‘A Paradigm Shift’

Meadows Institute leaders call for expanding the crisis care continuum into pretrial detention

From left: Yolanda Lewis, executive vice president for justice and health at the Meadows Institute, Tim Bray, vice president for justice and health policy at the Meadows Institute, and Manuel F. Zamora, assistant chief deputy of the Fort Bend County, Texas Sheriff’s Office

Just six days after her 19th birthday, Noni Battiste-Kosoko was found face down and unresponsive in her Atlanta jail cell, dead of an apparent suicide. The teenager, who was reportedly experiencing a mental health crisis, had been detained for 53 days on a bench warrant as a result of a failure to appear for court on misdemeanor charges of trespass and vandalism.

Battiste-Kosoko died before having her day in court and without being convicted of a crime, and she is far from alone.

Speaking to a capacity crowd June 5 at the National Alliance on Mental Illness’ annual convention, known as NAMICon, Meadows Mental Health Policy Institute Executive Vice President for Justice and Health Yolanda Lewis, shared Battiste-Kosoko’s story, and the stories of other pre-trial detainees with “clear mental health challenges” who died of apparent suicides behind bars, to shed a light on “how critical a period of time pre-trial detention is, starting at hour one.”

Lewis made her remarks while moderating a panel called “A paradigm shift: expanding the crisis care continuum into pretrial detention.” She was joined on the panel by Tim Bray, a lawyer and the vice president of justice and health policy at the Meadows Institute, and Manuel F. Zamora, assistant chief deputy of the Fort Bend County, Texas Sheriff’s Office.

According to the Bureau of Justice Statistics, the suicide rate of pretrial detainees – those who are presumed innocent and have not been convicted of a crime — is three times higher than the jail population who have been convicted. Additionally, more than half of jail suicides occur within the first 30 days of incarceration.

“A crisis is not a crime,” said Lewis, noting that most pretrial detainees, like Battiste-Kosoko, are charged with misdemeanor offenses.

Yolanda Lewis addresses NAMICon24

Many jurisdictions across the country have made efforts to divert people with significant mental health needs away from the criminal legal system and into community-based care. And yet, said Bray, many people living with behavioral health disorders continue to experience arrest and the perils of pretrial detention.

With increased risks of suicide and self-harm, the panelists agreed that expanding the crisis care continuum into the initial detention phase of incarceration is critical.

“There is maximum discretion at the pretrial stage,” Bray explained. “That period is an opportunity to access care for people with mental illness when all of the people involved in a pretrial hearing come together to say that access to care is in the best interest of public safety.”

Such collaboration doesn’t come naturally in an adversarial legal system like ours, with prosecutors on one side and defense attorneys on the other, said Chief Zamora. But the benefit of such cooperation is that the various actors can “hold each other accountable” for making services available to accomplish pretrial diversion.

That’s the aim of The First 48, a new initiative from the Meadows Institute to gather support from national entities to expand resources, training and policy initiatives aimed at improving collaboration among justice and health officials, so individuals are more efficiently diverted from justice systems to safe places for care at initial detention.

Said Lewis: “If every system is working well, it means that more people are getting care and more family members are going home to their family. We look forward to working with jurisdictions as they are thinking about how to respond well to people with behavioral health needs.”