National Association of County Behavioral Health and Developmental Disability Directors

1. National Association of County Behavioral Health and Developmental Disability Directors 2008 Legislative and Policy Conference February 29, 2009 Washington, DC NACBHDD Corrections Committee Bexar County Jail Diversion Initiatives 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

2. NACBHDD Corrections Committee

3. WE CORRECTIONS NACBHDD

4. 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

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

6. America's Prision Growth Now Available !

8. The Center for Health Care Services Update Jail Diversion Crisis Services

9. 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

10. How We Started 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 Community Medical Directors Roundtable Private Sponsorship Aztrazeneca

11. Transformation Collaborative The Transformation Team

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

13. 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

14. Crisis Care Center Summary First Year of Operations Actual Facility Total Seen = 7,619 (from Sep 05 to Aug 06) Opened Aug 30, 2005 Hurricane Katrina Evacuees Arrive Aug 31, 2005 Full Year Completed Aug 31, 2006

15. 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. WAIT TIME for LAW ENFORCEMENT • 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 .

16. 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

17. Texas Department of Criminal JusticeMHMR Match StatisticsOctober, 2007

18. 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%

19. 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

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

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

22. 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

23. 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.

24. Jail Diversion in Bexar County, Texas:A Cost StudyPresented by Alexander J. Cowell2008 RTI International is a trade name of Research Triangle Institute

25. Study Objectives • 4 Inter-connected Objectives

26. Methods: Research Question 1a • Estimate the value of the resources needed to start the program

27. Pre-booking: Who Pays What Share

28. Post-booking Bond: Who Pays What Share

29. Post-booking Docket: Who Pays What Share

30. Jail Diversion Toolkit – Coming soon, May 2008

31. Thank you ! www.chcsbc.org 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