2011 9-22_LeonEvans_presentation_Lilly-Community_Conversationsv3_final

Improving Mental Health and Criminal Justice Outcomes

Community Solutions for Effective Criminal Justice and Behavioral Health Interventions Leon Evans President and Chief Executive Officer, The Center for Health Care Services Mental Health and Substance Abuse Authority, Bexar County, San Antonio, Texas, levans@chcsbc.org

Raise your hand if you think there will be more Local, State, and Federal Dollars.

President’s Freedom Commission On Mental Health Interim Report: “… the mental health delivery system is fragmented and in disarray…leading to unnecessary and costly disability, unemployment, homelessness, school failure and incarceration.” 2003 President’s Freedom Commission On Mental Health – Final Report “ In addition to the tragedy of lost lives, mental illnesses come with a devastatingly high financial cost. In the US, the annual economic, indirect cost of mental illness is estimated to be $79 billion”.

"abject failure of our society to address critical needs for persons with severe mental illness" FAILED PUBLIC POLICY The Problem:

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

The Cost
Costly for taxpayers
Space is taken up which could be used
for violent offenders
It's just wrong
In the U.S., the annual economic, indirect cost of mental illness is Estimated to be $79 billion. 2003 President’s New Freedom Commission on Mental Health

The Case of Million Dollar Murray MILLION-DOLLAR MURRAY by MALCOLM GLADWELL The New Yorker Magazine, Issue of 2006-02-13 and 20, Posted 2006-02-06 News Release Emergency Departments See Dramatic Increase in People with Mental Illness Seeking Care Emergency Physicians Cite State Health Care Budget Cuts at Root of Problem American Psychiatric Association Hillarie Turner, 703-907-8536 June 2, 2004 hturner@psych.org Release No. 04-30 Sharon Reis 202-745-5103 Cost “ in one study, it had been concluded that one homeless person can cost the City and County about $200,000 in one year”. Philip F. Mangano, Executive Director of the United States Interagency Council on Homelessness (USICH), May 1, 2007. “ It cost us one million dollars not to do something about Murray,”

More Challenges
The United States has roughly 2 million people incarcerated in federal, state and local prisons or jails USA Today July 14, 2011
67% of former prisoners are re-arrested, and 52% are re-incarcerated at a cost of $60 billion a year Commission on Safety and Abuse in America’s Prisons
In Texas, the estimated lifetime cost of maintaining one person in the criminal justice system is more than $2 million Report to 81th Texas Legislature, Integration of Health and Behavioral Health Workgroup, August 2010
16 to 20+% of incarcerated persons have a serious mental illness and 64 percent of jail inmates have a mental health problem Mental Health Association, nmha.org et al
75% of inmates and prisoners with mental illness also have an addiction disorders Skeem and Louden, 2006
More than 50% of prisoners have substance abuse problems but only one in ten receive treatment jails USA Today July 14, 2011

Texas Department of Criminal Justices

The Problem gets worse: Poor and or reduced funding Scant, limited and rationed services Reduction of State Hospital treatment beds

Poor communication
Poor system design
Silos
No strategic
improvement plan
Little use of prevailing best practices
Lack of leadership and overview
Why ?

Poor System Design There’s no integrated Plan The Individual Vocational Services Employment Law Enforcement Treatment Housing Poor Communication Jails Emergency Rooms Medical Homeless Services

Severe Mental Illness: the illness is devastating because of the illness a person can’t manage their own lives at onset, most people don’t understand mental illness, families don’t understand it and the person is rejected by the family and friends because of it many times the person starts self medicating with alcohol or drugs there is a lack of education and services because of the pain and suffering personal ties are cut

Homeless persons
People who are homeless frequently report health problems:
38% report alcohol use problems
26% report other drug use problems
66% report either substance use and/or mental health problems
39% report some form of mental health problems (20-25% meet
criteria for serious mental illness)
26% report acute health problems other than HIV/AIDS such as
tuberculosis, pneumonia, or sexually transmitted diseases
46% report chronic health conditions such as high blood pressure,
diabetes, or cancer
Source: National Resource Center on Homelessness and Mental Illness, 2004 People with Serious Mental Illness die 25 years early : People with serious mental illnesses served in the public system are dying 25 years early, on average, from a full range of preventable health problems such as heart disease and diabetes. (NASMHPD, 2006)

What Can We Do About it

Who’s Gonna Make Us Do It?

Therapeutic Justice Model: The Integration of Treatment and Justice “The Therapeutic Justice model is defined as a systemic approach which insures a collaborative partnership between the Courts, the Criminal Justice System and the Health/Behavioral Health system while providing that the public safety net is able to provide for the most efficient and effective support for persons who are in crisis and or are experiencing psychiatric and substance abuse disorders.” Leon Evans, President and CEO, CHCS Bexar County Mental Health Authority

Starting Points Two Views Sequential Intercepts for Developing CJ-MH Partnerships Gains Center The Bexar County Jail Diversioin Model System County Wide Entry Points

Sequential Intercepts for Developing CJ-MH Partnerships * * The Center for Mental Health Services, National GAINS Center

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 Substance Abuse Services Specialty Offender Services Community Dynamic Crisis Jail Diversion Information Exchange Police, Sheriff Probation, Parole CIVIL AND CRIMINAL DIVERSION INITIATIVES Treatment Continuity of Care County City-wide Emergency Services
Community Collaborative
Crisis Care Center
Crisis Transitional Unit
Crisis Hotline (Nurselink)
CIT/DMOT
Jail and Juvenile Detention
Statewide CARE Match
System County City-wide Entry Points System Level The Bexar County Jail Diversioin Model System County Wide Entry Points

Collaboration: It’s an unnatural act between… … two or more unconsenting adults .

