National Association of County Behavioral Health and Developmental Disability Directors
2008 Legislative and Policy ConferenceFebruary 29, 2009Washington, DC
Gilbert R. Gonzales, Chief, Development and Community Action
The Center for Health Care ServicesBexar County, San Antonio Texas
Leon Evans, President and Chief Executive OfficerThe Center for Health Care Services
NACBHDD Corrections CommitteeBexar County Jail Diversion Initiatives
NACBHDDCorrections Committee
CORRECTIONSWE
NACBHDD
National Leadership Forum for Behavioral Health and Criminal Justice
ServicesSt. Gregory Hotel Washington, DC
February 26, 2008
Goals (for serving justice involved persons with mental illness)
• Provide a forum to create new partnerships and products
• Stimulate innovative thinking about effective collaborations
• Influence Policy and Legislation
• Improve practice
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UpdateJail Diversion
Crisis Services
The Center for Health Care Services
Community Wide Jail DiversionThe Problem
• Criminalization of Mentally Ill• Inappropriate Cost to Society
–20% + in jail– Increase use of emergency rooms–Homelessness
• Public Safety Net–Consumers at risk–Law Enforcement at risk–Public at risk
Community PartnershipCity GovernmentCounty GovernmentState GovernmentUniversity – LocalPrivate HospitalsLaw EnforcementCriminal/Civil CourtsAdvocacy – NAMIConsumersSan Antonio State HospitalMental Health Partners
The Jail Diversion Over-sightCommittee
The Jail Diversion Planning & Advisory Committee
How We Started
Community Medical Directors Roundtable
Private SponsorshipAztrazeneca
Transformation
Collaborative
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 CriminalTreatm
entC
ontinuity of Care
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
Crisis Care Center• 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
Crisis Care Center SummaryActual Facility Total Seen = 7,619
(from Sep 05 to Aug 06)
Summary Stats
Sep - Dec 2005
Monthly Average Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06 Total
Facility Total 2777 694.25 666 523 770 463 670 600 581 569 7619
Psychiatric Crisis Clinic 2076 519 497 405 609 313 487 425 418 443 5673
Express Med Clinic (Med
Clear) 701 175.25 169 118 161 150 183 175 163 126 1946
Express Med Stats
Sep - Dec Average Jan-06
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06 Total
Cases Requiring Lab and/or X-Ray 236 59 56 40 41 44 67 47 60 38 629
First Year of
Operations
Opened Aug 30, 2005 Hurricane Katrina Evacuees Arrive Aug 31, 2005 Full Year Completed Aug 31, 2006
Crisis Care CenterPreliminary DATA (continued)
Then
• Wait times for Medical Clearance/ Screening at UHS ER - 9 hours, 18 minutes. • Wait times for Medical Clearance/ Screening and Psychiatric Evaluation is 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 .
WAIT TIME for LAW ENFORCEMENT
Crisis Intervention TrainingFor Law Enforcement
The Crisis Intervention Teams (CIT) – *Officers trained by Law Enforcement
and Mental Health Personnel via a 40 hour
curriculum including role play demonstrations. * Weekly operational meetings with MH
and Community Stakeholders * Work jointly on identified high utilizers
Texas Department of Criminal JusticeMHMR Match Statistics
October, 2007
C.I.D. Parole Probation TotalTotal TDCJ Population 152,661 77,755 432,359 662,775
# of Care Matches* 40,883 19,763 54,727 115,373
% of Total Population 26.78% 25.41% 12.65% 17.40%
*Represents all Clients served since 1985, including those whose diagnosis is no longer eligible for MHMR
Program Recidivism RateGenesis – Offender Outpatient program for
Felony Probation and Parolees FY 2007
429 - Felony Probation and Parole Offenders Served
29 - Re-arrested
State Revocation/Decompensation rate (without treatment)= 52%
Genesis Revocation Rate (with treatment)= 6%
Re-incarceration/Re-HospitalizationSample Outcome: Forensic Intensive Case
Management - 2006
• Objective: Reduce rates of re-incarceration for Manos program mentally ill offenders released from jail or prison by 25%.
– Of the 371 patients admitted to the Manos Program, 23 were re-incarcerated for a 6.2% rate. This compares to a re-incarceration rate of 67% for mentally ill offenders without the intensive case management services offered by the jail diversion program.
