Dr. Xyzeidria Ensley is a mental health professional and author who has served as the Director of Behavioral Health Services at the Davidson County Sheriff’s Office for nearly 20 years.
Ensley’s path led her to the Sheriff’s Office after she worked as a Forensic Assertive Community Treatment (FACT) case manager at the Mental Health Cooperative. According to the Substance Abuse and Mental Health Services Administration, also known as SAMHSA, FACT is a service delivery model intended for individuals with serious mental illness (SMI) who are involved with the criminal justice system.
“We would help transition adults with severe mental illnesses from correctional facilities into the community,” Ensley explained. “This endeavor was under the leadership of Amanda Bracht at the time, and this was my first encounter dealing with the criminal justice system.”
While working as a FACT case manager, Ensley got to know the late Jeff Blum, a legend among local homeless service providers due to his influence bridging different systems and helping address the needs of people experiencing homelessness.
“My current role actually was Jeff Blum’s role,” Ensley said, adding that she became the Director of Behavioral Health Services after Blum retired. In that role, she oversees the behavior management of all facilities in the Davidson County Sheriff’s Office, which includes, among a number of other things, the coordination of forensic evaluations, and oversight of an intensive outpatient treatment program.
Nationwide, people with mental illness are overrepresented in the justice system. Do you have an estimate of how many people in Nashville jails have a mental health condition?
In 2024, there were nearly 7,000 individuals with severe mental illness (SMI) that came through our doors. The volume of people in the Sheriff’s Office housed with SPMI (severe and persistent mental illness) in the jail, it seems to be still disproportionate compared to the volume of people with SPMI in the general population. We are close to two thirds of individuals in the correctional settings having SPMI.
The Davidson County Sheriff’s Office has implemented some innovative approaches including the Behavioral Care Center (BCC). What are some of the outcomes of the BCC that you would like to highlight?
The Sheriff (Daron Hall) speaks a lot about BCC’s readmission rate, and it is always something that should be highlighted. There is only 36 percent of the population that have returned to jail after completing BCC. We also have Increased the amount of time between incarcerations for those who have returned to jail after completing the program.
I believe this is due to increasing access to services for folks, not only while they are in custody but also when they return to the community.
Every resident at BCC received discharge planning services, a plan that addresses their housing, their mental health care or aftercare, their substance abuse treatment, medical care, and employment. If residents refuse any specific services or discharge planning, they receive resources when they leave, so that they can pursue [services] independently. That was one thing that the Sheriff really wanted to highlight regarding BCC. He wanted to make sure that someone was handed to some type of community provider.
The program model has also helped with enhancing collaboration within the criminal justice system [that includes] the DA’s (District Attorney) Office, the PD’s (Public Defender) Office and Probation. These relationships foster systems that work more efficiently.
Besides the BCC, what other approaches is the Sheriff’s Office taking to assist people with mental illness who are incarcerated?
Aside from BCC, one thing that the Sheriff’s Office does differently, at least compared to other counties in Tennessee, is that we have a robust in-house mental health team [providing] medical services, which include medical discharge planners. A lot of the other jails rely on having maybe a mental health nurse or a specialist, and some rely on having just a medical staff who may continue orders for mental health medications once these medications have been verified.
At the Davidson County Sheriff’s Office, we have multidisciplinary meetings, which can help identify individuals who have mental health needs and monitor services that they are receiving.
As far as the unique processes, one of the things that we have is that the Sheriff’s Office put in place a distribution of reports that are sent out daily to some of the community partners. These reports really assist with collateral information regarding those who’ve been newly incarcerated who are in outpatient mental health care, so that our in-house mental health team can do their best to ensure the continuity of care.
Some years ago, the former Metropolitan Homelessness Commission director, Will Connelly, who now is the executive director of The Contributor, partnered with the Metro Public Health Department and the Sheriff’s Office to implement a SOAR (SSI/SSDI Outreach, Access and Recovery) program in jail. Is that program still going, and how would you describe its impact?
Yes, the SOAR Program is still being implemented within the facilities. We currently have two staff members working in our population to assist them with this process. I believe the program has been really impactful because it has created opportunities for some of the most vulnerable individuals in our system to have access to resources that seriously improve their ability to thrive once they reintegrate into the community.
About how many inmates who experience homelessness would you say are arrested in Nashville on a monthly basis? How do you determine their homelessness status, and what is the cost per night of housing people in jail?
Homelessness status is self-reported based on address. If an inmate gives the address as “homeless” or lists one of the local shelters, we consider them to be homeless upon booking.
In 2024, we had about 2,576 justice-involved individuals booked as being homeless or unhoused. That averages out to 215 a month. Of those, only 1,625 were unique inmates, so many were booked multiple times.
As far as the cost per night is concerned, it may cost about $118 per night to house individuals that are justice-involved.
You serve on the Continuum of Care’s Homelessness Planning Council. What are some opportunities that you see for organizations working on preventing and ending homelessness to partner with the Sheriff’s Office?
The Sheriff’s Office has always partnered with community providers to bring opportunities to our population. In the past, the agency has put on some resource fairs for community stakeholders to introduce their services to the population. Also, quarterly Transition from Jail to Community meetings provide a forum for community partners to highlight their services.
We hope to continue to move forward by utilizing key community providers that cater to the unhoused individuals to provide coordination and linkage for streamlining access for services.
Is there anything else you would like to highlight?
This goes back to the over-representation we have talked about earlier in regard to people with severe mental health issues. The Sheriff’s Office has created a flag system that helps to ensure that people who are up for release are assessed in order to try to make sure we are not releasing individuals who are not able to take care of themselves or maintain their safety once they are out of the facility. That flagging system helps us identify those who are really ill in our population, and we do great work in not releasing those into the community who are unable to care for themselves.
What happens when after an assessment it is determined that a person cannot take care of themselves. What’s the next step?
If the mental health and medical providers feel that these individuals are unable to care for themselves, they will do their best to get them [into services to address their needs]. If it’s deemed a crisis situation, they will make sure they are connected to a hospital, whether it’s the Crisis Resolution Center or other services that could be beneficial.