- [Anita] Coming up on "ncImpact."

Mental health is a challenge for the criminal justice system.

I hope you'll join us for the "ncImpact" Town Hall where we'll explore the solutions working to promote wellbeing among those impacted by the system.

- [Announcer] "ncImpact" is a PBS, North Carolina Production in association with the University of North Carolina School of Government.

Funding for "ncImpact" is made possible by.

- [Announcer 2] Changing the course of people's lives.

That's the impact UNC Health and the UNC School of Medicine work to deliver every day.

Our 40,000 team members across the state of North Carolina are committed to caring for you, our patients and communities, as well as educating the next generation of healthcare professionals.

Individually, we can do a little but collectively we can do a lot to create impact.

- Hello and welcome to "ncImpact".

I'm Anita Brown-Graham.

I'm joined tonight by a live studio audience and three great experts.

For one of four town halls focused on the troubling rise of mental health challenges.

Tonight we focus in on people impacted by the justice system.

It's estimated that up to 40% of people in jails and prisons have been diagnosed with a mental health disorder.

Those conditions sometimes go untreated, leading to a cycle of incarceration and re-incarceration.

"ncImpact's" Evan Howell introduces us to a unique solution in Brunswick County that is working to break the cycle.

[audience applauding] - [Evan] Judge Jason Disbrow says drug addiction and mental health go hand in hand.

- It's hard to explain to people the impact that I get to see.

- Now she calls me and says- - Disbrow presides over the Brunswick County Mental Health Treatment Court.

The court focuses on the link between substance use disorders and mental health.

The goal of the court is to ensure that participants receive the help and treatment they need to become healthy law abiding members of the community.

- We're encouraging them, telling them, "Look, we understand you're dealing with a substance use disorder.

We understand that there's going to be some missteps along the way, but you're helping them through the entire process."

- She's making good progress.

- [Evan] The court has held twice a month where Judge Disbrow and his staff review the cases of every participant on the docket that morning.

Participants are reviewed on the progress made towards things like group session attendance, probation violations, and drug test results.

But not everyone is eligible.

Court staff make an assessment whether an individual meets the criteria to participate.

A participant must be on probation in addition to being diagnosed with both a substance use disorder and mental health disorder.

- They have underlying traumas that they've never dealt with before.

So they turn to substance use disorders and then they steal and then they have drug possession charges.

[audience applauding] - [Evan] The participant's progress is monitored by the court and the goal is to generate positive outcomes in their lives.

Debose Barnes says, partnerships with local recovery centers such as nearby coastal horizons are crucial to making it work.

- Helping them avoid going to prison, getting a sentence by focusing on substance use disorder and mental health.

And mental health is critical because the mental health drives every aspect of our lives.

- [Evan] Judge Disbrow says a typical program period is 24 months.

Once a participant completes the program, the order is signed to move them to unsupervised probation.

- When we have them in treatment court, we have a real opportunity to change everything for them, to change the trajectory of the rest of their lives and the lives of their children, the lives of their spouses the lives of their family members.

- There's no drugs in my system.

[audience cheering] - For "ncImpact," I'm Evan Howell.

[applauding continues] - Judge Perez.

I suspect that there are gonna be people who watch this Town Hall, who will go, "That's a courtroom?

That's happening in a courtroom?"

Help us unpack the intersection among behavioral health, substance use, and criminal justice outcomes.

- Well, as Judge Disbrow said in that little video, they're so interconnected.

Folks who are suffering from significant mental health issues do self-medicate.

They turn to drugs and eventually they end up in our criminal justice system.

Maybe more than one time.

This is the opportunity and Pit County has a mental health recovery court as well, an opportunity to get these people in a courtroom setting but with you can tell people who care about them who are enthusiastic to make these people understand that they can have a stake in this process.

And we're with them every step of the way if they want us to be.

So it's exciting to see now, a move now in the judicial system to having these recovery courts because I think statistically we're gonna find they're gonna work.

Are we gonna succeed in every case?

No.

But if we can succeed in one or two cases, I think we're making an impact.

- I wanna go to you, Sheriff, because law enforcement is also changing the way it engages in these issues with mobile crisis units, for example, going out with law enforcement officers and first responders.

What are you seeing that gives you hope?

- I think think law enforcement over the last several years, excuse me, has had to change.

The mobile crisis units has been unbelievably meeting people with those needs on scene.

I mean, they can meet at their homes, they can meet at schools, they can meet at churches, but having those mobile units to get ahead of the problem before we see it turn into the recidivism and inside our jails.

So absolutely, we've gotta have 'em and we've gotta support 'em and they have to have the community buy-in to support those.

