the psychology of hoarding - tmcec · animals until they interfere with day‐to‐day functions...

1

The Psychology of Hoarding

Stephen A. Thorne, Ph.D.Texas Municipal Courts Education Center

Austin, TexasFebruary 27, 2015

(512) 342‐1661 (ph) 512‐306‐9234 (fax)[email protected]

Research Assistant: Lauren Farwell, M.A.

Hoarding? Messy? Pack Rat? ADHD? OCD? Normal? Cat Lady?

Hoarding Defined

• Hoarding can be defined as:

– “the excessive collection and retention of things or animals until they interfere with day‐to‐day functions such as home, health, family, work and social life”.

(Fairfax County Hoarding Task Force Annual Report, 2009)

• Hoarding is a multi‐faceted problem that has a variety of psychological, physical welfare, economic, and public safety implications.

2

Not a diagnosis, but…

“Hoarding” is NOT a DSM‐IV‐TR diagnosis and there are no universally accepted diagnostic criteria. Frost and Hartl (1996) do, however, offer the following hallmarks of hoarding:

• The acquisition of and failure to discard a large number of possessions that appear to be useless or of limited value.

• Living spaces sufficiently cluttered so as to preclude activities for which those spaces were designed.

• Significant distress or impairment in functioning caused by the hoarding.

• Reluctance or inability to return borrowed items; as boundaries blur, impulsive acquisitiveness could sometimes lead to kleptomania or stealing.

Hoarding is NOT…

‐Being messy (lucky for me).

‐Collecting a bunch of “stuff”.

‐Having a lot of trash in your backyard.

‐A filthy/cluttered house.

‐Simply having too many of something.

‐Being a big‐time animal lover.

Hoarding IS…

Excessive and seemingly unreasonable keeping of things (i.e. animals, inanimate possessions), in such a way that significantly impairs/disrupts the day‐to‐day use of the residence. The need/desire to keep these objects assumes TOP PRIORITY (more important than anything else), and, as such, friends/family/loved ones (frequently children, elderly, disabled), animals, work, health, safety, and self‐care may be neglected and/or ignored.

3

Hoarder Profiles

1. Good Samaritan

2. Disabled / Elderly Person

3. Cruel / Neglectful Person

4. True Hoarder

Kaup‐Fett, CCCHD (2010)

Good Samaritan Characteristics

• This person has taken on a burden in order to do a good thing but has become overwhelmed.

• Intervention by government officials may be perceived as threatening or insulting since their intentions are not to harm.

• This person is generally capable of correcting the problem with assistance.

• This person is generally willing to accept help in obtaining the desired end point as long as euthanasia is not an option for the animals.

Disabled/Elderly Person Characteristics

• This person has gradually decompensated, through disability, age or isolation, and is unable to manage his/her life and possessions. Intervention may be perceived as threatening and frightening.

• This person is generally capable of correcting the problem with help.

• This person is generally eager to accept help in obtaining the desired end point after they are reassured that no one is trying to force them into a home or euthanize their pets.

4

Cruel/Neglectful Person Characteristics

• This person has allowed the environment to become unsafe and unsanitary through neglectful or purposeful means.

• This person may acknowledge your viewpoint, but will resist or refuse to correct the problem due to ulterior motives, such as:– money from the sale of purebred animals– sport– desire for “power” or displaced anger– a cruel and vindictive temper– reckless indifference to pain or neglect– drug abuse

True Hoarder Characteristics

• This person may feel threatened or insulted any type of intervention. He/she truly believes they are improving the condition of the animals (disease & starvation) within their household environment (in spite of overcrowding & unsanitary conditions).

• This person typically responds to intervention attempts with hostility and disinterest and may appear not to fully grasp the plight of the animals, his or her own health and well‐being, and on that of other household members.

• May often be disinterested or hostile to the negative effect of the animals or trash on the health and welfare of neighbors.

In short…

• Good Samaritan and Elderly/Disabled Person situations are fairly easy to resolve due to lack of ill intentions and good faith desire.

• Cruel / Neglectful Person typically requires enforcement to resolve their situation.

• The True Hoarder requires special attention, resources to successfully resolve their situation due to lack of insight and desire to change their situation.

5

Where Does It Come From?

Hoarding appears to be a secondary symptom of one or more of the following problems:

• Delusional disorders and grandiosity

• Obsessive‐Compulsive Disorder

• Dementia/Cognitive deterioration

• Addiction and/or substance abuse

• Zoophilia

• Attachment disorders

• Depression/anxiety

Intervention: Sometimes Too Little Too Late

• Citizens do report compromised/ blighted properties, and neighbors do complain about residents that neglect property and create a public nuisance. That being said, interior hoarding conditions are rarely discovered until an emergency arises. A true hoarder may also be able to defend, hide or mask the severity of their living situation very well, and therefore serious situations may go unreported.

Levels of Hoarding

6

Animal Hoarding

Animal Hoarder ‐ Definition

Any individual who possesses a large number of companion animals, fails to provide adequate nutrition and veterinary care, and keeps the animals in a severely overcrowded environment.

Fleury, 2007

Real Consequences…

• Many animal hoarders also neglect or provide inadequate care to humans (including self, children, elderly, disabled) in the home. Negative effects include complications from infection, inadequate nutrition, lack of water/electricity/bathroom. Fire hazards and insect infestations are also common. Animal waste toxicity produces an especially dangerous living situation.

• Animal victims also prone to psychological, behavioral, and/or physical problems, and, as such, have difficulty being placed or adopted. Many animal victims undergo euthanasia after being placed in shelter.

7

Animal Hoarder Profile

• 76% are female.

• Most are unmarried and most live alone.

• 46% are age 60 or older.

• 65% keep cats. 60% keep dogs.

• 80% have dead or sick animals in the home.

• 69% have animal feces and urine in the living areas.

• 60% are repeat offenders.

• Most hoarded inanimate objects as well.» Clark County Health District, 2010

A few more stats…

• Cats, dogs, birds, and farm animals most commonly hoarded (Patronek, 1999).

• 80% hoarded inanimate objects (Patronek, 1999).

• Avg. # of animals per case – 39 (Patronek, 1999).

• Nearly 100% recidivism after prosecution (Patronek, 2006).

• 34% of animal hoarders found to have one or more dead animals in home (Berry, Patronek, & Lockwood, 2005).

Understanding the Animal Hoarder

Who?

Men, women, young, old, all SES, all nationalities, all education levels. Though not universal, many animal hoarders live a rather solitary lifestyle. Many animal hoarders also started collecting various items/objects as a child.

What?

Keeping/housing a larger than usual number of animals and providing them with inadequate care, while at the same time being unable to recognize/understand, or simply disregarding, the adverse effect of the environment on the health and well‐being of animals/humans in the home. Denial is a core feature.

8

Why?

Hoarders, in general, often view their possessions as being a core component (if not the core component) of their identity. Animal hoarders care deeply about their animals/pets and find it extremely difficult to let them go. They typically cannot comprehend that they are in any way harming the animals and, in fact, truly believe they are improving the life of the animal and doing what “is right” for the animals, if not truly “saving them” (all the while believing others should respect/admire them for their actions). Hoarding” can provide them with self‐esteem and purpose. If their purpose/self‐esteem is challenged, this is when they tend to go to greater and/or more pathological means to defend their actions. Excuses and/or shifts of blame are common, and they generally lack insight (or interest) into the various negative effects of the hoarding behavior.

Intervention

Key word = multidisciplinary.

‐Human health and social services‐Housing authorities‐Legislators‐Community health professionals‐Animal welfare professionals

Fleury, 2007

The American Society for the Prevention of Cruelty to Animals hasdeveloped a “Hoarding Prevention Team” to assist hoarders.

Treatment?

• Psychopharmacological treatment.

Various antidepressants are prescribed to manage symptoms. This should not be viewed as a “cure”.

• Generally a consensus that psychotherapy is needed in conjunction with meds. Appears to be some empirical support for ERP as therapy modality. Remember, however, relapse rates for animal hoarders are extremely high, as truly addressing the denial and/or delusional thinking associated with hoarding can be quite the challenge.

1

Behavioral Health Issues andCrisis Services

for Adults & Juveniles

Brettany H. Boozer, LCSW & Courtney Heard, Ph.D., LPC

TMCEC One-Day Clinic

Austin, Texas

Copyright © Heard, C. & Boozer, B. (2015)

What Is Mental Illness?

National Alliance of the Mentally Ill (NAMI) reports that a mental illness is a medical condition that disrupts a person's thinking, feeling, mood, ability to relate to others and daily functioning (NAMI, 2014)


Serious Mental Health Diagnoses

Some Serious Mental Illnesses Include:

Major Depressive Disorder

Schizophrenia

Bipolar Disorder

Post-Traumatic Stress Disorder (PTSD)


2

Who Gets a Mental Health Diagnosis?

The reality is that any of us, at any time, given the right set of circumstances, can experience the

symptoms of a mental health diagnosis


Who Makes a Mental Health Diagnosis?

In Texas, individuals with the following licensure type can make a mental health diagnosis: Medical Doctor

Psychiatrist

Licensed masters-level counselor

Licensed masters-level social worker

Licensed masters-level psychological associate


Emotionally Disturbed

Since only certain professionals can make a mental health diagnosis, law enforcement has developed an appropriate descriptor of someone who might be experiencing a mental health diagnosis:

Emotionally Disturbed Person (EDP)


3

Emotionally Disturbed?

Common Symptoms of Emotionally DisturbedWithdrawn IrritableUnreasonable ArgumentativeUnkempt LethargicEmotionally Volatile

Triggers for Someone Emotionally DisturbedTraffic TaxesTeenagers TraumaSubstance Use Mental Health Diagnosis


Effective Problem Solving

Think about a time you were really upset What would have helped you gather yourself together?

What worked?

What didn’t?


De-escalation

What is the most effective outcome of dealing with someone who is emotionally disturbed and may be experiencing a mental health diagnosis?

What do we want to have happen?

What works?


4

Do’s and Don'ts

Do’s Remain Calm Speak in a measured

tone of voice Monitor body language Be ready to calmly

remove the individual from the situation

Provide reassurance and validation if needed

Don’ts Become agitated Speak loudly Appear threatening Be ready to “take down”

or “detain” the individual Take the “my way or the

highway” approach Spell out the

“consequences”


Communication Skills

Active Listening

Empathetic Responses: Maintain Non-threatening Eye Contact

Body Language

Volume and Validation


Validation?

Validation is not “agreeing” with someone. Validation is acknowledging that an individual’s experience makes sense to them “Being around a lot of people right now appears to be

concerning to you.”

“I imagine if my wife were taking me to court of child support, I’d be upset too.”


5

It’s Not Working….

When do you call? Despite your attempts if the person is not or cannot be

re-directable

The person begins to actively be a danger to his or her self or others


Who Do You Contact?

Contact the Local Mental Health Authorities (LMHA) Crisis Hotlines are listed at

http://www.dshs.state.tx.us/mhsa-crisishotline/

Search the DSHS MHSA online database by city, county, or ZIP code: http://www.dshs.state.tx.us/mhservices-search/

LMHAs are listed at http://www.dshs.state.tx.us/mhsa/lmha-list/


Crisis Services: Jail Diversion

6

Mental Health Diagnosis and Jail System

ADULTS:In Fiscal Year (FY) 2014, a total of 42,743 individuals were admitted to state prisons and 22,272 were admitted to state jailsAccording to the Texas Correctional Office of Offenders With Medical or Mental Impairments (TCOOMMI): As of 2009, there were a total of 665,940 individuals who had a previous

encounter with a Local Mental Health Authority (LMHA) or Local Behavioral Health Authority (LBHA) (i.e. Mental Health and Mental Retardation (MHMR) Centers) 37,865 of these individuals had a diagnosis of Bipolar Disorder, Schizophrenia,

or, Major Depressive Disorder This figure included individuals on probation, parole, and detained in correctional

institutional divisions

In 2010, the total number of individuals who had a previous encounter with an LMHA or LBHA decreased to 660,820 However, there was an increase in the number of individuals identified to

have a core mental illness to include Schizophrenia, Bipolar Disorder, and Major Depressive Disorder to 40,232


Mental Health Diagnosis and Jail System

YOUTH:There were 63,914 formal referrals to Juvenile probation departments throughout the state in FY 2014

TDCJ-TCOOMMI FY 2012

Served a statewide total of 1,983 juvenile probationers and Texas Juvenile Justice Department (TJJD) parole clients, which represents a small segment of those juvenile offenders with mental health diagnoses

FY 2013Estimated that 33% of youth in the juvenile probation justice system and 60% of TJJD institution admissions have a diagnosed mental health disorder


DSHS Diversion Initiatives-Adults

Assertive Community Treatment (ACT) Teams Interdisciplinary model of treatment

Psychiatrist

Nursing staff

Social workers

Mental health professionals

Target diagnosis: Schizophrenia

History of multiple psychiatric hospitalizations

Texas ACT ACT is the most intensive level of service provided by the LMHA or LBHA

Case-management caseloads of no more than 10

Each individual is provided services equating to an average of 10 hours a month


7


Other ACT Services Forensic Assertive Community Treatment

Offer the intensity of services associated with ACT

Clients: Extensive arrest histories

Chronic symptoms of mental illness, and/or

History of multiple psychiatric hospitalizations

Referred to programming from criminal justice agencies

Non-engagement in services may include legal sanctions



Harris County Jail Diversion Program Senate Bill 1185 This program will operate for a period of 3 years Treatment must incorporate principles of Critical Time Intervention Program staff will provide community-based jail diversion services to

individuals with: Mental illness with or without substance abuse/use: Major Depressive

Disorder, Schizophrenia, Bipolar Disorder, and PTSD Current treatment in Harris County Sheriff’s Office (HCSO) Mental Health

Unit History of recurring psychotropic medication treatment in HCSO Must have one or more of the above criteria and 3 or more bookings within

the past 2 years

Program Goals: Reduce recidivism rates Reduce the frequency of arrests of individuals with mental illness



Outpatient Competency Restoration (OCR) Programs 80th Legislative Session DSHS allocated $4,000,000 to establish 4 OCR pilot programs

82nd Legislative Session Rider 78 mandated that 5 new OCR pilots be established

Treatment Contract with LMHAs and ValueOptions-NorthSTAR Provide restoration to competency Case-management Services Medication Supportive employment Housing Counseling Substance use treatment


8

DSHS Diversion Initiatives-Adults and Children

Texas Correctional Office on Offender’s with Medical or Mental Impairments (TCOOMMI)

Contract with the LMHAs or LBHA

Program – 2 years

Treat people on probation or parole with severe and persistent mental illness

Provide intensive case-management services Supported employment

Permanent supportive housing

Co-occurring Psychiatric and Substance Abuse Disorders treatment

Cognitive Behavioral Therapy


DSHS Diversion Initiatives-Adults and Children

Partnering with county jails, the District Attorney’s Office, and the courts Texas Law Enforcement Telecommunications System

(TLETS) 80th Legislative Session, Senate Bill 839 When an individual is booked into any county jail, a TLETS query is

initiated First name, last name, date of birth, gender, race, and social security

number; Entered into the TLETS portal; and Matched against names that are in the CARE system operated through

DSHS If a partial or exact match is yielded The jail is notified and they notify the LMHA or LBHA LMHA or LBHA – conducts a screening The goal is to link the inmate to community mental health services


DSHS Diversion Initiatives-Children

Residential Treatment Centers (RTCs): Provides 24-hour care for children 18 years of age or less

Offers programmatic services such as transitional living or emergency care, or may offer treatment services for emotional disorders or primary medical needs

DSHS and DFPSDeveloped an RTC initiative

Provides an intensive service alternative for children/youth at risk for parental relinquishment of custody due to a lack of mental health resources

Children between 5 and 17 years of age are referred by DFPS’ Child Protective Services in collaboration with LMHAs and have “no finding” of abuse/neglect by the parents/guardians. LMHAs provide assessments and access to RTCs

Waco Center for Youth Residential Treatment Center: A state-operated, psychiatric residential treatment facility

Serves adolescents 13 to 17 years of age with significant or severe emotional difficulties and/or behavioral problems.

Serves approximately 70 youth from across the state and is located in Waco

9

DSHS Diversion Initiatives-Children

Youth Empowerment Services (YES):

Serves youth 3 to 18 years of age

Services are geared towards children who would otherwise need an institutional level of care or whose parents would turn to out-of-home placement due to the child/youth’s serious emotional disturbance (SED)

Treatment is provided in a child’s home and local community

Individuals must be eligible for Medicaid and meet specific requirements to receive services

Services are currently available in Travis, Bexar, Tarrant, Harris, Cameron, Hidalgo, Willacy, Williamson, Burnet, and McLennan counties. The remaining Texas counties are anticipated to begin enrolling participants by September 2015

For More Information:

Courtney Heard, Ph.D, LPCDepartment of State Health ServicesProgram SpecialistEmail: [email protected]: 512-206-5081Fax: 512-206-5303

Brettany H. Boozer, LCSWDepartment of State Health ServicesProgram SpecialistEmail: [email protected]: 512-206-4563Fax: 512-206-5805

&


Questions


Crisis Services

1

Behavioral Health Issues and Crisis Services for Adults and Juveniles

Brettany Boozer, LCSW & Courtney Heard, Ph.D., LPC

Texas Department of State Health Services

Heard, C., & Boozer, B. (2015, February). Behavioral health issues and crisis services for adults and

juveniles. Educational session presented at the Mental Health Issues and Procedures in

Municipal Courts, Austin, TX.

Jail Diversion involves collaboration between Local Mental Health Authorities (LMHA),

NorthSTAR, and judicial officials such as judges and representatives from the District

Attorney’s Office, and law enforcement. Jail Diversion in the state of Texas parallels the

Sequential Intercept Model published by the Substance Abuse and Mental Health Services

Administration (SAMSHA), with jail diversion occurring across five intercepts: law

enforcement, initial detention/initial court hearings, jails/courts, re-entry, and community

corrections (i.e.

http://gainscenter.samhsa.gov/pdfs/integrating/GAINS_Sequential_Intercept.pdf).

In Texas, there are two overarching methods of jail diversion (i.e., Adults and Children):

1. Crisis Response Services: Mobile crisis response and crisis facilities

2. Access to Ongoing Care: Characterized by interagency collaboration to provide linkage to

on-going mental health treatment which may occur pre-booking, or post-booking of an inmate.

For some, additional supports may be provided through the Texas Correctional Office on

Offenders with Medical or Mental Impairments (TCOOMMI) to avoid future interaction with

law enforcement.

The ultimate goal of jail diversion practices is to intervene at the earliest point of the intercept

model; thus, there is a primary focus on pre-booking interventions.

Crisis Response Services

Pre-booking activities are designed to provide an intervention to individuals arrested for

committing a crime prior to being booked in jail for the arrest. Pre-booking is the most

frequently employed jail diversion strategy. Two overarching pre-booking diversion strategies

are crisis response services and Crisis Intervention Training (CIT) for law enforcement officials.

Crisis response services. The 80th

Texas Legislature appropriated $82 million for the Fiscal

Year 2008-2009 biennium. Guiding the appropriation of these funds was the expansion of crisis

services in the areas of mental health and substance abuse. Services that were implemented, or,

http://gainscenter.samhsa.gov/pdfs/integrating/GAINS_Sequential_Intercept.pdf

Please address correspondences electronically to the presenters at

[email protected], or, [email protected].

enhanced included crisis hotline, Mobile Crisis Outreach Teams (MCOT), and Psychiatric

Emergency Service Programs, all of which are currently utilized for jail diversion purposes.

Crisis Hotline – Crisis hotline services are available 24/7 and serve as the first point

of contact for mental health crises in the community. Qualified staff determines if

mobile emergency services are required to further assess the caller’s needs.

MCOT – These services are available 24/7 and are often the result of a referral that is

obtained through the crisis hotline. MCOTs deploy to various sites in the community

where a crisis situation has been reported. Generally, they are accompanied by law

enforcement.

