Wayne County behavioral health pilot project helping 'familiar faces' in the justice system

The Wayne County Probate Court announces that its Behavioral Health Unit (BHU)/Assisted Outpatient Treatment (AOT) pilot project launched in November 2021 has initiated widespread use of AOT in Wayne County, instead of a simple discharge of individuals from hospital ERs. Court-ordered outpatient care, known as AOT, is highly successful in preventing the need for hospitalization for persons with serious mental illness and focuses on helping them to stabilize and improve their condition, preserve resiliency, and become productive members of society.

The pilot project includes stakeholders from courts, law enforcement, jails, the mental health profession, hospitals, education, mental health advocacy groups, and more. In particular, the BHU has been working with inpatient hospitals and the Detroit-Wayne Integrated Health Network (DWIHN) to coordinate care with clinically responsible service providers. A major focus of this partnership is on helping “familiar faces” (those who have had multiple interactions with the Wayne County Probate Court) by working to engage families and guardians with their loved one’s AOT order. Specific actions include holding review hearings at the first sign of noncompliance, employing other services (Assertive Care Treatment or Med Drop Program) through the clinically responsible service providers, handling complex case management through DWIHN, and finding other resources in the community, such as stable housing.

Wayne County Probate Court Chief Judge Freddie G. Burton Jr. oversees the project. “Sending residents with behavioral health and substance use disorders through the revolving doors of jails, courts, and hospitals needs to stop. The only way to make effective change is through collaboration,” he said. “By bringing together the many stakeholders in the community that address mental health issues, we can have the kind of connectivity necessary for a more effective mental health system that works to remove the stigma of mental illness and ensure the delivery of humane, thoughtful services.”  

Main pilot project goals include:

• Saving the county millions of dollars by diverting individuals with mental health issues from the criminal justice system and preventing a revolving door of offenders repeatedly receiving emergency room treatment and instead being directed by the Wayne County Probate Court to receive appropriate outpatient services.

• Ensuring that these individuals receive consistent, effective mental health treatment. The benefits include a decreased need for jail and hospital beds, reduced risk to law enforcement and community members, and facilitation of more efficient use of taxpayer and health care dollars.

• Serving as a model for all of Michigan, which can be adopted by counties and community mental health agencies throughout the state, resulting in dramatic cost savings and improvement of the delivery of mental health services.

As part of the BHU/AOT pilot project, the Court has been tracking “familiar faces,” which refers to individuals who have been petitioned 10 or more times from 2015 to 2021. Some data on familiar faces:

• Of the court’s 76 familiar faces, 39 (51 percent) of them had been booked into the Wayne County Jail.

• One individual had 34 bookings and another had 31 bookings, which were the highest utilizers.

• The 76 individuals accounted for 224 jail bookings in the Wayne County Jail.

• The 76 individuals spent a total of 10,118 days in the Wayne County Jail at a cost of $1,600,000.

• Of the court’s 76 familiar faces, 42 (or 55 percent) had guardians.

For familiar faces who have been petitioned since the pilot project began, the BHU is working with their Clinically Responsible Service Provider and DWIHN to ensure they are receiving the services they were ordered to receive.

Also, the court continues to conduct training on AOT with outpatient mental health providers, attorneys, and crisis stabilization units in Wayne County.

This process for this pilot project began in October 2018 with creation of the Wayne County Jail Mental Health Initiative, which brought together key stakeholders in government, judiciary, law enforcement, and mental health service. The Initiative is a collaborative effort dedicated to diverting non-violent individuals with serious mental health disorders and co-occurring substance abuse from the criminal justice system and into the appropriate level of treatment. The BHU/AOT project continues functions initially undertaken by the Wayne State University School of Social Work’s Center for Behavioral Health and Justice.

State Court Administrator Emeritus Milton L. Mack Jr. the former Wayne County Probate Court chief judge, currently chairs the Governor’s Mental Health Diversion Council and has long been involved in addressing the issue of mental illness in the criminal justice system on local, state, and national levels. He wrote a policy paper in 2017 called “Decriminalization of Mental Illness: Fixing a Broken System,” which led to establishment of the National Judicial Task Force to Examine State Courts’ Response to Mental Illness.

“This project is already helping hundreds of individuals get the treatment they need to stay in recovery and avoid incarceration, hospitalization and homelessness,” Mack said. “The model demonstrates the value of judicial leadership in bringing stakeholders together to finally deliver on the promise in the Michigan Constitution to provide services for those with mental illness.”

In 2016 and 2018, the legislature modified Michigan’s Mental Health Code to make Michigan a national leader in promoting earlier intervention for those suffering from a serious mental illness and by making AOT more readily available.

Previously, the cycle of short hospital stays and discharges without connection to community treatment created a revolving door that assures repeat emergency room visits, wasting resources and risking lives. For example, in Wayne County over the last five years:

• 16,000 petitions for mental health treatment were filed for 9,000 individuals.
• Only 600 of these individuals represented more than one-third of all petitions filed.
• 57 had at least 10 petitions during that time.

Over the last year:

• These 57 individuals had hundreds of ER visits at a cost of nearly $3,300,000 (56 visits for one individual alone).
• Nearly half had been incarcerated at the Wayne County Jail.
• None of these individuals appear to have been connected to community treatment.

Michigan has since converted its Mental Health Code from an inpatient to an outpatient model to match established best practices for care delivery. AOT is a less restrictive method of treatment than inpatient psychiatric hospitalization and is typically ordered for persons at risk of harm due to an inability to understand their need for treatment. These changes enable private and public entities to more effectively coordinate care.