Community Mental Health Systems Improvement Public Investment Plan (2017)
Dr. Bill Paul, Metro Public Health Department
Mental illnesses ideally should be treated like other illnesses—by trained providers in an appropriate care setting. No one would, upon suspecting appendicitis, deliver someone to the jail.
Unfortunately, Nashville’s “system” for mental health care is fragmented and under-resourced. This means people with mental illness often are routed to the criminal justice system. On any given night, there are now 300-plus seriously and persistently mentally ill people being housed at the County Jail. Their detention is not designed around treatment of illness, so stabilization and continuity of care are addressed poorly--on the margins of the criminal justice system. In recent years the census of the jail has declined, but not the census of mentally ill people in jail. We shouldn’t be criminalizing mental illness, and we should expand our ability to manage people with mental illnesses without arrest or incarceration.
A mental health planning workgroup, comprised of key providers of mental health services and criminal justice entities, asked the question:
“What do we need to have in place in the next 3 years to serve our community and improve outcomes for people with mental illness in Metro Nashville/Davidson County?”
Answers fell into 8 agreed-upon focus areas:
- 24/7 Health Hub (Urgent Care)
- Backbone Organization/Collective Impact Planning
- Data/Outcomes Measurement
- Citywide Campaign
- Processes for Expanded Diversion
- Care Management for Uninsured and Underinsured
- Expanded Housing Options
- Dedicated Mental Health Funding
The following 3 actions were identified as critical first steps to address the needs:
- Close gaps in Nashville’s public 24/7 Mental Health Urgent Care hubs (Mental Health Co-op and Nashville General Hospital) to provide realistic alternatives to arrest and incarceration for more patients.
- Create and facilitate a community mental health planning group to monitor the system of services, identify strategic gaps, and mobilize resources and system changes to improve service.
- Support preventive strategies “upstream” in the mental health system by preventing and responding to Adverse Childhood Experiences.
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