PESC Programs – PESC programs encompass facilities that are staffed with mental

health and medical professionals that offer assessment and psychiatric stabilization to

individuals with behavioral health issues. These sites can be used for jail diversion

strategies, as law enforcement is encouraged to utilize these services, to achieve

detainee stabilization as an alternative to jail booking. A variety of PESC programs

are available:

o Extended Observation Units (EOU) - Extended observation units are designed

to provide emergency stabilization to individuals in behavioral health crisis

for up to 48 hours.

o Crisis Residential Services - Crisis residential services provide short-term,

community-based residential crisis treatment to persons who may pose some

risk of harm to self or others, and who may have fairly severe functional

impairment. The recommended length of stay ranges from 1-14 days.

o Crisis Respite Services - In contrast with crisis residential services, crisis

respite services provide short-term, community-based residential, crisis

treatment to persons who have low risk of harm to self or others and may have

some functional impairment who require direct supervision and care, but do

not require hospitalization.

o Inpatient Hospital Services - Hospital services staffed with medical and

nursing professionals who provide 24-hour professional monitoring,

supervision, and assistance in an environment designed to provide safety and

security during acute behavioral health crisis.

o Crisis Stabilization Units (CSU) - Short-term residential treatment designed to

reduce acute symptoms of mental illness provided in a secure and protected

clinically staffed, psychiatrically supervised, treatment environment that

complies with crisis stabilization unit licensing requirements.



Crisis intervention training (CIT)/mental health deputy/peace officer programs (i.e., Adults

and Children). In 2005, the Texas Commission on Law Enforcement Officer Standards and

Education mandated that all cadets receive 24 hours of crisis intervention training. This mandate

has since been changed to 16 hours. However, through the development of CIT, officers have

the opportunity to enhance their awareness of intervening with behavioral health populations

through taking a 40 hour course. CIT or, mental health deputy officers are generally called upon

when there is an individual with behavioral health issues in a crisis requiring law enforcement

intervention. These officers generally have strong collaboration with LMHAs and other agencies

that treat behavioral health issues. As an alternative to booking the individual into county jail,

many of these officers will transport the individual to a local treatment facility as a jail diversion

strategy.

Critical time intervention (CTI): Harris County Jail Diversion Program (i.e., Adults). S.B.

1185 of the 83rd

Legislative Session mandated the development of a jail diversion pilot program

in Harris County to reduce recidivism and the frequency of arrests and incarceration among

persons with mental illness. The 2014-2015 General Appropriations Act, S.B. 1, 83rd

Legislature, 2013 (Article II, Department of State Health Services, Rider 95) allocates $10

million to the establishment of the program, to which Harris County must match the dollar

amount. Services provided to participants will include integrated medical, mental, and physical

treatment. Additionally, the bill mandated that treatment encompass CTI principles, which

include psychiatric treatment and medication management, money management, substance abuse

treatment, housing, and life skills training.

Forensic Commitments

Outpatient Competency Restoration (i.e., Adults). S.B.867 of the 80th

Legislature amended

Chapter 46B of the Code of Criminal Procedure: Incompetency to Stand Trial. These

amendments explicitly permitted the outpatient treatment of individuals found incompetent to

stand trial, and determined not to be a danger to the community, for the purpose of competency

restoration treatment (see Article 46B.072. a-1). The Department of State Health Services

(DSHS) was provided funding to establish pilot sites for the implementation of OCR programs,

through local mental health authorities (LMHA), in collaboration with local judicial officials.

Since 2008 there have been twelve OCR sites established:

Center for Health Care Services - Bexar County

Austin Travis County Integral Care - Travis County

ValueOptions – NorthSTAR - Dallas County

MHMR of Tarrant County - Tarrant County

Emergence Health Network - El Paso

Gulf Coast Center & Tri-County Services - Galveston and East Texas areas

Spindletop Center - Beaumont area

StarCare Specialty Health System - Lubbock



Behavioral Health Center of Nueces County - Nueces County

Andrews Center Behavioral Healthcare Center - Tyler area

Community Healthcore - Longview area

Heart of Texas Region MHMR Center – Waco

Jail-based Competency Restoration Pilot Program (i.e., Adults). S.B. 1475 of the 83rd

Legislative Session directed DSHS to pilot a jail-based competency restoration program. The

2014-2015 General Appropriations Act, S.B. 1, 83rd

Legislative Session, 2013 (Article II, DSHS

Rider 74) appropriated $3.05 million for this purpose. S.B. 1475 requires that this pilot:

employ similar clinical treatment provided as part of a competency restoration

program at an inpatient mental health facility;

provide weekly treatment hours commensurate to the treatment hours provided as part

of a competency restoration program at an inpatient mental health facility; and

assign a staff to participant/defendant average ratio of not lower than 3.7 to 1.

Access to Ongoing Care

TCOOMMI (i.e., Adults and Children). In Texas, post-booking diversion strategies are

representative of interventions applied during Intercept 5of the Sequential Intercept Model.

TCOOMMI provides funding to some LMHAs for the development of treatment programs for

individuals on probation or parole. These individuals are generally identified by the courts to be

in need of mental health treatment. As a condition of their probation or parole, they must engage

in mental health treatment provided through the LMHA. Treatment generally entails linkage to

the LMHA where they meet with a case-worker weekly, receive psychotropic medication

treatment via a psychiatrist, and receive additional services consistent with the DSHS Texas

Resilience and Recovery Utilization Management Guidelines (i.e. visit

http://www.dshs.state.tx.us/mhsa/trr/um/ click on Texas Resilience and Recovery Utilization

Management Guidelines – Adult Services). If the individual complies with treatment, charges

may be dropped, severity of the offense may be reduced, or the sentence may be reduced.

Extended Jail Diversion Strategies

The below strategies may not be considered programs with the specific intent of diverting

individuals with mental illness out of the criminal justice system; however, they are strategies

implemented in Texas that have both direct and indirect influences on existing jail diversion

initiatives.

Texas Law Enforcement Telecommunications Systems (TLETS) (i.e., Adults and Children).

DSHS in conjunction with the Department of Public Safety (DPS) utilizes TLETS, which

permits the sharing of data between DPS and various agencies. Every individual booked into a

county jail receives a Continuity of Care Query (CCQ). The DPS TLETS permits that individual

(i.e. based on first and last name, date of birth, sex, social security number, and race) to be



searched across the DSHS Clinical Management for Behavioral Health Services system (i.e. a

data warehouse system including treatment information for all individuals who have received

services at institutions funded through DSHS such as LMHAs or state hospitals) to establish a

match of identity. Once a match is identified, the county jail receives a report with that

individual’s name and the location of the last LMHA in which a service was provided. County

jail staff contacts the LMHA to conduct a screening and provide linkage to mental health

services provided in the community via the LMHA, or, additional agencies (i.e. please see

http://www.dshs.state.tx.us/mhcontracts/ContractDocuments.shtm click on Information Item T).

Harris County Jail Diversion Pilot Program (i.e., Adults). S.B. 1185 of the 83rd

Legislative

Session mandated the establishment of a jail diversion pilot program that will operate for a

period of three years and treatment must incorporate principles of Critical Time Intervention.

Program staff will provide community-based jail diversion services to individuals with mental

illness with, or, without substance use issues. These individuals must have received treatment in

Harris County Sheriff’s Office (HCSO) Mental Health Unit, a history of recurring psychotropic

medication treatment in HCSO, and have one or more of the above criteria, as well as, three or

more bookings within the past two years. Program goals include reducing recidivism rates and

reducing the frequency of arrests for individuals with mental illness.

Health Community Collaboratives (i.e., Adults). S.B. 58 of the 83rd

Legislative Session directed

DSHS to enhance or expand existing services to persons experiencing homelessness and mental

illness in the 5 largest metropolitan cities in Texas. DSHS was allocated $6.9 million for Fiscal

Year (FY) 2014 and $16.5 million for FY 2015 for the implementation and expansion of these

projects. An example of such a project is Haven for Hope located in San Antonio. Haven for

Hope is a hub for individuals who are homeless. Law enforcement officers may drop off

individuals who are homeless at this site for assessment and linkage to treatment services. While

residing at Haven for Hope, individuals are provided with employment and job readiness

training, substance abuse treatment, education, spiritual, and additional services. Haven for

Hope services are rooted in a holistic and recovery-based treatment focus. There are over 80

organizations who partner towards maintaining Haven for Hope, 40 of which are located on the

premises.

Supportive housing and intensive community supports (i.e., Adults). The 83rd

Legislative

Session appropriated $24,840,940 towards the expansion of supportive housing for people with

mental illness who are homeless or at risk for homelessness. Eighteen LMHAs were awarded

funding towards the implementation of supportive housing to help stabilize a high need

population at potential risk of incarceration.

http://www.dshs.state.tx.us/mhcontracts/ContractDocuments.shtm

A Community Support Guide

for Alternatives to Inpatient

Mental Health Treatment

Mental Health and Substance Abuse Division

[Page intentionally left blank]

i

Hello from Lauren Lacefield Lewis, Assistant Commissioner It is estimated that one in five Americans will experience a mental health issue

during their lifetime and that one in 20 will develop a serious mental illness.

Mental illness is not a personality weakness; it is a disease like many other diseases, such as cancer or diabetes.

Our mission is to restore hope, resilience, and recovery for the people we serve. The good news is that

treatment works; recovery from a mental illness is possible; and help is available for Texans living with mental health issues and substance use disorders.

Inpatient care is an important part of the overall service array for people with mental illness. However, this guide is designed to educate the public about community treatment options that can be used to help

children and adults with behavioral health issues avoid inpatient treatment if a less intensive alternative is appropriate.

Beyond the behavioral health crisis system in Texas, there are numerous resources that can provide the support and treatment that people with mental illness may need to move toward recovery and avoid

psychiatric crises. Local Mental Health Authorities and NorthSTAR providers, located in the Dallas region, can help link people to these important services.

In addition, The Hogg Foundation for Mental Health has produced an overview of services across the

state. You may find this to be a helpful reference:

A Guide to Understanding Mental Health Systems and Services in Texas, Second Edition, 2014. https://hoggblogdotcom.files.wordpress.com/2014/12/mhguide_final-1.pdf.

https://hoggblogdotcom.files.wordpress.com/2014/12/mhguide_final-1.pdf

ii

[Page intentionally left blank]

iii

Table of Contents

About This Guide ........................................................................................................................ 1

Types of Services Available ........................................................................................................ 4

STATEWIDE RESOURCES

Northern Regions of Texas ......................................................................................................... 8

Local Mental Health Authorities: Betty Hardwick Center, Center for Life Resources,

Central Plains Center, Denton County MHMR Center, Helen Farabee Centers, Pecan Valley Centers for Behavioral & Developmental HealthCare, StarCare Specialty Health System,

MHMR Tarrant, Texas Panhandle Centers, Texoma Community Center, and NorthSTAR/Value Options

Counties: Archer, Armstrong, Bailey, Baylor, Briscoe, Callahan, Carson, Castro, Childress,

Clay, Cochran, Coleman, Collin, Collingsworth, Comanche, Cooke, Cottle, Crosby, Dallam, Dallas, Deaf Smith, Denton, Dickens, Donley, Eastland, Ellis, Erath, Fannin, Floyd, Foard,

Gray, Grayson, Hale, Hall, Hansford, Hardeman, Hartley, Haskell, Hemphill, Hockley, Hood, Hunt, Hutchinson, Jack, Johnson, Jones, Kaufman, King, Knox, Lamb, Lubbock, Lipscomb,

Lynn, McCulloch, Mills, Montague, Moore, Motley, Navarro, Ochiltree, Oldham, Palo Pinto, Parker, Parmer, Potter, Randall, Roberts, Rockwall, San Saba, Shackelford, Sherman,

Somervell, Stephens, Stonewall, Swisher, Tarrant, Taylor Brown, Throckmorton, Wichita,

Wilbarger, Wise, Wheeler, and Young

Eastern/Central Regions of Texas ...........................................................................................12

Local Mental Health Authorities: ACCESS, Andrews Center Behavioral Healthcare System, Austin Travis County Integral Care, Bluebonnet Trails Community Services, MHMR Authority

of Brazos Valley, Burke, Central Counties Services, Community Healthcore, Gulf Coast Center,

MHMR Authority of Harris County, Heart of Texas Region MHMR Center, Lakes Regional Community Center, Spindletop Center, Texana Center, and Tri-County Services

Counties: Anderson, Angelina, Austin, Bastrop, Bell, Brazoria, Brazos, Bosque, Bowie, Burleson, Burnet, Caldwell, Camp, Cass, Chambers, Cherokee, Colorado, Coryell, Delta, Falls,

Freestone, Fayette, Fort Bend, Franklin, Galveston, Gregg, Grimes, Guadalupe, Hamilton,

Hardin, Harris, Harrison, Hill, Henderson, Hopkins, Houston, Jasper, Jefferson, Lamar, Lampasas, Lee, Leon, Liberty, Limestone, Madison, Marion, Matagorda, McLennan, Milam,

Montgomery, Morris, Nacogdoches, Newton, Orange, Panola, Polk, Rains, Red River, Robertson, Rusk, Sabine, San Augustine, San Jacinto, Shelby, Smith, Titus, Travis, Trinity,

Tyler, Upshur, Van Zandt, Walker, Waller, Washington, Wharton, Williamson, and Wood

Southern Regions of Texas ......................................................................................................20

Local Mental Health Authorities: Border Region Behavioral Health Center, Camino Real

Community Services, The Center for Health Care Services, Coastal Plains Community Center, Gulf Bend Center, Hill Country Mental Health & Developmental Disabilities Centers, Behavioral

Health Center of Nueces County, and Tropical Texas Behavioral Health

Counties: Aransas, Atascosa, Bandera, Bee, Bexar, Brooks, Calhoun, Cameron, Comal,

DeWitt, Dimmit, Duval, Edwards, Frio, Gillespie, Goliad, Hidalgo, Jackson, Jim Hogg, Jim

Wells, Karnes, Kendall, Kenedy, Kerr, Kinney, Kleberg, La Salle, Lavaca, Live Oak, Maverick, Medina, McMullen, Nueces, Real, Refugio, San Patricio, Starr, Uvalde, Val Verde, Victoria,

Webb, Wilson, Willacy, Zapata, and Zavala

iv

Western Regions of Texas ........................................................................................................23

Local Mental Health Authorities: Emergence Health Network, MHMR Services for the Concho Valley, Permian Basin Community Centers for MHMR, and West Texas Centers

Counties: Andrews, Brewster, Borden, Coke, Concho, Crane, Crockett, Culberson, Dawson, Ector, El Paso, Fisher, Gaines, Garza, Glasscock, Howard, Hudspeth, Irion, Jeff Davis, Kent,

Loving, Martin, Mitchell, Midland, Nolan, Pecos, Presidio, Reagan, Reeves, Runnels, Scurry,

Sterling, Terrell, Terry, Tom Green, Upton, Ward, Winkler and Yoakum

Appendix A: Local Mental Health Authorities ..........................................................................25

Appendix B: Outreach, Screening, Assessment and Referral Centers ....................................29

Appendix C: Helpful Links ........................................................................................................30

1

About This Guide

The purpose of this guide is to help people better understand mental health care in Texas. This guide provides basic information regarding the services available across the state and the organizations that

can help people get connected to these resources.

Local Mental Health Authorities:

Every community in Texas is served by a Local Mental Health Authority (LMHA). LMHAs help people understand what treatment options will address the challenges associated with their mental illness and

ultimately achieve recovery. LMHAs provide a wide array of treatment services and support, and also

connect people with resources unique to their community.

The map below helps identify the LMHA nearest you. In addition, the Department of State Health Services (DSHS) website can help you identify which LMHA serves your community. For a complete list of

LMHAs visit www.dshs.state.tx.us/mhsa/lmha-list, or review Appendix A: Local Mental Health Authorities.

ID Center Name ID Center Name ID Center Name

1 ACCESS 14 Community Healthcore 27 MHMR of Tarrant County

2 Andrews Center Behavioral Healthcare System 15 Denton County MHMR Center 28 MHMR Services for the Concho Valley

3 Austin Travis County Integral Care 16 Emergence Health Network 29 Texoma Community Center

4 Betty Hardwick Center 17 Gulf Bend Center 30 NorthSTAR/ValueOptions

5 Bluebonnet Trails Community Services 18 Gulf Coast Center 31 Pecan Valley Centers for Behavioral & Developmental HealthCare

6 Border Region Behavioral Health Center 19 Heart of Texas Region MHMR Center 32 Permian Basin Community Centers

7 Burke 20 Helen Farabee Centers 33 Spindletop Center

8 Camino Real Community Services 21 Hill Country Mental Health & Developmental Disabilities Centers

34 Texana Center

9 Center for Health Care Services 22 Lakes Regional Community Center 35 Texas Panhandle Centers

10 Center for Life Resources 23 StarCare Specialty Health System 36 Tri-County Services

11 Central Counties Services 24 MHMR Authority of Brazos Valley 37 Tropical Texas Behavioral Health

12 Central Plains Center 25 MHMR Authority of Harris County 38 West Texas Centers

13 Coastal Plains Community Center 26 Behavioral Health Center of Nueces County

http://www.dshs.state.tx.us/mhsa/lmha-list

2

Available Services:

People don’t have to wait until they are in crisis to receive help. Services are available to assist people receive employment, find or keep safe housing, and get access to medications when needed. This guide

provides a description of such services. We hope this will help you better understand what an LMHA does and how these organizations can assist you or someone you know.

For many people, a crisis causes an initial request for help from the mental health system. That is why LMHAs have a variety of services to assist people in crisis – even if they are not yet connected with care.

Some services, like the crisis hotlines, are available in every community. Others, such as the various

types of crisis facilities, have been developed by communities to meet their local needs and may not exist in every area. This guide will help you understand what options are available where you live. It also

provides a description of the services and lists contact information for each provider.

What do I need? Are there any openings right now? LMHAs have mental health professionals available 24/7 to help people understand what kind of care they need and how they can receive services. LMHA staff knows what openings are available and what the

best options are if a person has to wait. Some programs are designed for walk-ins. However, LMHAs

work with people to ensure they arrive at the right program that has the space and staff available to meet their needs. We encourage people to reach out directly to their LMHA when assistance is needed.

Sometimes it’s more appropriate to call 9-1-1 or go directly to a hospital. For example, if an individual has

hurt themselves, calling 9-1-1 for an ambulance or going directly to a hospital for immediate care is the most appropriate means to access immediate services. LMHAs help people make the best choice possible

in difficult crisis situations.

How much will services cost?

Services provided by LMHAs are available on a “sliding fee scale,” meaning payment for services may be greatly reduced based on a person’s income. LMHAs also accept most forms of insurance.

Are there options for people who have been arrested? A number of services are available to people in the criminal justice system. Typically referred to as

“forensic services,” this guide lists the communities that offer community-based services to people who are unable to stand trial due to mental illness. LMHAs also partner with the Texas Correctional Office on

Offenders with Medical or Mental Impairments. Information regarding these specialized services is also

provided in this guide.

Services designed for people involved in the criminal justice system are noted by the symbol to the left.

NorthSTAR:

NorthSTAR is an integrated mental health and substance abuse managed care program that serves Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, and Rockwall counties. NorthSTAR takes the place of an LMHA for

these communities. For more information visit: www.valueoptions.com/northstar/members/ resources/NorthSTAR_Provider_Directory.pdf

http://www.valueoptions.com/northstar/members/resources/NorthSTAR_Provider_Directory.pdf

http://www.valueoptions.com/northstar/members/resources/NorthSTAR_Provider_Directory.pdf

3

You may find the following acronyms helpful:

ACT Assertive Community Treatment CSU Crisis Stabilization Unit

DFPS Department of Family and Protective Services

DSHS Department of State Health Services

EOU Extended Observation Units JBCR Jail-based Competency Restoration

LMHA Local Mental Health Authority MCOT Mobile Crisis Outreach Team

MHMR Mental Health and Mental Retardation Center (traditional name for the LMHA)

OCR Outpatient Competency Restoration Program

RTC Residential Treatment Center

PESC Psychiatric Emergency Service Center TCOOMMI Texas Correctional Office on Offenders

with Medical or Mental Impairments

4

Types of Services Available

Crisis Services and Facilities

Across the state there is a wide array of crisis services available to individuals in crisis. A crisis may be a

period of intense difficulty where an individual may be experiencing severe symptoms related to mental

illness, be a danger to themselves or others, or feel extremely hopeless. In crisis situation where you or someone you know is in immediate danger, call 9-1-1. Otherwise, the first step is to call the crisis hotline.