• Objective: Reduce rates of hospitalization for Manos program mentally ill offenders released from jail or prison by 25%.
– Of the 371 patients participating in the jail diversion program 12 were hospitalized after diversion for a program rate of 3.2%.
Manos – a post diversion program for misdemeanor offenders
Partial/Day Hospital,“Intensive” Outpatient
Substance Abuse System of Care
Outpatient Treatment
Urgent Care Center“Front-Door”
• Substance Abuse Triage
• Mental Health Jail Diversion
Haven for Hope• Homeless Housing Initiative
Recovered !
Community Patients
XRelapse
Medical Detoxification CHCS Detoxification
Community Patients
The MAP
CHCS Urgent Care Center (2) Emergency Psychiatric Screening
County Jail (6)
Community MedicalClinic (1)
CHCS Detox Center (3)
CHCS Substance Abuse Outpatient Services (5)
600 Bed HomelessResidential Facility (4)
Research
The Bexar County Jail Diversion Program:Measuring the Potential Economic and Societal BenefitsPolicy Report
Michael Johnsrud, PhD Sponsored by the Associate Director Center for Health Care Services
The Center for Pharmacoeconomic Studies Robert L. Jimenez, M.D., F.A.P.A ChairmanThe University of Texas at Austin Leon Evans, President and CEODecember 2004
Dr. Johnsrud - Findings• In the last decade, persons with mental illness
accounted for 7% of all police contacts, 16% of prison inmates, and 7% of the entire jail population.
• As a percentage of total county revenues, Bexar County spends approximately 75% of all public funds on law enforcement, detention, and the justice system. As much as 14% of the Bexar County jail population is estimated to have a mental illness.
• Interim results of the program show over 1,700 diversions from jail incarcerations during state Fiscal Year 2004, potentially resulting in an estimated range of $3.8 million to $5.0 million dollars in avoided costs within the Bexar County Criminal Justice System.
RTI International is a trade name of Research Triangle Institute
Jail Diversion in Bexar County, Texas:
A Cost Study
Presented by Alexander J. Cowell
2008
Study Objectives• 4 Inter-connected Objectives
OBJECTIVE 3
Assess the Cost-Effectiveness of Diversion
“What is the program’s bang-for-buck?”
OBJECTIVE 1
Compare the costs of pre-booking and post-
booking diversion
“What does each type of diversion cost?”
OBJECTIVE 2
Assess Cost-shifting Between Criminal Justice
System and Treatment
“Are increased treatment costs offset by reductions in criminal justice costs?”
OBJECTIVE 4
Refocus Objectives 1-3 on Crisis Care Center (CCC)
Methods: Research Question 1a• Estimate the value of the resources needed to
start the program
Pre-booking: Who Pays What Share
CHCS - Residential Specialist45.82%
Sherif f - DMOT<1%
County/City Courts - Magistrate Judge
<1%
SAPD - Off icer3.34%
CCC - Med. Clearance4.27%
CHCS - Assessors<1%
CHCS - Psychiatrist23.99%
CHCS - Clerical Staff<1%
CHCS - Nurse19.15%
County/City CourtsClerk<1%
Sherif f - Off icer1.50%
Post-booking Bond: Who Pays What Share
County/City Courts - Nurse4.95%
County/City Courts - Assistant District Attorney
2.69%
County/City Courts - Defense Attorney35.69%
County/City Courts - Magistrate
4.04%CHCS -Clinician
2.51%
CHCS - Casew orker3.92%
PTS - Pretrial Bond Officer46.20%
Post-booking Docket: Who Pays What Share
CHCS - Clinican<1%
CHCS - Casew orker49.03%
County/City Courts - Defense Attorney40.27%
County/City Courts - Assistant District Attorney
3.03%
County/City Courts - Magistrate4.56% County/City Courts - Jail Staff
<1%
PTS - Population Monitor1.59%
Jail Diversion Toolkit – Coming soon, May 2008
Leon Evans, President and Chief Executive Officer, The Center for Health Care Services San Antonio, Texas
For additional information contact: Leon Evans, Ph. 210 731-1300 Email: [email protected]
Thank you !
www.chcsbc.org