And we're seeing a lot of that.

- We're gonna come back and talk about community buy-in.

Latoya, one of the purposes of the program we saw here is to provide an alternative to incarceration.

But I'm wondering if you could just talk to us a little bit about what role incarceration plays in exacerbating mental health issues.

So let's start from the back.

- Sure, I think one role that it plays is that incarceration has really become the default option for people with mental illness who don't have access to mental health care.

At the beginning of the segment, you said that studies show that about 40% of people who are incarcerated have a mental health diagnosis.

It's significantly higher than that for children.

So I'm gonna speak from the juvenile justice perspective because I serve as general counsel for the Division of Juvenile Justice.

So that's my expertise.

And earlier this year we did a point in time study of confined youth in our population, those who are confined to a youth development center or YDC which is a long term locked facility for a youth equivalent to a prison for an adult.

And what that study showed is that for youth in YDCs, 99% have at least one mental health diagnosis.

- No, no, did you say 99%?

- 99.

99.

So nearly every youth who is in a YDC in North Carolina has at least one mental health diagnosis.

But on average, a youth has four or more distinct mental health diagnosis and 48% have co-occurring mental health and substance abuse.

30% have been diagnosed with PTSD.

So that tells us that youth with mental health issues are disproportionately being placed in locked facilities.

But a prison or YDC is not an inpatient mental health treatment facility.

So they're not getting the appropriate care that they need to resolve those issues.

More and more importantly, incarceration can cause further harm by leading to more trauma, which perpetuates the mental illness.

Another issue that we're seeing in juvenile justice is that incarceration creates a barrier to mental health treatment.

Because once a child gets placed in a locked facility, they become ineligible for Medicaid funded treatment and services.

Federal law prohibits Medicaid reimbursement for any services provided to an inmate, that includes children.

So we are fighting a constant battle in juvenile justice trying to get services for kids in our custody who need, very much need mental health treatment oftentimes intensive residential mental health treatment.

But we can't find a resource to pay for it because they're not eligible for Medicaid.

So it's very counterproductive to place these kids in facilities when what they really need is mental health treatment.

- Thank you.

Trauma affects our mental health in many different ways.

It's why some communities have implemented what's called trauma-informed court systems.

"ncImpact's" David Hurst takes us to one coastal community to show us how it works.

- So we've got windows that wrap all the way around this corner of the building.

- [David] Chief District Court Judge J Corpening has experienced a lot of new recently.

Not only is he proud of the new Juvenile Justice Center and New Hanover County, he also has a new perspective As a judge - When I start my day, I start with the sort of premise that everybody who walks through that door has experienced trauma.

- Your Honor, the state will- - This new perspective is part of what's called a trauma-informed court system.

The idea is to help people with trauma and prevent them from becoming entangled in the criminal justice system.

- I'm gonna insist on accountability for misconduct or whatever the issue may be, but I'm gonna treat these people with dignity and respect and I'm gonna encourage them to be better.

- If two people- - It's work that's come as a result of the Chief Justice's ACEs informed task force.

The task force began in 2021 and its goal is to infuse the science of adverse childhood experiences or ACEs into the court system of North Carolina.

One of the pilot programs is in District five which includes New Hanover and Pender counties.

- In the entire time I've been district attorney.

I've never seen anything like this in terms of excitement by people seemingly from different backgrounds all coming together for the same thing.

- [David] District Attorney, Ben David, says the goal is to attack the issue upstream.

Children with high ACE scores are at higher risk of developing mental health concerns and substance misuse disorders which can then turn into criminal justice events.

- For drug addiction and for mental illness, we need to find alternatives to incarceration and we need to be involved in therapeutic justice.

In other words, navigating people to community-based alternatives.

- Blue seats, because blue is the calming color we've got- - [David] And with all the new going on, this is the work that Judge J Corpening says he's most excited about.

- That has brought a coalition together across the spectrum of silos in our community.

Bringing them together so that we're able to collaborate more effectively to be a healthy community.

- [David] It's work that's providing help and hope to those who need it.

For "ncImpact", I'm David Hurst.

- Latoya, we've heard that these issues are broad based.

You also served on the commission.

What is the role of agencies like school systems, social services, child welfare organizations in working to support these lifestream efforts?

- I think it's very simple.

Their role is to build resiliency.

That's what trauma informed courts are about.

Making children and individuals who are engaged in the justice system more resilient.

And that can happen if they get adequate support.

They won't end up in the criminal justice system.

Children won't end up in the juvenile justice system.