The services listed below are in order from least intensive to most intensive treatment options.

Crisis Hotline: Provides information, support, referrals, screening, and intervention services 24/7.

Mobile Crisis Outreach Teams (MCOT): Provides immediate response to the location where a

psychiatric crisis is occurring. MCOT is available 24/7 and medical and mental health professionals respond to calls from the home, school, street, or clinic.

Crisis Intervention, Relapse Prevention, and Follow-Up: Provides services to individuals who are

not in imminent danger of harm to self or others, but require additional assistance to avoid reoccurrence

of the crisis event. Mental health professionals respond to crises to reduce symptoms and prevent admission of an individual to a more restrictive environment.

Crisis Respite: Provides short-term, community-based crisis care for individuals who have low-risk of

harm to themselves or others, but may have some functional impairment. This is the least intensive,

facility-based crisis option. Services occur outside of a person’s home and may be provided for a few hours or a few days. Many people served in these programs have experienced an event causing

significant distress, are having housing challenges, or have loved ones/caretakers who are seeking temporary support or supervision for the individual. Facility-based crisis respite services have mental

health professionals on-site 24/7.

Crisis Residential: Provides up to 14 days of short-term, community-based residential, crisis treatment

for individuals who may pose some risk of harm to themselves or others, have a fairly severe impairment in their ability to function, and demonstrate a psychiatric crisis that cannot be stabilized in a less intensive

setting. This is a more intensive, facility-based crisis option. Mental health professionals are on-site 24/7 and provide support and rehabilitative services.

Psychiatric Service Emergency Centers (PESC): Provides a combination of facility-based crisis care services, such as those listed above. PESCs must be available for walk-ins and provide immediate access

to assessment, triage and a continuum of stabilizing treatment for individuals experiencing a behavioral health crisis. PESCs are staffed by medical personnel and mental health professionals and provide care

24/7.

Extended Observation Units (EOU): Provide emergency services for up to 48 hours to individuals in

psychiatric crisis. Services are provided in a secure and protected, clinically staffed, psychiatrically supervised environment with immediate access to urgent or emergent medical and psychiatric evaluation

and treatment. Individuals seeking treatment in an EOU may pose a moderate- to high-risk of harm to themselves or others. A determination of whether the individual has stabilized or requires a psychiatric

hospitalization is made prior to the end of the 48-hour period.

5

Crisis Stabilization Units: Provide short-term, residential treatment to reduce acute symptoms of

mental illness. Although it is slightly less intensive than a full psychiatric hospitalization, this is one of the most intensive facility-based crisis options.

Rapid Crisis Stabilization Beds: Provides very brief stays in licensed hospitals to relieve acute

symptomatology and restore an individual’s ability to function in a less restrictive setting.

Residential Treatment Centers (RTCs): Provides 24-hour care for children less than 18 years of age

and may offer programmatic services such as transitional living or emergency care, or may offer treatment services for emotional disorders or primary medical needs. Residential treatment centers are a

subset of General Residential Operations that serve only children needing treatment services for emotional disorders.

A specialized RTC initiative implemented through a partnership between DSHS and the Department of Family and Protective Services (DFPS) provides an intensive service alternative for children/youth at risk

for parental relinquishment of custody due to a lack of mental health resources. Youth reside in these facilities an average of 6 months. Children between 5 and 17 years of age are referred by DFPS’ Child

Protective Services in collaboration with LMHAs and have “no finding” of abuse/neglect by the

parents/guardians. LMHAs provide assessments and access to RTCs.

Waco Center for Youth Residential Treatment Center: A state-operated, psychiatric residential treatment facility that serves adolescents 13 to 17 years of age with significant or severe emotional

difficulties and/or behavioral problems. This is a unique facility that serves approximately 70 youth from across the state and is located in Waco.

Contact: Admissions Coordinator 254-745-5399, or Admissions/Aftercare Assistant 254-745-5302.

Outpatient Services

Across the state of Texas there are core services provided by LMHAs and NorthSTAR providers to help you or someone you know get better. Youth Empowerment Services (YES) is only offered in certain

counties for now, but, these services will be expanding to other parts of Texas soon.

Access to Benefits: When an individual is enrolled in services, the benefits officer may assist the

individual in applying for Supplemental Security Income (SSI) or Supplemental Security Disability Income (SSDI).

Case Management: Case managers are employed by LMHAs or NorthSTAR providers and help adults, children, or caregivers obtain needed services, such as employment, medication, and substance abuse

treatment.

Peer Services and Supports: Peer providers share their experience related to recovery; act as a model of hope and resilience to others; provide education, training, and interventions within the recovery

process; and promote integration with community resources. Peer providers have experienced mental

illness which makes them uniquely able to promote wellness, recovery, and an independent life in the community.

Medication and Medication Training: Physicians (and people who assist physicians, such as nurse

practitioners and physician assistants) assess whether medications would help adults and children

address symptoms, achieve stability, and ultimately recover. Physicians also work with treatment teams to provide education and guidance about these medications and their possible side effects.

6

Counseling (Cognitive Behavioral Therapy and Cognitive Processing Therapy): Individual,

family, and group therapy works to reduce or eliminate an individual’s symptoms of mental illness and increase the individual’s ability to perform normal, daily activities. This evidence-based practice is

frequently recommended for people with diagnoses of major depression or post-traumatic stress disorder.

Rehabilitation and Skills Training: Provide evidence-base intervention services as a part of the

overall treatment planning process to facilitate recovery.

Supported Employment: This evidence-based practice builds upon rehabilitation services and works to help people choose, obtain, and maintain employment in regular community jobs.

Supported Housing: This evidence-based practice builds upon case management and rehabilitation

services to help people choose, obtain, and maintain regular, integrated housing.

Assertive Community Treatment (ACT): An evidence-based practice that is specifically designed for

those who have difficulty avoiding repeated admissions or long stays in inpatient psychiatric facilities. ACT provides a full array of intensive, in-home services and utilizes person-centered recovery planning to help

these individuals achieve stability and facilitate community living.

Youth Empowerment Services (YES): The YES program serves youth 3 to 18 years of age by

providing services in a child’s home and local community to children who would otherwise need an institutional level of care or whose parents would turn to out-of-home placement due to the child/youth’s

serious emotional disturbance (SED). Individuals must be eligible for Medicaid and meet specific requirements to receive services. Parental income is not included in financial eligibility determinations for

Medicaid, often resulting in eligibility for children/youth not otherwise Medicaid eligible. Services are

currently available in Travis, Bexar, Tarrant, Harris, Cameron, Hidalgo, Willacy, Williamson, Burnet, and McLennan counties. The remaining Texas counties are anticipated to begin enrolling participants by

September 2015, including the NorthSTAR area that is anticipated to begin offering these services in the spring of 2015. Visit www.dshs.state.tx.us/mhsa/yes for additional information.

Substance Abuse Services: LMHAs work closely with Outreach, Screening, Assessment, and Referral Centers (OSARS) to help people with issues related to substance use. Regardless of their ability to pay,

Texas residents seeking substance abuse services and information may qualify for services based on need. For a complete list of OSARS visit www.dshs.state.tx.us/sa/OSAR, or Appendix B: Outreach,

Screening, Assessment, and Referral Centers.

Services for People in the Criminal Justice System

Forensic Services

A number of services are available to people involved in the criminal justice system. Typically referred to as forensic services, this guide lists the communities that offer community-based services to people who

are unable to stand trial due to mental illness. LMHAs also partner with the Texas Correctional Office on Offenders with Medical or Mental Impairments. Information regarding these specialized services is also

provided in this guide.

Services designed for people involved in the criminal justice system are noted by the symbol to the left.

Outpatient Competency Restoration Program: Provided through an LMHA or NorthSTAR, this program offers a full array of mental health services to adults deemed incompetent to stand trial. This

http://www.dshs.state.tx.us/mhsa/yes

http://www.dshs.state.tx.us/sa/OSAR

7

program also provides services and supports in a person’s home or community and is created as an

alternative to inpatient treatment for competency restoration at state mental health facilities.

Texas Correctional Office on Offenders with Medical or Mental Impairments Programs (TCOOMMI): LMHAs and NorthSTAR providers connect juvenile and adult offenders with special needs

to a full array of psychiatric and medical services upon their release on probation or parole. The Texas

Department of Criminal Justice, county jails, and Texas Juvenile Justice Division Institutions refer juvenile or adult offenders to this program. LMHA and NorthSTAR providers also work closely with parole and

probation officers to help the person comply with the conditions of his or her release, with a particular focus on engaging them in behavioral health treatment.

Contact: Texas Department of Criminal Justice – Reentry and Integration Division, Community Based Interventions, 512-671-2134

8

Resources Available in the Northern Regions of Texas

Betty Hardwick Center (LMHA) www.bhcmhmr.org/

2616 S Clack St., Abilene, TX 79606 Main Phone: 325-690-5100 Crisis Hotline: 1-800-758-3344

Counties: Callahan, Jones, Shackelford, Stephens and Taylor

Crisis Respite Center: Population Served: Adults 18+ years of age

Address: 2616 S. Clack St., Abilene, TX 79606

Phone: 1-800-758-3344

Center for Life Resources (LMHA) www.cflr.us

408 Mulberry St., Brownwood, TX 76801

Main Phone: 325-646-9574 Crisis Hotline: 1-800-458-7788

Counties: Brown, Coleman, Comanche, Eastland, McCulloch, Mills and San Saba

Crisis Respite:

Population Served: Adults 18+ years of age

Address: 1200 3rd St., Brownwood, TX 76801 Phone: 1-800-458-7788

Central Plains Center (LMHA)

www.clplains.org

715 Houston St., Plainview, TX 79072


Counties: Bailey, Briscoe, Castro, Floyd, Hale, Lamb, Motley, Parmer and Swisher

Crisis Respite:

Population Served: Adults 18+ years of age Address: 801 Houston, Plainview, TX 79072 and 2601 Dimmitt Rd., Plainview, TX 79072

Phone: 1-800-687-1300

Denton County MHMR Center (LMHA)

www.dentonmhmr.org/

2509 Scripture St., Denton, TX 76201 Main Phone: 940-381-5000 Crisis Hotline: 1-800-762-0157

Counties: Denton

http://www.bhcmhmr.org/

http://www.cflr.us/

http://www.clplains.org/

http://www.dentonmhmr.org/

9

Crisis Residential Center:

Population Served: Adults 18+ years of age Address: 2519 Scripture St., Denton, TX 76201

Phone: 1-800-762-0157

Psychiatric Triage Center: Evaluations are provided to individuals in crisis. Walk-ins are accepted and referrals to other community resources are provided as needed.

Population Served: Adults 18+ years of age Address: 2509 Scripture St., Suite 100, Denton, TX 76201

Phone: 940-381-9965

Helen Farabee Centers (LMHA) www.helenfarabee.org/

1000 Brook, Wichita Falls, TX 76301 Main Phone: 1-800-669-4166 Crisis Hotline: 1-800-621-8504

Counties: Archer, Baylor, Clay, Cottle, Foard, Hardeman, Haskell, Jack, Knox, Montague, Stonewall,

Throckmorton, Wichita, Wilbarger, Young, Childress, Dickens, King and Wise

Crisis Respite and Rapid Crisis Stabilization Beds:

Population Served: Children/adolescents 6-17 years of age and adults 18+ years of age Crisis Respite – Address: 500 Broad St., Wichita Falls 76301

Phone: 1-800-621-8504

Rapid Crisis Stabilization Beds – Phone: 1-800-621-8504

Pecan Valley Centers for Behavioral and Developmental HealthCare (LMHA) www.pvmhmr.org

2101 W. Pearl St., Granbury, TX 76048

Maine Phone: 817-579-4400 Crisis Hotline: 1-800-772-5987

Counties: Erath, Hood, Johnson, Palo Pinto, Parker and Somervell

Green Street Crisis Respite: The Green Street Crisis Respite facility serves all six Pecan Valley Centers

counties and is open 24/7. Assistance with transportation is available. Individuals seeking services must not be actively suicidal or homicidal, must be medically stable and able to self-manage personal hygiene

needs. Eligibility and admission determination is made through a face-to-face assessment by calling the

Pecan Valley Centers Crisis Hotline. Population Served: Adults 18+ years of age

Address: 532 Green Street, Stephenville 76401 Phone: 254-552-2050 Crisis Hotline: 1-800-772-5987

StarCare Specialty Health System (LMHA)

www.StarCarelubbock.org

904 Avenue O St., Lubbock, TX 79401


Counties: Cochran, Crosby, Hockley, Lubbock and Lynn

http://www.helenfarabee.org/

http://www.pvmhmr.org/

http://www.starcarelubbock.org/

10

Outpatient Competency Restoration (OCR) Program:

Population Served: Adults 18+ years of age deemed incompetent to stand trial Address: 904 Ave. O St., Lubbock, TX 79408

Phone: 806-766-0310

MHMR Tarrant (LMHA) www.MHMRtarrant.org

3840 Hulen St., Fort Worth, TX 76107 Main Phone: 817-335-3022 Crisis Hotline: 1-800-866-2465

Counties: Tarrant

Crisis Respite (Adolescents): Population Served: Adolescents 13-17 years of age

Address: 1520 Rio Grande Ave., Fort Worth, TX 76102 Phone: 1-800-866-2465

Crisis Respite and Residential (Men): Population Served: Males 18+ years of age

Address: 1350 E Lancaster, Fort Worth, TX 76102 Phone: 1-800-866-2465

Crisis Respite & Residential (Women): Population Served: Females 18+ years of age

Address: 815 S. Jennings, Fort Worth, TX 76104 Phone: 1-800-866-2465


Population Served: Ages 3-18 years

Counties: Tarrant Phone: 817-569-5600

Website: www.dshs.state.tx.us/mhsa/yes


Population Served: Adults 18+ years of age, deemed incompetent to stand trial Address: 3840 Hulen Tower North, Fort Worth, TX 76107

Phone: 817-335-3022 or 1-800-866-2465

Texas Panhandle Centers (LMHA) www.texaspanhandlecenters.org/

901 Wallace Blvd., Amarillo, TX 79106 Main Phone: 806-358-1681 or 1-800-299-3699 Crisis Hotline: 1-800-692-4039

Counties: Armstrong, Carson, Collingsworth, Dallam, Deaf Smith, Donley, Gray, Hall, Hansford, Hartley, Hemphill, Hutchinson, Lipscomb, Moore, Ochiltree, Oldham, Potter, Randall, Roberts, Sherman and

Wheeler

Rapid Crisis Stabilization Beds: Population Served: Adults 18+ years of age

Address: 901 Wallace Blvd, Amarillo, TX 79106

Crisis Hotline: 1-800-692-4039

http://www.mhmrtarrant.org/


http://www.texaspanhandlecenters.org/

11

Texoma Community Center (LMHA) www.mhmrst.org/location.html

315 W McLain Dr., Sherman, TX 75092


Counties: Cooke, Fannin and Grayson

Long-Term Residential:


Address: 102 (A) Memorial Dr., Denison, TX 75020 Phone: 903-957-4700


Crisis Respite Facility: Population Served: Adults 18+ years of age

Address: 102 (B) Memorial Dr., Denison, TX 75020

Phone: 903-957-4700 Crisis Hotline: 1-877-277-2226

NorthSTAR/Value Options

www.valueoptions.com/northstar

1199 S. Beltline Rd., Ste. 100, Coppell, TX 95019

Main Phone: 1-888-800-6799 Crisis Hotline: 1-866-260-8000

Counties: Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall

Crisis Respite:

Population Served: Adults 18+ years of age Address: 233 W. 10th St., Dallas TX 75208

Phone: 214-941-3500 Crisis Hotline: 1-866-260-8000

Outpatient Competency Restoration (OCR) Program: Population Served: Adults 18+ years of age, deemed incompetent to stand trial

Counties: Dallas Phone: 214-653-3535

Athletes for Change-RTC Placement: Population Served: Ages 13-17

Address: 1205 E. Bear Creek Rd., Glenn Heights, TX 75154 Phone: 972-223-2011

Youth Empowerment Services (YES): Population Served: Ages 3-18 years

Phone: 888-800-6799 Website: www.dshs.state.tx.us/mhsa/yes

http://www.mhmrst.org/location.html

http://www.valueoptions.com/northstar


12

Resources Available in the Eastern/Central Regions of Texas

ACCESS (LMHA) www.accessmhmr.org

913 N. Jackson St., Jacksonville, TX 75766 Main Phone: 903-586-5507 Crisis Hotline: 1-800-621-1693

Counties: Anderson and Cherokee

This community does not have any facility-based crisis options. See the LMHA for other crisis options.

Andrews Center Behavioral Healthcare System (LMHA)

www.andrewscenter.com

2323 West Front St., Tyler, TX 75702 Main Phone: 903-597-1351 Crisis Hotline: 1-877-934-2131

Counties: Henderson, Rains, Smith, Van Zandt and Wood

Crisis Respite and Psychiatric Service Emergency Center: Population Served: Adults 18+ years of age

Address: 959 Farm Rd., Tyler, TX 75705

Phone: 903-566-6410 or 1-800-374-6058


Population Served: Adults 18+ years of age deemed incompetent to stand trial

Address: 2323 West Front St., Tyler, TX 75702-7747 Phone: 903-597-1351

Austin Travis County Integral Care (LMHA)

www.integralcare.org

1430 Collier St. Austin, TX 78704

Main Phone: 512-447-4141 24/7 Hotline: 512-472-HELP (4357) Crisis Hotline: 844-398-8252 TTY: 512-703-1395

Counties: Travis

24/7 Walk-in Psychiatric Emergency Services Clinic: Population Served: Children, adolescents, and adults

Address: 56 East Ave., Austin, TX 78701 Phone: 512-472-HELP (4357)

Website: www.integralcare.org/content/psychiatric-emergency-services-pes

Crisis Respite and Rapid Crisis Stabilization Beds: Next Step provides short-term psychiatric respite

services for adults residing in Travis County who are recovering from a psychiatric crisis. The Inn provides short-term community-based residential crisis treatment. The Inn offers residential services, medication

http://www.accessmhmr.org/

http://www.andrewscenter.com/

http://www.integralcare.org/

http://www.integralcare.org/content/psychiatric-emergency-services-pes

13

stabilization, around-the-clock nursing services, psychosocial rehabilitative skills training, case

management and group treatment. Population Served: Adults 18+ years of age

Rapid Crisis Stabilization Beds – Address: 56 East Ave., Austin TX 78701 Phone: 512-472-HELP (4357)

Crisis Respite – Address: 6222 N. Lamar, Austin, TX 78752

Phone: 512-472-HELP (4357)


Phone: 512-472-HELP (4357)


Population Served: Ages 3-18 years of age Phone: 512-255-1720


Bluebonnet Trails Community Services (LMHA) www.bbtrails.org

1009 N. Georgetown St., Round Rock, TX 78664 Main Phone: 512-255-1720 Crisis Hotline: 1-800-841-1255

Counties: Bastrop, Burnet, Caldwell, Fayette, Guadalupe Lee and Williamson

Crisis Respite & Extended Observation Unit: Population Served: Adults 18+ years of age

Address: 711 North College St., Georgetown, TX 78626 Phone: 1-800-841-1255

Extended Observation Unit: Population Served: Adults 18+ years of age

Address: 2713 E. Court, Seguin, TX 78155 Phone: 1-800-841-1255

Youth Empowerment Services (YES): Population Served: Ages 3-18 years of age

Counties: Burnet and Williamson Phone: 512-255-1720


MHMR Authority of Brazos Valley (LMHA)

www.mhmrabv.org/

804 S. Texas Ave., Bryan, TX 77802 Main Phone: 979-822-6467 Crisis Hotline: 1-888-522-8262

Counties: Brazos, Burleson, Grimes, Leon, Madison, Robertson and Washington

Rapid Crisis Stabilization Beds: Population Served: Adults 18+ years of age

Address: 804 S. Texas Ave., Bryan, TX 77802

Phone: 1-888-522-8262


http://www.bbtrails.org/


http://www.mhmrabv.org/

14

Everyday Life, Inc. – RTC Placement:

Population Served: Ages 10-17 Address: 6955 Broach Rd., Bryan, TX 77808

Phone: 979-589-1885 Website: www.everydaylifertc.com/Home.html

Helping Hand Home for Children – RTC Placement: Population Served: Ages 13-17

Address: 3804 Avenue B, Austin, TX 78751 Phone: 512-459-3353

Website: www.helpinghandhome.org/

Pegasus Schools, Inc. – RTC Placement:

Population Served: Ages 10-17 Address: 896 Robin Ranch Road, Lockhart, TX 78644

Phone: 512-376-2101 Website: www.pegasusschool.net/

Burke (LMHA) www.myburke.org/

2001 S Medford Dr., Lufkin, TX 75901

Main Phone: 936-639-1141 Crisis Hotline: 1-800-392-8343 Counties: Angelina, Houston, Jasper, Nacogdoches, Newton, Polk, Sabine, San Augustine, San Jacinto,

Shelby, Trinity and Tyler

Mental Health Emergency Center (MHEC): MHEC provides assessment and/or brief treatment to individuals that are experiencing a mental health crisis. MHEC is comprised of two programs – extended

observation unit and crisis residential unit.

