7 22 2010 efforts to address mh sa and homelessness a one stop approach
DESCRIPTION
Efforts to Address Mental Illness, Substance Abuse and Homelessness: A One Stop Approach. July 22, 2010.TRANSCRIPT
Efforts to Address Mental Illness, Substance Abuse and
Homelessness: A One Stop Approach
Gilbert GonzalesDirector, Communications
and Diversion InitiativesThe Center for Health Care Services
Mental Health and Substance Abuse AuthorityBexar County
San Antonio, Texas [email protected]
Aaron DiazDirector, Crisis and Diversion Services
The Center for Health Care ServicesMental Health and Substance Abuse Authority
Bexar CountySan Antonio, Texas
July 19-23, 2010 / Austin Convention Center / Austin, Texas
The Crisis Care Center
The Restoration Center
Haven for Hope Homeless Campus
The Purpose
The Service
The Value
1
2
3
Show me the DATA !!!
An Ounce of PreventionTaxpayer Costs Avoided through Preventing
Crime
Criminal Behavior and Its Cost to Society• 1.7 Trillion including victimless crime – Perazzo 2002
• 674 Billion Federal, State and Local – Shapiro 1999
• 1.0 Trillion (2 million people incarcerated) – Adrienne
2005
Cost Avoided if One Criminal Career is Prevented$ 976,217.81• Average annual adult cost (2004) - $40,865• Average annual juvenile cost (2004) - $32,888
Source: Dr. Victoria Reinhardt, An Ounce of Prevention presentationTo NACo, July 2008
San Diego
529 high utilizers ran up a cost of $18 million dollars (2000-2003) including:
$4 million for Emergency, Police, and Court
$14 million for medical, ICU and surgery
Impact San Diego SIP, Annals of Emergency Medicine, Vol 47, No.4:April 2006
15 chronic homeless inebriates (ineighteen months) cost $1.5 million
The New Yorker Magazine, Million Dollar Murray, Issue 2006-02-13 and 20, 2006
The Case of Million Dollar Murray
MILLION-DOLLAR MURRAYby MALCOLM GLADWELLThe New Yorker Magazine, Issue of 2006-02-13 and 20, Posted 2006-02-06
News ReleaseEmergency Departments See Dramatic Increase inPeople with Mental Illness Seeking CareEmergency Physicians Cite State Health Care Budget Cuts at Root of Problem
American Psychiatric AssociationHillarie Turner, 703-907-8536 June 2, [email protected] Release No. 04-30Sharon Reis 202-745-5103
Cost
“in one study, it had been concluded that one homeless person can cost the City and County about $200,000 in one year”. Philip F. Mangano, Executive Director of the United States Interagency Council on Homelessness (USICH), May 1, 2007.
“It cost us one million dollars not to do something about Murray,”
The Problem gets worse:
Poor and or reduced funding
Scant, limited and rationed services
Reduction of State Hospital treatment beds
The Problem
Law EnforcementDetention/Jail
CIT
Judicial/CourtsMagistrate, County, District
Mental HealthPublic and Private
Providers
Crisis Care CenterJail DiversionPsychiatric and Medical
ClearanceSpecialty Offender Services
CommunityDynamicCrisis Jail Diversion
Information Exchange
Pol
ice,
She
riff
Pro
batio
n, P
arol
e
Civil and CriminalT
reatment
Continuity of C
are
County City-wide
Emergency Services
Data exchange through• Community Collaborative• Crisis Care Center • CIT/DMOT• Jail and Juvenile Detention• Statewide CARE Match
System County City-wideEntry Points
System Level
Operations
• 24/7 services• Psychiatric screening and evaluation• Jail and detention medical consultation &
clearance• Medical screening• Lab and Radiology• Appropriate Staffing and Co-located office
space allocations• Coordinated Services with SA/Homeless
5803
2955
0
1000
2000
3000
4000
5000
6000
Admissions CCC Admissions PSU
Persons Admitted to CHCS for Intervention and DiversionApril 2008 - March 2009
Figure 2
73
90
70
101
72
9084
6976 76
96 94
0
20
40
60
80
100
120
Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar
Emergency Detentions to Crisis Care Center Apr 08 - Mar 09
Figure 3
Total = 991
Total = 8,758
Crisis Care Center Data
April 16, 2008 – March 31, 2009
Then (prior to Sept 2005)• Wait times for Medical Clearance/ Screening at UHS ER - 9 hours, 18 min.
• Wait times for Medical Clearance/ Screening and
Psychiatric Evaluation was between 12 and 14 hours.
Now• The wait time for Medical
Clearance/ Screening at the Crisis Care Center is 45 minutes.
• Wait time for Medical Clearance/Screening and Psychiatric Evaluation is 60-65 minutes.
Impact on WAIT TIME for LAW ENFORCEMENT
Emergency Room utilization has dropped 40% since the inception of the Crisis Care Center.