And so what we see in juvenile court is that oftentimes the kids who are in juvenile court, at the same time they're engaged in child welfare court, they are in the special education system, they're involved with the mental health system and you know, among others.

But these different systems and agencies aren't working together to make sure that children don't fall through the cracks.

And so that's, you know, that results in them unnecessarily coming into the juvenile justice system for issues that could have been effectively addressed within the community.

And so I think again, building resiliency by working together more effectively.

One of the best examples that I've seen in recent years in North Carolina of effective multi-system stakeholder collaboration is the school justice partnership program which I had the honor of talking with you about a couple years ago on this program.

But that is a great example of various stakeholders working together to support kids and help them avoid that unnecessary contact with the court system.

And so about five years ago the administrative office of the courts IN conjunction with the raise the age legislation developed a program called the School Justice Partnership where a local school district can partner with the courts and other local stakeholders, including law enforcement the district attorney's office, juvenile justice and others to keep kids in school and out of court by directly referring them to community-based resources.

Things like teen court, mediation, different types of restorative justice programs where their behavior can be addressed without the trauma of court involvement.

And it works because we've seen about half of the counties in North Carolina now have a school justice partnership.

And in counties like New Hanover where we just heard from Judge Corpening, in their first year they were able to reduce school-based referrals to court by about 50%.

That's significant.

If we could do that throughout the entire state, we would have a lot more, much more resilient kids.

- And there may be more resources within the judicial system to focus on the people who are there.

- Absolutely.

- I hear all this conversation and I'm wondering, sheriff, you talked about community partners.

How much of what law enforcement is doing in North Carolina is this kind of prevention or early intervention versus people who have gone through the system and now are gonna be incarcerated?

- I would say 90% has got to be the early intervention.

And I'll speak for myself, what we do locally and also sheriffs across the state I hear.

We've got to get involved with our younger kids.

We do a teen academy.

We do an athletic league with over 300 girls every year.

I have mobile classrooms that we use.

Other sheriffs have all sorts of programs because we understand if we, we would much rather prevent it than ever have to investigate something.

And we've gotta help them understand, you know, before they get into the system, you know, mental health is something we've got to see or we've got to work on.

Educate them and let 'em understand it.

I'll speak just for the last week ago, we had an 11-year-old commit suicide.

That's mental health.

So law enforcement along with those things, everything from school resource officers in school, you know, we see that and we'll probably get to it shortly but all those are the front lines of what we've got to to solve the big problem.

- I'm gonna turn to you all for some audience questions, but Latoya, given what you said at the beginning about some of the barriers for reentry particularly for young people needing services just walk us through what the process looks like.

- Sure.

So obviously any individual leaving a correctional facility, child or adult is especially vulnerable during that time period.

We talked about the significantly high rates of substance abuse and mental health for children who are in confined facilities.

And when they, in the YDC setting, they are getting care from a team of professionals including nurses, licensed mental health clinicians, social workers who are managing their care and treatment.

When they leave the facility significant risk that their mental health will decline without those supports.

So reentry is a big part of our program at Juvenile Justice and some of the things that we're doing, we are very excited about a new grant funded program that we have through a federal second chance grant, called Reentry to Resilience or R to R for short.

This is a program operating in eight counties right now where a youth is paired with a youth success coach from the moment they enter a YDC up until 12 months post-release.

So this person is with the youth, getting to know them, building a relationship with trust, understanding what their needs are both while they're in the facility.

And then when they get released they're helping that youth with all the support they need with getting re-enrolled in school, getting housing, getting a job, finding a way to get to the job.

'Cause oftentimes they don't have transportation.

And so with that type of support, we've seen an extremely reduced recidivism rate for those youth at only 4%.

The average recidivism rate for a child coming out of a YDC is 80%.

So 80% of children leaving a YDC re-offend within two years.

Children who have been an R to R is about two years old now.

We're only seeing about a 4% recidivism rate.

So again, resiliency with the right type of support, these children can succeed.

- Yeah, but it goes to you've got to have a trusting relationship with someone who can guide you.

- And resources.

- And resources, yeah.

- It's grant funded so we're only in doing it in eight counties but we're hoping to be able to expand it with more funding.

- It's amazing.

All right, we'll get the mic.

We're ready for questions.

- Hello everyone.

I enjoyed hearing all your comments.

How do you get the different systems to share data?

- That's a good one.

- As far as the people that are being served you can have the aggregate data, but I mean, when you talk about care data.

Thank you.

- We had in one of our task force meetings a gentleman from Wilmington who talked about the data and was just starting and he was offering it.

I think you go online and look at things, but that is a very good question and I think that's one of the things we've got to work on is sharing the data so we can use that data to benefit these people who are at risk.

