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

Central Receiving Center Update (CRC)

5 Years of Operation



June 10, 2008June 10, 2008

Presentation OutlinePresentation Outline

• History

• What is the CRC?

• CRC Data

• Jail Impacts

• Funding Issues

• Summary


• History

• What is the CRC?What is the CRC?

• CRC DataCRC Data

• Jail ImpactsJail Impacts

• Funding IssuesFunding Issues

• SummarySummary

HistoryHistoryThe 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

HistoryHistory

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


• HistoryHistory

• What is the CRC?




• SummarySummary

• 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? What is the CRC?

What is the CRC?What is the CRC?

• 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

Pre CRC

System of Care

Pre CRC

System of Care

CONSUMERMental Health

Baker Act

Substance AbuseMarchman Act

Law EnforcementOfficer

Orlando Regional Hospital

Emergency Room

Florida HospitalEmergency Room

Health Central

Jail

Center for Drug Free Living

Addiction Receiving Facility (ARF)

Lakeside Behavioral Healthcare

• 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?What is the CRC?

Permanent HousingShelter + Care

HUD, SROLow income

Central Receiving CenterPhase Two3-6 months

VOLUNTARY

Phase Two Phase Two CRCCRC

Center for Drug Free Living

Detox3-5 days

Lakeside Behavioral Healthcare Crisis Stabilization Unit / Short-term Residential

Treatment Unit3-4 days

ORH Behavioral Healthcare

Florida HospitalBehavioral

Healthcare Medical-Surgical Psychiatric

3-4 days

Lakeside Behavioral Healthcare

Hospital3-4 days

INVOLUNTARY

Law Enforcement

Officer

Central Receiving Center< 23 hours

CRC System of CareCRC System of Care

What is CRC?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


• HistoryHistory


• CRC Data



• SummarySummary

CRC DataCRC 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

CRC DataCRC Data

0200400600800

100012001400160018002000

2003-2004 2004-2005 2005-2006 2006-2007 2007-2008

Screened Placed

ER Referrals Placed by CRC

CRC DataCRC Data

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2004-2005 2005-2006 2006-2007 2007-2008

Saved ER Beds

CRC DataCRC Data

Orange County Sheriff 9026Orlando Police 3512Winter Park 1004Orange County Corrections 739

Ocoee 544Apopka 502Winter Garden 391Maitland 203Eatonville 121UCF 114Edgewood 37Oakland 29Florida Highway Patrol 9Windermere 6Use of CRC by LEO

Agencies

Law Enforcement SavingsLaw 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


• HistoryHistory



• Jail Impacts


• SummarySummary

Jail ImpactsJail 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


9894

1156012614

9690

7990

0

2000

4000

6000

8000

10000

12000

14000

2003-2004 2004-2005 2005-2006 2006-2007 2007-2008

Jail Beds Saved by CRC


0

20

40

60

80

100

120

140

160

180

2003-2004 2004-2005 2005-2006 2006-2007 2007-2008

Released From Jail to CRC


• HistoryHistory




• Funding Issues

• SummarySummary

Funding IssuesFunding Issues

Original Partners (2003)

• Orange County $1,240,000• Florida Hospital $ 250,000• Orlando Regional $ 250,000• State of Florida (DCF) $ 300,000


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


• 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 bedsCase management programSome services out of CRC

Fidelity of the CRC model

Total Reduction of $1.75M from State


• HistoryHistory





• Summary

Summary 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





June 10, 2008June 10, 2008

Documents

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