National Association of County Behavioral Health and Developmental Disability Directors

2008 Legislative and Policy ConferenceFebruary 29, 2009Washington, DC

Gilbert R. Gonzales, Chief, Development and Community Action

The Center for Health Care ServicesBexar County, San Antonio Texas

Leon Evans, President and Chief Executive OfficerThe Center for Health Care Services

NACBHDD Corrections CommitteeBexar County Jail Diversion Initiatives

NACBHDDCorrections Committee

CORRECTIONSWE

NACBHDD

National Leadership Forum for Behavioral Health and Criminal Justice

ServicesSt. Gregory Hotel Washington, DC

February 26, 2008

Goals (for serving justice involved persons with mental illness)

• Provide a forum to create new partnerships and products

• Stimulate innovative thinking about effective collaborations

• Influence Policy and Legislation

• Improve practice

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Now Available !

UpdateJail Diversion

Crisis Services

The Center for Health Care Services

Community Wide Jail DiversionThe Problem

• Criminalization of Mentally Ill• Inappropriate Cost to Society

–20% + in jail– Increase use of emergency rooms–Homelessness

• Public Safety Net–Consumers at risk–Law Enforcement at risk–Public at risk

Community PartnershipCity GovernmentCounty GovernmentState GovernmentUniversity – LocalPrivate HospitalsLaw EnforcementCriminal/Civil CourtsAdvocacy – NAMIConsumersSan Antonio State HospitalMental Health Partners

The Jail Diversion Over-sightCommittee

The Jail Diversion Planning & Advisory Committee

How We Started

Community Medical Directors Roundtable

Private SponsorshipAztrazeneca

Transformation

Collaborative

Law EnforcementDetention/Jail

CIT

Judicial/CourtsMagistrate, County, District

Mental HealthPublic and Private

Providers

Crisis Care CenterJail DiversionPsychiatric and Medical

ClearanceSpecialty Offender Services

CommunityDynamicCrisis Jail Diversion

Information Exchange

Pol

ice,

She

riff

Pro

batio

n, P

arol

e

Civil and CriminalTreatm

entC

ontinuity of Care

County City-wide

Emergency Services

Data exchange through• Community Collaborative• Crisis Care Center • CIT/DMOT• Jail and Juvenile Detention• Statewide CARE Match

System County City-wideEntry Points

System Level

Crisis Care Center• 24/7 services• Psychiatric screening and evaluation• Jail and detention medical consultation &

clearance• Medical screening• Lab and Radiology• Appropriate Staffing and Co-located office

space allocations

Crisis Care Center SummaryActual Facility Total Seen = 7,619

(from Sep 05 to Aug 06)

Summary Stats  

Sep - Dec 2005

Monthly Average Jan-06

Feb-06

Mar-06

Apr-06

May-06

Jun-06

Jul-06

Aug-06 Total

Facility Total   2777 694.25 666 523 770 463 670 600 581 569 7619

Psychiatric Crisis Clinic   2076 519 497 405 609 313 487 425 418 443 5673

                   

Express Med Clinic (Med

Clear)   701 175.25 169 118 161 150 183 175 163 126 1946

Express Med Stats  

Sep - Dec Average Jan-06

Feb-06

Mar-06

Apr-06

May-06

Jun-06

Jul-06

Aug-06 Total

Cases Requiring Lab and/or X-Ray   236 59 56 40 41 44 67 47 60 38 629

First Year of

Operations

Opened Aug 30, 2005 Hurricane Katrina Evacuees Arrive Aug 31, 2005 Full Year Completed Aug 31, 2006

Crisis Care CenterPreliminary DATA (continued)

Then

• Wait times for Medical Clearance/ Screening at UHS ER - 9 hours, 18 minutes. • Wait times for Medical Clearance/ Screening and Psychiatric Evaluation is between 12 and 14 hours.

Now

• The wait time for Medical Clearance/ Screening at the Crisis Care Center is 45 minutes

• Wait time for Medical Clearance/ Screening and Psychiatric Evaluation is 60-65 minutes .

WAIT TIME for LAW ENFORCEMENT

Crisis Intervention TrainingFor Law Enforcement

The Crisis Intervention Teams (CIT) – *Officers trained by Law Enforcement

and Mental Health Personnel via a 40 hour

curriculum including role play demonstrations. * Weekly operational meetings with MH

and Community Stakeholders * Work jointly on identified high utilizers

Texas Department of Criminal JusticeMHMR Match Statistics

October, 2007

C.I.D. Parole Probation TotalTotal TDCJ Population 152,661 77,755 432,359 662,775

# of Care Matches* 40,883 19,763 54,727 115,373

% of Total Population 26.78% 25.41% 12.65% 17.40%

*Represents all Clients served since 1985, including those whose diagnosis is no longer eligible for MHMR

Program Recidivism RateGenesis – Offender Outpatient program for

Felony Probation and Parolees FY 2007

429 - Felony Probation and Parole Offenders Served

29 - Re-arrested

State Revocation/Decompensation rate (without treatment)= 52%

Genesis Revocation Rate (with treatment)= 6%

Re-incarceration/Re-HospitalizationSample Outcome: Forensic Intensive Case

Management - 2006

• Objective: Reduce rates of re-incarceration for Manos program mentally ill offenders released from jail or prison by 25%.

