In a family of engineers, psychiatrist Thomas Simpatico couldn’t help but want to address the system issues people face in mental healthcare. He first witnessed them when he was a resident at the University of Chicago and moonlighting at a community mental health center near Wrigley Field. “From day one, a light bulb went on,” he says. “I knew this is what I wanted to do.”
Simpatico wanted to help people with serious mental illnesses or substance use disorders whom society and the healthcare system seemed to have forgotten — those siphoned to the emergency department and thrust into the criminal justice system and homelessness. “There were all of these potential points of contact in the community holding system and yet very little coordination.”
His goal was to get these intersecting systems talking.
Over two decades ago, in 2001, the Cook County Jail in Illinois was one of those siloed systems, and on any given day, roughly 400-500 people sat in holding. “A disproportionate number had serious mental illness,” says Simpatico. Anyone who entered the community mental health centers with an open case was swept into the jail. “There were roughly 86 centers in Chicago that fed the Cook County Jail. People would then fall off the radar and these futile cycles continued.”
It was 2001 and Simpatico was the Metro Chicago Bureau Chief for the Illinois State Mental Health Authority. To address the connectivity issue, he co-developed an information system that facilitated two-way communication between community and jail clinical teams. “We wanted to make it so they could easily interface.”
To ensure information could flow in both directions, the project was granted an exception to the Illinois Confidentiality Act — a decision supported by advocacy groups. “Suddenly, the no-brainer goal of having bi-directional coordination and continuity between teams was not only possible but hard to evade.”
The Cook County Jail Linkage Project went on to win the American Psychiatric Association Gold Achievement Award. According to an article in Psych Services, the jail had become the largest psychiatric facility in the state, with “at least 10 percent of the 10,000 detainees on psychiatric medication.”
Three years later, Simpatico built a division of public psychiatry at the University of Vermont. He soon helped to create a mental health intergovernmental support system that would be cross-matched daily with intersecting databases. “We did a series of logical extensions to the Chicago project, looking at subpopulations at risk of incarceration like veterans.”
The project was funded by academic and federal grants, making the project less comprehensive than Simpatico would have liked. That said, it profoundly affected veterans who otherwise would have faced incarceration by providing judges and law enforcement a means to divert. “Whenever someone had a police encounter, the officers would check the criminal justice feed and be able to use the information to create a contingency plan instead of incarceration.” The plans were trackable, allowing judges to learn what was in place to support the person.
While Simpatico was pleased the jail and judicial system connectivities were working, he wanted to improve access and diversion for more people on a larger scale. He’d been talking to experts in the tech industry when he received a call from one of his contacts; they were now at Google and heading up public sector services for the Central United States. “He said, ‘We want to find the next YouTube in the mental health space, and I think what you’re doing is it.’” He invited Simpatico to join the Google Partners program.
Simpatico brainstormed how to create the production system with his good friend, Judge Steven Leifman, who developed the concept of the Miami Center for Mental Health and Recovery, a comprehensive diversion facility scheduled to open this year. It will include crisis care, trauma services, primary care services, housing, peer-run day activities and a culinary supportive employment program. The 208-bed center also has indoor basketball, a library, educational services and vocational rehabilitation. “We want to provide all the essential elements of recovery in one place,” Leifman told #CrisisTalk in 2019. “We know comprehensive systems work, and we believe it’s the answer to the most challenging cases of people with SMI that, for the most part, have been given up on. It just needs to be highly accessible.”
These late-night discussions, says Simpatico, resulted in napkins chock full of scribbled notes and diagrams. They quickly realized that the mental health and recovery center created the perfect opportunity for Simpatico and his team to build out their web-based technology. At its core, the center is a forensic diversion complex, which means there must be communication between the many systems that intersect with mental health and substance use disorder healthcare.
What Simpatico and his colleagues at MTS have developed is the WayFinder Miami model jail diversion production system. The real-time, web-based technology interconnects the court system, CIT-trained officers, Veterans Affairs (roughly 12% of those incarcerated are veterans), and case management. Those in any connected system can search for a person they encounter. If the person is already in WayFinder, staff can quickly find the constellation of systems with which they’ve had contact.
The individual dashboard also includes support and services to address social determinants of health — employment, education, transportation, housing, social support, family, and healthcare (mental health, substance use disorder, and medical care). “These elements provide a great, comprehensive safety net,” says Simpatico. A map illustrates where the person receives services, so there’s consideration for accessibility and efficient case management. The virtual treatment plan follows the person through the entire care continuum to ensure they don’t fall through the cracks.
Identifying veterans is also a focus of the production system. Typically, only 3% of incarcerated people will identify themselves as veterans. However, with proper screening, including an avatar-assisted PTSD assessment, that number increases to 12%. “There are all kinds of reasons people might conceal being a veteran, but it’s to their detriment,” says Simpatico, “because veterans can often receive additional benefits, programs and funding.” For instance, identified veterans get directly connected to the emergency homeless service program in Miami-Dade County.
Incarceration, points out Simpatico, is one of the fastest ways to become or remain homeless. It’s also why people remain incarcerated even when they become eligible for parole or probation. “People shouldn’t be incarcerated one day longer than their eligibility,” he says. The diversion production model works to connect people to housing.
The virtual treatment plan is tailored to people at risk of or who have cycled through these systems. The dashboard includes the person’s individualized treatment plan and case management. “It’s based on forensic assertive community treatment [a service delivery model intended for people with serious mental illness] with a couple of modifications to make it especially applicable to our populations circling in and out of the criminal justice system.”
Simpatico is careful to point out that the production system is not immutable. He hopes to incorporate AI and machine learning soon, and this specific iteration is designed for Miami-Dade jail diversion. The model breathes life into the Sequential Intercept Model, which tracks how people with behavioral health and quality-of-life challenges enter and move through the criminal justice system, data that inform community-based solutions.
“We want to provide strategies relevant to where the person is on the continuum,” he says. “If they encounter law enforcement, instead of arresting the person, they’ll connect them to their case manager or ensure they have fast-track access to an assessment. That will be the default.”
If the person is before a judge determining whether to incarcerate or divert them, that can also be the entry point. “It can happen at any point — we want to build accountability into the system and it learns with experience.” The system will be informed by how the elements work together, allowing Simpatico and his colleagues to make modifications.
Whether the person is in the community or incarcerated, the model facilitates communication between treatment teams and systems. Simpatico aims to have the production system up and running in incremental steps over the next six weeks. “We think that’s going to coincide perfectly with the ribbon cutting for the Miami center.”