Population Served: Adults 18+ years of age Crisis Residential – Address: 105 Mayo Place, Lufkin, TX 75904

Phone: 1-800-392-8343 Extended Observation Unit – Address: 105 Mayo Place, Lufkin, TX 75904

Phone: 1-800-392-8343

Central Counties Services (LMHA)

www.cccmhmr.org

304 S. 22nd St., Temple, TX 76501 Main Phone: 254-298-7000 Crisis Hotline: 1-800-888-4036

Counties: Bell, Coryell, Hamilton, Lampasas and Milam

Crisis Respite: Designed to give individuals brief care to prevent a state of crisis that requires

hospitalization. Population Served: Adults 18+ years of age

Address: 207 N. Lutterloh, Gatesville, TX 76528 Phone: 254-217-1856

http://www.everydaylifertc.com/Home.html

http://www.helpinghandhome.org/

http://www.pegasusschool.net/

http://www.myburke.org/

http://www.cccmhmr.org/

15

Community Healthcore (LMHA) www.communityhealthcore.com

107 Woodbine Pl., Longview, TX 75601 Main Phone: 903-758-2471 Crisis Hotline: 1-800-832-1009

Counties: Bowie, Cass, Gregg, Harrison, Marion, Panola, Red River, Rusk and Upshur

Crisis Residential, Extended Observation Unit, and Psychiatric Emergency Center: Population Served: Adults 18+ years of age

Address: 7470 State Hwy 154, Marshall, TX 75670

Phone: 903-927-1466

Outpatient Competency Restoration Program: Population Served: Adults 18+ years of age, deemed incompetent to stand trial

Address: 950 N. 4th St., Longview, TX 75601 Phone: 903-758-2471

Gulf Coast Center (LMHA) www.gulfcoastcenter.org

123 Rosenberg, Ste. 6, Galveston, TX 77550


Counties: Brazoria and Galveston

Crisis Respite (Galveston County):


Address: 5825 Emmet Lowry, Texas City, TX 77591 Phone: 409-763-2373

Crisis Respite (Brazoria County):

Population Served: Adults 18+ years of age Address: 2320 East Mulberry, Angleton, TX 77515

Phone: 409-763-2373


Population Served: Ages 3-18 years Phone: 409-763-2373


MHMR Authority of Harris County (LMHA)

www.mhmraharris.org

7011 Southwest Freeway, Houston, TX 77074 Main Phone: 713-970-7000 Crisis Hotline: 1-866-970-4770

Counties: Harris

Crisis Respite: Provides respite care. This facility has nine apartments with capacity for 16 residents.

Population Served: Adults 18+ years of age Address: 612 Branard St., Houston, TX 77006

Phone: 713-970-7070

http://www.communityhealthcore.com/

http://www.gulfcoastcenter.org/


http://www.mhmraharris.org/

16

Crisis Residential Unit: There are 18 beds at this facility.

Population Served: Adults 18+ years of age Address: 2627 Caroline St., Houston, TX 77004, Bristow Building, 1st Floor

Phone: 713-970-7070

Critical Time Intervention Program: This program assists homeless individuals with mental illness in their

transition from the streets, shelters, psychiatric hospitals, or criminal justice system into the community. Population Served: Adults 18+ years of age

Address: 9401 Southwest Freeway, 8th Floor, Houston, TX 77074 Phone: 713-970-7070

The Neuropsychiatric Center – Crisis Stabilization Unit: This inpatient stabilization unit is for people

experiencing a mental health crisis. It is open 24/7, 365 days per year; the average stay is three-five

days; and a doctor must refer clients. Population Served: Adults 18+ years of age

Address: 1502 Taub Loop (2nd Floor), Houston, TX 77030 Phone: 713-970-7070

Psychiatric Emergency Services: The Psychiatric Emergency Services Unit is staffed 24 hours a day with registered nurses, clinical social workers, licensed professional counselors and psychiatric technicians.

Each person treated receives an individualized clinical service plans that can include medication administration, reinforcement of coping skills, close observation by clinical staff, family meetings and

determination of appropriate community supports. Population Served: Screening available for individuals at any age

Address: 1502 Taub Loop (1st Floor), Houston, TX 77030

Phone: 713-970-7070


Phone: 713-970-7212


Heart of Texas Region MHMR Center (LMHA) www.hotrmhmr.org

110 S 12th St. Waco, TX 76701


Counties: Bosque, Falls, Freestone, Hill, Limestone and McLennan

Crisis Respite Population Served: Adults 18+ years of age

Address: 301 Londonderry, Waco, TX 76712 Phone: 1-866-752-3451

Psychiatric Emergency Service Center:


Address: 1200 Clifton St., Waco, TX 76704 Phone: 1-866-752-3451 (after hours and weekends)


http://www.hotrmhmr.org/

17


Population Served: Adults 18+ years of age deemed incompetent to stand trial Address: 110 S 12th St., Waco, TX 76703

Phone: 1-866-752-3451

Lakes Regional Community Center (LMHA) www.lrmhmrc.org

400 Airport Rd., Terrell, TX 75160 Main Phone: 972-524-4159 Crisis Hotline: 1-877-466-0660

Counties: Camp, Delta, Franklin, Hopkins, Lamar, Morris and Titus


Spindletop Center (LMHA) www.stmhmr.org

655 S 8th St., Beaumont, TX 77701

Main Phone: 409-784-5400 Crisis Hotline: 409-838-1818

Counties: Chambers, Hardin, Jefferson and Orange

Crisis Respite: Population Served: Adolescents 13-17 years of age and adults 18+ years of age (separately)

Address: 2750 South 8th Street, Building C, Beaumont, TX 77701 Phone: 1-800-937-8097

Crisis Residential: Population Served: Adults 18+ years of age

Address: 2555 Jimmy Johnson Blvd., Port Arthur, TX 77640 Phone: 1-800-937-8097

Extended Observation Units:


Location 1 – Address: 3080 College St., Beaumont, TX 77701 Phone: 1-800-937-8097

Location 2 – Address: 2555 Jimmy Johnson Blvd., Port Arthur, TX 77640 Phone: 1-800-937-8097


Address: 655 S. 8th St., Beaumont, TX 77701 Phone: 409-784-5400

http://www.lrmhmrc.org/

http://www.stmhmr.org/

18

Texana Center (LMHA) www.texanacenter.com

5311 Ave. N., Rosenberg, TX 77471 Main Phone: 281-239-1300 Crisis Hotline: 1-800-633-5686

Counties: Austin, Colorado, Fort Bend, Matagorda, Waller and Wharton

Crisis Center: Access is available only via MCOT screenings (not a walk-in center). Population Served: Adults 18+ years of age



Population Served: Ages 3-18 years Counties: Fort Bend

Phone: 281-239-1485 Website: www.dshs.state.tx.us/mhsa/yes

Tri-County Services (LMHA) www.tricountyservices.org

1506 FM-2854, Conroe, TX 77304


Counties: Liberty, Montgomery and Walker

Crisis Stabilization Unit (Psychiatric Emergency Treatment Center), and Extended Observation Unit:


Address: 706 FM 2854, Conroe TX 77301 Phone: 1-800-659-6994


Population Served: Adults 18+ years of age deemed incompetent to stand trial Address: 1020 Riverwood Ct., Conroe, TX 77304

Phone: 936-521-6100

Guardian Angels – RTC Placement:

Population Served: Ages 9-17 Address: 9530 W. Montgomery Rd., Houston, TX 77088

Phone: 281-447-1812

Gulf Winds – RTC Placement:

Population Served: Ages 10-17 Address: 2904 1st St., Bay City, TX 77414

Phone: 979-254-2334

Have Haven – RTC Placement:

Population Served: Ages 10-17 Address: 14054 Ambrose St., Houston, TX 77045

Phone: 713-413-9490 Website: www.havehaven.org/

http://www.texanacenter.com/


http://www.tricountyservices.org/

http://www.havehaven.org/

19

Krause Children’s Residential – RTC Placement:

Population Served: Ages 12-17 Address: 25752 Kingsland Blvd., Katy, TX 77494

Phone: 281-392-7505 Website: www.krausechildrenscenter.org/

Renewed Strength, Inc. – RTC Placement: Population Served: Ages 5-18

Address: 110 Hambrick Rd., Houston, TX 77060 Phone: 281-448-7550

Website: www.renewedstrength.net/

Shamar Hope Haven- RTC Placement:

Population Served: Ages 10-17 Address: 2719 Truxillo St., Houston, TX 77004

Phone: 713-942-8822

Unity Children’s Home – RTC Placement:

Population Served: Ages 6-17 Address: 2111 River Valley Dr., Spring, TX 77373

Phone: 281-355-0716 Website: www.unityresidentialtreatmentcenter.org/

http://www.krausechildrenscenter.org/

http://www.renewedstrength.net/

http://www.unityresidentialtreatmentcenter.org/

20

Resources Available in the Southern Regions of Texas

Border Region Behavioral Health Center (LMHA) www.borderregion.org

1500 Pappas St., Laredo, TX 78041 Main Phone: 956-794-3000 Crisis Hotline: 1-800-643-1102

Counties: Jim Hogg, Starr, Webb and Zapata


Camino Real Community Services (LMHA)

www.caminorealcs.org

19965 FM-3175 N., Lytle, TX 78052 Main Phone: 210-261-1000 Crisis Hotline: 1-800-543-5750

Counties: Atascosa, Dimmit, Frio, Karnes, La Salle, Maverick, McMullen, Wilson and Zavala

Crisis Respite: Population Served: Adults 18+ years of age

Address: 419 East San Marcos, Pearsall, TX 78061

Phone: 210-357-0300

The Center for Health Care Services (LMHA) www.chcsbc.org

3031 W I-10, San Antonio, TX 78201

Main Phone: 210-261-1000 Crisis Hotline: 210-223-7233

Counties: Bexar

Crisis Care Center and Extended Observation Unit: Population Served: Adults 18+ years of age

Address: 601 N. Frio, San Antonio, TX 78207 Phone: 210-223-7233 or 1-800-316-9241

Children’s Crisis Unit: The Children’s Crisis Unit provides crisis assessments to children if they are perceived to be a potential danger to themselves or others and they are physically within the boundaries

of Bexar County. Crisis assessors also conduct crisis assessments in the field, at schools, residences, and other locations.

Population Served: Ages 3-17 Address: 227 West Drexel, San Antonio, TX 78210

Phone: 210-223-7233 or 1-800-316-9241


Population Served: Ages 3-18 years Phone: 210-261-1135


http://www.borderregion.org/

http://www.caminorealcs.org/

http://www.chcsbc.org/


21


Population Served: Adults 18+ years of age deemed incompetent to stand trial Address: 3031 IH-10 West, San Antonio, TX 78201 Phone: 210-261-1000

Coastal Plains Community Center (LMHA)

www.coastalplainsctr.org

200 Marriott Dr., Portland, TX 78374


Counties: Aransas, Bee, Brooks, Duval, Jim Wells, Kenedy, Kleberg, Live Oak and San Patricio

Rapid Crisis Stabilization Beds:

Population Served: Adults 18+ years of age Address: 200 Marriott Dr, Portland, TX 78374

Phone: 1-800-841-6467

Gulf Bend Center (LMHA) www.gulfbend.org

6502 Nursery Drive, Suite 100, Victoria, TX 77904-1178


Counties: Calhoun, DeWitt, Goliad, Jackson, Lavaca, Refugio and Victoria


Address: 2701 Hospital Dr., Victoria, TX 77901 Phone: 1-877-723-3422

Hill Country Mental Health & Developmental Disabilities Centers (LMHA)

www.hillcountry.org

819 Water St, Suite 300, Kerrville, TX 78028 Main Phone: 830-792-3300 Crisis Hotline: 1-877-466-0660

Counties: Bandera, Comal, Edwards, Gillespie, Kendall, Kerr, Kinney, Medina, Real, Uvalde and Val

Verde

Crisis Stabilization Unit: Population Served: Adults ages 18+

Address: 643 Sheppard Rees Rd. Kerrville, TX 78028 Phone: 1-877-466-0660

Hector Garza Center – RTC Placement: Population Served: Ages 10-17

Address: 620 E. Afton Oaks Blvd., San Antonio, TX 78232 Phone: 210-568-8600

Website: www.abraxasyfs.com/facilities/hectorgarza/

Hill Country Youth Ranch – RTC Placement:

Population Served: Ages 5-17 Address: 522 Junction Hwy., Ingram, TX 78025 Phone: 830-367-2131

Website: www.youth-ranch.org/

http://www.coastalplainsctr.org/

http://www.gulfbend.org/

http://www.hillcountry.org/

22

New Life Children’s Treatment Center- RTC Placement:

Population Served: Ages 11-17 Address: 650 Scarbourough, Canyon Lake, TX 78133

Phone: 830-964-4390 Website: www.newlifechildrenscenter.org/

Behavioral Health Center of Nueces County (LMHA) www.bhcnc.org

1630 S. Brownlee Blvd., Corpus Christi, TX 78405


Counties: Nueces

Crisis Respite:

Population Served: Adults 18+ years of age Address: 1546 S. Brownlee, Corpus Christi, TX 78404

Phone: 1-888-767-4493


Population Served: Adults 18+ years of age, deemed incompetent to stand trial Address: 1630 S. Brownlee, Corpus Christi, TX 78404-3178

Tropical Texas Behavioral Health (LMHA) www.ttbh.org

1901 S. 24 St., Edinburg, TX 78539


Counties: Cameron, Hidalgo and Willacy

Crisis Respite:

Population Served: Adults 18+ years of age Address: 715 North H St., Harlingen, TX 78550

Phone: 1-877-289-7199


Population Served: Adults 18+ years of age Address: 1901 South 24th Ave., Edinburg, TX 78540

Phone: 1-877-289-7199

Shoreline, Inc. – RTC Placement:

Population Served: Ages 13-17 Address: 1220 Gregory St., Taft, TX 78390

Phone: 361-528-3356

Website: www.shorelinetreatmentcenter.com/


Address: 1901 S. 24 St., Edinburg, TX 78540 Phone: 956-289-7000


http://www.bhcnc.org/

http://www.ttbh.org/

http://www.shorelinetreatmentcenter.com/


23

Resources Available in the Western Regions of Texas

Emergence Health Network (LMHA) www.emergencehealthnetwork.org

1600 Montana Ave., El Paso, TX 79902 Main and Crisis Phone: 915-887-3410

Counties: El Paso

Crisis Residential and Rapid Crisis Stabilization Beds: Population Served: Adults 18+ years of age

Crisis Respite – Address: 8716 Independence, El Paso, TX 79907

Phone: 915-887-3410 Rapid Crisis Stabilization Beds

Phone: 915-887-3410


Phone: 915-887-3410


Population Served: Adults 18+ years of age deemed incompetent to stand trial Phone: 915-887-3410

MHMR Services for the Concho Valley (LMHA) www.mhmrcv.org

1501 W Beauregard St., San Angelo, TX 76901


Counties: Coke, Concho, Crockett, Irion, Reagan, Sterling and Tom Green

Crisis Respite:


Address: 244 N. Magdalen Bldg. #240, San Angelo, TX 76903 Phone: 1-800-375-8965


Population Served: Adults 18+ years of age Address: 1501 W Beauregard, San Angelo, TX 76901

Phone: 1-800-375-8965

http://www.emergencehealthnetwork.org/

http://www.mhmrcv.org/

24

Permian Basin Community Centers for MHMR (LMHA) www.pbmhmr.com

401 E Illinois Ave., Midland, TX 79701 Main Phone: 432-570-3300 Crisis Hotline (Alpine, Presidio, & Van Horn): 1-800-542-4005 Crisis

Hotline (Ft. Stockton): 1-877-475-7322 Crisis Hotline (Midland): 432-570-3300 Crisis Hotline (Odessa): 432-333-3265

Counties: Brewster, Culberson, Ector, Hudspeth, Jeff Davis, Midland, Pecos and Presidio


West Texas Centers (LMHA)

www.wtcmhmr.org

319 Runnels St., Big Spring, TX 79720 Main Phone: 432-263-0007 Crisis Hotline: 1-800-375-4357

Counties: Andrews, Borden, Crane, Dawson, Fisher, Gaines, Garza, Glasscock, Howard, Kent, Loving,

Martin, Mitchell, Nolan, Reeves, Runnels, Scurry, Terrell, Terry, Upton, Ward, Winkler and Yoakum



Address: 319 Runnels St., Big Spring, TX 79720 Phone: 1-800-375-4357

Crisis Respite:


Address: 2607 Chanute, Big Spring, TX 79720 Phone: 432-263-0007

http://www.pbmhmr.com/

http://www.wtcmhmr.org/

25

Appendix A Local Mental Health Authorities

ACCESS

www.accessmhmr.org 913 N. Jackson St.

Jacksonville, TX 75766 903-586-5507

Counties: Anderson and Cherokee

Andrews Center Behavioral Healthcare

System www.andrewscenter.com

2323 West Front St. Tyler, TX 75702

903-597-1351

Counties: Henderson, Rains, Smith, Van Zandt and Wood

Austin Travis County Integral Care

www.integralcare.org

1430 Collier St. Austin, TX 78704

512-447-4141 Counties: Travis

Behavioral Health Center of Nueces

County

www.bhcnc.org 1630 S Brownlee Blvd.

Corpus Christi, TX 78404 361-886-6900

Counties: Nueces

Betty Hardwick Center

www.bhcmhmr.org 2616 S Clack St.

Abilene, TX 79606

325-690-5100 Counties: Callahan, Jones, Shackelford,

Stephens and Taylor

Bluebonnet Trails Community Services

www.bbtrails.org 1009 N. Georgetown St.

Round Rock, TX 78664 512-255-1720

Counties: Bastrop, Burnet, Caldwell, Fayette,

Gonzales, Guadalupe, Lee and Williamson

Border Region Behavioral Health Center www.borderregion.org

1500 Pappas St. Laredo, TX 78041

956-794-3000

Counties: Jim Hogg, Starr, Webb, and Zapata

Burke www.myburke.org

2001 S Medford Dr.

Lufkin, TX 75901 936-639-1141

Counties: Angelina, Houston, Jasper, Nacogdoches, Newton, Polk, Sabine, San

Augustine, San Jacinto, Shelby, Trinity and Tyler

Camino Real Community Services

www.caminorealcs.org 19965 FM-3175 N.

