The landscape of health care innovation is complex and vast, and often leads to a global web of conversations that, very often, run parallel without ever intersecting to collaborate. That space where innovators are working at the fringe toward a similar outcome is where Scouting Health has stepped in to close the conversation gap.

Scouting Health, funded by the Robert Wood Johnson Foundation, is a partnership between Westat, a social science research, statistical analysis, and evidence-based communications firm, and Rare Dots, a health care consultancy focused on provoking connected communities to action. Scouting Health draws attention to these innovators—with a goal of inspiring more aware and capable communities by elevating the debate and highlighting advancements in various areas of health.

Making a community’s resources, such as parks for exercise and police for public safety, easily available to people is the bedrock of ensuring that people have what they need to live healthy lives. When our lives at home, work, and school are focused on an expectation of health, we have the opportunity to achieve our desired health outcomes.

Scouting Health has looked past the traditional sources of care to seek out the unexpected partners and stakeholders within communities that are working to integrate care or advance health in some way. This search led Scouting Health over to Bexar County, Texas (where San Antonio is located), which used an approach from the criminal justice system to expand mental health interventions among youth.


Some Background

Prior to entering the field, law enforcement officials receive extensive training. They become adept at assessing situations and ensuring that public safety is at the forefront of their work each day. But what is the right course of action for an officer who encounters a person in the midst of a mental health crisis? In many instances, officers become the decision point between mental health treatment and entry to the criminal justice system.

In 2014, nearly 12 million Americans reported experiencing an unmet need for additional mental health services. When we drill down to the population of the criminal justice system, a staggering 1.2 million people across federal, state, and local prison systems reported current symptoms, or a recent history, of mental illness in 2005. Those with mental illness who are incarcerated are often recipients of inadequate care. According to surveys of inmates in 2002 and 2004, over one in three state prisoners and one in six jail inmates with a mental health problem received mental health services since admission to prison.

Foregoing treatment can have dire consequences for physical health. People living with an undiagnosed or untreated mental illness are at greater risk of developing a chronic medical condition and of dying earlier than others.

But this is only one side of the criminal justice system. Here is a more alarming fact: Research has shown that between 65 and 70 percent of youth in contact with the juvenile justice system have a diagnosable mental illness. Also, sometimes youth enter the juvenile justice system more than once.

While early treatment of mental health disorders is the key to decreasing the risk that the illness will become more difficult to treat, or become a life-long struggle, 75 to 80 percent of adolescents in general with a mental health diagnosis report that they do not receive appropriate services. When the cost of mental illness among the population under age twenty-four is tallied, including health care, use of services such as special education and juvenile justice, and decreased productivity, that cost is $247 billion each year, said a 2013 report from the Centers for Disease Control and Prevention.

Bexar County Initiative For Adults

One county in Texas, Bexar County, created a model for aligning its criminal justice system, hospital, mental health services, and community partners. Facing extreme overcrowding in the jail system, largely from people with severe mental illness, the Bexar County Jail, in San Antonio, began transforming its mental health system into a program focused on diverting people with serious mental illness from jail and into treatment.

Unveiled in 2004, the Bexar County Jail Diversion Program (BCJDP) is an initiative aimed at supporting and improving the lives of adults with mental health and behavioral health needs by partnering with nearly sixty community stakeholders, including public health departments, emergency medical services, hospitals, and businesses. This effort has successfully diverted more than 100,000 adults from jails and emergency departments and resulted in a cost savings of nearly $100 million over an eight-year period.

Model Expanded To Help Youth

Realizing the extreme gap in care within the juvenile system, Bexar County expanded its model to include the following two services focused on its youth.

The BCJDP team launched a parallel initiative focused on expanding services to address the mental health and behavioral health needs among county youth and their families to try to prevent future entry of youth into the criminal justice system. The team expanded the program to include educators and school system leaders. The youth initiative uses the BCJDP’s adult-focused program as a guidepost in creating interventions focused on adolescent mental illness and behavioral health conditions. This was particularly challenging for the team, since early treatment is crucial to ensure that a child’s brain does not consistently use disordered thinking, as such use decreases the likelihood of finding an appropriate treatment for a condition.

Bexar County also created and runs Bexar CARES (Coordinated Access to Resources Equals Success), a program that works in collaboration with police, health care providers, and community stakeholders to proactively screen children within the child welfare and public school systems for behavioral health conditions using a Pediatric Symptom Checklist. If a screening reveals the need for intervention, families receive a more extensive mental health assessment. An individualized plan detailing recommended ongoing care goals is also created in partnership with the child and family. Bexar CARES has reached many children and adolescents—with 741 having participated in the program.

For Bexar County, coordination among health providers, law enforcement officers, educators, and community stakeholders is the key to creating an environment of early intervention in mental illnesses to prevent unnecessary, costly, and ultimately unhelpful alternatives.