National Association of County Behavioral Health and Developmental Disability Directors 2008 Legislative and Policy Conference February 29, 2009 Washington, DC Gilbert R. Gonzales, Chief, Development and Community Action The Center for Health Care Services Bexar County, San Antonio Texas Leon Evans, President and Chief Executive Officer The Center for Health Care Services NACBHDD Corrections Committee Bexar County Jail Diversion Initiatives

NACBHDD Corrections Committee

CORRECTIONS WE NACBHDD

National Leadership Forum for Behavioral Health and Criminal Justice Services St. Gregory Hotel Washington, DC February 26, 2008 Goals (for serving justice involved persons with mental illness) Provide a forum to create new partnerships and products Stimulate innovative thinking about effective collaborations Influence Policy and Legislation Improve practice

Join Now and we will throw in the link to this fabulous publication !

Now Available !

Update Jail Diversion Crisis Services The Center for Health Care Services

Community Wide Jail Diversion The Problem Criminalization of Mentally Ill Inappropriate Cost to Society –20% + in jail –Increase use of emergency rooms –Homelessness Public Safety Net –Consumers at risk –Law Enforcement at risk –Public at risk

Community Partnership City Government County Government State Government University – Local Private Hospitals Law Enforcement Criminal/Civil Courts Advocacy – NAMI Consumers San Antonio State Hospital Mental Health Partners The Jail Diversion Over-sight Committee The Jail Diversion Planning & Advisory Committee How We Started Community Medical Directors Roundtable Private Sponsorship Aztrazeneca

SAPD SHERIFF CHCS METRO HEALTH UHS Criminal Justice Mag Pre Trial EMS NAMI Courts MH District Attorney MH County Clerk SASH Juvenile Justice Adult Probation Private Hospitals Consumers Family DSHS UT County Judge Transformation Collaborative

Law Enforcement Detention/Jail CIT Judicial/Courts Magistrate, County, District Mental Health Public and Private Providers Crisis Care Center Jail Diversion Psychiatric and Medical Clearance Specialty Offender Services Community Dynamic Crisis Jail Diversion Information Exchange Police, Sheriff Probation, Parole Civil and Criminal Treatment Continuity of Care County City-wide EmergencyServices Data exchange through Community Collaborative Crisis Care Center CIT/DMOT Jail and Juvenile Detention Statewide CARE Match System County City-wide Entry Points System Level

Crisis Care Center 24/7 services Psychiatric screening and evaluation Jail and detention medical consultation & clearance Medical screening Lab and Radiology Appropriate Staffing and Co-located office space allocations

Crisis Care Center Summary Actual Facility Total Seen = 7,619 (from Sep 05 to Aug 06) Summary Stats Sep - Dec 2005 Monthly AverageJan-06 Feb -06 Mar- 06 Apr -06 May -06 Jun -06 Jul- 06 Aug -06Total Facility Total Psychiatric Crisis Clinic Express Med Clinic (Med Clear) Express Med Stats Sep - DecAverageJan-06 Feb -06 Mar- 06 Apr -06 May -06 Jun -06 Jul- 06 Aug -06Total Cases Requiring Lab and/or X-Ray First Year of Operations Opened Aug 30, 2005 Hurricane Katrina Evacuees Arrive Aug 31, 2005 Full Year Completed Aug 31, 2006

Crisis Care Center Preliminary DATA (continued) Then Wait times for Medical Clearance/ Screening at UHS ER - 9 hours, 18 minutes. Wait times for Medical Clearance/ Screening and Psychiatric Evaluation is between 12 and 14 hours. Now The wait time for Medical Clearance/ Screening at the Crisis Care Center is 45 minutes Wait time for Medical Clearance/ Screening and Psychiatric Evaluation is minutes. WAIT TIME for LAW ENFORCEMENT

Crisis Intervention Training For Law Enforcement The Crisis Intervention Teams (CIT) – *Officers trained by Law Enforcement and Mental Health Personnel via a 40 hour curriculum including role play demonstrations. * Weekly operational meetings with MH and Community Stakeholders * Work jointly on identified high utilizers

Texas Department of Criminal Justice MHMR Match Statistics October, 2007 C.I.D.ParoleProbationTotal Total TDCJ Population 152,66177,755432,359662,775 # of Care Matches*40,88319,76354,727115,373 % of Total Population26.78%25.41%12.65%17.40% *Represents all Clients served since 1985, including those whose diagnosis is no longer eligible for MHMR

Program Recidivism Rate Genesis – Offender Outpatient program for Felony Probation and Parolees FY Felony Probation and Parole Offenders Served 29 - Re-arrested State Revocation/Decompensation rate (without treatment)= 52% Genesis Revocation Rate (with treatment)= 6%

Re-incarceration/Re-Hospitalization Sample Outcome: Forensic Intensive Case Management Objective: Reduce rates of re-incarceration for Manos program mentally ill offenders released from jail or prison by 25%. –Of the 371 patients admitted to the Manos Program, 23 were re-incarcerated for a 6.2% rate. This compares to a re-incarceration rate of 67% for mentally ill offenders without the intensive case management services offered by the jail diversion program. Objective: Reduce rates of hospitalization for Manos program mentally ill offenders released from jail or prison by 25%. –Of the 371 patients participating in the jail diversion program 12 were hospitalized after diversion for a program rate of 3.2%. Manos – a post diversion program for misdemeanor offenders

Partial/Day Hospital, “Intensive” Outpatient Substance Abuse System of Care Outpatient Treatment Urgent Care Center “Front-Door” Substance Abuse Triage Mental Health Jail Diversion Haven for Hope Homeless Housing Initiative Recovered ! Community Patients X Relapse Medical Detoxification CHCS Detoxification Community Patients

The MAP CHCS Urgent Care Center (2) Emergency Psychiatric Screening County Jail (6) Community Medical Clinic (1) CHCS Detox Center (3) CHCS Substance Abuse Outpatient Services (5) 600 Bed Homeless Residential Facility (4)

Research The Bexar County Jail Diversion Program: Measuring the Potential Economic and Societal Benefits Policy Report Michael Johnsrud, PhD Sponsored by the Associate Director Center for Health Care Services The Center for Pharmacoeconomic Studies Robert L. Jimenez, M.D., F.A.P.A Chairman The University of Texas at Austin Leon Evans, President and CEO December 2004

Dr. Johnsrud - Findings In the last decade, persons with mental illness accounted for 7% of all police contacts, 16% of prison inmates, and 7% of the entire jail population. As a percentage of total county revenues, Bexar County spends approximately 75% of all public funds on law enforcement, detention, and the justice system. As much as 14% of the Bexar County jail population is estimated to have a mental illness. Interim results of the program show over 1,700 diversions from jail incarcerations during state Fiscal Year 2004, potentially resulting in an estimated range of $3.8 million to $5.0 million dollars in avoided costs within the Bexar County Criminal Justice System.

RTI International is a trade name of Research Triangle Institute Jail Diversion in Bexar County, Texas: A Cost Study Presented by Alexander J. Cowell 2008

Study Objectives 4 Inter-connected Objectives

Methods: Research Question 1a Estimate the value of the resources needed to start the program 4-year cost of director Track time spent with other stakeholders (calendar) Stakeholder attendance at relevant mtgs (minutes) Load with wage rates provided by Bexar County

Pre-booking: Who Pays What Share

Post-booking Bond: Who Pays What Share

Post-booking Docket: Who Pays What Share

Jail Diversion Toolkit – Coming soon, May 2008

Leon Evans, President and Chief Executive Officer, The Center for Health Care Services San Antonio, Texas For additional information contact: Leon Evans, Ph Thank you !