“ If you want a partner, you have to be a partner”.

First Steps Identify one single accountable person – full time Engage Continuous Quality Improvement Show the data Show me the Data!!!

How the Process Worked
Designated Full Time (Coordinator)
Empowered Staff assigned to
attend meetings
Monthly Stakeholder meetings
Recorded Minutes with
Action/No Action updates
Set Community Priorities
Reported all successes/failures
Followed Data Based Outcomes
with Continuous Quality
Improvement (CQI)
Focused on creating a culture of
collaboration
Community Partnership City Government County Government State Government University – Local Private Hospitals Law Enforcement Criminal/Civil Courts Advocacy – NAMI Consumers San Antonio State Hospitals Mental Health Partners The Jail Diversion Over-sight Committee The Jail Diversion Planning & Advisory Committee Community Medical Directors Roundtable Private Sponsorship

Jail Diversion Oversight Committee
(34+ Community Agencies/Stakeholders)
Community Medical Directors Roundtable
Children’s Medical Directors Roundtable
Bexar County Children’s Diversion School District Sub Committee
Bexar County Children’s Diversion Child Protective Services Sub
Committee
Bexar County Children’s Diversion Juvenile Justice Probation Sub
Committee
Community Co-Location Coalition (29 Community Agencies including law
enforcement entities meeting to address the homeless & public inebriate)
Stakeholder Collaboration via:

Evolution - Milestones 2002 – Bexar County Jail Diversion Collaborative meets for 1 st time 2003 – First Crisis Intervention Team Training begins 2004 – Specialty Jail Diversion Facility opens 2005 – 24/7 One Stop Crisis Care Center Opened 2006 – Bexar County Jail Diversion receives APA’s Gold Award 2008 – Detox, Sobering, Drug Abuse Restoration Center Opened 2010 – Haven for Hope 1,600 Bed Homeless Facility Opened 2010 – International Crisis Intervention Team Conference hosts 1,600 Officers 2000 – CEO begins diversion efforts, full time coordinator is hired 2003 – Deputy Mobile Outreach Team begun

Across the Nation with Diversion Efforts http://gainscenter.samhsa.gov/html/jail_diversion/jd_map.asp

With more mental health utilization there is less incarceration.

The Bottom Line Outcomes:
Treatment Works – Revocation Rates
Involuntary Outpatient Commitment Data
Impact on Wait Time for Law Enforcement
Documented and Immediate Cost Avoidance
Jail Census

Revocation Rates 2010 Federal Revocation Rate : 66% Two-thirds of returning prisoners are re-arrested for new crimes within 3 years or their release. Second Chance Act, 110TH CONGRESS REPORT to US HOUSE OF REPRESENTATIVES
State Revocation Rate :
Texas Felony Revocation Rate = 11.8%
* For Offenders enrolled in TDCJ Casemanagement
Local Revocation Rate:
Bexar County Mentally Impaired
Caseload Department
Probation Department = 10.8%
* Report to the Governor and LBB, December 2010

Involuntary Outpatient Commitment Program Pre IOPC Program Post 79% Reduction in Bed Day Use, Post Program First Year Evaluation

Then (prior to Sept 2005)
Wait times for Medical
Clearance/ Screening at
UHS ER - 9 hours, 18 min.
Wait times for Medical
Clearance/ Screening and Psychiatric Evaluation was 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.
Impact on WAIT TIME for LAW ENFORCEMENT

Combined CCC and Restoration Documented and Immediate Cost Avoidance Documented and Immediate Cost Avoidance, Two Year Analysis April 16, 2008 – March 31, 2010 $6,668,693 $8,825,403 $15,494,096 $5,174,599 $7,002,055 $12,176,654 $1,494,094 $1,823,348 $3,317,442 Total Year 1 Total Year 2 TWO YEAR TOTALS $385,522 $221,000 $385,522 $221,000 K. 0 Reduction in Jail Time for Competency Restoration on Bond and on Return $137,898 $900,000 $137,898 $900,000 J. 0 Reduction in Wait Time in Jail for Outpatient Competence/Wait Time for Restoration compared to Inpatient $255,055 $1,020,000 $255,055 $1,020,000 I. 0 Reduction in Competency Restoration Wait Time in Jail for Hosp Admission $579,509 $502,133 $371,350 $322,300 H. $208,159 $179,833 G. Mentally Ill Diverted from Magistration Facility $1,096,500 $959,500 $774,000 $676,000 F. $322,500 $283,500 E. Mentally Ill Diverted from UHS ER Cost $1,795,200 $1,479,000 $1,267,200 $1,044,000 D. $528,000 $435,000 C. Injured Prisoner Diverted from UHS ER $2,419,009 $3,743,770 $1,983,574 $2,818,755* B. $435,435 $925,015 A. Public Inebriates Diverted from Detention Facility Direct Cost Avoidance Bexar County City of San Antonio Cost Category

As of May 2011, there were 883 empty beds in the jail

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_address] Thank you !

2011 9-22_LeonEvans_presentation_Lilly-Community_Conversationsv3_final

by Gilbert Gonzales

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2011 9-22_LeonEvans_presentation_Lilly-Community_Conversationsv3_final Presentation Transcript