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
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NACBHDD Corrections Committee
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CORRECTIONS WE NACBHDD
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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
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Join Now and we will throw in the link to this fabulous
publication !
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Now Available !
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Update Jail Diversion Crisis Services The Center for Health
Care Services
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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
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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
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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
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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
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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
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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 2777694.256665237704636706005815697619
Psychiatric Crisis Clinic 20765194974056093134874254184435673
Express Med Clinic (Med Clear)
701175.251691181611501831751631261946 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
236595640414467476038629 First Year of Operations Opened Aug 30,
2005 Hurricane Katrina Evacuees Arrive Aug 31, 2005 Full Year
Completed Aug 31, 2006
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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 60-65 minutes. WAIT TIME for LAW ENFORCEMENT
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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
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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
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Program Recidivism Rate Genesis 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%
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Re-incarceration/Re-Hospitalization Sample 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
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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
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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)
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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
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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.
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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
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Study Objectives 4 Inter-connected Objectives
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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
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Pre-booking: Who Pays What Share
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Post-booking Bond: Who Pays What Share
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Post-booking Docket: Who Pays What Share
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Jail Diversion Toolkit Coming soon, May 2008
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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:
[email protected] Thank you ! www.chcsbc.org