MINUTES OF THE INFORMAL MEETING OF THE JOHNSON COUNTY BOARD OF SUPERVISORS:

APRIL 12, 2001

TABLE OF CONTENTS

Chairperson Lehman called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 5:37 p.m. Members present were: Pat Harney, Mike Lehman, Terrence Neuzil, Sally Stutsman, and Carol Thompson.

DISCUSSION: MENTAL HEALTH COURTS

Lehman: We have Ken Kress here who is on the Planning Council and faculty at the University of Iowa, but is representing himself as an individual to give us some information, and we also have Rosemary Randolph. I don’t know if you’d like to come forward, and be free to make some comments, here too.

University of Iowa Faculty Member/Planning Council Member Ken Kress: I have some copies of the relevant Federal Statute for anyone that doesn’t have one, if there’s interest back here, and also copies of some talking points and some copies of a memorandum about this matter. I take it that you’ve asked me here just to tell you a little bit about Mental Health Courts. So unless anybody asks what my personal opinion is, I’m just going to try to inform you what I know about them, and what I think their effects will be. But I should tell you that this is, to a certain extent, speculation, because there’s been very little study of mental health courts; they’ve only been around for 3 years in Brower County Florida, for 2 years in King County, and quite a number, maybe 10-15 have sprung up since them. In general, what a mental health court is, is that an individual who has serious mental illness or mental illness, and who has violated the law, but in a non-violent manner, may be given the option of accepting mental health treatment under the supervision of the court, rather than going through the criminal process. Mental health courts differ as to how exactly people end up in mental health court, rather than criminal process. Some have police officers who pre-screen before the individuals are booked. Others have people going through the jails and seeing who has signs of mental illness, or a record that indicates that they have mental illness. Some divert them from criminal court while they’re in court, so there are different methods and techniques for finding out who might be eligible for this, or who should be considered for this. They also have differences in terms of where in the process you would end up going into mental health court treatment, if you so choose. This is always a voluntary matter, that is, an individual can say, no thank you, I’ll go through the regular criminal process, and accept what sanction I might get there for the infraction or crime I’m alleged to have committed. Some require that you decide and opt for treatment in the mental health before a trial has occurred; others only have you make a decision after there has already been a trial and a sentence has come down, and then you make the choice between that sentence and mental health court. So, if one were to set one up, there would be a number of variations, and I have found recently from the Justice Department a 100-page analysis of the workings of 4 different mental health courts, and I’ll leave that with the Board of Supervisors for their perusal. I regret I didn’t have it earlier; I just found out about it yesterday. What are mental health courts likely to do and why might one be interested in them? Well, the 2 main reasons why you might be interested in them is that they’re going to improve the quality of life and the standard of living of mental health consumers. By being in treatment, an individual is more likely to be able to maintain a job, is more likely to be able to maintain housing, and obviously not going to jail for most mental health consumers will be a benefit. In addition, being in treatment is likely to reduce inpatient hospital days, therefore, once again creating more stability in terms of their ability to have jobs and also to have a good quality of life. So it’s also going to save the government the treatment cost. This won’t be as much in Johnson County as in other counties, for Johnson County anyway, because many of our hospital costs are free at the University of Iowa, but certainly in terms of our share of the MHI costs, there would be a savings. Just to give you an appreciation of this, being on outpatient commitment, which is different than mental health court in some ways, but alike in others, according to Dr. Barbara Roland, formerly in the Psychiatry Department at the University of Iowa, reduce hospital days by 86%, a reduction from 33 days to 4 days in a study which I cite in the memo that I sent to you, which is discussed in the article which I had provided you. In addition, the most sophisticated studies show that outpatient treatment in the form of outpatient commitment reduces violence, reduces arrests, minimizes criminalization of persons with mental illness, and reduces victimization. I’m obviously making a jump from outpatient commitment to mental health courts, and saying that we might get the same results. I’m doing this because there’s no studies actually on mental health courts which we can look at directly. But a mental health court at one sense is totally voluntary, because it says to an individual, you can go through the criminal process, if you like, or you can accept treatment. So in one sense the treatment is completely voluntary. But in another sense, most people would prefer not to go to Jail. So if your possible sentence includes spending time in prison, most people would prefer to accept treatment than to go to prison, and in a certain sense you have a choice of the lesser of 2 evils if you’re a consumer who does not want to take treatment. If you’re a consumer who wants to take treatment anyway, then obviously this is a no-brainer for you. I think of course, once you have accepted the deal to go to treatment rather than to go through the criminal process, you are now under court order to accept treatment. So, in that sense, it’s like court-ordered outpatient treatment, and has, I suspect, many of the same consequences in terms of reduction of hospitalization and reduction of violent activity and improvement in the quality of life and standard of living. Why might somebody be against this? Well, some mental health consumers might perceive it as coercive and increasing government intervention with regard to them. I have heard one consumer, in fact somebody from (inaudible), say that if you opened up such a court, police might trump up trivial charges and then try to bring people into forced treatment through either accepting the consequence of that charge or accepting the mental health court’s treatment plan. So that might be another concern. Indeed, there is a book by Susan Steffan in which she mentions that she saw some of this. What people who say this have not yet done is compared the number of "alleged trumped-up charges in mental health court" to the number of alleged trumped-up charges in ordinary criminal court to see if there’s a difference. Are there more where there’s a mental health court? I would not expect that to happen here in Iowa; I don’t think the police would create such a difference in policy, but this, anyway, is a concern which some people have expressed. That’s most of what I want to say. Much of this is said in much more detail, with citations to studies and precise figures, in the memo, and I’ll be glad to take questions at any time. Do you want to say something?

