Locally Driven State Policymaking

An approach to improving public health and safety

Overview

Communities across the country are calling for more effective and equitable approaches to public health and safety. Consequently, many community leaders are building systems to improve responses to people in crisis, prevent unnecessary arrest and incarceration, reduce the length of jail stays, and strengthen connections to care and supports. But as local communities work to tackle these complex problems, they encounter challenges that state leaders are best—and often exclusively—positioned to help them overcome.

State policymakers are central to accelerating progress at the local level. They can unlock a variety of resources and supports for communities to divert, treat, and support people with behavioral health needs and can amplify lessons learned across the state, allowing local efforts to scale up. However, to do this successfully, state governments need locally informed guidance on where and how to target their actions to meet a wide range of community needs.

Locally driven state policymaking enables leaders to identify effective, long-term solutions to complex public health and safety problems. By analyzing their state’s distinct policy landscape and meaningfully engaging local leaders, state policymakers are able to pinpoint actions that will address specific local gaps. Ultimately, these actions help communities achieve better outcomes; maximize existing investments; and reduce harmful over-reliance on law enforcement, hospitals, and jails.

Getting Started

To support local efforts in reducing the number of people with behavioral health needs in the criminal justice system, state leaders need to ensure that the necessary infrastructure is in place. State-level actions can help establish the building blocks for initiating or advancing this work, including collaboration structures, cross-system data collection and information sharing, and dedicated funding to strengthen care and supports.

See what other approaches states are taking to improve responses to people with behavioral health needs in the criminal justice system.

Collaboration

Communities are struggling to address public health and safety problems that no one system or sector has the resources, ability, or responsibility to solve alone. Successful change thus hinges on intentional and meaningful collaboration at many different levels, including

  • Between states and localities (counties, municipalities);
  • Across branches of government (executive, legislative, judicial);
  • Within and across systems (behavioral health/health, criminal justice, housing, etc.);
  • Across sectors (public and private); and
  • With community members (including people with behavioral health needs who are in contact with the justice system).

This type of collaboration is not easy. It requires support and guidance to navigate and align multiple perspectives, priorities, and resources. States can help by bringing together cross-system leaders to understand the most pressing needs, establish shared goals, and identify opportunities to support—and fund—local collaborative responses to improve public health and safety.

Key state policy strategies to strengthen and formalize cross-system collaboration include

  • Issuing a clear state-level mandate that demonstrates and formalizes a statewide commitment to a shared public health and safety goal (e.g., reducing the number of people with behavioral health conditions in local criminal justice systems);
  • Establishing a new, or repurposing an existing, collaborative body that brings together state and local stakeholders across multiple systems, sectors, and vantage points; and
  • Supporting the creation of local councils or similar entities to advance cross-system strategic planning and systems change

Resources

Data Collection and Information Sharing

Effective locally-driven state policymaking hinges on understanding the nature and extent of different needs, what strategies can best address them, how well these strategies are working, and what services and supports are available locally. This data must also encompass qualitative information drawn from the perspectives of people who are directly impacted by health and public safety policies. However, current data on behavioral health needs of people in the criminal justice system is often disjointed. And many communities lack the necessary data infrastructure.

Key state policy strategies to improve local capacity to collect, use, and share data include

  • Issuing common definitions across agencies to identify a target population and establish shared metrics for tracking progress toward common goals;
  • Reviewing and improving state policies related to information sharing; and
  • Supporting infrastructure and capacity to help communities collect, analyze, and share data at the local level.

Resources

Funding

As communities work to build comprehensive, collaborative systems with needed care and services, they often face persistent funding and resource gaps. To fill these gaps, many communities try to combine a range of inconsistent and restricted funding sources. This approach places a significant administrative burden on individual agencies and organizations and often fails to cover the full range of supports needed in a given community. These funding challenges have intensified in recent years with budget shortfalls and competing priorities in the wake of the COVID-19 pandemic.

Key state policy strategies to help local communities address persistent funding gaps include

  • Providing consistent, flexible funding that can be used to support community investments;
  • Leveraging federal resources, especially those focused on health and housing; and
  • Forming partnerships to help secure financial participation from the private sector.

Resources

Tackling Key Issues

Many community members are rethinking what public safety and public health mean, building upon efforts to prevent harm and keep people with behavioral health needs out of the criminal justice system in the first place. But communities across the country, particularly Black, Indigenous, and People of Color (BIPOC) communities, continue to face deep-rooted inequities and roadblocks that have been exacerbated by the COVID-19 pandemic. These sections offer guidance on strategies states can take to tackle specific areas that are essential to address in meeting communities’ public health and safety needs.

Housing

Stable housing is integral to ending the cycle of arrest and incarceration for people with behavioral health needs. Evidence suggests that a highly effective way to reduce future contact with law enforcement and (re)incarceration is to connect people to housing at as many points as possible—particularly as they leave prison or jail. The most effective interventions follow a Housing First approach in which housing is made available with as few barriers as possible, and there are no preconditions such as sobriety or treatment engagement.

Key state policy strategies to increase the availability of and connections to housing include

  • Leveraging federal funding and tax credits to further prioritize support for people with behavioral health needs who experience homelessness upon discharge or diversion from jail;
  • Increasing the availability of permanent supportive housing through capital investments and rental assistance; and
  • Encouraging local public housing authorities to remove barriers for people with criminal records.