Lytle, TX 78052 210-357-0300

Counties: Atascosa, Dimmit, Frio, Karnes, La

Salle, Maverick, McMullen, Wilson and Zavala

Center for Life Resources www.cflr.us

408 Mulberry St.

Brownwood, TX 76801 325-646-9574

Counties: Brown, Coleman. Comanche, Eastland, McCulloch, Mills and San Saba

http://www.accessmhmr.org/

http://www.andrewscenter.com/

http://www.integralcare.org/

http://www.bhcnc.org/

http://www.bhcmhmr.org/

http://www.bbtrails.org/

http://www.borderregion.org/

http://www.myburke.org/

http://www.caminorealcs.org/

http://www.cflr.us/

26

Central Counties Services

www.cccmhmr.org 304 S 22nd St.

Temple, TX 76501 254-298-7000

Counties: Bell, Coryell, Hamilton, Lampasas

and Milam

Central Plains Center www.clplains.org

2700 Yonkers St. Plainview, TX 79072

806-293-2636

Counties: Bailey, Briscoe, Castro, Floyd, Hale, Lamb, Motley, Parmer and Swisher

Coastal Plains Community Center

www.coastalplainsctr.org

200 Marriott Dr. Portland, TX 78374

361-777-3991 Counties: Aransas, Bee, Brooks, Duval, Jim

Wells, Kenedy, Kleberg, Live Oak and San Patricio

Community Healthcore www.communityhealthcore.com

107 Woodbine Pl. Longview, TX 75601

903-758-2471

Counties: Bowie, Cass, Gregg, Harrison, Marion, Panola, Red River, Rusk and Upshur

Denton County MHMR Center

www.dentonmhmr.org

2519 Scripture St. Denton, TX 76201

940-381-5000 Counties: Denton

Emergence Health Network

www.emergencehealthnetwork.org

1600 Montana Ave. El Paso, TX 79902

915-887-3410 Counties: El Paso

Gulf Bend Center

www.gulfbend.org 6502 Nursery Drive, Suite 100

Victoria, TX 77904-1178 361-575-0611

Counties: Calhoun, DeWitt, Goliad, Jackson,

Lavaca, Refugio and Victoria

Gulf Coast Center www.gulfcoastcenter.org

123 Rosenberg, Ste. 6 Galveston, TX 77550

409-763-2373

Counties: Brazoria and Galveston

Heart of Texas Region MHMR Center www.hotrmhmr.org

110 S 12th St.

Waco, TX 76701 254-752-3451

Counties: Bosque, Falls, Freestone, Hill, Limestone and McLennan

Helen Farabee Centers

www.helenfarabee.org

1000 Brook Wichita Falls, TX 76301

800-669-4166 Counties: Archer, Baylor, Childress, Clay,

Cottle, Dickens, Foard, Hardeman, Haskell, Jack,

King, Knox, Montague, Stonewall, Throckmorton, Wichita, Wilbarger, Wise and

Young

Hill Country Mental Health and

Developmental Disabilities Centers www.hillcountry.org

819 Water St, Suite 300 Kerrville, TX 78028

830-792-3300 Counties: Bandera, Blanco, Comal, Edwards,

Gillespie, Hays, Kendall, Kerr, Kimble, Kinney,

Llano, Mason, Medina, Menard, Real, Schleicher, Sutton, Uvalde and Val Verde

http://www.cccmhmr.org/

http://www.clplains.org/

http://www.coastalplainsctr.org/

http://www.communityhealthcore.com/

http://www.dentonmhmr.org/

http://www.emergencehealthnetwork.org/

http://www.gulfbend.org/

http://www.gulfcoastcenter.org/

http://www.hotrmhmr.org/

http://www.helenfarabee.org/

http://www.hillcountry.org/

27

Lakes Regional Community Center

www.lrmhmrc.org 400 Airport Rd.

Terrell, TX 75160 972-524-4159

Counties: Camp, Delta, Franklin, Hopkins,

Lamar, Morris and Titus

MHMR Authority of Brazos Valley www.mhmrabv.org

804 S. Texas Ave. Bryan, TX 77802

979-822-6467

Counties: Brazos, Burleson, Grimes, Leon, Madison, Robertson and Washington

MHMR Authority of Harris County

www.mhmraharris.org

7011 Southwest Fwy. Houston, TX 77074

713-970-7000 Counties: Harris

MHMR Services for the Concho Valley

www.mhmrcv.org

1501 W Beauregard St. San Angelo, TX 76901

325-658-7750 Counties: Coke, Concho, Crockett, Irion,

Reagan, Sterling and Tom Green

MHMR Tarrant

www.mhmrtarrant.org 3840 Hulen St.

Fort Worth, TX 76107

817-335-3022, 1-800-866-2465 Counties: Tarrant

Pecan Valley Centers for Behavioral &

Developmental HealthCare www.pvmhmr.org

2101 W. Pearl

Granbury, TX 76048 817-579-4400

Counties: Erath, Hood, Johnson, Palo Pinto, Parker and Somervell

Permian Basin Community Centers for

MHMR www.pbmhmr.com

401 E Illinois Ave. Midland, TX 79701

432-570-3300

Counties: Brewster, Culberson, Ector, Hudspeth, Jeff Davis, Midland, Pecos and

Presidio

Spindletop Center www.stmhmr.org

655 S 8th St.

Beaumont, TX 77701 409-784-5400

Counties: Chambers, Hardin, Jefferson and Orange

StarCare Specialty Health System www.StarCarelubbock.org

904 Avenue O St. Lubbock, TX 79401

806-766-0310 Counties: Cochran, Crosby, Hockley, Lubbock

and Lynn

Texana Center

www.texanacenter.com 4910 Airport Ave.

Rosenberg, TX 77471

281-239-1300 Counties: Austin, Colorado, Fort Bend,

Matagorda, Waller and Wharton

Texas Panhandle Centers

www.texaspanhandlecenters.org 901 Wallace Blvd.

Amarillo, TX 79106 806-358-1681

Counties: Armstrong, Carson, Collingsworth, Dallam, Deaf Smith, Donley, Hall, Hansford,

Hartley, Hemphill, Hutchinson, Lipscomb, Moore,

Ochiltree, Oldham, Potter, Randall, Roberts, Sherman and Wheeler

http://www.lrmhmrc.org/

http://www.mhmrabv.org/

http://www.mhmraharris.org/

http://www.mhmrcv.org/

http://www.mhmrtarrant.org/

http://www.pvmhmr.org/

http://www.pbmhmr.com/

http://www.stmhmr.org/

http://www.starcarelubbock.org/

http://www.texanacenter.com/

http://www.texaspanhandlecenters.org/

28

Texoma Community Center

www.mhmrst.org 315 W McLain Dr.

Sherman, TX 75092 903-957-4700

Counties: Cooke, Fannin and Grayson

The Center for Health Care Services

www.chcsbc.org 3031 W I-10

San Antonio, TX 78201 210-261-1000

Counties: Bexar

Tri-County Services

www.tricountyservices.org 1506 FM-2854

Conroe, TX 77304

936-521-6100 Counties: Liberty, Montgomery and Walker

Tropical Texas Behavioral Health

www.ttbh.org 1901 S. 24 St.

Edinburg, TX 78540 956-289-7000

Counties: Cameron, Hidalgo and Willacy

West Texas Centers

www.wtcmhmr.org 319 Runnels St.

Big Spring, TX 79720 432-263-0007

Counties: Andrews, Borden, Crane, Dawson,

Fisher, Gaines, Garza, Glasscock, Howard, Kent, Loving, Martin, Mitchell, Nolan, Reeves, Runnels,

Scurry, Terrell, Terry, Upton, Ward, Winkler and Yoakum

http://www.mhmrst.org/

http://www.chcsbc.org/

http://www.tricountyservices.org/

http://www.ttbh.org/

http://www.wtcmhmr.org/

29

Appendix B Outreach, Screening, Assessment and

Referral Centers (OSARS)

Substance Abuse Intervention and Treatment

Abilene Regional Council on Alcohol/Drug Abuse

104 Pine St., Suite #210, Abilene, TX 79601

325-673-2242 or 1-800-588-8728

Bay Area Council on Drugs and Alcohol 1300-A Bay Area Blvd., #102, Houston, TX

77058 800-510-3111

Bluebonnet Trails Community Services 1009 N. Georgetown St., Round Rock, TX 78664

512-244-8444 or 1-800-841-1255

East Texas Council on Alcohol and Drug

Abuse 708 Glencrest Lane, Longview, TX 75601

903-753-7633 or 1-800-441-8639

El Paso Hospital District

5959 Gateway West, Suite 520, El Paso, TX 79925

915-521-7818 or 866-369-7199

Mid Coast Family Services 700 S. Zamora St., Suite LL5, San Antonio, TX

787207

210-271-9452 or 888-575-7842

120 S. Main St., Victoria, TX 77901 361-575-7842 or 888-575-7842

Permian Basin Regional Council on Alcohol and Drug Abuse

120 East 2nd St., Odessa, TX 79761

432-580-5100 or 1-800-332-2174

Recovery Resource Council 2700 Airport Fwy, Fort Worth, TX 76111

817-332-6329 or 877-332-6329

Rio Grande Valley Council 5510 N. Cage Blvd., Suite C, Pharr, TX 78577

956-787-7111 or 1-800-748-3577

400 Mann St. #903, Corpus Christi, TX 78401

361-884-9596 or 1-800-748-3577

Southwest Regional Planning Commission 4347 Phelan Blvd., Suite 104, Beaumont, TX

77707

409-833-7774 or 888-833-9077

StarCARE Specialty Health System 1950 Aspen Ave., Lubbock, TX 79404

806-767-1716 or 1-800-687-7581

The Council on Alcohol and Drugs Houston

303 Jackson Hill Street, Houston, TX 77007 713-942-4100 or 877-777-8829

ValueOptions – NorthSTAR

1199 South Beltline Rd., Ste. 100, Coppell, TX

75019 888-800-6799

30

Appendix C Helpful Links

2-1-1 Texas Mental Health Services

www.211texas.org/cms/search-mental-health-services-in-texas

Disability Rights Texas

www.disabilityrightstx.org/

Mental Health America of Texas

www.mhatexas.org

MentalHealthTX.org www.mentalhealthtx.org/

National Alliance on Mental Illness www.nami.org/

National Alliance on Mental Illness – Texas

www.namitexas.org/

Speak Your Mind Texas

www.speakyourmindtexas.org/

Substance Abuse and Mental Health Services Administration

www.samhsa.gov/

Texas Council of Community Centers

www.txcouncil.com/


www.dshs.state.tx.us/


– Mental Health and Substance Abuse Division

www.dshs.state.tx.us/mhsa/

Texas Health and Human Services

Commission www.hhsc.state.tx.us/

Texas Workforce Commission

www.twc.state.tx.us/

United Ways of Texas

www.uwtexas.org/

https://www.211texas.org/cms/search-mental-health-services-in-texas

https://www.211texas.org/cms/search-mental-health-services-in-texas

https://www.disabilityrightstx.org/

https://www.mhatexas.org/

http://www.mentalhealthtx.org/

http://www.nami.org/

http://www.namitexas.org/

http://www.speakyourmindtexas.org/

http://www.samhsa.gov/

http://www.txcouncil.com/

https://www.dshs.state.tx.us/

https://www.dshs.state.tx.us/mhsa/

http://www.hhsc.state.tx.us/

http://www.twc.state.tx.us/

http://www.uwtexas.org/

Crisis Services

1

Behavioral Health Issues and Crisis Services for Adults and Juveniles

Brettany Boozer, LCSW & Courtney Heard, Ph.D., LPC


Heard, C., & Boozer, B. (2015, February). Behavioral health issues and crisis services for adults and

juveniles. Educational session presented at the Mental Health Issues and Procedures in

Municipal Courts, Austin, TX.

Jail Diversion involves collaboration between Local Mental Health Authorities (LMHA),

NorthSTAR, and judicial officials such as judges and representatives from the District

Attorney’s Office, and law enforcement. Jail Diversion in the state of Texas parallels the

Sequential Intercept Model published by the Substance Abuse and Mental Health Services

Administration (SAMSHA), with jail diversion occurring across five intercepts: law

enforcement, initial detention/initial court hearings, jails/courts, re-entry, and community

corrections (i.e.

http://gainscenter.samhsa.gov/pdfs/integrating/GAINS_Sequential_Intercept.pdf).

In Texas, there are two overarching methods of jail diversion (i.e., Adults and Children):

1. Crisis Response Services: Mobile crisis response and crisis facilities

2. Access to Ongoing Care: Characterized by interagency collaboration to provide linkage to

on-going mental health treatment which may occur pre-booking, or post-booking of an inmate.

For some, additional supports may be provided through the Texas Correctional Office on

Offenders with Medical or Mental Impairments (TCOOMMI) to avoid future interaction with

law enforcement.

The ultimate goal of jail diversion practices is to intervene at the earliest point of the intercept

model; thus, there is a primary focus on pre-booking interventions.

Crisis Response Services

Pre-booking activities are designed to provide an intervention to individuals arrested for

committing a crime prior to being booked in jail for the arrest. Pre-booking is the most

frequently employed jail diversion strategy. Two overarching pre-booking diversion strategies

are crisis response services and Crisis Intervention Training (CIT) for law enforcement officials.

Crisis response services. The 80th

Texas Legislature appropriated $82 million for the Fiscal

Year 2008-2009 biennium. Guiding the appropriation of these funds was the expansion of crisis

services in the areas of mental health and substance abuse. Services that were implemented, or,

http://gainscenter.samhsa.gov/pdfs/integrating/GAINS_Sequential_Intercept.pdf



enhanced included crisis hotline, Mobile Crisis Outreach Teams (MCOT), and Psychiatric

Emergency Service Programs, all of which are currently utilized for jail diversion purposes.

Crisis Hotline – Crisis hotline services are available 24/7 and serve as the first point

of contact for mental health crises in the community. Qualified staff determines if

mobile emergency services are required to further assess the caller’s needs.

MCOT – These services are available 24/7 and are often the result of a referral that is

obtained through the crisis hotline. MCOTs deploy to various sites in the community

where a crisis situation has been reported. Generally, they are accompanied by law

enforcement.

PESC Programs – PESC programs encompass facilities that are staffed with mental

health and medical professionals that offer assessment and psychiatric stabilization to

individuals with behavioral health issues. These sites can be used for jail diversion

strategies, as law enforcement is encouraged to utilize these services, to achieve

detainee stabilization as an alternative to jail booking. A variety of PESC programs

are available:

o Extended Observation Units (EOU) - Extended observation units are designed

to provide emergency stabilization to individuals in behavioral health crisis

for up to 48 hours.

o Crisis Residential Services - Crisis residential services provide short-term,

community-based residential crisis treatment to persons who may pose some

risk of harm to self or others, and who may have fairly severe functional

impairment. The recommended length of stay ranges from 1-14 days.

o Crisis Respite Services - In contrast with crisis residential services, crisis

respite services provide short-term, community-based residential, crisis

treatment to persons who have low risk of harm to self or others and may have

some functional impairment who require direct supervision and care, but do

not require hospitalization.

o Inpatient Hospital Services - Hospital services staffed with medical and

nursing professionals who provide 24-hour professional monitoring,

supervision, and assistance in an environment designed to provide safety and

security during acute behavioral health crisis.

o Crisis Stabilization Units (CSU) - Short-term residential treatment designed to

reduce acute symptoms of mental illness provided in a secure and protected

clinically staffed, psychiatrically supervised, treatment environment that

complies with crisis stabilization unit licensing requirements.



Crisis intervention training (CIT)/mental health deputy/peace officer programs (i.e., Adults

and Children). In 2005, the Texas Commission on Law Enforcement Officer Standards and

Education mandated that all cadets receive 24 hours of crisis intervention training. This mandate

has since been changed to 16 hours. However, through the development of CIT, officers have

the opportunity to enhance their awareness of intervening with behavioral health populations

through taking a 40 hour course. CIT or, mental health deputy officers are generally called upon

when there is an individual with behavioral health issues in a crisis requiring law enforcement

intervention. These officers generally have strong collaboration with LMHAs and other agencies

that treat behavioral health issues. As an alternative to booking the individual into county jail,

many of these officers will transport the individual to a local treatment facility as a jail diversion

strategy.

Critical time intervention (CTI): Harris County Jail Diversion Program (i.e., Adults). S.B.

1185 of the 83rd

Legislative Session mandated the development of a jail diversion pilot program

in Harris County to reduce recidivism and the frequency of arrests and incarceration among

persons with mental illness. The 2014-2015 General Appropriations Act, S.B. 1, 83rd

Legislature, 2013 (Article II, Department of State Health Services, Rider 95) allocates $10

million to the establishment of the program, to which Harris County must match the dollar

amount. Services provided to participants will include integrated medical, mental, and physical

treatment. Additionally, the bill mandated that treatment encompass CTI principles, which

include psychiatric treatment and medication management, money management, substance abuse

treatment, housing, and life skills training.

Forensic Commitments

Outpatient Competency Restoration (i.e., Adults). S.B.867 of the 80th

Legislature amended

Chapter 46B of the Code of Criminal Procedure: Incompetency to Stand Trial. These

amendments explicitly permitted the outpatient treatment of individuals found incompetent to

stand trial, and determined not to be a danger to the community, for the purpose of competency

restoration treatment (see Article 46B.072. a-1). The Department of State Health Services

(DSHS) was provided funding to establish pilot sites for the implementation of OCR programs,

through local mental health authorities (LMHA), in collaboration with local judicial officials.

Since 2008 there have been twelve OCR sites established:

Center for Health Care Services - Bexar County

Austin Travis County Integral Care - Travis County

ValueOptions – NorthSTAR - Dallas County

MHMR of Tarrant County - Tarrant County

Emergence Health Network - El Paso

Gulf Coast Center & Tri-County Services - Galveston and East Texas areas

Spindletop Center - Beaumont area

StarCare Specialty Health System - Lubbock



Behavioral Health Center of Nueces County - Nueces County

Andrews Center Behavioral Healthcare Center - Tyler area

Community Healthcore - Longview area

Heart of Texas Region MHMR Center – Waco

Jail-based Competency Restoration Pilot Program (i.e., Adults). S.B. 1475 of the 83rd

Legislative Session directed DSHS to pilot a jail-based competency restoration program. The

2014-2015 General Appropriations Act, S.B. 1, 83rd

Legislative Session, 2013 (Article II, DSHS

Rider 74) appropriated $3.05 million for this purpose. S.B. 1475 requires that this pilot:

employ similar clinical treatment provided as part of a competency restoration

program at an inpatient mental health facility;

provide weekly treatment hours commensurate to the treatment hours provided as part

of a competency restoration program at an inpatient mental health facility; and

assign a staff to participant/defendant average ratio of not lower than 3.7 to 1.

Access to Ongoing Care

TCOOMMI (i.e., Adults and Children). In Texas, post-booking diversion strategies are

representative of interventions applied during Intercept 5of the Sequential Intercept Model.

TCOOMMI provides funding to some LMHAs for the development of treatment programs for

individuals on probation or parole. These individuals are generally identified by the courts to be

in need of mental health treatment. As a condition of their probation or parole, they must engage

in mental health treatment provided through the LMHA. Treatment generally entails linkage to

the LMHA where they meet with a case-worker weekly, receive psychotropic medication

treatment via a psychiatrist, and receive additional services consistent with the DSHS Texas

Resilience and Recovery Utilization Management Guidelines (i.e. visit

http://www.dshs.state.tx.us/mhsa/trr/um/ click on Texas Resilience and Recovery Utilization

Management Guidelines – Adult Services). If the individual complies with treatment, charges

may be dropped, severity of the offense may be reduced, or the sentence may be reduced.

Extended Jail Diversion Strategies

The below strategies may not be considered programs with the specific intent of diverting

individuals with mental illness out of the criminal justice system; however, they are strategies

implemented in Texas that have both direct and indirect influences on existing jail diversion

initiatives.

Texas Law Enforcement Telecommunications Systems (TLETS) (i.e., Adults and Children).