Lehman: Rosemary, is there anything you wanted to add?

Research and Development Committee Chair Rosemary Randolph: I’m the chair for the Resource and Development Committee for the MH/DD Planning Council, and we looked at this. We know that it is something that would fit with MH/DD but because we are a purely volunteer committee organization, it is very difficult for us to take on a grant of this capacity. Yet to let it just go by is also a concern, because it really could affect the county in 2 ways: financially and ethically, as far as treatment toward the client. If you look at the bill itself, there is a 75% grant, with a 25% match, but it also says that the federal share of the grant made under this part may not exceed 75%, and they can waive… The Attorney General can waive wholly or in part the requirement of a matching fund contribution (inaudible) limited to new expenses, including the development of treatment services and the hiring and training of personnel. In-kind contributions may contribute toward the portion of your portion of the grant. It also talks about specialized training of law enforcement and judicial personnel to identify and address the unique needs of mentally ill and mentally retarded offenders, centralized case management, continuity of psychiatric care, and it is all a part of the grant. It says in here, in Ken’s memorandum, it says including funding ordered treatment. So, it does help to cover some of the cost, actually, of the actual process after the court, after the person appears. It’s not just the judge, and they appear at the court, and then the county has to decide how to pay for, for instance, all of the treatment that would be involved outside of the actual time spent, say, in the hospital. As Ken alluded, that, in our situation, we have the opportunity for the extension of that fee, because of the University Hospitals. So there are some built-in assets to the bill.

Kress: The bill does say that the Federal Government will pick up up to 75%, and can even go higher in some circumstances, both for the court cost and for the treatment costs. A question which I think needs to be looked into is what exactly does court costs entail? Does it just entail the judge, or the room, or does it also take into account the… No doubt you would have a prosecutor devoted to this, or at least half a prosecutor, and a certain amount of a defender devoted to this, and maybe other personnel as well. So I’m not quite sure. I would recommend that if you do decide to go forward, you should be aware of 2 things. First, though it’s been authorized to spend 10 million dollars a year for each of 4 years, the bill actually, or permissible to authorize that, that 10 million dollars has not yet been authorized to my knowledge. You could begin to think about whether you would want to go forward with this, but obviously you’re not going to submit a proposal until such time as implementing legislation has actually been passed, and there are the funds available. You will also note that there is a requirement in here to come up with a report studying the mental health court and also discussing how it is that you might be able to continue it, where you might get funds after the 4 years is over, and so on. Since apparently the federal government thinks that mental health courts are going to be a thing of the future, that drug courts have turned out to be very successful, and so they’re interested in getting people interested, having a good experience, and proceeding, presumably on their own funds after the 4 years is over.