40% of (7619 total seen at CCC) 3048 Persons diverted from the ER (in 2006 first year)
X $1545Cost Savings relative to ER Utilization $4,709,160
Source: Jean R. Setzer, Ph.D., University Health System
Emergency Room Utilization (Medical Clearance)
What Works
TheRestoration Center
OpenedApril 15, 2008
•
• Public Safety- Sobering Unit• Detoxification Facility• Community Court• Outpatient Substance Abuse Services
To establish a system of care for homeless, serial inebriates that
includes
• 24/7 Access to Substance Abuse Treatment 24/7 Access to Substance Abuse Treatment
• Safe affordable housingSafe affordable housing
• Medical CareMedical Care
• Psychiatric CarePsychiatric Care
• Vocational/Employment AssistanceVocational/Employment Assistance
The Restoration Center Programs include:
• Public Safety Unit (PSU) Injured Prisoner Medical Clearance & Treatment
• 40 person sobering unit (4-6 hr stay)
• Detoxification Unit – 27 beds - 3 to 5 day stay
• Substance Abuse Intensive Outpatient Services 16 weeks- 6 days per week, 4 hrs per day counseling program
Substance Abuse System of Care
Partial/Day Hospital,Partial/Day Hospital,““Intensive” OutpatientIntensive” Outpatient
Outpatient TreatmentOutpatient Treatment
Urgent Care CenterUrgent Care Center“Front-Door”
•Substance Abuse Triage•Mental Health Jail
Diversion
Haven for HopeHaven for Hope•Homeless Housing Initiative
Recovery !Recovery !
Community PatientsCommunity Patients
XRelapse
Medical Detoxification Medical Detoxification
CHCS Detoxification CHCS Detoxification
Community PatientsCommunity Patients
Public Safety Sobering Unit
Cost is High Cost Savings can be achieved
Public Inebriates are sobered Up In Jail
Can Now Be Sobered upIn a location where treatmentIs possible.
Experienced Peer Recovery Specialists provide Motivation to enter treatment
RNs monitor/evaluate 24/7
Therapeutic Justice Partnershipswith Bexar County Community
Supervision and Corrections Dept.• Two-100 Bed Substance Abuse Treatment Facilities (SATF-1 & SATF-2,
• 60 Bed Young Adult “boot camp” residential facility- Zero Tolerance)
• One- 60 Bed Dual Diagnosis Unit (MH/SA) Mentally Ill Offender Facility• Outpatient Substance Abuse Treatment Program (lH 10)
• Dual Diagnosis Outpatient Substance Abuse Program (Palo Alto)
• Drug Court Treatment Services, Dual Diagnosis Drug Court Treatment Services, Mental Health Court Services, and the upcoming commencement of Veteran Drug Court Services.
Therapeutic Jurisprudence Partnerships with
the Public Inebriate PopulationApril 16, 2008 – March 31, 2009
Cost Category City of San Antonio
Bexar County Direct Cost Avoidance
Public Inebriates Diverted from Detention Facility
$435,435. $1,983,574. $2,419,009.
Injured Prisoner Diverted from UHS Emergency Room
$528,000. $1,267,200. $1,795,200.
July 2010 Update
July 2010 Update
July 2010 Update
Cost Category City of San Antonio Bexar County Direct Cost Avoidance
Public Inebriates Diverted from Detention Facility
$435,435 A.
$1,983,574 B.
$2,419,009
Injured Prisoner Diverted from UHS ER
$528,000 C.
$1,267,200 D.
$1,795,200
Mentally Ill Diverted from UHS ER Cost
$322,500 E.
$774,000 F.
$1,096,500
Mentally Ill Diverted from Magistration Facility
$208,159 G.
$371,350 H.
$579,509
Reduction in Competency Restoration Wait Time in Jail for Hosp Admission 5/08-3/09
0 $255,055 I.
$255,055
Reduction in Wait Time in Jail for Outpatient Competence/Wait Time for Restoration compared to Inpatient
0 $137,898 J.
$137,898
Reduction in Jail Time for Competency Restoration on Bond and on Return
0 $385,522 K.
$385,522
Total $1,494,094 $5,174,599 $6,668,693
Combined CCC and Restoration Documented and Immediate Cost Avoidance
Centralized Services Sites
Haven for Hope
The Community Wide InitiativeHaven for Hope and CHCS
collaborationGoal:
To increase the community capacity for mental health, substance abuse and
detoxification services
Haven for Hope Homeless Facility CNN Video Clip
• http://www.diversioninitiatives.net/2010/07/haven-for-hope-cnn-video-just-before.html
Haven for Hope Facts• Haven for Hope is the largest, most comprehensive
Homeless Transformation Campus in the U.S.A. • Haven for Hope conducted a best practice study
reviewing the homeless services in 12 states and over 200 shelter operations.
• The Haven for Hope Campus is made up of 15 Buildings, on 37 Acres, with almost a half a million square feet of service space under roof.
• Haven for Hope currently has a network of service provision with 78 non-profit and government Partner Agencies
• On any given night there will be roughly 1600 individuals residing on the Haven for Hope Campus.
http://havenforhope.org
Haven for Hope Campus
http://havenforhope.org
Haven For HopeDaily Counts Report
7-20-2010
Campus Intakes Today Total
Men 1 350
Women 2 109
Family Today Total
Adults 0 116
Children 0 166
Total Campus Intakes
3 741
PCY Intakes Today Total
Total PCY Intakes
5 1098
PCY+Campus Intakes
8 1839
Current Residents
Today Total
Men 3 294
Women 2 106
Family Today Total
Adults 0 113
Children 0 138
For additional information online
Copies of this presentation and additional data on diversion initiatives
can be found at:
http://diversioninitiatives.net
The Center for Health Care Services
Leon Evans, President/CEOThe Center for Health Care Services
Mental Health Authoritywww.chcsbc.org