DSHS in conjunction with the Department of Public Safety (DPS) utilizes TLETS, which

permits the sharing of data between DPS and various agencies. Every individual booked into a

county jail receives a Continuity of Care Query (CCQ). The DPS TLETS permits that individual

(i.e. based on first and last name, date of birth, sex, social security number, and race) to be



searched across the DSHS Clinical Management for Behavioral Health Services system (i.e. a

data warehouse system including treatment information for all individuals who have received

services at institutions funded through DSHS such as LMHAs or state hospitals) to establish a

match of identity. Once a match is identified, the county jail receives a report with that

individual’s name and the location of the last LMHA in which a service was provided. County

jail staff contacts the LMHA to conduct a screening and provide linkage to mental health

services provided in the community via the LMHA, or, additional agencies (i.e. please see

http://www.dshs.state.tx.us/mhcontracts/ContractDocuments.shtm click on Information Item T).

Harris County Jail Diversion Pilot Program (i.e., Adults). S.B. 1185 of the 83rd

Legislative

Session mandated the establishment of a jail diversion pilot program that will operate for a

period of three years and treatment must incorporate principles of Critical Time Intervention.

Program staff will provide community-based jail diversion services to individuals with mental

illness with, or, without substance use issues. These individuals must have received treatment in

Harris County Sheriff’s Office (HCSO) Mental Health Unit, a history of recurring psychotropic

medication treatment in HCSO, and have one or more of the above criteria, as well as, three or

more bookings within the past two years. Program goals include reducing recidivism rates and

reducing the frequency of arrests for individuals with mental illness.

Health Community Collaboratives (i.e., Adults). S.B. 58 of the 83rd

Legislative Session directed

DSHS to enhance or expand existing services to persons experiencing homelessness and mental

illness in the 5 largest metropolitan cities in Texas. DSHS was allocated $6.9 million for Fiscal

Year (FY) 2014 and $16.5 million for FY 2015 for the implementation and expansion of these

projects. An example of such a project is Haven for Hope located in San Antonio. Haven for

Hope is a hub for individuals who are homeless. Law enforcement officers may drop off

individuals who are homeless at this site for assessment and linkage to treatment services. While

residing at Haven for Hope, individuals are provided with employment and job readiness

training, substance abuse treatment, education, spiritual, and additional services. Haven for

Hope services are rooted in a holistic and recovery-based treatment focus. There are over 80

organizations who partner towards maintaining Haven for Hope, 40 of which are located on the

premises.

Supportive housing and intensive community supports (i.e., Adults). The 83rd

Legislative

Session appropriated $24,840,940 towards the expansion of supportive housing for people with

mental illness who are homeless or at risk for homelessness. Eighteen LMHAs were awarded

funding towards the implementation of supportive housing to help stabilize a high need

population at potential risk of incarceration.

http://www.dshs.state.tx.us/mhcontracts/ContractDocuments.shtm

1

The Varieties of Traumatic Experience: Risk and Legality In

PTSD

Michelle Richter, Ph.D.

St. Edward’s University

Overview Legal Implications

Diagnosis Debate

PTSD Points

PTSD and Criminal Behavior Correlation between criminal behavior and a

PTSD diagnosis

Correlations can be misleading…

Little research examining role of specific PTSD symptoms and criminal behavior

2

The Law and Diagnosis Following the birth of the PTSD diagnosis,

PTSD began to instantly appear in many criminal trials

Battered-wife and Battered-child syndrome also began to appear as types of PTSD

How Often is PTSD a Court Issue? Recent review of case law resulted in almost

200 appellate cases in which PTSD was part of a criminal defense

Five types of PTSD defense…

Insanity

Mixed decisions from courts – some courts explicitly state a link from PTSD to violence –others explicitly deny it

Defense based many cases of dissociative episodes involving murder

3

Unconsciousness Defense Defendant not conscious during criminal act

PTSD and Self-Defense Primarily used as defense to support murder

by victim of domestic assault

Defendant feared imminent death or bodily harm

PTSD and Mens Rea Diminished capacity to form requisite state of

mind for a crime

4

PTSD As A Mitigating Circumstance

PTSD found by some courts to be a mitigating circumstance

Several cases, on appeal, found that PTSD should have been presented in court and reversed their original decisions

PTSD and Successful Defense Clear and direct connection between PTSD

symptoms and criminal behavior found by “expert”

Courts have found to be most relevant to criminal defenses :

Dissociations

Hyperarousal

Overestimation of danger

Legal Scholars Recommend… Assessing the veracity of the trauma -Examining confirmatory records

-Being alert to exaggerated/factitious trauma

- Begin with open-ended questions before asking about PTSD symptoms

- An accurate PTSD diagnosis

- Elucidate how PTSD symptoms contributed to crime

5

The Origin of the Debate

Expert testimony in court has its origin in a set of landmark rulings…

Daubert Trio Supreme Court landmark cases establishing

the admission of expert witness testimony in court

Reliability of diagnosis assumed

But should it be for PTSD?

Let’s Look Deeper… Before speaking of PTSD specifically, let’s

talk disorders generally…

Any Talk of Disorders Begins In One Place…

6

The Big ManualDSM = Diagnostic and Statistical Manual of Mental Disorders, now in it’s 5th Edition!

Let’s do a little pop quiz…

Which Disorder?

“I feel so sad almost every day, I’ve lost any desire to do anything fun anymore. I spend all my time being depressed all day long.”

7

And the diagnosis is… Major Depression

Generalized Anxiety Disorder

Posttraumatic Stress Disorder

Obsessive Compulsive Disorder

Bipolar Disorder

Which Disorder?

“I can’t get the past trauma out of my head. I keep reliving the same event over and over, all I can think about is how I could have done things differently.”





Bipolar Disorder

8

Which Disorder?

“You can’t leave the house until you check the locks on every window and door over and over again. You go through the same rituals and are terrified that you will harm someone you care about. You just can’t get those thoughts out of your head.”





Bipolar Disorder

And the correct diagnosis is…

Drum Roll Please…

9

And the correct diagnosis is… √Major Depression

√ Generalized Anxiety Disorder

√ Posttraumatic Stress Disorder

√ Obsessive Compulsive Disorder

√ Bipolar Disorder

DSM Dilemmas Comorbidity = Many of the disorders occur in

groups, it is uncommon to have just one disorder

Depression and Anxiety occur together in 80% of cases. What’s wrong with this picture?

DSM Dilemmas Categorical model dominates the

conceptualization of mental disorders

10

Let’s Talk Depression…

A page from the DSM…1) depressed mood most of the day2) markedly diminished interest in activities 3) significant weight loss when not dieting 4) insomnia or hypersomnia nearly every day 5) psychomotor agitation or retardation 6) fatigue or loss of energy nearly every day 7) feelings of worthlessness or guilt8) diminished ability to think or concentrate 9) recurrent thoughts of death

A page from the DSM… To be clinically depressed you must meet 5 of

9 possible symptoms…

But what if you meet 4? Will your health insurance still cover you?

11

Another page from the DSM…1) Feeling wound-up, tense, or restless2) Easily becoming fatigued3) Concentration Problems4) Irritability5) Significant tension in muscles6) Difficulty with sleep

Overall Conclusions for DSM Categorical System of the DSM fails to

adequately differentiate disorders…

A new diagnostic structure is needed…

New Classification System for Everything

A dimensional model (no strict cut-off points) vs. a categorical model

How would diagnosis look?

12

Dimensional Diagnosis

20

35

50

65

80

95

46 38 46 38 62 58 57 49 61 46 52 65

PAR SZD STP AS BDL HIS NAR AVD DPN OC DPR PA

T S

core

Scale

Diagnostic Scales

Now back to PTSD problems… Some Diagnostic Dilemmas…

Limitations of using the DSM for PTSD Diagnosis

High comorbidity rates of PTSD with:

depression

substance abuse

and other anxiety disorders

In court, someone diagnosed with PTSD is likely to have some of these other symptoms as well, whether diagnosed or not….

13

DSM Limitations Two potential limitations:

PTSD may include symptom overlap among many different disorders (i.e., PTSD and depression)

DSM cannot differentiate!

Major clinical problem!

And Now, Let’s Talk Trauma But we may be getting ahead of ourselves..

First, what is PTSD???

PTSD was born with DSM-III in 1980

Wait, why 1980???

Currently it is made up of several symptom groups…

14

Symptom Cluster #1 reexperiencing symptoms

Symptom Cluster #2 symptoms of avoidance and emotional

numbing

Symptom Cluster #3 hyperarousal symptoms

15

Newest Edition to the Family!

Cluster 4 – Negative Mood and Cognition

So What Else Is There? We’ve mentioned the symptoms, but what

qualifies as a stressor?

What Do You Think? Do you think the following scenarios might

cause PTSD???

16

To PTSD or not to PTSDExperiencing severe combat situations

To PTSD or not to PTSD

Witnessing a car accident

To PTSD or not to PTSDWatching a distressing news story on TV

17

Watching Reality TV?

Watching the final episode…

DSM-4 Stressor Criteria for PTSD Involves actual or threatened death or serious

injury to self or others, and intense fear, helplessness, or horror.

Why is this definition important? Because…

Why Is Diagnosis Important? The DSM-5 PTSD diagnosis will… Have enormous impact on who qualifies for a

PTSD diagnosis (military, domestic assault)

Affect the direction of PTSD research and funding

Significant legal implications

18

Studies Say… New revisions of the DSM should keep fear,

helplessness, horror, and dissociative symptoms as stressor criteria for PTSD

RESTRICT the diagnosis

Did the DSM authors listen to the research?

DSM‐5 Stressor Criteria for PTSD

Absolutely Not!

With DSM‐5, the stressor criterion has been expanded to include almost everything…

Fear, helplessness, horror is gone…

You can qualify by hearing a tragic story from a friend…

Legal Implications may be substantial

Who’s At Risk for these Symptoms?

Individual Risk/Resiliencey Factors Include:

Optimism

Self-Esteem

Social Support

Smaller Hippocampus

Genes! (short forms of 5HTTLPR gene)

Psychosocial Stressors

19

Copyright © Houghton Mifflin Company. All rights reserved.

9 - 55

James D. Laird and Nicholas S. Thompson, Psychology. Copyright © 1992 by Houghton Mifflin Company. Reprinted by permission.

The Diathesis Stress Model

Demographics PTSD in 6.8% of people. Women more likely

to be diagnosed with PTSD (9.7 % vs. 3.6 % men)

One study reported that 95 % of women who had been raped met criteria for PTSD 2 weeks later, but 45.9 % after three months

Why the Gender Difference? Reason for difference not fully understood:

Some biology: Women with PTSD have higher levels of cortisol (not same for men)

Sexual Assault more likely to lead to PTSD

So, type of stressor affects prevalence rates…

20

Treatment and Risk Exposure Exposure Exposure

Medications???

Risk in public

Thank You! Q and A

Understanding

PTSDHave you, or someone you love

Been through combat?

Lived through a disaster?

Been raped?

Experienced any other kind of traumatic event?

Have you ever thought that painful memories of that experience were still causing problems for you or a loved one?

You may have heard of PTSD—posttraumatic stress disorder—on the news or from friends and family, and wondered

what it is, or whether you or someone you know has it.

This booklet will help you understand what PTSD is. You’ll learn how to get help for yourself, a friend, or a family

member. It includes stories from people who have gotten help for their PTSD and have returned to their normal lives,

activities, and relationships.

The important thing to remember is that effective treatment is available.

You don’t have to live with your symptoms forever.

This guide covers:

What Is PTSD? .....................2

Getting Help ........................6

Resources .............................8

Produced by the National Center for PTSD | August 2013 U.S. Department of Veterans Affairs | www.ptsd.va.gov

2www.ptsd.va.gov

What Is PTSD?

PTSD

Posttraumatic stress disorder, or PTSD, can occur after someone goes through, sees, or learns about a traumatic event like:

• Combat exposure

• Child sexual or physical abuse

• Terrorist attack

• Sexual/physical assault

• Serious accident

• Natural disaster

Most people have some stress-related reactions after a traumatic event. If your reactions don’t go away over time and they disrupt your life, you may have PTSD.

See the next few pages for common reactions to trauma and PTSD symptoms.

How Common Is PTSD?

Many Americans have had a trauma. About 60% of men and 50% of women experience at least one traumatic event. Of those who do, about 8% of men and 20% of women will develop PTSD. For some events, like combat and sexual assault, more people develop PTSD.

Men

61% Experience

Trauma

8% Develop PTSD

Women

51% Experience

Trauma

20% Develop PTSD

3www.ptsd.va.gov

What Are Some Common Stress Reactions after a Trauma?

It is normal to have stress reactions after a traumatic event. Your emotions and behavior can change in ways that are troubling to you.

Fear or anxiety In moments of danger, our bodies prepare to fight our enemy, flee the situation, or freeze in the hope that the danger will move past us. But those feelings of alertness may stay even after the danger has passed. You may:

• feel tense or afraid• be agitated and jumpy• feel on alert

Sadness or depression Sadness after a trauma may come from a sense of loss---of a loved one, of trust in the world, faith, or a previous way of life. You may:

• have crying spells• lose interest in things you used to enjoy• want to be alone all the time• feel tired, empty, and numb

Guilt and shame You may feel guilty that you did not do more to prevent the trauma. You may feel ashamed because during the trauma you acted in ways that you would not otherwise have done. You may:

• feel responsible for what happened• feel guilty because others were injured or killed and you

survived

Anger and irritability Anger may result from feeling you have been unfairly treated. Anger can make you feel irritated and cause you to be easily set off. You may:

• lash out at your partner or spouse• have less patience with your children• overreact to small misunderstandings

Behavior changes You may act in unhealthy ways. You may:

• drink, use drugs, or smoke too much• drive aggressively• neglect your health• avoid certain people or situations

Most people will have some of these

reactions at first, but they will get better

at some time. If symptoms last longer

than three months, cause you great

distress, or disrupt your work or home life,

you should seek help.

4www.ptsd.va.gov

What Are the Symptoms of PTSD?

PTSD has four types of symptoms.

Reliving the event (also called reexperiencing) Memories of the trauma can come back at any time. You may feel the same fear and horror you did when the event took place. You may have nightmares or feel like you’re going through it again. This is called a flashback. Sometimes there is a trigger—a sound or sight that causes you to relive the event.

• Seeing someone who reminds you of the trauma may bring back memories of the event.

• You may think about the trauma at work or school when you need to concentrate on something else.

Avoiding situations that remind you of the event You may try to avoid situations or people that trigger memories of the traumatic event. You may even avoid talking or thinking about the event.

• You may avoid crowds, because they feel dangerous.• If you were in a car accident or if your military convoy

was bombed, you may avoid driving.• Some people may keep very busy or avoid seeking

help. This keeps them from having to think or talk about the event.

Negative changes in beliefs and feelings The way you think about yourself and others changes because of the trauma. This symptom has many aspects, including the following:

• You may not have positive or loving feelings toward other people and may stay away from relationships.

• You may forget about parts of the traumatic event or not be able to talk about them.

• You may think the world is completely dangerous, and no one can be trusted.

Feeling keyed up (also called hyperarousal) You may be jittery, or always on the alert and on the lookout for danger. You might suddenly become angry or irritable. This is known as hyperarousal.

• You may want to have your back to a wall in a restaurant or waiting room.

• A loud noise can startle you easily.• If someone bumps into you, you might fly into a rage.

Real Stories: Teresa

On a military mission, the truck in front of Teresa’s

went over a roadside bomb, and there were no

survivors. She was badly injured in the explosion,

but the person in the seat where Teresa was

supposed to have been was injured much worse.

Teresa felt guilty about that.

After returning home, Teresa started having

nightmares and panic attacks. The awful images

of that day haunted her. The medicines she was

prescribed for her anxiety and sleep problems

didn’t seem to help. She didn’t want to leave

the house, go to work, or do anything. One day

she lost control and verbally abused her platoon

leader. Her first sergeant stepped in and insisted

that she see a psychiatrist.

Teresa was diagnosed with PTSD. She’s doing

better thanks to treatment at her local VA.

Although Teresa’s problems have not gone away,

she now has a great support team to help her.

“Now I’ve got a great support team. I owe a tremendous thanks to my counselor.”

5www.ptsd.va.gov

Real Stories: Frank

“It was nice to know there was a reason for what I was doing.”

Frank served our country in Vietnam. Before

the war, he had been a happy person, but

he rarely smiled once he came home.

For many years, Frank didn’t talk about

Vietnam, thinking he would spare people.

He started drinking more. He had a short

temper, and had to have his back to the

wall in restaurants because he kept thinking

someone was after him. He couldn’t hold a

job or have a successful relationship. He just

felt that something was wrong. Frank didn’t

realize it, but he was having many of the

symptoms of PTSD.

Frank went to the VA, where he was

diagnosed with PTSD and given treatment

and support. He’s doing much better now.

“I would definitely recommend any Veteran go and get help.”

What Other Problems Do People with PTSD Experience?

People with PTSD may feel hopelessness, shame, or despair. Employment and relationship problems are also common. Depression, anxiety, and alcohol or drug use often occur at the same time as PTSD. In many cases, the PTSD treatments described in the Getting Help section will also help these other disorders, because the problems are often related and the coping skills you learn work for all of them.

How Likely Is a Person to Develop PTSD after a Trauma?

How likely you are to get PTSD can depend on things like:

• How intense the trauma was or how long it lasted

• If you lost someone you were close to or if you were hurt

• How close you were to the event

• How strong your reaction was

• How much you felt in control of events

• How much help and support you got after the event

Some groups of people may be more likely than others to develop PTSD. You are more likely to develop PTSD if you:

• Are female or a minority

• Have little education

• Had an earlier life-threatening event or trauma

• Have another mental health problem

• Have family members who have had mental health problems

• Have little support from family and friends

• Have had recent, stressful life changes

6www.ptsd.va.gov

G etting Help

When Should a Person Get Evaluated for PTSD?

If you continue to be upset for more than three months, seek help. You can feel better!

Who Can Conduct an Evaluation, and What Does It Consist of?

PTSD is usually diagnosed in one or two sessions. Your doctor or a mental health professional will evaluate you. You will be asked about your trauma and symptoms. You may also be asked about other problems you have. Your spouse or partner may be asked to provide information.

The Department of Veterans Affairs has a PTSD questionnaire that you can take online. You can also take the screening test below.

If you find that you answered “yes” to many of the questions asked, you may have PTSD. It is best to talk to a mental health professional to find out for sure.

PTSD Screen

In your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you:

❑ Have had nightmares about the experience or thought about it when you did not want to?

❑ Tried hard not to think about the experience or avoided situations that reminded you of it?

❑ Were constantly on guard, watchful, or easily startled?

❑ Felt numb or detached from others, activities, or your surroundings?

Current research recommends that if you answered “yes” to any three items, you should seek more information from a mental health care provider. A positive screen does not mean that you have PTSD. Only a qualified mental health care practitioner, such as a clinician or psychologist, can diagnose you with PTSD.

https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_pageLabel=mentalHealth&contentPage=mh_screening_tools/PTSD_SCREENING.HTML

https://www.myhealth.va.gov/mhv-portal-web/anonymous.portal?_nfpb=true&_pageLabel=mentalHealth&contentPage=mh_screening_tools/PTSD_SCREENING.HTML

7www.ptsd.va.gov

What Treatments Are Effective for PTSD?

There are good treatments available for PTSD. The two main types are psychotherapy, sometimes called “counseling,” and medication. Sometimes people combine psychotherapy and medication.

Psychotherapy Cognitive Behavioral Therapy (CBT) is the most effective treatment for PTSD. CBT usually involves meeting with your therapist once a week for 3-6 months. There are different types of CBT that are effective for PTSD.

Cognitive Processing Therapy (CPT) is a CBT in which you learn skills to better understand how a trauma changed your thoughts and feelings. It will help you see how you have gotten “stuck” in your thinking about the trauma. It helps you identify trauma-related thoughts and change them so they are more accurate and less distressing.

Prolonged Exposure (PE) therapy is a CBT in which you talk about your trauma repeatedly until the memories are no longer upsetting. You also go into situations that are safe but which you may have been avoiding because they are related to the trauma.

Eye Movement Desensitization and Reprocessing (EMDR) involves focusing on distractions like hand movements or sounds while you talk about the traumatic event. Over time, it can help change how you react to memories of your trauma.