– Of the 371 patients admitted to the Manos Program, 23 were re-incarcerated for a 6.2% rate. This compares to a re-incarceration rate of 67% for mentally ill offenders without the intensive case management services offered by the jail diversion program.

• Objective: Reduce rates of hospitalization for Manos program mentally ill offenders released from jail or prison by 25%.

– Of the 371 patients participating in the jail diversion program 12 were hospitalized after diversion for a program rate of 3.2%.

Manos – a post diversion program for misdemeanor offenders

Partial/Day Hospital,“Intensive” Outpatient

Substance Abuse System of Care

Outpatient Treatment

Urgent Care Center“Front-Door”

• Substance Abuse Triage

• Mental Health Jail Diversion

Haven for Hope• Homeless Housing Initiative

Recovered !

Community Patients

XRelapse

Medical Detoxification CHCS Detoxification

Community Patients

The MAP

CHCS Urgent Care Center (2) Emergency Psychiatric Screening

County Jail (6)

Community MedicalClinic (1)

CHCS Detox Center (3)

CHCS Substance Abuse Outpatient Services (5)

600 Bed HomelessResidential Facility (4)

Research

The Bexar County Jail Diversion Program:Measuring the Potential Economic and Societal BenefitsPolicy Report

Michael Johnsrud, PhD Sponsored by the Associate Director Center for Health Care Services

The Center for Pharmacoeconomic Studies Robert L. Jimenez, M.D., F.A.P.A ChairmanThe University of Texas at Austin Leon Evans, President and CEODecember 2004

Dr. Johnsrud - Findings• In the last decade, persons with mental illness

accounted for 7% of all police contacts, 16% of prison inmates, and 7% of the entire jail population.

• As a percentage of total county revenues, Bexar County spends approximately 75% of all public funds on law enforcement, detention, and the justice system. As much as 14% of the Bexar County jail population is estimated to have a mental illness.

• Interim results of the program show over 1,700 diversions from jail incarcerations during state Fiscal Year 2004, potentially resulting in an estimated range of $3.8 million to $5.0 million dollars in avoided costs within the Bexar County Criminal Justice System.

RTI International is a trade name of Research Triangle Institute

Jail Diversion in Bexar County, Texas:

A Cost Study

Presented by Alexander J. Cowell

2008

Study Objectives• 4 Inter-connected Objectives

OBJECTIVE 3

Assess the Cost-Effectiveness of Diversion

“What is the program’s bang-for-buck?”

OBJECTIVE 1

Compare the costs of pre-booking and post-

booking diversion

“What does each type of diversion cost?”

OBJECTIVE 2

Assess Cost-shifting Between Criminal Justice

System and Treatment

“Are increased treatment costs offset by reductions in criminal justice costs?”

OBJECTIVE 4

Refocus Objectives 1-3 on Crisis Care Center (CCC)

Methods: Research Question 1a• Estimate the value of the resources needed to

start the program

Pre-booking: Who Pays What Share

CHCS - Residential Specialist45.82%

Sherif f - DMOT<1%

County/City Courts - Magistrate Judge

<1%

SAPD - Off icer3.34%

CCC - Med. Clearance4.27%

CHCS - Assessors<1%

CHCS - Psychiatrist23.99%

CHCS - Clerical Staff<1%

CHCS - Nurse19.15%

County/City CourtsClerk<1%

Sherif f - Off icer1.50%

Post-booking Bond: Who Pays What Share

County/City Courts - Nurse4.95%

County/City Courts - Assistant District Attorney

2.69%

County/City Courts - Defense Attorney35.69%

County/City Courts - Magistrate

4.04%CHCS -Clinician

2.51%

CHCS - Casew orker3.92%

PTS - Pretrial Bond Officer46.20%

Post-booking Docket: Who Pays What Share

CHCS - Clinican<1%

CHCS - Casew orker49.03%

County/City Courts - Defense Attorney40.27%

County/City Courts - Assistant District Attorney

3.03%

County/City Courts - Magistrate4.56% County/City Courts - Jail Staff

<1%

PTS - Population Monitor1.59%

Jail Diversion Toolkit – Coming soon, May 2008

Leon Evans, President and Chief Executive Officer, The Center for Health Care Services San Antonio, Texas

For additional information contact: Leon Evans, Ph. 210 731-1300 Email: levans@chcsbc.org

Thank you !

www.chcsbc.org