But there is an effort and I think we have dashboards which are people putting together the information, putting it online, and we can look at it.

For example, I was looking at one the other day at the number of children who are in our welfare courts, who, you know, are staying in the welfare system for how many months or days or where do they go to foster home, how often, how many foster homes do they go to, we get data but it's certainly something we continue to work on.

But it's important to have the data.

- It's absolutely important.

A large part of what I do is help to develop policy and legislation for juvenile justice.

And all of that is driven by data.

So we share a lot of data actually with various stakeholders.

The challenge with juvenile justice is that our data is confidential 'cause we're serving children.

And so most of the data that we're sharing is de-identified.

So we're not necessarily sharing information about individual youth because we don't want to stigmatize a child by, you know, disclosing to the public that a child is involved in juvenile justice.

That has all sorts of negative collateral consequences.

But we do share a lot of de-identified data with schools, with social services, with courts, with law enforcement that helps to inform some of these policy decisions.

- And I'll just go ahead.

I agree wholeheartedly.

The information is I guess we do share a lot, but it goes back to the old fashioned just sitting down, having your means.

Do you see children and adults that's in the cross?

I mean, I'm talking about the recidivism's up.

We've seen 'em a couple times.

You still just have the means and that helping hand to reach out and say, "Hey, this is gonna be a problem."

Those types of communications I still think is very, it just pays huge dividends.

- Thank you.

Other questions?

- Hi to everybody.

This is such a timely conversation.

This week, Durham County got an update on our ACEs scores, our resiliency plan and where we update it.

And you know, if this was a stool, if I could throw another leg on this school stool, it would be education.

So we launched a community resiliency model for my ACEs resiliency plan and it was a teacher collaborative.

So we have like five newly trained teachers.

I'm wondering, since you all are all over the state, you know, what are some best practices that you've seen?

Because I imagine a lot of the referrals that you get that have to go to him are coming from the schools.

And even though we have diversion, how could we better prepare our educators who already have enough on their plate, I understand that, to like be that first eye contact that says, "You know what, we don't need to call him.

We don't need to call you.

We need to call you."

So what are just your thoughts on that?

- I'll say this, in Greenville, there's a resource that I use.

A group of educators from ECU and other therapists and they have a community based trauma and force therapy and they offer it to the public.

So what I do in my custody cases, typically when I see parents who are very toxic with each other, I see young child or children who are in the middle of it, that's trauma, that's gonna create trauma, that's one of the trauma scores.

I will require them to attend the education part of the therapy where they go for an hour or two hours, learn about ACEs, what that means.

And then if I feel necessary, I'll have 'em do a parenting class that involves trauma therapy.

So 'cause I want to educate these parents who no longer live together, what they're doing and what they can do better if they realize that their relationship is going to forever change that child for the good or the bad.

- We did a Town Hall that focused on older adults and talked a lot about screening that non-clinicians might be able to do.

Is there an opportunity for educators to do screening?

- I was just going to, and I don't know if this would necessarily be considered screening but one thing that we're doing in juvenile justice is all of our staff is being trained in Youth mental Health First aid.

And that helps just, you know, a average citizen be able to identify a person who's in crisis.

And so something that might look like for to a teacher as bad behavior is really a mental health crisis.

And instead of calling a school resource officer and filing a complaint, they need to be calling the managed care organization looking for to get a referral for an assessment.

And so something that, you know, that type of training, you know, we're in the process of having all 2,500 juvenile justice employees trained in that, I think could be very helpful in an education setting.

- Judge, Latoya, sheriff, thank you for all that each of you is doing in North Carolina under what obviously are difficult circumstances but you continue to innovate, to run around and get grants to do whatever it takes to make the work happen.

And we are grateful to that.

To my live audience, thank you so much for being with us this afternoon.

Really appreciate you and your good questions.

And then of course we say thank you to the people who were featured in the stories.

We never want to overlook the expertise that they bring into the room.

And finally, to our audience thank you for watching and engaging.

This is "ncImpact."

We know there are solutions out there if we work together.

[dramatic music] [dramatic music continues] [dramatic music continues] - [Announcer] "ncImpact is a PBS, North Carolina Production in Association with the University of North Carolina School of Government.

Funding for "ncImpact" is made possible by.

- - [Announcer 2] Changing the course of people's lives.

That's the impact UNC Health and the UNC School of Medicine work to deliver every day.

Our 40,000 team members across the state of North Carolina are committed to caring for you, our patients and communities as well as educating the next generation of healthcare professionals.

Individually we can do a little but collectively we can do a lot to create impact.

[no audio] [no audio]