Medication Selective Serotonin Reuptake Inhibitors (SSRIs) can raise the level of serotonin in your brain, which can make you feel better. The two SSRIs that are currently approved by the FDA for the treatment of PTSD are sertraline (Zoloft) and paroxetine (Paxil).

Sometimes, doctors prescribe medicines called benzodiazepines for people with PTSD. These medicines are often given to people who have problems with anxiety. While they may be of some help at first, they do not treat the core PTSD symptoms. They may lead to addiction and are not recommended for long-term PTSD treatment.

Real Stories: GinaGina had a great job, a loving husband, and a beautiful home. But

she was miserable. Some days, a kiss from her husband would

make her heart start pounding, and she would feel very afraid. She

did not realize that these panicky feelings were flashbacks—the

rexperiencing of the feelings that she had felt when she was a small

child and couldn’t protect herself.

Gina sought help. She went to a therapist, and finally revealed that

her uncle had repeatedly sexually abused her as a child. Her therapist

diagnosed PTSD, and started cognitive behavioral therapy with Gina.

Therapy taught her to challenge her thoughts and feel less distress.

She still has occasional flashbacks and panic attacks, but they’re now controllable, and she knows they will

pass. Before, she thought she’d always have to live with the flashbacks and bad feelings. Now, she can go

weeks without thinking about the abuse, and she feels certain that someday it will be years.

“You can be a normal thriving person and have mental health issues, get help for those, and still be okay.”

8www.ptsd.va.gov

R esources

How Can I Learn More About PTSD?

View the multimedia companion to this brochure and other resources at www.ptsd.va.gov/public/

In a Crisis?• Call 911

• Go to an emergency room

• Call 1-800-273-TALK (1-800-273-8255) (Español: 1-888-628-9454)

Veterans, go to www.suicidepreventionlifeline.org/Veterans to chat live with a crisis counselor

Where Can I Get Help for Myself or a Family Member?These links are accessible online at http://www.ptsd.va.gov/public/where-to-get-help.asp

• Where to Get Help for PTSD

• Mental Health Services Locator

• VA PTSD Program Locator

This guide was created by the National Center for PTSD, U.S. Department of Veterans Affairs. The Center conducts research and education on trauma and PTSD. Our website offers extensive information, educational materials, and multimedia presentations

for a variety of audiences, including Veterans and their families, providers, and researchers. Website: www.ptsd.va.gov

http://www.ptsd.va.gov/public/index.asp

http://www.suicidepreventionlifeline.org/Veterans/

http://www.ptsd.va.gov/public/where-to-get-help.asp



http://findtreatment.samhsa.gov/MHTreatmentLocator

http://www2.va.gov/directory/guide/PTSD.asp

1

MENTAL HEALTHCOMMITMENT PROCESS

Texas Municipal Courts Education Center

Mental Health Clinic

February, 2015

Statutory Authority

• Health & Safety Code, Subchapter C

• Chapter 571 through Chapter 579

• Purpose of Subchapter C:

– Civil in nature – not a criminal sanction

– Define patient rights to notice and hearing

– Concept of “least restrictive means”

– Define criteria for detention and safeguards to “patient” rights

Distinctions

• Mental Health Services under Subchapter C are divided into voluntary and involuntary services

• Rights are retained under both voluntary and involuntary

• Mental Health is differentiated from Mental Retardation

• Mental Health is distinguished from Chemical Dependency

2

Jurisdiction

• Jurisdiction for placement beyond emergency detention lies with a County Probate Court, or the County Court with Probate jurisdiction.

• Ultimate case disposition is that of the Probate Court.

• Peace officers have the authority to make an emergency detention

• Magistrates’ have the ability to consider and order of protective custody

Emergency DetentionTx.H&SC ‐ Chapter 573

• A peace officer, without warrant may detain a person who the officer believes is (a) mentally ill, and (b) because of that mental illness there is a substantial risk of harm to self or others, if there is insufficient time to obtain a warrant.

• A “substantial risk of harm” may be shown by the person’s behavior or evidence of emotional distress and deterioration to the extent the person cannot remain at liberty.

Process for Emergency Detention

• A peace officer may form opinion based on personal observation or information of a credible person.

• Once in custody, the officer must immediately transport the person to an appropriate mental health facility (not a jail)

• Officer must inform the patient of reasons in non‐technical terms, and facility must provide patient with rights within 24 hours of detention.

• Officer may seize firearm from patient.

3

Application Other than Peace Officer

• An adult may file application for emergency detention with a Judge or Magistrate with the same standard regarding behavior.

• Application must be in person

• Magistrate must find mental illness, risk of harm, and that necessary restraint cannot be accomplished without detention.

• If basis found, magistrate shall issue warrant to peace officer.

Once Patient Detained

• Facility must accept patient detained by peace officer

• May detain NOT LONGER than 48 HOURS.

• During 48 Hours, patient must be examined by doctor within 12 hours

• Must be released at end of examination unless basis found

• If basis shown, application for Protective Custody (under Ch. 574) must be filed.

Court‐Ordered Mental Health ServicesChapter 574

• Any person may apply to a court with probate jurisdiction to find that a person is in need of mental health services.

• May be filed in county where person resides or is found

• If filed by a county/ district attorney, no CME is required at time of filing

• Person remains at liberty during application and until time of hearing

4

Hearing

• Hearing must be set w/in 14 days after filing• Application must be served on patient• State represented by county/ district attorney• Court must appoint an attorney• Attorney must discuss rights, hearing and appeal and must receive a copy of application.

• Two (2) CMEs made w/in last 30 days must be presented to the court. May order patient to submit to examination. If no CMEs, must release.

• Hearing must be before Judge of court with probate jurisdiction or associate judge.

Certificates of Medical Examination

• CMEs must be made by physician or psychiatrist within last 30 days.

• Must provide diagnosis and treatment• Must find that the person is:

– mentally ill; – “likely to cause serious harm to self or others;– Suffering severe, abnormal mental or emotional distress– Unable to provide for person basic needs or safety– Unable to make rational decision to submit to treatment; and

– If part of a request for protective custody, that restraint is necessary to prevent harm to self or others

PROTECTIVE CUSTODY

• Motion for Protective Custody (574.021) must be filed in a court in which an application for mental health services is pending.

• Filed at the request of the county/ district attorney or the court’s own motion

• The (probate) judge may designate a magistrate to issue protective orders

• Magistrate or judge may issue order for detention based upon opinion of a physician

5

Order for Protective Custody

• Order for apprehension and detention must be based on finding of mental illness and danger to self or others

• Must find risk based on behavior or action to the extent that the patient cannot remain at liberty.

• Order directed to officer to apprehend and detain patient and to transport them to an appropriate facility.

Hearing on Protective Custody(Probable Cause Hearing)

• Attorney must be appointed for patient

• Patient entitled to notice and pleadings

• Before Judge or assigned Magistrate

• Probable Cause as to patient is risk of harm to self or others

• Requires consideration of physician’s opinion

• MUST BE HELD within 72 HOURS of detention(with limited exception) TH&SC 574.025

• May consider all testimony and evidence

CONTINUED DETENTION

• A Protective Custody Order may order that the patient be:– detained in a mental health facility operated by the Texas Department of Health until the Hearing on application for Mental Health Services (w/in 14 days)

– Detained in another mental health facility the court finds appropriate;

– RELEASED if the judge finds no probable cause;

– Order the patient reappear at hearing for Court Ordered Mental Health Services (w/in 14 days of application)

6

TEMPORARY ORDERS (Hearing on Application)

• Must be heard by a Judge with probate jurisdiction (or associate judge)

• If by Associate judge, recommendations must be adopted by the Judge

• If basis shown, the Judge may order the detention of the patient for NOT LONGER than 90 days.

• Patient must submit to treatment during detention.

• Patient entitled to jury trial.

• Court may order “out‐patient” services

• Orders subject to “post‐commitment” modification

General Concepts

• All mental health services are intended to be “temporary” and should aim toward re‐integration into community

• Mental health issues are not “criminal”• Magistrate’s emergency orders are a “sub‐part” of the over‐all process under the probate court’s direction

• Proceedings are time sensitive.• Proceedings are confidential and not a matter of public record (i.e. Style of case – initials only)

Dependent on County Structure

• Familiarize yourself with your county processes.

• Often integrated with Justice of the Peace

• Contact your sheriff’s office to determine if special resources are available (mental health unit)

• Contact your County Court with probate jurisdiction.

HEALTH AND SAFETY CODE

TITLE 7. MENTAL HEALTH AND MENTAL RETARDATION

SUBTITLE C. TEXAS MENTAL HEALTH CODE

CHAPTER 573. EMERGENCY DETENTION

SUBCHAPTER A. APPREHENSION BY PEACE OFFICER OR TRANSPORTATION

FOR EMERGENCY DETENTION BY GUARDIAN

Sec. 573.001. APPREHENSION BY PEACE OFFICER WITHOUT

WARRANT. (a) A peace officer, without a warrant, may take a

person into custody if the officer:

(1) has reason to believe and does believe that:

(A) the person is mentally ill; and

(B) because of that mental illness there is a

substantial risk of serious harm to the person or to others

unless the person is immediately restrained; and

(2) believes that there is not sufficient time to

obtain a warrant before taking the person into custody.

(b) A substantial risk of serious harm to the person or

others under Subsection (a)(1)(B) may be demonstrated by:

(1) the person's behavior; or

(2) evidence of severe emotional distress and

deterioration in the person's mental condition to the extent

that the person cannot remain at liberty.

(c) The peace officer may form the belief that the person

meets the criteria for apprehension:

(1) from a representation of a credible person; or

(2) on the basis of the conduct of the apprehended

person or the circumstances under which the apprehended person

is found.

(d) A peace officer who takes a person into custody under

Subsection (a) shall immediately transport the apprehended

person to:

(1) the nearest appropriate inpatient mental health

facility; or

(2) a mental health facility deemed suitable by the

local mental health authority, if an appropriate inpatient

mental health facility is not available.

(e) A jail or similar detention facility may not be deemed

suitable except in an extreme emergency.

(f) A person detained in a jail or a nonmedical facility

shall be kept separate from any person who is charged with or

convicted of a crime.

Text of subsection as added by Acts 2013, 83rd Leg., R.S., Ch.

318 (H.B. 1738), Sec. 1

(g) A peace officer who takes a person into custody under

Subsection (a) shall immediately inform the person orally in

simple, nontechnical terms:

(1) of the reason for the detention; and

(2) that a staff member of the facility will inform

the person of the person's rights within 24 hours after the time

the person is admitted to a facility, as provided by Section

573.025(b).

Text of subsection as added by Acts 2013, 83rd Leg., R.S., Ch.

776 (S.B. 1189), Sec. 1

(g) A peace officer who takes a person into custody under

Subsection (a) may immediately seize any firearm found in

possession of the person. After seizing a firearm under this

subsection, the peace officer shall comply with the requirements

of Article 18.191, Code of Criminal Procedure.

Added by Acts 1991, 72nd Leg., ch. 76, Sec. 1, eff. Sept. 1,

1991. Amended by Acts 2001, 77th Leg., ch. 367, Sec. 5, eff.

Sept. 1, 2001.

http://www.legis.state.tx.us/tlodocs/83R/billtext/html/HB01738F.HTM

http://www.statutes.legis.state.tx.us/GetStatute.aspx?Code=HS&Value=573.025&Date=6/28/2014

http://www.legis.state.tx.us/tlodocs/83R/billtext/html/SB01189F.HTM

http://www.statutes.legis.state.tx.us/GetStatute.aspx?Code=CR&Value=18.191&Date=6/28/2014

Amended by:

Acts 2013, 83rd Leg., R.S., Ch. 318 (H.B. 1738), Sec. 1,

eff. September 1, 2013.

Acts 2013, 83rd Leg., R.S., Ch. 776 (S.B. 1189), Sec. 1,


Sec. 573.002. PEACE OFFICER'S NOTIFICATION OF DETENTION.

(a) A peace officer shall immediately file with a facility a

notification of detention after transporting a person to that

facility in accordance with Section 573.001.

(b) The notification of detention must contain:

(1) a statement that the officer has reason to

believe and does believe that the person evidences mental

illness;


believe and does believe that the person evidences a substantial

risk of serious harm to the person or others;

(3) a specific description of the risk of harm;


believe and does believe that the risk of harm is imminent

unless the person is immediately restrained;

(5) a statement that the officer's beliefs are

derived from specific recent behavior, overt acts, attempts, or

threats that were observed by or reliably reported to the

officer;

(6) a detailed description of the specific behavior,

acts, attempts, or threats; and

(7) the name and relationship to the apprehended

person of any person who reported or observed the behavior,

acts, attempts, or threats.

(c) The facility where the person is detained shall

include in the detained person's clinical file the notification

of detention described by this section.

(d) The peace officer shall give the notification of

detention on the following form:




Notification--Emergency Detention NO.

____________________ DATE:_______________ TIME:_______________

THE STATE OF TEXAS

FOR THE BEST INTEREST AND PROTECTION OF:

______________________________________

NOTIFICATION OF EMERGENCY DETENTION

Now comes _____________________________, a peace officer with

(name of agency) _____________________________, of the State of

Texas, and states as follows:

1. I have reason to believe and do believe that (name of person

to be detained) __________________________ evidences mental

illness.

2. I have reason to believe and do believe that the above-named

person evidences a substantial risk of serious harm to

himself/herself or others based upon the following:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

3. I have reason to believe and do believe that the above risk

of harm is imminent unless the above-named person is immediately

restrained.

4. My beliefs are based upon the following recent behavior,

overt acts, attempts, statements, or threats observed by me or

reliably reported to me:

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

5. The names, addresses, and relationship to the above-named

person of those persons who reported or observed recent

behavior, acts, attempts, statements, or threats of the above-

named person are (if applicable):

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

For the above reasons, I present this notification to seek

temporary admission to the (name of facility)

_________________________ inpatient mental health facility or

hospital facility for the detention of (name of person to be

detained) __________________________ on an emergency basis.

6. Was the person restrained in any way? Yes □ No □

_________________________ BADGE NO.

_____________________

PEACE OFFICER'S SIGNATURE

Address: _________________________ Zip Code:

____________________

Telephone: ______________________

A mental health facility or hospital emergency department may

not require a peace officer to execute any form other than this

form as a predicate to accepting for temporary admission a

person detained under Section 573.001, Texas Health and Safety

Code.

(e) A mental health facility or hospital emergency

department may not require a peace officer to execute any form

other than the form provided by Subsection (d) as a predicate to

accepting for temporary admission a person detained under

Section 573.001.


1991.

Amended by:





Sec. 573.003. TRANSPORTATION FOR EMERGENCY DETENTION BY

GUARDIAN. (a) A guardian of the person of a ward who is 18

years of age or older, without the assistance of a peace

officer, may transport the ward to an inpatient mental health

facility for a preliminary examination in accordance with

Section 573.021 if the guardian has reason to believe and does

believe that:

(1) the ward is mentally ill; and

(2) because of that mental illness there is a

substantial risk of serious harm to the ward or to others unless

the ward is immediately restrained.

(b) A substantial risk of serious harm to the ward or

others under Subsection (a)(2) may be demonstrated by:

(1) the ward's behavior; or


deterioration in the ward's mental condition to the extent that

the ward cannot remain at liberty.

Added by Acts 2003, 78th Leg., ch. 692, Sec. 6, eff. Sept. 1,

2003.

Sec. 573.004. GUARDIAN'S APPLICATION FOR EMERGENCY

DETENTION. (a) After transporting a ward to a facility under

Section 573.003, a guardian shall immediately file an

application for detention with the facility.

(b) The application for detention must contain:

(1) a statement that the guardian has reason to

believe and does believe that the ward evidences mental illness;


believe and does believe that the ward evidences a substantial

risk of serious harm to the ward or others;






believe and does believe that the risk of harm is imminent

unless the ward is immediately restrained;

(5) a statement that the guardian's beliefs are

derived from specific recent behavior, overt acts, attempts, or

threats that were observed by the guardian; and


acts, attempts, or threats.

(c) The guardian shall immediately provide written notice

of the filing of an application under this section to the court

that granted the guardianship.


2003.

SUBCHAPTER B. JUDGE'S OR MAGISTRATE'S ORDER FOR EMERGENCY

APPREHENSION AND DETENTION

Sec. 573.011. APPLICATION FOR EMERGENCY DETENTION. (a)

An adult may file a written application for the emergency

detention of another person.

(b) The application must state:

(1) that the applicant has reason to believe and does

believe that the person evidences mental illness;


believe that the person evidences a substantial risk of serious

harm to himself or others;



believe that the risk of harm is imminent unless the person is

immediately restrained;

(5) that the applicant's beliefs are derived from

specific recent behavior, overt acts, attempts, or threats;


acts, attempts, or threats; and

(7) a detailed description of the applicant's

relationship to the person whose detention is sought.

(c) The application may be accompanied by any relevant

information.


1991.

Sec. 573.012. ISSUANCE OF WARRANT. (a) Except as

provided by Subsection (h), an applicant for emergency detention

must present the application personally to a judge or

magistrate. The judge or magistrate shall examine the

application and may interview the applicant. Except as provided

by Subsection (g), the judge of a court with probate

jurisdiction by administrative order may provide that the

application must be:

(1) presented personally to the court; or

(2) retained by court staff and presented to another

judge or magistrate as soon as is practicable if the judge of

the court is not available at the time the application is

presented.

(b) The magistrate shall deny the application unless the

magistrate finds that there is reasonable cause to believe that:

(1) the person evidences mental illness;

(2) the person evidences a substantial risk of

serious harm to himself or others;

(3) the risk of harm is imminent unless the person is

immediately restrained; and

(4) the necessary restraint cannot be accomplished

without emergency detention.

(c) A substantial risk of serious harm to the person or

others under Subsection (b)(2) may be demonstrated by:

(1) the person's behavior; or


deterioration in the person's mental condition to the extent

that the person cannot remain at liberty.

(d) The magistrate shall issue to an on-duty peace officer

a warrant for the person's immediate apprehension if the

magistrate finds that each criterion under Subsection (b) is

satisfied.

(e) A person apprehended under this section shall be

transported for a preliminary examination in accordance with

Section 573.021 to:

(1) the nearest appropriate inpatient mental health

facility; or

(2) a mental health facility deemed suitable by the

local mental health authority, if an appropriate inpatient

mental health facility is not available.

(f) The warrant serves as an application for detention in

the facility. The warrant and a copy of the application for the

warrant shall be immediately transmitted to the facility.

(g) If there is more than one court with probate

jurisdiction in a county, an administrative order regarding

presentation of an application must be jointly issued by all of

the judges of those courts.

(h) A judge or magistrate may permit an applicant who is a

physician to present an application by:

(1) e-mail with the application attached as a secure

document in a portable document format (PDF); or

(2) secure electronic means, including:

(A) satellite transmission;

(B) closed-circuit television transmission; or

(C) any other method of two-way electronic

communication that:

(i) is secure;

(ii) is available to the judge or

magistrate; and

(iii) provides for a simultaneous,

compressed full-motion video and interactive communication of

image and sound between the judge or magistrate and the

applicant.


(h-1) After the presentation of an application under

Subsection (h), the judge or magistrate may transmit a warrant

to the applicant:

(1) electronically, if a digital signature, as

defined by Article 2.26, Code of Criminal Procedure, is

transmitted with the document; or

(2) by e-mail with the warrant attached as a secure

document in a portable document format (PDF), if the

identifiable legal signature of the judge or magistrate is

transmitted with the document.

(i) The judge or magistrate shall provide for a recording

of the presentation of an application under Subsection (h) to be

made and preserved until the patient or proposed patient has

been released or discharged. The patient or proposed patient

may obtain a copy of the recording on payment of a reasonable

amount to cover the costs of reproduction or, if the patient or

proposed patient is indigent, the court shall provide a copy on

the request of the patient or proposed patient without charging

a cost for the copy.


1991. Amended by Acts 1991, 72nd Leg., 1st C.S., ch. 15, Sec.

5.19, eff. Sept. 1, 1991; Acts 1995, 74th Leg., ch. 243, Sec.

