Behavioral Health Urgent Care Center

Nature of the Problem

The jail in Knox County, Tennessee continues to see a record number of inmates and spends around $40 million per year on its jail. Many of the inmates in Knox County are suffering from mental health and addiction issues and the jail continues to be a revolving door for those incarcerated following non-violent, low-level offenses. According to the Knox County jail, the goal of incarceration is to correct an individual’s behavior, and release that person back into the community without expecting their return. However, that’s not happening. The community needs an option to provide intervention to these individuals in need of services who are not receiving the needed treatment in the jail.

Program Description

The Behavioral Health Urgent Care Center (BHUCC) is a partnership between Knox County, the City of Knoxville and the Helen Ross McNabb Center. The goal is to divert people from jail who need treatment and social services rather than incarceration. The BHUCC provides 16 jail diversion beds for low-level offenders with behavioral health issues. Individuals who come into contact with law enforcement for one of nine misdemeanor offenses may be eligible to receive treatment at the BHUCC facility as an alternative to jail. Clinical staff at the BHUCC provide a thorough assessment, medication evaluation, treatment planning, discharge planning and engagement in community resources in addition to individual and group therapies on site. Individuals can stay in the facility for up to three days to receive treatment before returning to the community with detailed plans for follow up care.

Disruption

A large percentage of individuals revolving through the jail are not engaged with any outpatient mental health providers. The BHUCC provides true pre-arrest diversion and has an embedded policing station onsite. Individuals who come into contact with police for one of the nine identified misdemeanors is universally screened for BHUCC eligibility. This means BHUCC is able to reach individuals who have, in the past, gone without any care. For this group, engagement and discharge planning are key. BHUCC’s focus on discharge planning and engaging individuals with community-based treatment post discharge are a unique strategy to address the problem of individuals revolving through an overcrowded jail system.

Leadership

The Behavioral Health Urgent Care Center is the result of collaboration between the governor’s office, the Tennessee Department of Mental Health & Substance Abuse Services, Knox County, the City of Knoxville, Knox County Sheriff’s Office, Knoxville Police Department and the district attorney’s office. Each of these organizations has a unique role within the project, working toward addressing the mental health and addiction needs of the citizens in Knoxville. Because of the collaboration, the groups are more actively involved in the common goal of addressing the behavioral health needs of the community. The success of this project, which was developed by the community’s key stakeholders, will change the way the behavioral health community and law enforcement engage this population.

Scalability

In Knox County, the funding was a partnership between the state and local government with a required match from local communities. This framework can be replicated within any community that has a behavioral healthcare agency working with key stakeholders within the law enforcement organizations and district attorney’s office. Components of this program can be implemented at any scale and each component can be built upon in order to develop a robust program. For example, a community can implement Crisis Intervention Team training for law enforcement officers; training law enforcement officers on in-field behavioral health assessments; community partnership with an existing behavioral health provider to ensure access to treatment; and maintaining behavioral health providers within the legal system. Each of these elements can be implemented without a brick and mortar facility in place, but can build upon each other and developed into a physical location.

Results/Outcomes

In the first six months of operation, the BHUCC served nearly 170 individuals and completed assessments on nearly 225 people. The primary charge bringing an individual to the BHUCC was public intoxication. Of those served, 60 percent reported homelessness. The average length of stay at BHUCC was 3 days. • 88 percent of individuals were referred for post-discharge treatment. • 74 percent kept their initial post-discharge appointment. • Within the 6 month reporting period, 79 percent did not return to BHUCC because of law enforcement interaction The Center continues to track subsequent arrests 6 months post discharge.