Resources

Behavioral Health Crisis

When a person experiences a behavioral health crisis, they, or someone else, might call 911 to access support. Unfortunately, this call can sometimes result in unnecessary law enforcement contact or a costly visit to the emergency room. To address this concern, many communities have implemented local crisis hotlines or mobile crisis teams, but few jurisdictions have comprehensive crisis systems that enable them to prevent unnecessary justice system contact, connect people with effective crisis services, and facilitate connections to longer-term care and services. Local communities that have set up such systems have seen positive outcomes, including improved access to treatment, shorter jail stays for community members, and cost avoidance and savings for criminal justice agencies and health care payers. Yet they continue to lack dedicated, adequate, and flexible funding to support and scale this work.

States play a critical role in funding, scaling, and sustaining crisis systems, particularly as new federal resources become available and as states implement the national suicide prevention hotline (i.e., 988).

Key state policy strategies to improve local crisis systems include

  • Increasing direct state funding through general funds and grants;
  • Leveraging Medicaid—a jointly administered federal-state program—to recoup federal matching funds to improve access to crisis-related services across the continuum of care; and
  • Incorporating explicit provisions about crisis systems into state policies related to increasing access to behavioral health care and other supports.

Resources

Early Diversion

Local communities are working to prevent unnecessary involvement in the criminal justice system among people with behavioral health needs, reduce the amount of time that people are in the system, and decrease the likelihood that they return. To do this, they are implementing strategies and programs centered on connecting people to the appropriate community-based treatment and support services outside of the criminal justice system. To have the greatest impact, communities need a comprehensive, coordinated behavioral health diversion strategy that includes a continuum of diversion programs and practices at every point in the criminal justice system and fully leverages the community’s resources.

States can play a key role in supporting, expanding, and improving programs to divert people with behavioral health conditions as early as possible in their contact with the criminal justice system. They can also enhance, improve, and ensure the quality of diversion and care options for people who are charged or convicted.

Key state policy strategies to support diversion at the local level include

  • Ensuring that state citation authority statutes permit law enforcement officers to issue citations in lieu of arrest for behaviors that could be related to a person’s behavioral health conditions;
  • Supporting and mandating standardized training for law enforcement officers to identify people with behavioral health needs and respond appropriately; and
  • Reviewing and improving state-level policies for pretrial release, including those related to release on bail for people with behavioral health conditions.

Resources

Diving Deeper

The Behavioral Health-Criminal Justice State Policy Scan is a new tool to advance locally-driven state policymaking. The state policy scan equips state leaders with customized guidance to help communities address their most complex public health and safety problems. It can be used as part of a systematic but flexible process to address critical gaps and barriers, such as lack of housing, that have long stymied large-scale progress in reducing the number of people with behavioral health needs in local criminal justice systems. Starting with a thorough review of existing policies, The Council of State Governments (CSG) Justice Center uses a strong research base to pinpoint actions states can take to set local jurisdictions on track for sustained reforms. Each step of the way, state and local leaders take the reins in directing the extent and objectives of the state policy scan, ensuring that it’s in line with realities on the ground in their communities. States emerge with a tailored strategic plan for advancing public health and safety goals in partnership with local jurisdictions.

Pennsylvania's Story

The CSG Justice Center partnered with officials in Pennsylvania to test this approach starting in 2019 as part of the Stepping Up initiative. As a result of this process, Pennsylvania leaders identified three priority areas to advance further progress: (1) improving local capacity to collect data and share information, (2) increasing local diversion from arrest and incarceration as early as possible, and (3) increasing local availability of and connections to housing.

Learn more about Pennsylvania’s experience:

Free Consultation and Support

The Center for Justice and Mental Health Partnerships can help states at any stage of this effort with free consultation, resources, and support. For more information, please submit a request to the Center using the online form. 

Key Staff


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Alex Blandford
Program Director, Behavioral Health
Alex Blandford oversees and executes the CSG Justice Center's health policy portfolio and works to improve access to health care for people in the criminal justice system through federal, state, and local policy. Prior to joining the CSG Justice Center,
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Alex was a project coordinator for the Institute for Evaluation Science in Community Health, which is housed in the Graduate School of Public Health at the University of Pittsburgh. As a project coordinator, she oversaw a variety of research projects, including one examining the Pittsburgh region’s emergency response to mental health crises, and another evaluating the region’s Crisis Intervention Team training for police officers. She earned her BS in psychology and BA in French from the Pennsylvania State University and her MPH at the Graduate School of Public Health at the University of Pittsburgh.
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    Katie Holihen
    Senior Policy Analyst, Behavioral Health
    Katie Holihen works to advance locally driven state policymaking at the intersection of criminal justice, behavioral health, and housing. Prior to joining the CSG Justice Center, Katie was a grant analyst at the Cook County Public Defender’s Office in Chicago,
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    where she worked with cross-sector partners to launch holistic defense and data analytics programs. She also led curriculum development for national law enforcement training initiatives in procedural justice and cultural humility at the Center for Public Safety and Justice at the University of Illinois at Chicago. Katie has a BA in history and political science from Marquette University and an MSW from Jane Addams College of Social Work at the University of Illinois at Chicago.
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