Lehman: I think it’s a very interesting subject, in light of our county jail overpopulation problem, and with state prison officials have said that there’s people with mental illnesses that are in our state institutions, and they’re not being helped. If they are released, they’re not any better equipped to cope with the return to the situation they were in before. They say 2/3 of the inmates at our prison systems every year are return, repeat… Is there a way to deal with these people and help them return to a…

Randolph: 16% of our incarcerated population has mental illness. That is a federal statistic.

Kress: And among the more violent individuals with mental illness, the most recent study shows if you give them treatment, the number of violent incidents which they’re engaged in drops by 60%. This is laid out in the memorandum. So there could be a substantial drop in that kind of behavior. It’s not clear that mental health courts should be set up the way they are right now, so that they don’t take into account more violent behavior. You might get, actually, a better effect with that, but I take it there are political reasons for that that people have thought of that the public might not be happy if they heard that people who are committing serious, violent crime were not going through the criminal process, but were being diverted into treatment.

Stutsman: I think it has some merit; I just think it needs a lot more careful consideration before we move forward, especially if we’re not real sure about the funding. Elaine Sweet is here. Elaine, do you have a thought on what would be the next step, if we decided to pursue this further?

Mental Health/Developmental Disabilities Director Elaine Sweet: We’d probably want to bring together a group of people that could actually develop a (inaudible) proposal. I would say that would be the first step.

Randolph: That was my opinion too, that this…that… Rather than wait until it’s ready to go and you’ve got to hurry, hurry, hurry to try to get your act together and get your statistics together, and get your data and get your grant put together, you would be much better off if you had the time to know in advance, to determine whether you wanted to pursue it, and have the opportunity to discuss it and to read about it and know more about it so that you did feel comfortable with it. Then whenever the time came, you were ready.

Kress: I would certainly agree with that. My experience with grants of this kind from the federal government has been that after the first couple grants, the next 10 or 15 get the largest amount. I would certainly urge you not to be shy in asking for money. If I were put together a proposal on your part, I would ask for in the neighborhood of $200,000 a year, even though they’re saying 100 and $10 million, which comes to $100,000 each, I think that’s an inadequate amount. I think for it to work out, I would ask for a bigger amount, and see what they do. The most they could do is come back and say we’d consider a lesser amount. Also, generally, it’s on a first-come, first-served basis, with the one exception that they do say they’re going to take geographical diversity into account. So, they obviously are going to want to put a number in different states, and some in metropolitan areas, and some in rural areas. But I think the earlier one gets a grant of this kind in, once the implementing legislation has been set out, the higher your likelihood of getting it.

Randolph: The special needs of rural communities is one of the main considerations, and also cooperation with other entities, such as maybe, your surrounding area, with counties that are poorer than us, and have no mental health facilitation, and usually end up using Johnson County.

Lehman: Elaine, did you have some other clarification?

Sweet: One of the first questions we’d have to address is the source of the matching funds. Those matching funds are not readily available within MH/DD Service’s budget.

Thompson: Since we already provide case management, maybe we could use our case management money as the match. Does that sound like something…

Randolph: They say that you can use in-kind for your match, so it doesn’t have to be actual asset. It can be in-kind asset.

Stutsman: Just being the devil’s advocate, I don’t know if it would be appropriate to have a needs assessment done, first of all, to see what kind of needs there are in this community. We’re throwing around some statistics, but I hear that they’re federal statistics, and I guess I want to know what kind of need we have here in Johnson County, and if this would be appropriate.

