The article originally appeared in the January 2017 issue of Wellness Matters, an e-journal San Mateo County Behavioral Health and Recovery Services.

The Court Alternatives for the Mentally Ill (CAMI) effort began as a pilot to prevent unintentionally long incarcerations detrimental to seriously mentally ill adults booked for non-violent, minor offenses.

The original model sought to return individuals to their established housing and mental health providers and facilitate release within 24 hours of booking. This would afford them circumstances conducive to their mental health while they completed their court requirements. In its first 6 months, stakeholders learned they needed more than one day to resolve common barriers to reentry, such as homelessness, legal holds beyond any current charge, and lack of engagement in mental health services.

With very few candidates able to participate in CAMI, partners agreed to suspend and redesign the program, which relaunched November 1, 2016. In its current implementation, CAMI uses 5 days of custody time to resolve legal barriers and secure housing and treatment for those eligible. Having lifted the requirement of existing mental health services, Correctional Health and Behavioral Health and Recovery Services will work with participants to establish new treatment relationships with appropriate clinics or programs.

Probation's Pretrial Unit will closely supervise participants released from custody on their own recognizance. The District Attorney's Office and Private Defender Panel have each identified lead attorneys for CAMI, and they have worked closely with the Presiding Judge to standardize information about the program throughout the Courts. Maple Street Shelter has dedicated two beds for CAMI participants, whom Adult Resource Management will support with case management to stabilize them within this resource.

These adjustments have increased the number of candidates considered for CAMI, yet those ultimately cleared to participate remain few due to legal holds, reluctance to engage in services as offered, and limited housing remain barriers. The county continues to track outcomes to inform further development of this program.

The program was launched with funding from Measure K, a voter-approved countywide sales tax to support essential County services and to maintain or replace critical facilities. The Board of Supervisors approved a number of initiatives with local sales tax funds to create a Mental Health System of Care for adults that aims to reduce incarceration while providing needed mental health care services.

- Carol Clancy, MD, Correctional Health