1. Central Receiving Center Update (CRC) 5 Years of Operation June 10, 2008

2. Presentation Outline History What is the CRC? CRC Data Jail Impacts Funding Issues Summary

3. Presentation Outline

4. History The Crisis Lack of Mental Health funding in District 7 Lack of Coordination & Continuity in the Mental Health System Over utilization of ER & Orange County Jail for Mental Health Consumers Creation of Jail Oversight Commission (Chaired by Bill Sublette) CRC was a major recommendation of the Medical, Mental Health & Substance Abuse Sub Committee (Chaired by Rich Morrison) CRC opened in April 2003

5. History The System of Care Before CRC Jail had become the defacto mental health facility Long waits for a consumer to be placed in a treatment bed at every entry point Impacts on overcrowded emergency rooms for psychiatric patients and those needing detox services Bookings in the Orange County Jail, and the costs associated with risk, psychotropic medications and jail resources to manage these vulnerable consumers

6. Presentation Outline

7. Baker Act – Mental Health involuntary treatment act for those suffering with a mental illness in which they cannot take care of themselves and may be in danger to self or others due to their mental illness schizophrenia psychosis depression bipolar disease All brain disorders are classified as diseases Baker Act – Mental Health involuntary treatment act for those suffering with a mental illness in which they cannot take care of themselves and may be in danger to self or others due to their mental illness schizophrenia psychosis depression bipolar disease All brain disorders are classified as diseases What is the CRC?

8. Marchman Act is the involuntary treatment act that allows for treatment of a substance use disorder/addictive disorder in which the person may be dangerous to self or others due to their substance abuse Drug Addiction Alcohol Addiction Polysubstance abuse – combinations of drugs and alcohol Also classified as a disease

9. Pre CRC System of Care CONSUMER Mental Health Baker Act Substance Abuse Marchman Act Law Enforcement Officer Orlando Regional Hospital Emergency Room Florida Hospital Emergency Room Health Central Jail Center for Drug Free Living Addiction Receiving Facility (ARF) Lakeside Behavioral Healthcare

10. Central point of access for integrated assessment for involuntary mental health (Baker Act) and substance abuse (Marchman Act) Jail Diversion for Law Enforcement use in Orange County Partnerships Department of Children and Families Lakeside Behavioral Healthcare The Center for Drug Free Living Human Services Associates Florida Hospital and Orlando Regional Healthcare What is the CRC?

11. Permanent Housing Shelter + Care HUD, SRO Low income Central Receiving Center Phase Two 3-6 months VOLUNTARY Phase Two CRC Center for Drug Free Living Detox 3-5 days Lakeside Behavioral Healthcare Crisis Stabilization Unit / Short-term Residential Treatment Unit 3-4 days ORH Behavioral Healthcare Florida Hospital Behavioral Healthcare Medical- Surgical Psychiatric 3-4 days Lakeside Behavioral Healthcare Hospital 3-4 days INVOLUNTARY Law Enforcement Officer Central Receiving Center < 23 hours CRC System of Care

12. What is CRC? Consumers placed in most appropriate community resource within 24 hours Consumers diverted from over crowded emergency departments and jail 2005 award recipient as “most innovative” program from DCF and FADAA State of the art facility, only one of its kind in the State of Florida

13. Presentation Outline

14. CRC Data Integrated 24/7 model April 2003 - March 2008: –Approximately 23,000 screened –Of 23,000 - 86% Law Enforcement, 14% Hospitals Of those screened: –20,147 placed in mental health beds –2,113 placed in substance abuse beds –20% of those brought to the CRC are homeless

15. CRC Data ER Referrals Placed by CRC

16. CRC Data Saved ER Beds

17. CRC Data Orange County Sheriff 9026 Orlando Police 3512 Winter Park 1004 Orange County Corrections 739 Ocoee 544 Apopka 502 Winter Garden 391 Maitland 203 Eatonville 121 UCF 114 Edgewood 37 Oakland 29 Florida Highway Patrol 9 Windermere 6 Use of CRC by LEO Agencies

18. Law Enforcement Savings Prior to the CRC, LEO would spend approximately 2 - 4 hours with clients at an Emergency Department Savings: $1.2M over the last 5 years =27 Additional Positions

19. Presentation Outline

20. Jail Impacts April 2003 - March 2008 –No Marchman patients brought to jail for protective custody –Approximately 150 Baker Act patients received annually from Orange County Jail –Law enforcement is diverting over 8% of consumers from the jail –Nearly 52,000 jail bed days saved

21. Jail Impacts Jail Beds Saved by CRC

22. Jail Impacts Released From Jail to CRC

23. Presentation Outline

24. Funding Issues Original Partners (2003) Orange County $1,240,000 Florida Hospital $ 250,000 Orlando Regional $ 250,000 State of Florida (DCF) $ 300,000

25. Funding Issues Gains Via State Appropriations FY ‘05 - $2.8M Added: 20 MH Crisis Beds 6 Detox beds 7 Case Managers 10 Residential Substance Abuse beds FY ‘06 - $3.0M –Kept the resources from previous year

26. Funding Issues FY ‘07 – Appropriation cut to $2.25M Lost: 10 Crisis MH beds 3 Detox beds 6 Residential substance abuse beds FY ‘08 – Appropriation cut to $500,000 (As of July 1, 2008) Loss: 17 Mental Health beds Case management program Some services out of CRC Fidelity of the CRC model Total Reduction of $1.75M from State

27. Presentation Outline

28. Summary As Funding for the CRC decreases: Increase in arrests for mental health and substance use disorders Increase in jail population of those most vulnerable requiring more supervision and posing greater risks Mental health inmates stay longer by 67% Law enforcement may choose jail rather than emergency rooms for transport

29. Central Receiving Center Update (CRC) 5 Years of Operation June 10, 2008