Randolph: And you’re going to need that for the grant, anyway.

Stutsman: OK.

Neuzil: Right.

Randolph: So, it is something that you really do need to do.

Neuzil: What kind of impact, what’s the objective here? Is it going to reduce the amount of people we put in jail, then, obviously, I think…very interested in that. To try to determine that outcome is something, obviously, you’d have to put in that grant anyway, also. So maybe the Research and Development Committee could be the first start for this, through the MH/DD…

Randolph: Yes. We have a needs assessment coming up for MH/DD, and hopefully that can be beneficial in showing some numbers and things. We talk about Johnson County being a magnet county, and we are going to be able to prove that on paper, so I guess we do need… We have some homework to do.

Thompson: Another question that comes up in my mind is, if we got only a certain amount of money, so that we couldn’t serve all the clients who are committed in a year, would there be some problem with sort of running 2 concurrent sets of justice? Some people would be in the grant, and they would get those services. Other people wouldn’t be. There’s a fairness problem there in my mind.

Randolph: Yes. This is for mentally retarded, mentally ill, and concurrent substance abuse with mentally ill, are the 3 populations that it targets, and it has to be non-violent crime. So there are certain criteria to even be in front of that particular judge.

Kress: The courts do use different criteria. Some consider all mental illnesses; others consider only very serious ones such as schizophrenia and bipolar illness, and they use different criteria for what crimes they will consider as crimes appropriate to go to this court. So, presumably, if you had limited funds, you could make a decision as to which were the more important individuals to target…

Thompson: I see.

Kress: …and which are the more important crimes to target, and that could be a criteria alternatively. If everybody had ex ante, in advance, the same rough chance of getting into this program, and that they could only pick a certain amount who came, by some random method, there would be a certain fairness to that, even if… Even though people with the same criteria get treated differently, it’s a matter of, you had the same chance to end up with it as others. I would agree that having a principled criteria, enough cutting down what the illnesses are or what the crimes are, would make more sense.

Lehman: Does someone have a suggestion on how we, what level we will continue pursuing this would be? A planning council? This is all interesting, but how do we go to the next step?

Thompson: Were you saying that the planning… That the R & D group needs help to do this?

Randolph: We looked at this, that, like I said, we are all volunteer, which means we all have other professions as well, and not necessarily equipped to develop a grant of this capacity.

Stutsman: Well, the Board did allocate that $10,000…

Neuzil: $6,000

Stutsman: …$6,000 for a grant writer, and I guess the Board just needs to give direction to Elaine or, if we want to begin to seriously pursue this and use that.

Sweet: I might be able to clarify. It was discussed at Research and Development and the Planning Council, and I don’t have the resources at MH/DD Services, with all of the other projects that we have started, I just don’t have the ability to do this. Planning Council requested that it be brought directly to the Board of Supervisors to see if you would want to address it in another means other than through MH/DD Services.

Thompson: Maybe we should ask Jeff to contact the grant-writer person that we’ve talked to before and see if this is the kind of…

Lehman: Then report back and see what our options might be.

Thompson: Yes.

Lehman: OK. This is the first time…

Thompson: How much it would cost, and…

Lehman: It makes a lot of sense that…

Thompson: For $6,000, what we’d get.

Harney: I guess I’m somewhat unclear, also, is this dollars for the mental health treatment, or is it going to also go towards paying for staffing, or do we need to pick up that staffing elsewhere?

Randolph: It includes funding ordered treatment.

Kress: At the very least, it’s clear that it would include paying for the judge, and paying for treatment for people who come through the court. Whether it would pay for prosecutors and defense attorneys who are associated with the court and their time, or social workers, or probation officers, whatever, that I’m not clear from reading the statute.

Harney: That was my question.