3, eff. Aug. 28, 1995; Acts 2001, 77th Leg., ch. 367, Sec. 6,

eff. Sept. 1, 2001.

Amended by:

Acts 2007, 80th Leg., R.S., Ch. 1145 (S.B. 778), Sec. 1,


Acts 2011, 82nd Leg., R.S., Ch. 510 (H.B. 1829), Sec. 1,


SUBCHAPTER C. EMERGENCY DETENTION, RELEASE, AND RIGHTS

Sec. 573.021. PRELIMINARY EXAMINATION. (a) A facility

shall temporarily accept a person for whom an application for

http://www.statutes.legis.state.tx.us/GetStatute.aspx?Code=CR&Value=2.26&Date=6/28/2014



detention is filed or for whom a peace officer files a

notification of detention under Section 573.002(a).

(b) A person accepted for a preliminary examination may be

detained in custody for not longer than 48 hours after the time

the person is presented to the facility unless a written order

for protective custody is obtained. The 48-hour period allowed

by this section includes any time the patient spends waiting in

the facility for medical care before the person receives the

preliminary examination. If the 48-hour period ends on a

Saturday, Sunday, legal holiday, or before 4 p.m. on the first

succeeding business day, the person may be detained until 4 p.m.

on the first succeeding business day. If the 48-hour period ends

at a different time, the person may be detained only until 4

p.m. on the day the 48-hour period ends. If extremely hazardous

weather conditions exist or a disaster occurs, the presiding

judge or magistrate may, by written order made each day, extend

by an additional 24 hours the period during which the person may

be detained. The written order must declare that an emergency

exists because of the weather or the occurrence of a disaster.

(c) A physician shall examine the person as soon as

possible within 12 hours after the time the person is

apprehended by the peace officer or transported for emergency

detention by the person's guardian.

(d) A facility must comply with this section only to the

extent that the commissioner determines that a facility has

sufficient resources to perform the necessary services under

this section.

(e) A person may not be detained in a private mental

health facility without the consent of the facility

administrator.



June 11, 2001; Acts 2003, 78th Leg., ch. 692, Sec. 7, eff.

Sept. 1, 2003.

Amended by:


Acts 2007, 80th Leg., R.S., Ch. 202 (H.B. 518), Sec. 1,


Acts 2009, 81st Leg., R.S., Ch. 333 (H.B. 888), Sec. 1,

eff. June 19, 2009.



Sec. 573.022. EMERGENCY ADMISSION AND DETENTION. (a) A

person may be admitted to a facility for emergency detention

only if the physician who conducted the preliminary examination

of the person makes a written statement that:

(1) is acceptable to the facility;

(2) states that after a preliminary examination it is

the physician's opinion that:

(A) the person is mentally ill;

(B) the person evidences a substantial risk of

serious harm to himself or others;

(C) the described risk of harm is imminent

unless the person is immediately restrained; and

(D) emergency detention is the least restrictive

means by which the necessary restraint may be accomplished; and

(3) includes:

(A) a description of the nature of the person's

mental illness;

(B) a specific description of the risk of harm

the person evidences that may be demonstrated either by the

person's behavior or by evidence of severe emotional distress

and deterioration in the person's mental condition to the extent

that the person cannot remain at liberty; and

(C) the specific detailed information from which

the physician formed the opinion in Subdivision (2).

(b) A mental health facility that has admitted a person

for emergency detention under this section may transport the

person to a mental health facility deemed suitable by the local

mental health authority for the area. On the request of the




local mental health authority, the judge may order that the

proposed patient be detained in a department mental health

facility.

(c) A facility that has admitted a person for emergency

detention under Subsection (a) or to which a person has been

transported under Subsection (b) may transfer the person to an

appropriate mental hospital with the written consent of the

hospital administrator.



June 18, 1999; Acts 2001, 77th Leg., ch. 367, Sec. 7, eff.

Sept. 1, 2001.

Amended by:

Acts 2011, 82nd Leg., R.S., Ch. 510 (H.B. 1829), Sec. 2,


Sec. 573.023. RELEASE FROM EMERGENCY DETENTION. (a) A

person apprehended by a peace officer or transported for

emergency detention under Subchapter A or detained under

Subchapter B shall be released on completion of the preliminary

examination unless the person is admitted to a facility under

Section 573.022.

(b) A person admitted to a facility under Section 573.022

shall be released if the facility administrator determines at

any time during the emergency detention period that one of the

criteria prescribed by Section 573.022(2) no longer applies.



Sept. 1, 2003.

Sec. 573.024. TRANSPORTATION AFTER RELEASE. (a)

Arrangements shall be made to transport a person who is entitled

to release under Section 573.023 to:

(1) the location of the person's apprehension;






(2) the person's residence in this state; or

(3) another suitable location.

(b) Subsection (a) does not apply to a person who is

arrested or who objects to the transportation.

(c) If the person was apprehended by a peace officer under

Subchapter A, arrangements must be made to immediately transport

the person. If the person was transported for emergency

detention under Subchapter A or detained under Subchapter B,

the person is entitled to reasonably prompt transportation.

(d) The county in which the person was apprehended shall

pay the costs of transporting the person.



Sept. 1, 2003.

Sec. 573.025. RIGHTS OF PERSONS APPREHENDED, DETAINED, OR

TRANSPORTED FOR EMERGENCY DETENTION. (a) A person apprehended,

detained, or transported for emergency detention under this

chapter has the right:

(1) to be advised of the location of detention, the

reasons for the detention, and the fact that the detention could

result in a longer period of involuntary commitment;

(2) to a reasonable opportunity to communicate with

and retain an attorney;

(3) to be transported to a location as provided by

Section 573.024 if the person is not admitted for emergency

detention, unless the person is arrested or objects;

(4) to be released from a facility as provided by

Section 573.023;

(5) to be advised that communications with a mental

health professional may be used in proceedings for further

detention;

(6) to be transported in accordance with Sections

573.026 and 574.045, if the person is detained under Section





573.022 or transported under an order of protective custody

under Section 574.023; and

(7) to a reasonable opportunity to communicate with a

relative or other responsible person who has a proper interest

in the person's welfare.

(b) A person apprehended, detained, or transported for

emergency detention under this subtitle shall be informed of the

rights provided by this section and this subtitle:

(1) orally in simple, nontechnical terms, within 24

hours after the time the person is admitted to a facility, and

in writing in the person's primary language if possible; or

(2) through the use of a means reasonably calculated

to communicate with a hearing or visually impaired person, if

applicable.

(c) The executive commissioner of the Health and Human

Services Commission by rule shall prescribe the manner in which

the person is informed of the person's rights under this section

and this subtitle.



Sept. 1, 1999; Acts 2003, 78th Leg., ch. 692, Sec. 10, eff.

Sept. 1, 2003.

Amended by:



Sec. 573.026. TRANSPORTATION AFTER DETENTION. A person

being transported after detention under Section 573.022 shall be

transported in accordance with Section 574.045.


1999.






SUBCHAPTER B. PROTECTIVE CUSTODY

Sec. 574.021. MOTION FOR ORDER OF PROTECTIVE CUSTODY. (a)

A motion for an order of protective custody may be filed only in

the court in which an application for court-ordered mental

health services is pending.

(b) The motion may be filed by the county or district

attorney or on the court's own motion.

(c) The motion must state that:

(1) the judge or county or district attorney has

reason to believe and does believe that the proposed patient

meets the criteria authorizing the court to order protective

custody; and

(2) the belief is derived from:

(A) the representations of a credible person;

(B) the proposed patient's conduct; or

(C) the circumstances under which the proposed

patient is found.

(d) The motion must be accompanied by a certificate of

medical examination for mental illness prepared by a physician

who has examined the proposed patient not earlier than the third

day before the day the motion is filed.

(e) The judge of the court in which the application is

pending may designate a magistrate to issue protective custody

orders, including a magistrate appointed by the judge of another

court if the magistrate has at least the qualifications required

for a magistrate of the court in which the application is

pending. A magistrate's duty under this section is in addition

to the magistrate's duties prescribed by other law.



June 15, 2001.

Amended by:

Acts 2007, 80th Leg., R.S., Ch. 202 (H.B. 518), Sec. 2,



Sec. 574.022. ISSUANCE OF ORDER. (a) The judge or

designated magistrate may issue a protective custody order if

the judge or magistrate determines:

(1) that a physician has stated his opinion and the

detailed reasons for his opinion that the proposed patient is

mentally ill; and

(2) the proposed patient presents a substantial risk

of serious harm to himself or others if not immediately

restrained pending the hearing.

(b) The determination that the proposed patient presents a

substantial risk of serious harm may be demonstrated by the

proposed patient's behavior or by evidence of severe emotional

distress and deterioration in the proposed patient's mental

condition to the extent that the proposed patient cannot remain

at liberty.

(c) The judge or magistrate may make a determination that

the proposed patient meets the criteria prescribed by Subsection

(a) from the application and certificate alone if the judge or

magistrate determines that the conclusions of the applicant and

certifying physician are adequately supported by the information

provided.

(d) The judge or magistrate may take additional evidence

if a fair determination of the matter cannot be made from

consideration of the application and certificate only.

(e) The judge or magistrate may issue a protective custody

order for a proposed patient who is charged with a criminal

offense if the proposed patient meets the requirements of this

section and the facility administrator designated to detain the

proposed patient agrees to the detention.


1991.

Sec. 574.023. APPREHENSION UNDER ORDER. (a) A protective

custody order shall direct a person authorized to transport

patients under Section 574.045 to take the proposed patient into

protective custody and transport the person immediately to a

mental health facility deemed suitable by the local mental

health authority for the area. On request of the local mental

health authority, the judge may order that the proposed patient

be detained in an inpatient mental health facility operated by

the department.

(b) The proposed patient shall be detained in the facility

until a hearing is held under Section 574.025.

(c) A facility must comply with this section only to the

extent that the commissioner determines that the facility has

sufficient resources to perform the necessary services.

(d) A person may not be detained in a private mental

health facility without the consent of the facility

administrator.




Sept. 1, 2001.

Sec. 574.024. APPOINTMENT OF ATTORNEY. (a) When a

protective custody order is signed, the judge or designated

magistrate shall appoint an attorney to represent a proposed

patient who does not have an attorney.

(b) Within a reasonable time before a hearing is held

under Section 574.025, the court that ordered the protective

custody shall provide to the proposed patient and the proposed

patient's attorney a written notice that states:

(1) that the proposed patient has been placed under a

protective custody order;

(2) the grounds for the order; and

(3) the time and place of the hearing to determine

probable cause.





1991.

Sec. 574.025. PROBABLE CAUSE HEARING. (a) A hearing must

be held to determine if:

(1) there is probable cause to believe that a

proposed patient under a protective custody order presents a

substantial risk of serious harm to himself or others to the

extent that he cannot be at liberty pending the hearing on

court-ordered mental health services; and

(2) a physician has stated his opinion and the

detailed reasons for his opinion that the proposed patient is

mentally ill.

(b) The hearing must be held not later than 72 hours after

the time that the proposed patient was detained under a

protective custody order. If the period ends on a Saturday,

Sunday, or legal holiday, the hearing must be held on the next

day that is not a Saturday, Sunday, or legal holiday. The judge

or magistrate may postpone the hearing each day for an

additional 24 hours if the judge or magistrate declares that an

extreme emergency exists because of extremely hazardous weather

conditions or the occurrence of a disaster that threatens the

safety of the proposed patient or another essential party to the

hearing.

(c) The hearing shall be held before a magistrate or, at

the discretion of the presiding judge, before an associate judge

appointed by the presiding judge. Notwithstanding any other law

or requirement, an associate judge appointed to conduct a

hearing under this section may practice law in the court the

associate judge serves. The associate judge is entitled to

reasonable compensation.

(d) The proposed patient and the proposed patient's

attorney shall have an opportunity at the hearing to appear and

present evidence to challenge the allegation that the proposed

patient presents a substantial risk of serious harm to himself

or others.

(e) The magistrate or associate judge may consider

evidence, including letters, affidavits, and other material,

that may not be admissible or sufficient in a subsequent

commitment hearing.

(f) The state may prove its case on the physician's

certificate of medical examination filed in support of the

initial motion.



May 16, 1995.

Amended by:



Sec. 574.026. ORDER FOR CONTINUED DETENTION. (a) The

magistrate or associate judge shall order that a proposed

patient remain in protective custody if the magistrate or

associate judge determines after the hearing that an adequate

factual basis exists for probable cause to believe that the

proposed patient presents a substantial risk of serious harm to

himself or others to the extent that he cannot remain at liberty

pending the hearing on court-ordered mental health services.

(b) The magistrate or associate judge shall arrange for

the proposed patient to be returned to the mental health

facility or other suitable place, along with copies of the

certificate of medical examination, any affidavits or other

material submitted as evidence in the hearing, and the

notification prepared as prescribed by Subsection (d).

(c) A copy of the notification of probable cause hearing

and the supporting evidence shall be filed with the court that

entered the original order of protective custody.

(d) The notification of probable cause hearing shall read

as follows:


(Style of Case)

NOTIFICATION OF PROBABLE CAUSE HEARING

On this the __________ day of __________, 19___, the

undersigned hearing officer heard evidence concerning the need

for protective custody of __________ (hereinafter referred to as

proposed patient). The proposed patient was given the

opportunity to challenge the allegations that (s)he presents a

substantial risk of serious harm to self or others.

The proposed patient and his attorney _____________ have

been

(attorney)

given written notice that the proposed patient was placed under

an order of protective custody and the reasons for such order on

___________________.

(date of notice)

I have examined the certificate of medical examination for

mental illness and _________________________________________.

Based on

(other evidence considered)

this evidence, I find that there is probable cause to believe

that the proposed patient presents a substantial risk of serious

harm to himself (yes ___ or no ___) or others (yes ___ or no

___) such that (s)he cannot be at liberty pending

final hearing because

________________________________________________________________

_______________________________________________________________.

(reasons for finding; type of risk found)


1991.

Amended by:




Sec. 574.027. DETENTION IN PROTECTIVE CUSTODY. (a) A

person under a protective custody order shall be detained in a

mental health facility deemed suitable by the local mental

health authority for the area. On request of the local mental

health authority, the judge may order that the proposed patient

be detained in an inpatient mental health facility operated by

the department.

(b) The facility administrator or the administrator's

designee shall detain a person under a protective custody order

in the facility until a final order for court-ordered mental

health services is entered or the person is released or

discharged under Section 574.028.

(c) A person under a protective custody order may not be

detained in a nonmedical facility used to detain persons who are

charged with or convicted of a crime except because of and

during an extreme emergency and in no case for longer than 72

hours, excluding Saturdays, Sundays, legal holidays, and the

period prescribed by Section 574.025(b) for an extreme

emergency. The person must be isolated from any person who is

charged with or convicted of a crime.

(d) The county health authority shall ensure that proper

care and medical attention are made available to a person who is

detained in a nonmedical facility under Subsection (c).

(e) Repealed by Acts 2001, 77th Leg., ch. 367, Sec. 19,

eff. Sept. 1, 2001.


1991. Amended by Acts 2001, 77th Leg., ch. 367, Sec. 10, 19,

eff. Sept. 1, 2001.

Sec. 574.028. RELEASE FROM DETENTION. (a) The magistrate

or associate judge shall order the release of a person under a

protective custody order if the magistrate or associate judge

determines after the hearing under Section 574.025 that no

probable cause exists to believe that the proposed patient




presents a substantial risk of serious harm to himself or

others.

(b) Arrangements shall be made to return a person released

under Subsection (a) to:

(1) the location of the person's apprehension;

(2) the person's residence in this state; or

(3) another suitable location.

(c) A facility administrator shall discharge a person held

under a protective custody order if:

(1) the facility administrator does not receive

notice that the person's continued detention is authorized after

a probable cause hearing held within 72 hours after the

detention began, excluding Saturdays, Sundays, legal holidays,

and the period prescribed by Section 574.025(b) for extreme

emergencies;

(2) a final order for court-ordered mental health

services has not been entered within the time prescribed by

Section 574.005; or

(3) the facility administrator or the administrator's

designee determines that the person no longer meets the criteria

for protective custody prescribed by Section 574.022.


1991.

Amended by:



SUBCHAPTER C. PROCEEDINGS FOR COURT-ORDERED MENTAL HEALTH

SERVICES

Sec. 574.031. GENERAL PROVISIONS RELATING TO HEARING. (a)

Except as provided by Subsection (b), the judge may hold a

hearing on an application for court-ordered mental health

services at any suitable location in the county. The hearing





should be held in a physical setting that is not likely to have

a harmful effect on the proposed patient.

(b) On the request of the proposed patient or the proposed

patient's attorney the hearing on the application shall be held

in the county courthouse.

(c) The proposed patient is entitled to be present at the

hearing. The proposed patient or the proposed patient's

attorney may waive this right.

(d) The hearing must be open to the public unless the

proposed patient or the proposed patient's attorney requests

that the hearing be closed and the judge determines that there

is good cause to close the hearing.

(e) The Texas Rules of Evidence apply to the hearing

unless the rules are inconsistent with this subtitle.

(f) The court may consider the testimony of a nonphysician

mental health professional in addition to medical or psychiatric

testimony.

(g) The hearing is on the record, and the state must prove

each element of the applicable criteria by clear and convincing

evidence.

(h) A judge who holds a hearing under this section in

hospitals or locations other than the county courthouse is

entitled to be reimbursed for the judge's reasonable and

necessary expenses related to holding a hearing at that

location. The judge shall furnish the presiding judge of the

statutory probate courts or the presiding judge of the

administrative region, as appropriate, an accounting of the

expenses for certification. The presiding judge shall provide a

certification of expenses approved to the county judge

responsible for payment of costs under Section 571.018.

(i) A judge who holds hearings at locations other than the

county courthouse also may receive a reasonable salary

supplement in an amount set by the commissioners court.

(j) Notwithstanding other law, a judge who holds a hearing

under this section may assess for the judge's services a fee in

an amount not to exceed $50 as a court cost against the county


responsible for the payment of the costs of the hearing under

Section 571.018.

(k) Notwithstanding other law, a judge who holds a hearing

under this section may assess for the services of a prosecuting

attorney a fee in an amount not to exceed $50 as a court cost

against the county responsible for the payment of the costs of

the hearing under Section 571.018. For a mental health

proceeding, the fee assessed under this subsection includes

costs incurred for the preparation of documents related to the

proceeding. The court may award as court costs fees for other

costs of a mental health proceeding against the county

responsible for the payment of the costs of the hearing under

Section 571.018.




Sept. 1, 2001; Acts 2001, 77th Leg., ch. 1420, Sec. 10.006,

eff. Sept. 1, 2001.

Sec. 574.032. RIGHT TO JURY. (a) A hearing for temporary

mental health services must be before the court unless the

proposed patient or the proposed patient's attorney requests a

jury.

(b) A hearing for extended mental health services must be

before a jury unless the proposed patient or the proposed

patient's attorney waives the right to a jury.

(c) A waiver of the right to a jury must be in writing,

under oath, and signed and sworn to by the proposed patient and

the proposed patient's attorney unless the proposed patient or

the attorney orally waives the right to a jury in the court's

presence.

(d) The court may permit an oral or written waiver of the

right to a jury to be withdrawn for good cause shown. The

withdrawal must be made not later than the eighth day before the

date on which the hearing is scheduled.




(e) A court may not require a jury fee.

(f) In a hearing before a jury, the jury shall determine

if the proposed patient is mentally ill and meets the criteria

for court-ordered mental health services. The jury may not make

a finding about the type of services to be provided to the

proposed patient.


1991.

Sec. 574.033. RELEASE AFTER HEARING. (a) The court shall

enter an order denying an application for court-ordered

temporary or extended mental health services if after a hearing

the court or jury fails to find, from clear and convincing

evidence, that the proposed patient is mentally ill and meets

the applicable criteria for court-ordered mental health

services.

(b) If the court denies the application, the court shall

order the immediate release of a proposed patient who is not at

liberty.


1991.