioral health provider would not share its data with other agencies, undermining the County’s ability to implement coordinated solutions for individuals during and after their release. The third-party provider was also unable to assess mental health status for all new bookings. This prompted county leaders to explore new strategies for both data collection and sharing.
How was the strategy designed?
Collecting better data and enabling collaboration: The BJMHS, developed by Policy Research Associates, was chosen by Johnson County leaders because it was evidence-based, free to administer, and easy to implement. It could be administered by Sheriff’s Office deputies (rather than mental health professionals), and the data it produced could be immediately entered into shared data platforms that would enable coordinated services.
Building on a strong foundation of data sharing: Once adopted, data from the BJMHS could be entered into the Justice Information Management System (JIMs), enabling individuals across the justice system to see relevant data on clients. This data was also shared in the County’s My Resource Connection (MyRC), allowing actors across public systems to better understand client interactions with multiple agencies and service providers.
How was the plan implemented?
Building support from Corrections officers: To build buy-in for the BJMHS among Corrections leadership and staff, Coordinator Robert Sullivan worked closely with Corrections and Detention Center leadership to communicate the importance of administering the screen. Deputies then underwent training for administering the screen, and Corrections leadership ensured high levels of compliance.
BJMHS data facilitates cross-agency collaboration: When officers administer the screen, they enter the inmate data into the JIMS. Those answering four out of eight BJMHS questions positively are flagged in the JIMS and an alert is sent to Johnson County Mental Health. Staff at Johnson County Mental Health will cross-reference the JIMS data with MyRC to better understand client history and to inform support while they are incarcerated. If an individual is released before receiving services, Johnson County Mental Health conducts outreach within 72 hours of their release.
JIMS application streamlines workflow: Once Johnson County Mental Health began providing services to individuals who had screened positive on the BJMHS, JIMS staff created an application in the data platform to help staff cue referrals, track progress, and collect data.
How was the approach funded?
Free use and implementation of the BJMHS: The BJMHS was a free resource from the Policy Research Associates, and required no additional staff or funding to administer. Johnson County leaders first learned about the BJMHS during their participation in the Stepping Up Initiative.
JIMS managed by County: With the support of the County Manager’s Office and the Board of County Commissioners, JIMS was launched in the 1990s and continues to be funded by Johnson County. JIMS is staffed by over 25 professionals and has a current budget of $7.4 million. It has proven to be an invaluable tool for tracking and analyzing data and providing higher quality services.
U.S. Department of Justice funds intervention strategies: Johnson County’s co-responder program, which places licensed mental health clinicians in the County’s jail, launched in 2010 with multiple grants from the Department of Justice's Justice and Mental Health Collaboration Program and the Community Policing Development Crisis Intervention Teams program. Data from the BJMHS went on to inform the expansion of the co-responder program, helping leaders determine which municipalities needed the most mental health support staff.
Grant facilitates creation of mobile crisis response unit: As part of the U.S. Department of Justice’s Justice and Mental Health Collaboration Program, Johnson County Mental Health received around $250,000 to create the mobile crisis response unit, a team of staff that focuses on mental health emergencies, crisis stabilization, and case management. The unit plays a critical role in following up on findings from the BJMHS, spearheading outreach to released individuals flagged for an SMI and connecting them to community resources.
How was the approach measured and refined?
BJMHS study conducted by LEO: University of Notre Dame’s Wilson Sheehan Lab for Economic Opportunities (LEO) led the evaluation of the BJMHS in reducing recidivism rates among individuals with mental health needs. The evaluation spanned from 2016 to 2018 and involved tracking the impact of mental health outreach to individuals post-release. The results showed the model to be a success, building momentum for additional mental health resources within Corrections.
University of Chicago creates machine learning model: Once Johnson County had established protocols for cross-agency data sharing, they were able to partner with the University of Chicago to create a predictive model to identify individuals with SMIs at the greatest risk of returning to jail. By identifying these individuals, Johnson County is able to target mental health and social service interventions to prevent future incarcerations.
Carnegie Mellon advances machine learning predictions: Through its partnership with Carnegie Mellon’s Data Science and Public Policy Lab, Johnson County enhanced its machine learning capabilities to detect patterns in an individual's past interactions with various health and law enforcement systems. By analyzing these data, the system can identify those at risk of having a behavioral health crisis, allowing for early interventions and preventative measures.