Kress: We might either have to inquire of the Attorney General’s office when it’s implemented, or have something read and see what they think. But so far as I can tell, clearly the court and the treatment is included, and there’s a question about the rest of the court costs.

Harney: That was a question on mind, was whether the judge would be included, and also who would we have monitoring these individuals once they went through the system? We couldn’t just throw them back out, and not have someone attending to their needs.

Randolph: Right. It needs to be a holistic thing.

Kress: Yes, but the court obviously would make sure that they were at a facility where there were people who were capable of overseeing this, and the court… They would still come back in periodically to the court.

Neuzil: You’d have to have measurement, obviously.

Randolph: And the grant says that you need to work out your plan, and so what you request… It depends on what you want to request for, as well. $10,000,000 should pay for more than a judge, I’m sure. I think that they’ve written it so that it is flexible enough to fit the different entities, because this is for Indian reservations, it’s for a large… It’s for local courts, units of local government, state courts.

Stutsman: I wonder if we should check with the state first, Linda Hinton was mentioned in the letter, to see if they’re planning to do anything on the state level, first of all. I guess I’d feel comfortable checking with her first before we spend a lot of time and energy…

Thompson: (Inaudible).

Randolph: That might be a good start.

Stutsman: If they’re proposing some pilots on the state level, we’ll be writing the grants from the state level. So maybe we should check with her first, and then…

Randolph: Yes, that would be a very good starting point.

Thompson: Could we have Jeff look into it? Report back next week, or something?

Stutsman: Yes.

Lehman: OK. Is that enough direction here? Great information, I’m glad you brought this forward. Ken has a class he has to get to.

Randolph: Yes. Thank you very much, and I’m glad that you…

Neuzil: Anytime that…

Kress: I’ll give you this (inaudible). I hope that you can read it.

Lehman: OK. We’ll circulate this.

Neuzil: Anytime you bring up ideas to reduce the jail population, I think that we’ll certainly listening.

Kress: (Inaudible).

Randolph: Well, you know, the prison budget is being looked at as well, because of our change in our state financing, and so if they’re going to decrease the cost of the state funding toward our prison system, then that means that we probably will end up with even more people that are back into our local system. So if we had something that could help to take care of some of that cost, it would be beneficial all the way around. Thanks.

Lehman: Thank you very much. OK. I guess I’d like to recess from the informal and go back into the formal.

Recessed at 6:05 p.m.; reconvened at 8:45 p.m.

ASSISTANT COUNTY ENGINEER AL MILLER: BIDS RECEIVED FOR JOHNSON COUNTY CULVERT PROJECT L-U-12-1 ON WAPELLO AVENUE SE BIDS RECEIVED FOR JOHNSON COUNTY CULVERT PROJECT L-U-12-1 ON WAPELLO AVENUE SE

Lehman: Let’s just start in with Business from the County Engineer. We’ve got Al Miller, Assistant County Engineer, with Discussion Action Needed for Bids Received from the Johnson County Culvert Project L-U-12-1 on Wapsi Avenue SE.

Assistant County Engineer Al Miller: Tuesday we opened up bids on the Culvert Project L-U-12-1, which is on Wapello Avenue, South of Hwy 22. We did receive 4 bids and the low bid was Iowa Bridge and Culvert with a total bid of $81,116.32, which is below the Engineer’s estimate of $91,000. We would recommend approval of the bids and put that on for the Formal session next week to approve the contract.

Stutsman: It’s always nice when they come under.

Miller: This is fairly tight. There are some people looking for it right now. It worked out well. Iowa Bridge and Culvert has done a lot of work for us. They’ve built quite a few bridges over Old Man’s Creek and they built the bridge on the causeway last fall.

Lehman: OK. It always helps your budget being $10,000. Comes in handy elsewhere sometimes. I have consensus to put that on next week for approval then? Anything else?

Miller: That’s all I’ve got.

Lehman: OK. Thank you very much.

Miller: Thanks.

(Continued in Part 2)